Annex1 ListOfMedicalCaseRates

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FIRST CASE RATE
ICD CODE
P91.3
P91.4
P91.6
P91.8
DESCRIPTION
Case Rate
Professional
Fee
NEWBORN
NEWBORN
NEWBORN
NEWBORN
12,000
12,000
12,000
12,000
3,600
3,600
3,600
3,600
GROUP
Neonatal cerebral irritability

Neonatal cerebral depression
Hypoxic ischemic encephalopathy of newborn
Other specified disturbances of cerebral status of
newborn
Disturbance of cerebral status of newborn, unspecified
ABNORMAL
ABNORMAL
ABNORMAL
ABNORMAL
ABNORMAL SENSORIUM IN THE NEWBORN
12,000
3,600
ABSCESS OF RESPIRATORY TRACT
10,000
3,000
10,000
3,000
10,000
3,000
10,000
3,000
10,000
3,000

10,000
10,000
3,000
3,000

10,000
10,000
10,000
3,000
3,000
3,000
ACUTE
ACUTE
ACUTE
ACUTE
GASTROENTERITIS
GASTROENTERITIS
GASTROENTERITIS
GASTROENTERITIS
6,000
6,000
6,000
6,000
1,800
1,800
1,800
1,800
A03.1
Peritonsillar abscess; Abscess of tonsil; Peritonsillar

cellulitis; Quinsy
Other diseases of larynx; Abscess of larynx; Cellulitis
of larynx; Disease NOS of larynx; Necrosis of larynx;
Pachyderma of larynx; Perichondritis of larynx; Ulcer of
larynx
Retropharyngeal and parapharyngeal abscess;
Peripharyngeal abscess
Other abscess of pharynx; Cellulitis of pharynx;
Nasopharyngeal abscess
Other diseases of pharynx; Cyst of pharynx or
nasopharynx;
Abscess
withor
pneumonia
Oedema of
of lung
pharynx
nasopharynx
Abscess of lung without pneumonia; Abscess of lung
NOS
Abscess of mediastinum
Pyothorax with fistula
Pyothorax without fistula; Abscess of pleura; Abscess
of
Cholera
due to Vibrio
cholerae 01, biovar cholerae
thorax; Empyema;
Pyopneumothorax
Cholera due to Vibrio cholerae 01, biovar eltor
Cholera, unspecified
Shigellosis due to Shigella dysenteriae; Group A
shigellosis
Shigellosis
due
to Shigella flexneri;Group B shigellosis
[Shiga-Kruse
dysentery]
ACUTE GASTROENTERITIS
6,000
1,800
A03.2
A03.3
Shigellosis due to Shigella boydii; Group C shigellosis

Shigellosis due to Shigella sonnei; Group D shigellosis
6,000
6,000
1,800
1,800
A03.8
A03.9
A04.0
A04.1
A04.2
A04.3
A04.4
A04.5
A04.6
A04.7
Other shigellosis
Shigellosis, unspecified; ; Bacillary dysentery NOS
Enteropathogenic Escherichia coli infection
Enterotoxigenic Escherichia coli infection
Enteroinvasive Escherichia coli infection
Enterohaemorrhagic Escherichia coli infection
Other intestinal Escherichia coli infections
Campylobacter enteritis
Enteritis due to Yersinia enterocolitica
Enterocolitis due to Clostridium difficile; Foodborne
intoxication by Clostridium difficile;
Pseudomembranous colitis
Other specified bacterial intestinal infections
Bacterial intestinal infection, unspecified. Bacterial
enteritis
Foodborne
staphylococcal intoxication
NOS
Foodborne Clostridium perfringens [Clostridium
welchii] intoxication. Enteritis necroticans.
Pig-bel
Foodborne Vibrio parahaemolyticus intoxication
Foodborne Bacillus cereus intoxication
Other specified bacterial foodborne intoxications
Bacterial foodborne intoxication, unspecified
Balantidiasis; Balantidial dysentery
Giardiasis [lambliasis]
Cryptosporidiosis
Isosporiasis; Infection due to Isospora belli and
Isospora
Other
specified
protozoal
intestinal
diseases; Intestinal
hominis;
Intestinal
coccidiosis;
Isosporosis
trichomoniasis; Sarcocystosis; Sarcosporidiosis
ACUTE
ACUTE
ACUTE
ACUTE
ACUTE
ACUTE
ACUTE
ACUTE
ACUTE
ACUTE
GASTROENTERITIS
GASTROENTERITIS
GASTROENTERITIS
GASTROENTERITIS
GASTROENTERITIS
GASTROENTERITIS
GASTROENTERITIS
GASTROENTERITIS
GASTROENTERITIS
GASTROENTERITIS
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
1,800
1,800
1,800
1,800
1,800
1,800
1,800
1,800
1,800
1,800
6,000
6,000
1,800
1,800
6,000
6,000
1,800
1,800
ACUTE
ACUTE
ACUTE
ACUTE
ACUTE
ACUTE
ACUTE
ACUTE
GASTROENTERITIS
GASTROENTERITIS
GASTROENTERITIS
GASTROENTERITIS
GASTROENTERITIS
GASTROENTERITIS
GASTROENTERITIS
GASTROENTERITIS
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
1,800
1,800
1,800
1,800
1,800
1,800
1,800
1,800
6,000
1,800
Protozoal intestinal disease, unspecified;Flagellate

diarrhoea; Protozoal colitis; Protozoal diarrhoea;
Protozoal
Rotaviral
dysenteryenteritis
Acute gastroenteropathy due to Norwalk agent; Small
round structured virus enteritis
Adenoviral enteritis
Other viral enteritis
Viral intestinal infection, unspecified; Viral enteritis
NOS; Viral gastroenteritis NOS; Viral gastroenteropathy
NOS
Other specified intestinal infections
Infectious diarrhea
Acute gastroenteritis
Gastroenteritis and colitis due to radiation
Toxic gastroenteritis and colitis
6,000
1,800
6,000
6,000
1,800
1,800
6,000
6,000
6,000
1,800
1,800
1,800
ACUTE
ACUTE
ACUTE
ACUTE
ACUTE
6,000
6,000
6,000
6,000
6,000
1,800
1,800
1,800
1,800
1,800
Case Rate
Professional
Fee
6,000
1,800
6,000
1,800
P91.9
J36
J38.7
J39.0
J39.1
J39.2
J85.1
J85.2
J85.3
J86.0
J86.9
A00.0
A00.1
A00.9
A03.0
A04.8
A04.9
A05.0
A05.2
A05.3
A05.4
A05.8
A05.9
A07.0
A07.1
A07.2
A07.3
A07.8
A07.9
A08.0
A08.1
A08.2
A08.3
A08.4
A08.5
A09.0
A09.9
K52.0
K52.1
ICD CODE
K52.2
K52.8
DESCRIPTION
SENSORIUM
SENSORIUM
SENSORIUM
SENSORIUM
IN
IN
IN
IN
THE
THE
THE
THE
GASTROENTERITIS
GASTROENTERITIS
GASTROENTERITIS
GASTROENTERITIS
GASTROENTERITIS
GROUP
Allergic and dietetic gastroenteritis and colitis; Food

hypersensitivity gastroenteritis or colitis
Other specified noninfective gastroenteritis and colitis; ACUTE GASTROENTERITIS
Eosinophilic gastritis or gastroenteritis
FIRST CASE RATE
K52.9
K58.0
N17.0
N17.1
N17.2
N17.8
N17.9
O08.4
J80
T78.1
T78.3
T78.4
T78.8
T78.9
T88.7
A06.4
A06.0
A06.1
A06.2
A06.3
A06.7
A06.8
E85.8
T78.0
T78.2
T88.6
D50.0
D50.1
D50.8
D50.9
D51.0
D51.8
D51.9
D52.1
D52.9
D53.0
D53.1
D53.2
D53.8
D53.9
D55.0
ICD CODE
D55.1
D55.2
D55.8
D55.9
Noninfective gastroenteritis and colitis, unspecified;

Diarrhoea specified as noninfective, or NOS in
countries where the conditions can be presumed to be
of noninfectious origin; Enteritis specified as
noninfective, or
NOS in countries
where the
conditio
Irritable
bowel syndrome
with
diarrhoea
Acute renal failure with tubular necrosis; Tubular
necrosis NOS; Acute Tubular necrosis ; Renal Tubular
necrosis
Acute renal failure with acute cortical necrosis; Cortical
necrosis NOS; Acute Cortical necrosis ; Renal Cortical
necrosis
Acute renal failure with medullary necrosis; Medullary
papillary necrosis, NOS; Acute medullary papillary
necrosis; Renal medullary papillary necrosis
6,000
1,800
ACUTE RENAL FAILURE
6,000
19,300
1,800
5,790
ACUTE RENAL FAILURE
19,300
5,790
ACUTE RENAL FAILURE
19,300
5,790
Other acute renal failure

Acute renal failure, unspecified;
Renal failure following abortion and ectopic and molar
pregnancy; Oliguria Acute renal failure; Oliguria renal
shutdown; Oliguria renal tubular necrosis; Oliguria
Uraemia
Adult respiratory distress syndrome; Adult hyaline
membrane disease
Other adverse food reactions, not elsewhere classified
ACUTE RENAL FAILURE

ACUTE RENAL FAILURE
ACUTE RENAL FAILURE
19,300
19,300
19,300
5,790
5,790
5,790
ADULT RESPIRATORY DISTRESS SYNDROME
32,000
9,600
ALLERGIC REACTIONS
6,200
1,860
Angioneurotic oedema; Giant urticaria; Quinke's

oedema
Allergy, unspecified; Allergic reaction NOS;
Hypersensitivity
Other
adverse effects,
NOS; Idiosyncracy
NOSnot elsewhere classified
Adverse effect, unspecified
Unspecified adverse effect of drug or medicament;
Adverse effect of correct drug or medicament properly
administered; Allergic reactiion to correct drug or
medicament properly administered; Hypersensitivity
to
correct drug
medicament
properly
administe
Amoebic
liverorabscess;
Hepatic
amoebiasis
Acute amoebic dysentery; Acute amoebiasis; Intestinal
amoebiasis NOS
Chronic intestinal amoebiasis
Amoebic nondysenteric colitis
Amoeboma of intestine; Amoeboma NOS
Cutaneous amoebiasis
Amoebic Appendicitis
Other amyloidosis; Localized amyloidosis
Anaphylactic shock due to adverse food reaction
Anaphylactic shock, unspecified; Allergic shock NOS;
Anaphylactic reaction NOS; Anaphylaxis NOS
Anaphylactic shock due to adverse effect of correct
drug or
Iron
deficiency
anaemia
secondary to blood loss
medicament
properly
administered
(chronic);
Sideropenic
dysphagia;
Kelly-Paterson
Posthaemorrhagic
anaemia
(chronic) syndrome;
PlummerOther
deficiency anaemias
Vinsoniron
syndrome
Iron deficiency anaemia, unspecified
Vitamin B12 deficiency anaemia due to intrinsic factor
deficiency; Addison Anaemia; Biermer Anaemia;
CongenitalPernicious Anaemia; Congenital intrinsic
factor
deficiency
Other
vitamin B12 deficiency anaemias
Vitamin B12 deficiency anaemia, unspecified
Drug-induced folate deficiency anaemia
Folate deficiency anaemia, unspecified; Folic acid
deficiency anaemia NOS
Protein deficiency anaemia; Amino-acid deficiency
anaemia; Orotaciduric anaemia
Other megaloblastic anaemias, not elsewhere
classified;
Scorbutic
anaemia
Megaloblastic
anaemia NOS
Other specified nutritional anaemias; Anaemia
associated with deficiency of copper; Anaemia
associated with deficiency of molybdenum; Anaemia
associated with
deficiency of
zinc
Nutritional
anaemia,
unspecified; Simple chronic
anaemia
Anaemia due to glucose-6-phosphate dehydrogenase
[G6PD] deficiency; Favism;
G6PD deficiency anaemia
ALLERGIC REACTIONS
6,200
1,860
ALLERGIC REACTIONS
6,200
1,860
ALLERGIC REACTIONS
ALLERGIC REACTIONS
6,200
6,200
1,860
1,860
ALLERGIC REACTIONS
6,200
1,860
AMOEBIASIS, HEPATIC
AMOEBIASIS, NONHEPATIC
10,000
6,000
3,000
1,800
AMYLOIDOSIS
ANAPHYLACTIC SHOCK
ANAPHYLACTIC SHOCK
6,000
6,000
6,000
6,000
6,000
11,100
7,600
7,600
1,800
1,800
1,800
1,800
1,800
3,330
2,280
2,280
ANAPHYLACTIC SHOCK
7,600
2,280
ANEMIA
10,000
3,000
ANEMIA
10,000
3,000
ANEMIA
ANEMIA
ANEMIA
10,000
10,000
10,000
3,000
3,000
3,000
ANEMIA
ANEMIA
ANEMIA
ANEMIA
10,000
10,000
10,000
10,000
3,000
3,000
3,000
3,000
ANEMIA
10,000
3,000
ANEMIA
10,000
3,000
ANEMIA
ANEMIA
10,000
10,000
3,000
3,000
ANEMIA
10,000
3,000
ANEMIA
10,000
3,000
FIRST CASE RATE

Case Rate
Professional
Fee
ANEMIA
10,000
3,000
ANEMIA
10,000
3,000
ANEMIA
ANEMIA
10,000
10,000
3,000
3,000
DESCRIPTION
Anaemia due to other disorders of glutathione
metabolism; Anaemia due to enzyme deficiencies,
except G6PD, related to the hexose monophosphate
[HMP] shunt pathway; Anaemia due to haemolytic
nonspherocytic hereditary,
type
I
Anaemia
due to disorders of glycolytic enzymes;
Haemolytic nonspherocytic hereditary Anaemia, type
II; Hexokinase deficiency Anaemia; Pyruvate kinase
[PK] deficiency Anaemia; Triose-phosphate isomerase
deficiency
Anaemia
Other anaemias due to enzyme disorders
Anaemia due to enzyme disorder, unspecified
GROUP
D56.9
D57.0
D57.1
D57.3
D57.8
D58.0
D58.1
D58.2
D58.8
D58.9
D59.0
D59.1
D59.2
D59.4
D59.5
D59.6
D59.8
D59.9
D60.1
D61.0
D61.1
D61.2
D61.3
D61.8
D61.9
D62
D63.0*
D63.8*
D64.0
D64.1
D64.2
D64.3
Mediterranean anaemia; Mediterranean anaemia with ANEMIA

other haemoglobinopathy; Thalassaemia minor with
other haemoglobinopathy; Thalassaemia mixed with
other
haemoglobinopathy;
Sickle-cell
anaemia with crisis; Hb-SS disease with
ANEMIA
crisis
Sickle-cell anaemia without crisis; Sickle-cell anaemia ANEMIA
NOS; Sickle-cell disease NOS ; Sickle-cell disorder NOS
10,000
3,000
10,000
3,000
10,000
3,000
Sickle-cell trait; Hb-S trait ; Heterozygous

Haemoglobin S
Other sickle-cell disorders
Hereditary spherocytosis; Acholuric (familial) jaundice;
Congenital (spherocytic) haemolytic icterus;
MinkowskiHereditary
elliptocytosis; Congenital Elliptocytosis;
Chauffard syndrome
Congenital Ovalocytosis; Hereditary Ovalocytosis
Other haemoglobinopathies; Abnormal haemoglobin
NOS; Congenital Heinz body anaemia; Hb-C Disease;
Hb-C Disease; Hb-D Disease; Hb-E Disease;
Haemoglobinopathy NOS; Unstable haemoglobin
haemolytic disease
Other specified hereditary haemolytic anaemias;
Stomatocytosis
Hereditary haemolytic anaemia, unspecified; Acquired
haemolytic anaemia
Drug-induced autoimmune haemolytic anaemia
Other autoimmune haemolytic anaemias; Autoimmune
haemolytic disease, cold type; (Autoimmune
haemolytic disease, warm type; Chronic cold
haemagglutinin disease; Cold agglutinin disease; Cold
agglutinin haemoglobinuria; Secondary symptomatic
Haemolytic a
Drug-induced nonautoimmune haemolytic anaemia;
DrugOther
nonautoimmune
haemolytic
anaemias;
induced
enzyme deficiency
anaemia
Mechanical
Haemolytic anaemia; Microangiopathic Haemolytic
Paroxysmal
nocturnal
haemoglobinuria
[Marchiafavaanaemia; Toxic
Haemolytic
anaemia
Micheli]
Haemoglobinuria due to haemolysis from other
external causes; Haemoglobinuria from exertion;
Haemoglobinuria march; Haemoglobinuria paroxysmal
cold
Other acquired haemolytic anaemias
Acquired haemolytic anaemia, unspecified; Chronic
Idiopathic haemolytic anaemia
Transient acquired pure red cell aplasia
Constitutional aplastic anaemia; Congenital Pure red
cell Aplasia; Pure red cell Aplasia of infants; Primary
Pure red cell Aplasia; Blackfan-Diamond syndrome;
Familial hypoplastic anaemia; Fanconi's anaemia;
Pancytopenia
with malformations
Drug-induced
aplastic anaemia
Aplastic anaemia due to other external agents
Idiopathic aplastic anaemia
Other specified aplastic anaemias
Aplastic anaemia, unspecified; Hypoplastic anaemia
NOS;
Acute
posthaemorrhagic
anaemia
Medullary
hypoplasia; Panmyelophthisis
Anaemia in neoplastic disease
Anaemia in other chronic diseases classified elsewhere
ANEMIA
10,000
3,000
ANEMIA
ANEMIA
10,000
10,000
3,000
3,000
ANEMIA
10,000
3,000
ANEMIA
10,000
3,000
ANEMIA
10,000
3,000
ANEMIA
10,000
3,000
ANEMIA
ANEMIA
10,000
10,000
3,000
3,000
ANEMIA
10,000
3,000
ANEMIA
10,000
3,000
ANEMIA
10,000
3,000
ANEMIA
10,000
3,000
ANEMIA
ANEMIA
10,000
10,000
3,000
3,000
ANEMIA
10,000
3,000
ANEMIA
10,000
3,000
ANEMIA
ANEMIA
ANEMIA
ANEMIA
ANEMIA
10,000
10,000
10,000
10,000
10,000
3,000
3,000
3,000
3,000
3,000
ANEMIA
ANEMIA
ANEMIA
10,000
10,000
10,000
3,000
3,000
3,000
Hereditary sideroblastic anaemia; Sex-linked

hypochromic
Secondary
sideroblastic
sideroblastic
anaemia anaemia due to disease
Secondary sideroblastic anaemia due to drugs and
toxins
Other sideroblastic anaemias; Sideroblastic anaemia
NOS; pyridoxine-responsive NEC Sideroblastic anaemia
ANEMIA
10,000
3,000
ANEMIA
ANEMIA
10,000
10,000
3,000
3,000
ANEMIA
10,000
3,000
FIRST CASE RATE

ICD CODE
D64.8
D64.9
M00.16
M00.19
M00.29
M00.82
M00.90
M00.91
M00.93
M00.94
M00.95
M00.96
Case Rate
Professional
Fee
ANEMIA
10,000
3,000
ANEMIA
ARTHRITIS INFECTIOUS
10,000
9,700
9,700
3,000
2,910
2,910
9,700
2,910
9,700
2,910
9,700
2,910
9,700
2,910
9,700
2,910
9,700
2,910
9,700
2,910
9,700
2,910
DESCRIPTION
Other specified anaemias; Infantile pseudoleukaemia;
Leukoerythroblastic anaemia
Anaemia, unspecified
Pneumococcal arthritis and polyarthritis, Lower leg
Pneumococcal arthritis and polyarthritis, Site
unspecified
Other streptococcal arthritis and polyarthritis, Site
unspecified
Arthritis and polyarthritis due to other specified
bacterial
Pyogenic
arthritis,
agents upper
arm unspecified; Infective arthritis NOS
multiple sites
Pyogenic arthritis, unspecified; Infective arthritis NOS
shoulder region
forearm
hand
pelvic region and thigh
lower leg
GROUP
M00.97

ankle and foot
other sites
site unspecified
Reiter's disease, site unspecified
Adult-onset Still's disease, site unspecified
Juvenile arthritis with systemic onset; Still's disease
NOS
Reactive
arthropathy, unspecified, site unspecified
site unspecified
Seropositive rheumatoid arthritis, unspecified, site
unspecified
Seronegative rheumatoid arthritis, shoulder region
Seronegative rheumatoid arthritis, site unspecified
Rheumatoid nodule, lower leg
Inflammatory polyarthropathy, pelvic region and thigh
9,700
2,910
9,700
2,910
9,700
2,910
9,700
9,700
9,700
2,910
2,910
2,910
ARTHRITIS NONINFECTIOUS
7,000
7,000
2,100
2,100
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
7,000
7,000
7,000
7,000
2,100
2,100
2,100
2,100
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
7,000
7,000
7,000
7,000
7,000
2,100
2,100
2,100
2,100
2,100
7,000
2,100
7,000
2,100
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
7,000
7,000
7,000
7,000
7,000
7,000
7,000
2,100
2,100
2,100
2,100
2,100
2,100
2,100
M10.01
M10.02
M10.03
M10.04
M10.05
M10.06
Inflammatory polyarthropathy, site unspecified

Other specified rheumatoid arthritis, shoulder region
Other specified rheumatoid arthritis, lower leg
Other specified rheumatoid arthritis, ankle and foot
Other specified rheumatoid arthritis, site unspecified
Rheumatoid arthritis, unspecified, multiple sites
Rheumatoid arthritis, unspecified, shoulder region
Rheumatoid arthritis, unspecified, forearm
Rheumatoid arthritis, unspecified, hand
Rheumatoid arthritis, unspecified, pelvic region and
thigh
Rheumatoid arthritis, unspecified, lower leg
Rheumatoid arthritis, unspecified, ankle and foot
Rheumatoid arthritis, unspecified, other sites
Rheumatoid arthritis, unspecified, site unspecified
Juvenile rheumatoid arthritis; Juvenile rheumatoid
arthritis
Juvenile
rheumatoid
arthritis;
Juvenile
rheumatoid
with or without
rheumatoid
factor
lower
leg
arthritis with or without rheumatoid factor ankle and
foot
Juvenile rheumatoid arthritis; Juvenile rheumatoid
arthritis with or without rheumatoid factor site
unspecified
Juvenile ankylosing spondylitis site unspecified
Other juvenile arthritis lower leg
Other juvenile arthritis site unspecified
Juvenile arthritis, unspecified shoulder region
Juvenile arthritis, unspecified lower leg
Juvenile arthritis, unspecified site unspecified
Idiopathic gout; Gouty bursitis; Primary gout multiple
sites
Urate tophus of heart shoulder region
Urate tophus of heart upper arm
Idiopathic gout; Gouty bursitis; Primary gout forearm
Urate tophus of heart hand
Urate tophus of heart pelvic region and thigh
Idiopathic gout; Gouty bursitis; Primary gout lower leg
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
7,000
7,000
7,000
7,000
7,000
7,000
2,100
2,100
2,100
2,100
2,100
2,100
M10.07
M10.08
M10.09
M10.10
M10.29
Urate tophus of heart ankle and foot

Urate tophus of heart other sites
Urate tophus of heart site unspecified
Lead-induced gout multiple sites
Drug-induced gout site unspecified
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
7,000
7,000
7,000
7,000
7,000
2,100
2,100
2,100
2,100
2,100
Case Rate
Professional
Fee
M00.98
M00.99
M02.39
M06.19
M08.29
M02.99
M05.99
M06.01
M06.09
M06.36
M06.45
M06.49
M06.81
M06.86
M06.87
M06.89
M06.90
M06.91
M06.93
M06.94
M06.95
M06.96
M06.97
M06.98
M06.99
M08.06
M08.07
M08.09
M08.19
M08.86
M08.89
M08.91
M08.96
M08.99
M10.00
ICD CODE
DESCRIPTION
GROUP
FIRST CASE RATE
M10.30
Gout due to impairment of renal function multiple sites ARTHRITIS NONINFECTIOUS
7,000
2,100
M10.36
M10.39
Gout due to impairment of renal function lower leg

Gout due to impairment of renal function site
unspecified
Other secondary gout multiple sites
Other secondary gout site unspecified
Gout, unspecified multiple sites
Gout, unspecified shoulder region
Gout, unspecified upper arm
Gout, unspecified forearm
Gout, unspecified hand
Gout, unspecified lower leg
Gout, unspecified ankle and foot
Gout, unspecified other sites
Gout, unspecified site unspecified
Other specified crystal arthropathies site unspecified
Crystal arthropathy, unspecified multiple sites
Crystal arthropathy, unspecified site unspecified
Villonodular synovitis (pigmented) lower leg
Palindromic rheumatism site unspecified
Traumatic arthropathy multiple sites
Traumatic arthropathy upper arm
Traumatic arthropathy forearm
Traumatic arthropathy hand
Traumatic arthropathy pelvic region and thigh
Traumatic arthropathy lower leg
Traumatic arthropathy ankle and foot
Traumatic arthropathy other sites
Traumatic arthropathy site unspecified
Other specific arthropathies, not elsewhere classified;
Transient arthropathy lower leg
7,000
7,000
2,100
2,100
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
M10.40
M10.49
M10.90
M10.91
M10.92
M10.93
M10.94
M10.96
M10.97
M10.98
M10.99
M11.89
M11.90
M11.99
M12.26
M12.39
M12.50
M12.52
M12.53
M12.54
M12.55
M12.56
M12.57
M12.58
M12.59
M12.86
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
M12.89
M13.00
M13.01
M13.02
M13.06
M13.09
M13.13
M13.16
M13.17
M13.18
M13.80
M13.81
M13.85
M13.86
M13.87
M13.88
M13.89
M13.90
M13.91
M13.92
M13.93
M13.94
M13.95
M13.96
M13.97
M13.98
M13.99
A92.0
A92.1
A92.2
A92.8
A93.1
A93.8
A94
M15.0
ICD CODE
M15.2
M15.3
M15.4
M15.8
M15.9
M16.0
M16.1
M16.2
M16.3
M16.9
M17.0
M17.1
M17.2
M17.3
M17.5
M17.9
M18.0
M18.9
M19.00
M19.02
M19.05
M19.06
M19.08
M19.09
M19.10
Other specific arthropathies, not elsewhere classified;

Transient arthropathy site unspecified
Polyarthritis, unspecified multiple sites
Polyarthritis, unspecified shoulder region
Polyarthritis, unspecified upper arm
Polyarthritis, unspecified lower leg
Polyarthritis, unspecified site unspecified
Monoarthritis, not elsewhere classified forearm
Monoarthritis, not elsewhere classified lower leg
Monoarthritis, not elsewhere classified ankle and foot
7,000
2,100
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
Monoarthritis, not elsewhere classified other sites

Other specified arthritis; Allergic arthritis multiple
sites
Other specified arthritis; Allergic arthritis shoulder
region
Other specified arthritis; Allergic arthritis pelvic region
and
Other
thigh specified arthritis; Allergic arthritis lower leg
Other specified arthritis; Allergic arthritis ankle and
foot
Other specified arthritis; Allergic arthritis other sites
Other specified arthritis; Allergic arthritis site
unspecified
Arthritis, unspecified; Arthropathy NOS multiple sites
Arthritis, unspecified; Arthropathy NOS shoulder region
7,000
7,000
2,100
2,100
7,000
2,100
7,000
2,100
7,000
7,000
2,100
2,100
7,000
7,000
2,100
2,100
7,000
7,000
2,100
2,100
Arthritis,
Arthritis,
Arthritis,
Arthritis,
and
Arthritis,
thigh
Arthritis,
Arthritis,
Arthritis,
unspecified;
unspecified;
unspecified;
unspecified;
Arthropathy
Arthropathy
Arthropathy
Arthropathy
NOS
NOS
NOS
NOS
upper arm
forearm
hand
pelvic region
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
7,000
7,000
7,000
7,000
2,100
2,100
2,100
2,100
unspecified;
unspecified;
unspecified;
unspecified;
Arthropathy
Arthropathy
Arthropathy
Arthropathy
NOS
NOS
NOS
NOS
lower leg
ankle and foot
other sites
site unspecified
ARTHRITIS
ARTHRITIS
ARTHRITIS
ARTHRITIS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
NONINFECTIOUS
7,000
7,000
7,000
7,000
2,100
2,100
2,100
2,100
ARTHROPOD BORNE VIRAL FEVER
8,100
2,430

8,100
8,100
2,430
2,430

8,100
8,100
8,100
2,430
2,430
2,430
8,100
2,430
ARTHROSIS
7,000
2,100
Case Rate
Professional
Fee
ARTHROSIS
ARTHROSIS
7,000
7,000
2,100
2,100
ARTHROSIS
ARTHROSIS
ARTHROSIS
7,000
7,000
7,000
2,100
2,100
2,100
ARTHROSIS
ARTHROSIS
7,000
7,000
2,100
2,100
ARTHROSIS
ARTHROSIS
7,000
7,000
2,100
2,100
ARTHROSIS
ARTHROSIS
ARTHROSIS
7,000
7,000
7,000
2,100
2,100
2,100
ARTHROSIS
ARTHROSIS
7,000
7,000
2,100
2,100
ARTHROSIS
7,000
2,100
ARTHROSIS
ARTHROSIS
7,000
7,000
2,100
2,100
ARTHROSIS
ARTHROSIS
7,000
7,000
2,100
2,100
ARTHROSIS
7,000
2,100
ARTHROSIS
7,000
2,100
ARTHROSIS
7,000
2,100
ARTHROSIS
7,000
2,100
ARTHROSIS
7,000
2,100
ARTHROSIS
7,000
2,100
Chikungunya virus disease; Chikungunya

(haemorrhagic)
O'nyong-nyong
fever
fever
Venezuelan equine fever; Venezuelan equine
encephalitis; Venezuelan encephalomyelitis virus
disease
Other specified mosquito-borne viral fevers
Sandfly fever; Pappataci fever; Phlebotomus fever
Other specified arthropod-borne viral fevers; Piry virus
disease; Vesicular stomatitis virus disease [Indiana
fever]
Unspecified arthropod-borne viral fever; Unspecified
arthropod-borne viral fever; Arboviral fever NOS;
Arbovirus infection NOS
Primary generalized (osteo)arthrosis
DESCRIPTION
Bouchard's nodes (with arthropathy)
Secondary multiple arthrosis; Post-traumatic
polyarthrosis
Erosive (osteo)arthrosis
Other polyarthrosis
Polyarthrosis, unspecified; Generalized osteoarthritis
NOS
Primary coxarthrosis, bilateral
Other primary coxarthrosis; Primary coxarthrosis NOS;
Primary coxarthrosis unilateral
Coxarthrosis resulting from dysplasia, bilateral
Other dysplastic coxarthrosis; Dysplastic coxarthrosis
NOS;
Coxarthrosis,
unspecified
Dysplastic coxarthrosis
unilateral
Primary gonarthrosis, bilateral
Other primary gonarthrosis; Primary gonarthrosis NOS;
Primary gonarthrosis unilateral
Post-traumatic gonarthrosis, bilateral
Other post-traumatic gonarthrosis; Post-traumatic
gonarthrosis NOS; Post-traumatic gonarthrosis
unilateral
Other secondary gonarthrosis; Secondary gonarthrosis
NOS; Secondary gonarthrosis unilateral
Gonarthrosis, unspecified
Primary arthrosis of first carpometacarpal joints,
bilateral
Arthrosis of first carpometacarpal joint, unspecified
Primary arthrosis of other joints; Primary arthrosis
NOSmultiple sites
NOSupper arm
NOSpelvic region and thigh
NOSlower leg
NOSother sites
NOSsite
Post-traumatic
arthrosis of other joints; Post-traumatic
unspecified
arthrosis NOS multiple sites
FIRST CASE RATE

GROUP
M19.11
M19.12
M19.19
M19.21
M19.29
M19.81
M19.86
M19.87
M19.88
M19.89
M19.90
M19.91
M19.92
M19.93
M19.94
M19.95
M19.96
M19.97
M19.98
M19.99
J45.00
J45.10
J45.80
J45.90
J46
J98.1
M54.01
M54.06
M54.08
ICD CODE
M54.10
M54.11
M54.12
M54.14
M54.15
M54.16
M54.17
M54.18
M54.19
M54.2
M54.20
M54.22
M54.26
M54.3
M54.30
M54.31
M54.35
M54.36
M54.37
M54.38
M54.39
M54.4
M54.41
Post-traumatic arthrosis of other joints; Post-traumatic

arthrosis NOS shoulder region
arthrosis NOS upper arm
arthrosis NOS site unspecified
Other secondary arthrosis; Secondary arthrosis NOS
shoulder region
Other secondary arthrosis; Secondary arthrosis NOS
site
Other
specified arthrosis shoulder region
unspecified
Other specified arthrosis lower leg
Other specified arthrosis ankle and foot
Other specified arthrosis other sites
Other specified arthrosis site unspecified
Arthrosis, unspecified multiple sites
Arthrosis, unspecified shoulder region
Arthrosis, unspecified upper arm
Arthrosis, unspecified forearm
Arthrosis, unspecified hand
Arthrosis, unspecified pelvic region and thigh
Arthrosis, unspecified lower leg
Arthrosis, unspecified ankle and foot
Arthrosis, unspecified other sites
Arthrosis, unspecified site unspecified
Predominantly allergic asthma; Allergic bronchitis NOS;
Allergic rhinitis with asthma; Atopic asthma; Extrinsic
allergic asthma; Hay fever with asthma; in Acute
Exacerbation
Nonallergic asthma; Idiosyncratic asthma; Intrinsic
nonallergic asthma, in Acute Exacerbation
Mixed asthma, in Acute Exacerbation
Bronchial Asthma in Acute Exacerbation
Status asthmaticus; Acute severe asthma
Pulmonary collapse; Atelectasis; Collapse of lung;
Brock's
Panniculitis
syndrome affecting regions of neck and back
occipitoPanniculitis
atlanto-axialaffecting
region regions of neck and back lumbar
region
Panniculitis affecting regions of neck and back sacral
and
sacrococcygeal region
ARTHROSIS
7,000
2,100
ARTHROSIS
7,000
2,100
ARTHROSIS
7,000
2,100
ARTHROSIS
7,000
2,100
ARTHROSIS
7,000
2,100
ARTHROSIS
ARTHROSIS
ARTHROSIS
ARTHROSIS
ARTHROSIS
ARTHROSIS
ARTHROSIS
ARTHROSIS
ARTHROSIS
ARTHROSIS
ARTHROSIS
ARTHROSIS
ARTHROSIS
ARTHROSIS
ARTHROSIS
ASTHMA IN ACUTE EXACERBATION
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
9,000
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,100
2,700
9,000
2,700

ATELECTASIS
9,000
9,000
9,000
13,800
2,700
2,700
2,700
4,140
BACK PAIN, RADICULOPATHY, SCIATICA
6,400
1,920
6,400
1,920
6,400
1,920
FIRST CASE RATE

Case Rate
Professional
Fee
6,400
1,920
6,400
1,920
6,400
1,920
6,400
1,920
6,400
1,920
6,400
1,920
6,400
1,920
6,400
1,920
6,400
1,920
BACK
BACK
BACK
BACK
BACK
BACK
BACK
BACK
BACK
BACK
BACK
BACK
BACK
BACK
6,400
6,400
6,400
6,400
6,400
6,400
6,400
6,400
6,400
6,400
6,400
6,400
6,400
6,400
1,920
1,920
1,920
1,920
1,920
1,920
1,920
1,920
1,920
1,920
1,920
1,920
1,920
1,920
DESCRIPTION
Radiculopathy; Brachial Neuritis or radiculitis NOS;
Lumbar Neuritis or radiculitis NOS; Lumbosacral;
thoracic Neuritis or radiculitis NOS ; Radiculitis NOS
Multiple sites in spine
occipito-atlanto-axial region
cervical region
thoracic region
thoracolumbar region
lumbar region
lumbosacral region
sacral and sacrococcygeal region
site unspecified
Cervicalgia
Cervicalgia Multiple sites in spine
Cervicalgia cervical region
Cervicalgia lumbar region
Sciatica
Sciatica Multiple sites in spine
Sciatica occipito-atlanto-axial region
Sciatica thoracolumbar region
Sciatica lumbar region
Sciatica lumbosacral region
Sciatica sacral and sacrococcygeal region
Sciatica site unspecified
Lumbago with sciatica
Lumbago with sciatica occipito-atlanto-axial region
GROUP
PAIN,
PAIN,
PAIN,
PAIN,
PAIN,
PAIN,
PAIN,
PAIN,
PAIN,
PAIN,
PAIN,
PAIN,
PAIN,
PAIN,
RADICULOPATHY,
RADICULOPATHY,
RADICULOPATHY,
RADICULOPATHY,
RADICULOPATHY,
RADICULOPATHY,
RADICULOPATHY,
RADICULOPATHY,
RADICULOPATHY,
RADICULOPATHY,
RADICULOPATHY,
RADICULOPATHY,
RADICULOPATHY,
RADICULOPATHY,
SCIATICA
SCIATICA
SCIATICA
SCIATICA
SCIATICA
SCIATICA
SCIATICA
SCIATICA
SCIATICA
SCIATICA
SCIATICA
SCIATICA
SCIATICA
SCIATICA
M54.44
M54.46
M54.48
M54.49
M54.5
M54.50
M54.51
M54.52
M54.84
M54.88
M54.91
M54.93
M54.96
M54.97
M54.98
M54.99
N31.0
N31.1
N31.2
Lumbago with sciatica thoracic region

Lumbago with sciatica lumbar region
Lumbago with sciatica sacral and sacrococcygeal
region
Lumbago with sciatica site unspecified
Low back pain; Loin pain; Low back strain; Lumbago
NOS
Low back pain; Loin pain; Low back strain; Lumbago
NOS
Low
backsites
pain;
pain; Low back strain; Lumbago
Multiple
inLoin
spine
NOS
Low
back pain; Loin pain;
Low back strain; Lumbago
occipito-atlanto-axial
region
NOS
Other
dorsalgia
thoracic
region
cervical region
Other dorsalgia sacral and sacrococcygeal region
Dorsalgia, unspecified; Backache NOS occipito-atlantoaxial
Dorsalgia,
unspecified; Backache NOS cervicothoracic
region
region
Dorsalgia, unspecified; Backache NOS lumbar region
Dorsalgia, unspecified; Backache NOS lumbosacral
region
Dorsalgia, unspecified; Backache NOS sacral and
Dorsalgia, unspecified; Backache NOS site unspecified

6,400
6,400
6,400
1,920
1,920
1,920

6,400
6,400
1,920
1,920
6,400
1,920
6,400
1,920
6,400
1,920

6,400
6,400
6,400
1,920
1,920
1,920
6,400
1,920

6,400
6,400
1,920
1,920
6,400
1,920
6,400
1,920
Uninhibited neuropathic bladder, not elsewhere

classified
Reflex neuropathic bladder, not elsewhere classified
Flaccid neuropathic bladder, not elsewhere classified;
Atonic Motor Neuropathic bladder; Sensory Atonic
Motor Neuropathic bladder; Autonomous Neuropathic
bladder ; Nonreflex Neuropathic bladder
BLADDER DYSFUNCTION
9,000
2,700
BLADDER DYSFUNCTION
9,000
2,700
BLADDER DYSFUNCTION
9,000
2,700
FIRST CASE RATE

ICD CODE
N31.8
N31.9
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Other neuromuscular dysfunction of bladder

Neuromuscular dysfunction of bladder, unspecified;
Neurogenic bladder dysfunction NOS
Bladder disorder, unspecified
Stress incontinence
Other specified urinary incontinence; Overflow
incontinence, Reflex incontinence, Urge incontinence
Unspecified urinary incontinence; Enuresis NOS
Botulism; Classical foodborne intoxication due to
Clostridium botulinum
Compression of brain; [compression, Herniation] of
brain
Inflammatory
disorders of breast; Acute abscess of non
(stem)
puerperal areola; Acute abscess nonpuerperal breast;
Chronic abscess of nonpuerperal areola; Chronic
abscess of nonpuerperal breast; Carbuncle of breast;
Acute mastitis nonpuerperal, NOS; Acute inf
BLADDER DYSFUNCTION
BLADDER DYSFUNCTION
9,000
9,000
2,700
2,700
BLADDER DYSFUNCTION
BLADDER DYSFUNCTION
BLADDER DYSFUNCTION
9,000
9,000
9,000
2,700
2,700
2,700
BLADDER DYSFUNCTION
BOTULISM
9,000
4,800
2,700
1,440
BRAIN HERNIATION
22,400
6,720
BREAST INFECTIONS
7,900
2,370
BREAST INFECTIONS
7,900
2,370
BREAST INFECTIONS
7,900
2,370
BREAST INFECTIONS
7,900
2,370
BREAST INFECTIONS
BREAST INFECTIONS
7,900
7,900
2,370
2,370
C50.0
C50.1
C50.2
Infection of nipple associated with childbirth;

Gestational abscess of nipple; Puerperal abscess of
nipple
Abscess of breast associated with childbirth; Mammary
abscess gestational or puerperal; Purulent mastitis
gestational or puerperal; Subareolar abscess
gestational or
puerperal
Nonpurulent
mastitis associated with childbirth;
Lymphangitis of breast gestational or puerperal;
Mastitis NOS gestational or puerperal; Interstitial
mastitis gestational or puerperal; Parenchymatous
mastitis
gestationalnipple
or puerperal
Retracted
associated with childbirth
Cracked nipple associated with childbirth; Fissure of
nipple,
Malignant
of Nipple and areola, breast
gestationalneoplasm
or puerperal
Malignant neoplasm of Central portion of breast
Malignant neoplasm of Upper-inner quadrant of breast
BREAST MALIGNANCY
BREAST MALIGNANCY
BREAST MALIGNANCY
11,800
11,800
11,800
3,540
3,540
3,540
C50.3
Malignant neoplasm of Lower-inner quadrant of breast BREAST MALIGNANCY
11,800
3,540
C50.4
Malignant neoplasm of Upper-outer quadrant of breast BREAST MALIGNANCY
11,800
3,540
C50.6
C50.8
C50.9
L10.0
L10.1
L10.2
L10.4
L10.8
L10.9
L11.0
L11.1
L11.9
L12.0
L12.1
Malignant neoplasm of Axillary tail of breast

Malignant neoplasm of Overlapping lesion of breast
Malignant neoplasm of Breast, unspecified
Pemphigus vulgaris
Pemphigus vegetans
Pemphigus foliaceus
Pemphigus erythematosus; Senear-Usher syndrome
Other pemphigus
Pemphigus, unspecified
Acquired keratosis follicularis
Transient acantholytic dermatosis [Grover]
Acantholytic disorder, unspecified
Bullous pemphigoid
Cicatricial pemphigoid; Benign mucous membrane
pemphigoid
Chronic bullous disease of childhood; Juvenile
dermatitis
Acquired
epidermolysis bullosa
herpetiformis
BREAST MALIGNANCY
BREAST MALIGNANCY
BREAST MALIGNANCY
BULLOUS DISORDERS
BULLOUS DISORDERS
BULLOUS DISORDERS
BULLOUS DISORDERS
BULLOUS DISORDERS
BULLOUS DISORDERS
BULLOUS DISORDERS
BULLOUS DISORDERS
BULLOUS DISORDERS
BULLOUS DISORDERS
BULLOUS DISORDERS
11,800
11,800
11,800
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
3,540
3,540
3,540
3,600
3,600
3,600
3,600
3,600
3,600
3,600
3,600
3,600
3,600
3,600
BULLOUS DISORDERS
12,000
3,600
BULLOUS DISORDERS
12,000
3,600
N32.9
N39.3
N39.4
R32
A05.1
G93.5
N61
O91.0
O91.1
O91.2
O92.0
O92.1
L12.2
L12.3
L12.8
L13.0
L13.1
L13.9
T20.4
T21.0
T21.2
T21.5
T21.6
T22.2
T22.5
T22.6
T23.2
T23.4
T24.2
T24.5
T24.6
T25.2
ICD CODE
T25.5
T26.0
T26.4
T26.9
T27.3
T27.7
T28.9
T29.1
T30.0
T30.2
T30.3
T30.4
T30.5
T30.6
T30.7
T31.0
T31.1
T32.0
T32.1
T34.1
T35.0
T35.1
T20.2
T20.3
T20.6
T22.3
T23.3
T23.6
T23.7
T24.3
T24.7
T25.3
T26.1
T26.2
T26.3
T26.6
T27.0
T27.2
T28.0
T28.1
T28.2
T28.3
T28.5
T28.6
T28.7
T28.8
T29.2
T29.3
T29.6
T31.2
T31.3
T31.4
Other pemphigoid
Dermatitis herpetiformis; Duhring's disease
Subcorneal pustular dermatitis; Sneddon-Wilkinson
disease
Bullous disorder, unspecified
Corrosion of unspecified degree of head and neck
Burn of unspecified degree of trunk
Burn of second degree of trunk
Corrosion of first degree of trunk
Corrosion of second degree of trunk
Burn of second degree of shoulder and upper limb,
except
Corrosion
of first degree of shoulder and upper limb,
wrist and hand
except wrist and hand
Corrosion of second degree of shoulder and upper
limb,
Burn
of wrist
second
except
anddegree
hand of wrist and hand
Corrosion of unspecified degree of wrist and hand
Burn of second degree of hip and lower limb, except
ankle
Corrosion
and foot of first degree of hip and lower limb, except
ankle and foot
Corrosion of second degree of hip and lower limb,
except
Burn
second
ankleof
and
foot degree of ankle and foot
BULLOUS DISORDERS
BULLOUS DISORDERS
BULLOUS DISORDERS
12,000
12,000
12,000
3,600
3,600
3,600
BULLOUS DISORDERS
BURN A
BURN A
BURN A
BURN A
BURN A
BURN A
12,000
8,500
8,500
8,500
8,500
8,500
8,500
3,600
2,550
2,550
2,550
2,550
2,550
2,550
BURN A
8,500
2,550
BURN A
8,500
2,550
BURN A
BURN A
BURN A
8,500
8,500
8,500
2,550
2,550
2,550
BURN A
8,500
2,550
BURN A
8,500
2,550
BURN A
8,500
2,550
Case Rate
Professional
Fee
A
A
A
A
A
A
A
A
8,500
8,500
8,500
8,500
8,500
8,500
8,500
8,500
2,550
2,550
2,550
2,550
2,550
2,550
2,550
2,550
BURN A
8,500
2,550
BURN A
8,500
2,550
BURN A
8,500
2,550
BURN A
8,500
2,550
BURN A
8,500
2,550
BURN A
8,500
2,550
BURN A
8,500
2,550
BURN
BURN
BURN
BURN
BURN
BURN
A
A
A
A
A
A
8,500
8,500
8,500
8,500
8,500
8,500
2,550
2,550
2,550
2,550
2,550
2,550
BURN A
8,500
2,550
BURN
BURN
BURN
BURN
B
B
B
B
10,600
10,600
10,600
10,600
3,180
3,180
3,180
3,180
BURN
BURN
BURN
BURN
B
B
B
B
10,600
10,600
10,600
10,600
3,180
3,180
3,180
3,180
BURN B
10,600
3,180
DESCRIPTION
FIRST CASE RATE

GROUP
Corrosion of first degree of ankle and foot

Burn of eyelid and periocular area
Burn of eye and adnexa, part unspecified
Corrosion of eye and adnexa, part unspecified
Burn of respiratory tract, part unspecified
Corrosion of respiratory tract, part unspecified
Corrosion of other and unspecified internal organs
Burns of multiple regions, no more than first-degree
burns
Burn
of unspecified body region, unspecified degree;
mentioned
Burn
Burn
NOS of second degree, body region unspecified;
SecodnBurn
of burn
third NOS
degree, body region unspecified; Thirddegree
degree
Corrosion
burn NOS of unspecified body region, unspecified
degree;
Corrosion of
first degree, body region unspecified;
NOS
FirstCorrosion
of second
degree, body region unspecified;
degree corrosion
NOS
Second-degree corrosion NOS
Corrosion of third degree, body region unspecified;
ThridBurns
than 10% of body surface
degreeinvolving
corrosionless
NOS
Burns involving 10-19% of body surface
Corrosions involving less than 10% of body surface
Corrosions involving 10-19% of body surface
Frostbite with tissue necrosis of neck
Superficial frostbite involving multiple body regions;
Multiple superficial frosbite NOS
Frostbite with tissue necrosis involving multiple body
regions; Multiple frosbite with tissue necrosis NOS
Burn of second degree of head and neck
Burn of third degree of head and neck
Corrosion of second degree of head and neck
Burn of third degree of shoulder and upper limb,
except
Burn
third
degree of wrist and hand
wrist of
and
hand
Corrosion of second degree of wrist and hand
Corrosion of third degree of wrist and hand
Burn of third degree of hip and lower limb, except
ankle
Corrosion
and foot of third degree of hip and lower limb, except
ankle and foot
Burn of third degree of ankle and foot
Burn of cornea and conjunctival sac
Burn with resulting rupture and destruction of eyeball
Burn of other parts of eye and adnexa
Corrosion of cornea and conjunctival sac
Burn of larynx and trachea
Burn of other parts of respiratory tract; Thoracic cavity
BURN
BURN
BURN
BURN
BURN
BURN
BURN
BURN
BURN
BURN
BURN
BURN
BURN
BURN
BURN
B
B
B
B
B
B
B
10,600
10,600
10,600
10,600
10,600
10,600
10,600
3,180
3,180
3,180
3,180
3,180
3,180
3,180
Burn of mouth and pharynx

Burn of oesophagus
Burn of other parts of alimentary tract
Burn of internal genitourinary organs
Corrosion of mouth and pharynx
Corrosion of oesophagus
Corrosion of other parts of alimentary tract
Corrosion of internal genitourinary organs
Burns of multiple regions, no more than second-degree
burns mentioned
Burns of multiple regions, at least one burn of third
degree
Corrosions
mentioned of multiple regions, no more than seconddegree corrosions mentioned
BURN
BURN
BURN
BURN
BURN
BURN
BURN
BURN
BURN
B
B
B
B
B
B
B
B
B
10,600
10,600
10,600
10,600
10,600
10,600
10,600
10,600
10,600
3,180
3,180
3,180
3,180
3,180
3,180
3,180
3,180
3,180
BURN B
10,600
3,180
BURN B
10,600
3,180
BURN B
BURN B
BURN B
10,600
10,600
10,600
3,180
3,180
3,180
T31.5
T32.2
T32.3
T32.4
T34.9
T21.3
T31.6
T31.7
T31.8
T31.9
T32.9
I47.0
ICD CODE
I47.1

Frostbite with tissue necrosis of other and unspecified
sites; Frosbite with tissue necrosis NOS; Frosbite with
tissue of leg NOS; Frosbite with tissue necrosis of trunk
NOS
Burn of third degree of trunk
Burns involving 90% or more of body surface
Corrosions involving 90% or more of body surface
Re-entry ventricular arrhythmia
BURN
BURN
BURN
BURN
BURN
B
B
B
B
B
BURN C
BURN C
BURN C
BURN C
BURN C
BURN C
CARDIAC ARRHYTHMIA
DESCRIPTION
10,600
10,600
10,600
10,600
10,600
3,180
3,180
3,180
3,180
3,180
16,100
16,100
16,100
16,100
16,100
16,100
12,200
4,830
4,830
4,830
4,830
4,830
4,830
3,660
Case Rate
Professional
Fee
FIRST CASE RATE
GROUP
Supraventricular tachycardia; Atrial Paroxysmal

tachycardia; Atrioventricular [AV] Paroxysmal
tachycardia; Junctional Paroxysmal tachycardia; Nodal
Paroxysmal
tachycardia
Ventricular tachycardia
Paroxysmal tachycardia, unspecified; Bouveret (Hoffmann)
ATRIAL
FIBRILLATION AND FLUTTER
syndrome
Ventricular fibrillation and flutter
Atrial premature depolarization; Atrial premature beats
CARDIAC ARRHYTHMIA
12,200
3,660
CARDIAC ARRHYTHMIA
CARDIAC ARRHYTHMIA
12,200
12,200
3,660
3,660
CARDIAC ARRHYTHMIA
CARDIAC ARRHYTHMIA
CARDIAC ARRHYTHMIA
12,200
12,200
12,200
3,660
3,660
3,660
Junctional premature depolarization

Ventricular premature depolarization
Other and unspecified premature depolarization;
Ectopic beats; Extrasystoles; Extrasystolic
arrhythmias; Premature beats NOS; Premature
contractions
Sick sinus syndrome; Tachycardia-bradycardia
syndrome
Other specified cardiac arrhythmias; Coronary sinus
rhythm disorder; Ectopic rhythm disorder; nodal
rhythm disorder
Cardiac arrhythmia, unspecified; Cardiac arrhythmia
NOS
Dilated cardiomyopathy; Congestive cardiomyopathy
Obstructive hypertrophic cardiomyopathy;
Hypertrophic
Other
hypertrophic
subaortic
stenosis cardiomyopathy; Nonobstructive
hypertrophic cardiomyopathy
Endomyocardial (eosinophilic) disease;
Endomyocardial (tropical) fibrosis; Lffler's endocarditis
CARDIAC ARRHYTHMIA
CARDIAC ARRHYTHMIA
CARDIAC ARRHYTHMIA
12,200
12,200
12,200
3,660
3,660
3,660
CARDIAC ARRHYTHMIA
12,200
3,660
CARDIAC ARRHYTHMIA
12,200
3,660
CARDIAC ARRHYTHMIA
12,200
3,660
CARDIOMYOPATHY
CARDIOMYOPATHY
13,400
13,400
4,020
4,020
CARDIOMYOPATHY
13,400
4,020
CARDIOMYOPATHY
13,400
4,020
I42.4
Endocardial fibroelastosis; Congenital cardiomyopathy CARDIOMYOPATHY
13,400
4,020
I42.5
I42.6
I42.7
Other restrictive cardiomyopathy

Alcoholic cardiomyopathy
Cardio myopathy due to drugs and other external
agents
Other cardiomyopathies
Cardio myopathy, unspecified; Primary
cardiomyopathy NOS; Secondary cardiomyopathy NOS
CARDIOMYOPATHY
CARDIOMYOPATHY
CARDIOMYOPATHY
13,400
13,400
13,400
4,020
4,020
4,020
CARDIOMYOPATHY
CARDIOMYOPATHY
13,400
13,400
4,020
4,020
P29.0
Neonatal cardiac failure
IN THE
22,700
6,810
P29.1
Neonatal cardiac dysrhythmia
IN THE
22,700
6,810
P29.2
Neonatal hypertension
IN THE
22,700
6,810
P29.4
Transient myocardial ischaemia of newborn
IN THE
22,700
6,810
P29.8
Other cardiovascular disorders originating in the

perinatal
Cauda
period equina syndrome; Neurogenic bladder due to
cauda equina syndrome
Excludes: cord bladder NOS (G95.8)
Erysipelas
Gas gangrene; Clostridial cellulitis; Clostridial
myonecrosis
Cellulitis of finger and toe; Infection of nail; Onychia;
Paronychia; Perionychia
Cellulitis of other parts of limb, Axilla; Cellulitis of
Hip;Cellulitis of Shoulder
Cellulitis of face
Cellulitis of trunk;Cellulitis of Abdominal wall;Cellulitis
of Back [any part]; Cellulitis of Chest wall;Cellulitis of
Groin;Cellulitis of Perineum;Cellulitis of Umbilicus
CARDIOVASCULAR COMPLICATIONS
NEWBORN
NEWBORN
NEWBORN
NEWBORN
NEWBORN
CAUDA EQUINA SYNDROME
IN THE
22,700
6,810
8,800
2,640
CELLULITIS
CELLULITIS
9,600
9,600
2,880
2,880
CELLULITIS
9,600
2,880
CELLULITIS
9,600
2,880
CELLULITIS
CELLULITIS
9,600
9,600
2,880
2,880
CELLULITIS
9,600
2,880
CELLULITIS
CELLULITIS
CEREBRAL PALSY
9,600
9,600
9,500
2,880
2,880
2,850
CEREBRAL PALSY
CEREBRAL PALSY
CEREBRAL PALSY
9,500
9,500
9,500
2,850
2,850
2,850
CEREBRAL PALSY
9,500
2,850
I47.2
I47.9
I48
I49.0
I49.1
I49.2
I49.3
I49.4
I49.5
I49.8
I49.9
I42.0
I42.1
I42.2
I42.3
I42.8
I42.9
G83.4
A46
A48.0
L03.0
L03.1
L03.2
L03.3
L03.8
L03.9
L98.3
G80.0
G80.1
G80.2
G80.3
G80.4
Cellulitis of other sites; Cellulitis of Head [any part,

except
Cellulitis,
unspecified
face];Cellulitis
of Scalp
Eosinophilic cellulitis [Wells]
Spastic cerebral palsy; Congenital spastic paralysis
(cerebral); Spastic tetraplegic cerebral palsy
Spastic diplegia; Spastic cerebral palsy NOS
Infantile hemiplegia
Dyskinetic cerebral palsy; Athetoid cerebral palsy;
Dystonic
Ataxic
cerebral
cerebral
palsy palsy
G80.8
G80.9
K74.3
ICD CODE
K80.3
Other infantile cerebral palsy; Mixed cerebral palsy

syndromes
Infantile cerebral palsy, unspecified; Cerebral palsy
NOS
Primary biliary cirrhosis; Chronic nonsupparative
destructive cholangitis
CEREBRAL PALSY
9,500
2,850
CEREBRAL PALSY
9,500
2,850
CHOLANGITIS
13,200
3,960
FIRST CASE RATE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Calculus of bile duct with cholangitis; Any condition

listed
Calculus
of gallbladder
with acute cholecystitis; Any
in K80.5 with
cholangitis
condition listed in K80.2 with acute cholecystitis
Calculus of gallbladder with other cholecystitis; Any
condition listed in K80.2 with chronic cholecystitis;
Cholecystitis with cholelithiasis NOS
Calculus of bile duct with cholecystitis; Any condition
listed
Acute
cholecystitis;
Abscess
of gallbladder
in K80.5
with cholecystitis
(with
cholangitis)without
calculus; Angiocholecystitis without calculus; Acute
emphysematous cholecystitis without calculus;
Gangrenous cholecystitis without calculus; Supparative
cholecystitis without calculus; Empyema of gallbl
CHOLANGITIS
13,200
3,960
CHOLECYSTITIS
11,300
3,390
CHOLECYSTITIS
11,300
3,390
CHOLECYSTITIS
11,300
3,390
CHOLECYSTITIS
11,300
3,390
K81.1
K81.8
Q90.0
Q90.2
Q90.9
Q91.0
Q91.2
Q91.3
Q91.7
Q92.9
Chronic cholecystitis
Other cholecystitis
Trisomy 21, meiotic nondisjunction
Trisomy 21, translocation
Down's syndrome, unspecified; Trisomy 21 NOS
Trisomy 18, meiotic nondisjunction
Trisomy 18, translocation
Edwards' syndrome, unspecified
Patau's syndrome, unspecified
Trisomy and partial trisomy of autosomes, unspecified
CHOLECYSTITIS
CHOLECYSTITIS
CHROMOSOMAL
CHROMOSOMAL
CHROMOSOMAL
CHROMOSOMAL
CHROMOSOMAL
CHROMOSOMAL
CHROMOSOMAL
CHROMOSOMAL
ABNORMALITIES
ABNORMALITIES
ABNORMALITIES
ABNORMALITIES
ABNORMALITIES
ABNORMALITIES
ABNORMALITIES
ABNORMALITIES
11,300
11,300
12,700
12,700
12,700
12,700
12,700
12,700
12,700
12,700
3,390
3,390
3,810
3,810
3,810
3,810
3,810
3,810
3,810
3,810
Q93.1
Whole chromosome monosomy, mosaicism (mitotic

nondisjunction)
Chromosome replaced with ring or dicentric
Deletion of short arm of chromosome 5; Cri-du-chat
syndrome
Other deletions of part of a chromosome; Angelman
syndrome
Deletions with other complex rearrangements
Deletion from autosomes, unspecified
Balanced rearrangement and structural marker,
unspecified
Turner's syndrome, unspecified
Sex chromosome abnormality, female phenotype,
unspecified
Klinefelter's syndrome, unspecified
Fragile X chromosome; Fragile X syndrome
Other specified chromosome abnormalities
End-stage renal disease
Other chronic renal failure
Chronic renal failure, unspecified; Uraemia NOS
Unspecified renal failure
Chronic obstructive/ asthmatic/ emphysematous
pulmonary disease with acute lower respiratory
infection
Chronic obstructive/ asthmatic/ emphysematous
pulmonary disease with acute exacerbation,
unspecified
Chronic asthmatic (obstructive) bronchitis NOS;
Chronic emphysematous bronchitis NOS; Chronic
obstructive
Chronic
obstructive
pulmonary disease, unspecified;
bronchitis
NOS
Chronic obstructive airway disease NOS; Chronic
obstructive lung disease NOS
CLEFT HARD PALATE, BILATERAL; BILATERAL FISSURE
OF HARD PALATE; BILATERAL PALATOSCHISIS OF HARD
PALATE
Cleft hard palate
Cleft soft palate
Cleft hard palate with cleft soft palate
Cleft uvula
CLEFT PALATE, UNSPECIFIED, BILATERAL
Cleft palate, unspecified
Cleft lip, bilateral
Cleft lip, median
Cleft lip, unilateral; Cleft lip NOS
Cleft hard palate with bilateral cleft lip
Cleft hard palate with unilateral cleft lip; Cleft hard
palate
Cleft
soft palate
with cleft
lip NOSwith bilateral cleft lip
Cleft soft palate with unilateral cleft lip; Cleft soft
palate
Cleft
hard lip
and
soft palate with bilateral cleft lip
with cleft
NOS
Cleft hard and soft palate with unilateral cleft lip; Cleft
hard
Unspecified
cleftwith
palate
bilateral cleft lip
and soft palate
cleftwith
lip NOS
Unspecified cleft palate with unilateral cleft lip; Cleft
palate
Vascular
with cleftdementia
lip NOS of acute onset
CHROMOSOMAL ABNORMALITIES
12,700
3,810
12,700
12,700
3,810
3,810
12,700
3,810
12,700
12,700
12,700
3,810
3,810
3,810
12,700
12,700
3,810
3,810
CHRONIC KIDNEY DISEASE
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
12,700
12,700
12,700
14,500
14,500
14,500
14,500
12,200
3,810
3,810
3,810
4,350
4,350
4,350
4,350
3,660
12,200
3,660
12,200
3,660
12,200
3,660
CLEFT LIP AND PALATE
7,800
2,340
CLEFT
CLEFT
CLEFT
CLEFT
CLEFT
CLEFT
CLEFT
CLEFT
CLEFT
CLEFT
CLEFT
PALATE
PALATE
PALATE
PALATE
PALATE
PALATE
PALATE
PALATE
PALATE
PALATE
PALATE
7,800
7,800
7,800
7,800
7,800
7,800
7,800
7,800
7,800
7,800
7,800
2,340
2,340
2,340
2,340
2,340
2,340
2,340
2,340
2,340
2,340
2,340

7,800
7,800
2,340
2,340

7,800
7,800
2,340
2,340

7,800
7,800
2,340
2,340
COGNITIVE DYSFUNCTION
8,200
2,460
Case Rate
Professional
Fee
K80.0
K80.1
K80.4
K81.0
Q93.2
Q93.4
Q93.5
Q93.7
Q93.9
Q95.9
Q96.9
Q97.9
Q98.4
Q99.2
Q99.8
N18.0
N18.8
N18.9
N19
J44.0
J44.1
J44.8
J44.9
Q35.0
Q35.1
Q35.3
Q35.5
Q35.7
Q35.8
Q35.9
Q36.0
Q36.1
Q36.9
Q37.0
Q37.1
Q37.2
Q37.3
Q37.4
Q37.5
Q37.8
Q37.9
F01.0
ICD CODE
DESCRIPTION
LIP
LIP
LIP
LIP
LIP
LIP
LIP
LIP
LIP
LIP
LIP
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
GROUP
FIRST CASE RATE
R41.0
R41.3
R54
D34
Disorientation, unspecified; Confusion NOS

Other amnesia; Amnesia NOS
Senility; Old age without mention of psychosis;
Senescence without mention of psychosis; Senile
asthenia; Senile
Benign
debility neoplasm of thyroid gland
D35.0
Benign neoplasm of Adrenal gland
D35.1
Benign neoplasm of Parathyroid gland
D35.2
Benign neoplasm of Pituitary gland
D35.3
Benign neoplasm of Craniopharyngeal duct
D35.4
Benign neoplasm of Pineal gland
D35.9
Benign neoplasm of Endocrine gland, unspecified
D16.0
D16.1
Benign neoplasm of Scapula and long bones of upper

limb
Benign neoplasm of Short bones of upper limb
D16.2
Benign neoplasm ofLong bones of lower limb
D16.3
Benign neoplasm of Short bones of lower limb
D16.4
D16.5
Benign neoplasm of Bones of skull and face; Benign

neoplasm of Superior Maxilla; Benign neoplasm of
Orbital
Benign
bone neoplasm of Lower jaw bone
D16.6
Benign neoplasm of Vertebral column
D16.7
Benign neoplasm of Ribs, sternum and clavicle
D16.8
Benign neoplasm of Pelvic bones, sacrum and coccyx
D16.9
Benign neoplasm of Bone and articular cartilage,

unspecified
Benign neoplasm of Caecum;Benign neoplasm of
Ileocaecal valve
Benign neoplasm of Appendix
D12.0
D12.1
D12.3
D12.4
D12.5
D12.6
D12.7
D12.8
D12.9
D13.0
D13.1
D13.2
D13.3
D13.4
D13.5
D13.6
D13.7
D13.9
D17.5
ICD CODE
8,200
8,200
8,200
2,460
2,460
2,460
COMPLICATIONS OF BENIGN
ENDOCRINE GLANDS
ENDOCRINE GLANDS
ENDOCRINE GLANDS
ENDOCRINE GLANDS
ENDOCRINE GLANDS
ENDOCRINE GLANDS
ENDOCRINE GLANDS
THE
COMPLICATIONS
OF BENIGN
BONES
THE
COMPLICATIONS
OF BENIGN
BONES
THE
COMPLICATIONS
OF BENIGN
BONES
THE
COMPLICATIONS
OF BENIGN
BONES
THE BONES
NEOPLASMS OF
12,000
3,600
NEOPLASMS OF
12,000
3,600
NEOPLASMS OF
12,000
3,600
NEOPLASMS OF
12,000
3,600
NEOPLASMS OF
12,000
3,600
NEOPLASMS OF
12,000
3,600
NEOPLASMS OF
12,000
3,600
NEOPLASMS OF
10,500
3,150
NEOPLASMS OF
10,500
3,150
NEOPLASMS OF
10,500
3,150
NEOPLASMS OF
10,500
3,150
NEOPLASMS OF
10,500
3,150
THE
COMPLICATIONS
OF BENIGN
BONES
THE
COMPLICATIONS
OF BENIGN
BONES
THE
COMPLICATIONS
OF BENIGN
BONES
THE
COMPLICATIONS
OF BENIGN
BONES
THE
COMPLICATIONS
OF BENIGN
BONES
THE
COMPLICATIONS
OF BENIGN
DIGESTIVE SYSTEM
THE
COMPLICATIONS
OF BENIGN
DIGESTIVE SYSTEM
THE DIGESTIVE SYSTEM
NEOPLASMS OF
10,500
3,150
NEOPLASMS OF
10,500
3,150
NEOPLASMS OF
10,500
3,150
NEOPLASMS OF
10,500
3,150
NEOPLASMS OF
10,500
3,150
NEOPLASMS OF
8,700
2,610
NEOPLASMS OF
8,700
2,610
NEOPLASMS OF
8,700
2,610
COMPLICATIONS OF BENIGN NEOPLASMS OF

THE
Benign neoplasm of Sigmoid colon
COMPLICATIONS
OF BENIGN NEOPLASMS OF
DIGESTIVE SYSTEM
THE
Benign neoplasm of Colon, unspecified; Adenomatosis COMPLICATIONS
DIGESTIVE SYSTEM
of colon; Benign neoplasm of Large intestine NOS;
Hereditary
Benign
neoplasm
Polyposis
of colon of Rectosigmoid junction;
Adenomatosis of colon; Benign neoplasm of Large
intestine NOS;
Benign
neoplasm
of Rectum
Hereditary
Polyposis
of colon
THE
Benign neoplasm of Anus and anal canal
COMPLICATIONS
DIGESTIVE SYSTEM
THE
Benign neoplasm of Oesophagus
COMPLICATIONS
DIGESTIVE SYSTEM
THE
Benign neoplasm of Stomach
COMPLICATIONS
DIGESTIVE SYSTEM
THE
Benign neoplasm of Duodenum
COMPLICATIONS
DIGESTIVE SYSTEM
THE
Benign neoplasm of Other and unspecified parts of
COMPLICATIONS
DIGESTIVE SYSTEM
small
THE
Benign
neoplasm of Liver; Benign neoplasm of
COMPLICATIONS
intestine
DIGESTIVE SYSTEM
Intrahepatic
THE
Benign
neoplasm of Extrahepatic bile ducts
COMPLICATIONS
bile ducts
DIGESTIVE SYSTEM
THE
Benign neoplasm of Pancreas
COMPLICATIONS
DIGESTIVE SYSTEM
THE
Benign neoplasm of Endocrine pancreas; Benign
COMPLICATIONS
DIGESTIVE SYSTEM
neoplasm of Islet cell tumour; Benign neoplasm of
Islets of
Benign
neoplasm of Ill-defined sites within the
Langerhans
digestive system; Benign neoplasm of Digestive
system NOS; Benign neoplasm of Intestine NOS;
Benign neoplasm of Spleen
Benign lipomatous neoplasm of intra-abdominal
organs
THE
DIGESTIVE SYSTEM
8,700
2,610
8,700
2,610
8,700
2,610
8,700
2,610
8,700
2,610
8,700
2,610
8,700
2,610
8,700
2,610
8,700
2,610
8,700
2,610
8,700
2,610
8,700
2,610
8,700
2,610
8,700
2,610
8,700
2,610
8,700
2,610
Benign neoplasm of Transverse colon; Benign

neoplasm of Hepatic flexure; Benign neoplasm of
Splenic flexure
Benign neoplasm of Descending colon
DESCRIPTION
D17.6
Benign lipomatous neoplasm of spermatic cord
D17.7
D20.0
Benign lipomatous neoplasm of other sites; Benign

lipomatous neoplasm of Peritoneum; Benign
lipomatous
Benign
neoplasm
of of soft tissue of Retroperitoneum
neoplasm
of Retroperitoneum
D20.1
Benign neoplasm of of soft tissue of Peritoneum
FIRST CASE RATE

Case Rate
Professional
Fee

THE
COMPLICATIONS
DIGESTIVE SYSTEM
8,700
2,610
8,700
2,610

THE
COMPLICATIONS
DIGESTIVE SYSTEM
THE
DIGESTIVE SYSTEM
8,700
2,610
8,700
2,610
GROUP
D21.4
D25.0
D25.1
D25.2
D25.9
D26.0
D26.1
D26.7
D26.9
D27
D28.0
D28.1
D28.2
D28.7
D28.9
D29.0
D29.1
D29.2
D29.4
D32.0
D32.1
D32.9
D33.0
D33.1
D33.2
D33.3
D33.4
D33.7
D33.9
D36.1
D10.0
D10.1
D10.3
ICD CODE
D10.6
D10.7
D10.9
D11.0
D11.7
D11.9
Benign neoplasm of Connective and other soft tissue

of
Submucous
abdomen leiomyoma of uterus

THE
COMPLICATIONS
DIGESTIVE SYSTEM
THE
Intramural leiomyoma of uterus
COMPLICATIONS
BENIGN NEOPLASMS OF
FEMALE GENITALOF
TRACT
THE
Subserosal leiomyoma of uterus
COMPLICATIONS
BENIGN NEOPLASMS OF
FEMALE GENITALOF
TRACT
THE
Leiomyoma of uterus, unspecified
COMPLICATIONS
BENIGN NEOPLASMS OF
FEMALE GENITALOF
TRACT
THE
Other Benign neoplasm of Cervix uteri
COMPLICATIONS
BENIGN NEOPLASMS OF
FEMALE GENITALOF
TRACT
THE
Other Benign neoplasm of Corpus uteri
COMPLICATIONS
BENIGN NEOPLASMS OF
FEMALE GENITALOF
TRACT
THE
Other Benign neoplasm of Other parts of uterus
COMPLICATIONS
BENIGN NEOPLASMS OF
FEMALE GENITALOF
TRACT
THE
Other Benign neoplasm of Uterus, unspecified
COMPLICATIONS
BENIGN NEOPLASMS OF
FEMALE GENITALOF
TRACT
THE
Benign neoplasm of ovary
COMPLICATIONS
BENIGN NEOPLASMS OF
FEMALE GENITALOF
TRACT
THE
Benign neoplasm of Vulva
COMPLICATIONS
BENIGN NEOPLASMS OF
FEMALE GENITALOF
TRACT
THE
Benign neoplasm of Vagina
COMPLICATIONS
BENIGN NEOPLASMS OF
FEMALE GENITALOF
TRACT
THE
Benign neoplasm of Uterine tubes and ligaments;
COMPLICATIONS
BENIGN NEOPLASMS OF
FEMALE GENITALOF
TRACT
Benign neoplasm of Fallopian Tubes; Benign neoplasm THE FEMALE GENITAL TRACT
of Uterine Broad Ligament; Benign neoplasm of
Uterine round
ligament
Benign
neoplasm of Other specified female genital
organs
THE
Benign neoplasm of Female genital organ, unspecified COMPLICATIONS
BENIGN NEOPLASMS OF
FEMALE GENITALOF
TRACT
THE
Benign neoplasm of Penis
COMPLICATIONS
BENIGN NEOPLASMS OF
FEMALE GENITALOF
TRACT
THE
Benign neoplasm of Prostate
COMPLICATIONS
MALE GENITAL TRACT
THE
Benign neoplasm of Testis
COMPLICATIONS
MALE GENITAL TRACT
THE
Benign neoplasm of Scrotum; Benign neoplasm of Skin COMPLICATIONS
MALE GENITAL TRACT
of
THE
Benign
COMPLICATIONS
scrotumneoplasm of Cerebral meninges
MALE GENITAL TRACT
THE
Benign neoplasm of Spinal meninges
COMPLICATIONS
NERVOUS SYSTEM
THE
Benign neoplasm of Meninges, unspecified;
COMPLICATIONS
NERVOUS SYSTEM
Meningioma
THE
Benign
neoplasm of Brain, supratentorial; Benign
COMPLICATIONS
NOS
NERVOUS SYSTEM
neoplasm of Cerebral ventricle; Benign neoplasm of
THE NERVOUS SYSTEM
Cerebrum; Benign neoplasm of Frontal lobe; Benign
neoplasm of Occipital lobe; Benign neoplasm of
Parietal lobe; Benign
neoplasm
of Temporal
lobeinfratentorial; Benign
Benign
neoplasm
of Brain,
neoplasm of Brain stem; Benign neoplasm of
THE NERVOUS SYSTEM
Cerebellum; Benign
Benign
neoplasm
of ventricle
Brain, unspecified
neoplasm
of Fourth
THE
Benign neoplasm of Cranial nerves; Benign neoplasm COMPLICATIONS
NERVOUS SYSTEM
of
THE
Benign
neoplasm
of Spinal cord
COMPLICATIONS
Olfactory
bulb
NERVOUS SYSTEM
THE
Benign neoplasm of Other specified parts of central
COMPLICATIONS
NERVOUS SYSTEM
nervous system
THE
Benign neoplasm of Central nervous system,
COMPLICATIONS
NERVOUS SYSTEM
unspecified;
THE
Benign
of Peripheral
Central neoplasm
Nervous system
NOS nerves and autonomic COMPLICATIONS
NERVOUS SYSTEM
nervous system
THE
Benign neoplasm of Lip; Benign neoplasm of frenulum COMPLICATIONS
NERVOUS SYSTEM
of Lip; Benign neoplasm of Inner aspect of lip; Benign THE ORAL CAVITY, PHARYNX, LARYNX,
neoplasm of Mucosa of Lip; Vermilion border of Lip
SALIVARY
Benign neoplasm of Tongue;Benign neoplasm of
COMPLICATIONS
GLANDS
Lingual tonsil
THE
ORAL CAVITY, PHARYNX, LARYNX,
Benign neoplasm of Other and unspecified parts of
COMPLICATIONS
SALIVARY GLANDS
mouth; Benign neoplasm of Minor salivary gland NOS THE ORAL CAVITY, PHARYNX, LARYNX,
SALIVARY
GLANDS
DESCRIPTION
GROUP
Benign neoplasm of Nasopharynx; Benign neoplasm of COMPLICATIONS OF BENIGN NEOPLASMS OF

Pharyngeal tonsil; Benign neoplasm of Posterior
THE ORAL CAVITY, PHARYNX, LARYNX,
margin of
SALIVARY
Benign
of Hypopharynx
COMPLICATIONS
septumneoplasm
and choanae
GLANDS
SALIVARY
Benign neoplasm of Pharynx, unspecified
COMPLICATIONS
GLANDS
THE
Benign neoplasm of Parotid gland
COMPLICATIONS
SALIVARY GLANDS
SALIVARY
Benign neoplasm of Other major salivary glands
COMPLICATIONS
GLANDS
SALIVARY
Benign neoplasm of Major salivary gland, unspecified COMPLICATIONS
GLANDS
SALIVARY
GLANDS
8,700
2,610
9,600
2,880
9,600
2,880
9,600
2,880
9,600
2,880
9,600
2,880
9,600
2,880
9,600
2,880
9,600
2,880
9,600
2,880
9,600
2,880
9,600
2,880
9,600
2,880
9,600
2,880
9,600
2,880
7,700
2,310
7,700
2,310
7,700
2,310
7,700
2,310
14,800
4,440
14,800
4,440
14,800
4,440
14,800
4,440
14,800
4,440
14,800
4,440
14,800
4,440
14,800
4,440
14,800
4,440
14,800
4,440
14,800
4,440
9,500
2,850
9,500
2,850
9,500
2,850
FIRST CASE RATE

Case Rate
Professional
Fee
9,500
2,850
9,500
2,850
9,500
2,850
9,500
2,850
9,500
2,850
9,500
2,850
D14.1

THE
Benign neoplasm of Trachea
COMPLICATIONS
SALIVARY GLANDS
SALIVARY
Benign neoplasm of Kidney
COMPLICATIONS
GLANDS
THE
Benign neoplasm of Renal pelvis
COMPLICATIONS
URINARY SYSTEMOF BENIGN NEOPLASMS OF
THE
Benign neoplasm of Bladder; Benign neoplasm of
COMPLICATIONS
Urethral orifice of bladder; Benign neoplasm of ureteric THE URINARY SYSTEM
orifice of
Benign
bladderneoplasm of Urethra
THE
Benign neoplasm of Urinary organ, unspecified;
COMPLICATIONS
Benign
THE
Cardiac
septal
defect,
acquired;
Acquired
atrial
septal
COMPLICATIONS
neoplasm of Urinary system NOS
URINARY SYSTEMOF HEART DISEASES
defect old; Acquired auricular septal defect old ;
Acquired ventricular septal defect old
Rupture of chordae tendineae, not elsewhere classified COMPLICATIONS OF HEART DISEASES
9,500
2,850
9,500
2,850
8,300
2,490
8,300
2,490
8,300
2,490
8,300
2,490
8,300
2,490
14,400
4,320
14,400
4,320
Rupture of papillary muscle, not elsewhere classified

Intra cardiac thrombosis, notel sewhere classified; Old
Apical thrombosis; Old Atrial thrombosis; Old
Auricular thrombosis; Old Venticular thrombosis
Myocarditis, unspecified; Myocardial fibrosis;
Myocarditis
Myocardial
degeneration;
Fatty Degeneration of heart
NOS; Chronic
interstitial myocarditis
or myocardium fatty; Senile Degeneration of heart or
myocardium; Myocardial disease
Other ill-defined heart diseases; Acute carditis; Chronic
Carditis; Acute pancarditis; Chronic pancarditis
COMPLICATIONS OF HEART DISEASES

14,400
14,400
4,320
4,320
14,400
4,320
14,400
4,320
14,400
4,320
D18.0
Haemangioma, any site; Angioma NOS
OF HEMANGIOMA AND
9,000
2,700
D18.1
Lymphangioma, any site
OF HEMANGIOMA AND
9,000
2,700
D14.3
Benign neoplasm of Bronchus and lung
OF INTRATHORACIC BENIGN
10,100
3,030
D14.4
Benign neoplasm of Respiratory system, unspecified
10,100
3,030
D15.0
Benign neoplasm of Thymus
10,100
3,030
D15.1
Benign neoplasm of Heart
10,100
3,030
D15.2
Benign neoplasm of Mediastinum
10,100
3,030
D15.9
Benign neoplasm of Intrathoracic organ, unspecified
10,100
3,030
D17.4
Benign lipomatous neoplasm of intrathoracic organs
COMPLICATIONS
LYMPHANGIOMA
COMPLICATIONS
LYMPHANGIOMA
COMPLICATIONS
NEOPLASMS
COMPLICATIONS
NEOPLASMS
COMPLICATIONS
NEOPLASMS
COMPLICATIONS
NEOPLASMS
COMPLICATIONS
NEOPLASMS
COMPLICATIONS
NEOPLASMS
COMPLICATIONS
NEOPLASMS
COMPLICATIONS
NEOPLASMS
10,100
3,030
10,100
3,030
COMPLICATIONS OF SEXUALLY TRANSMITTED

DISEASES
DISEASES
5,500
1,650
5,500
1,650

DISEASES
5,500
1,650
D14.2
D30.0
D30.1
D30.3
D30.4
D30.9
I51.0
I51.1
I51.2
I51.3
I51.4
I51.5
I51.8
D21.3
A52.1
A52.3
A52.7
ICD CODE
Benign neoplasm of Larynx; Benign neoplasm of

suprahyoid portion of Epiglottis
Benign neoplasm of Connective and other soft tissue

of thorax; Benign neoplasm of Connective and other
soft tissue of Axilla; Benign neoplasm of Connective
and other soft tissue of Diaphragm; Benign neoplasm
of Connective
and other
soft tissue
of Great v Tabes dorsalis
Late
Symptomatic
neurosyphilis;
Neurosyphilis, unspecified; Syphilitic Gumma of
central nervous system NOS; Late Syphilis of central
nervous system NOS; Syphiloma of central nervous
system NOS
Other symptomatic late syphilis
DESCRIPTION
GROUP
FIRST CASE RATE

Case Rate
Professional
Fee
A53.0
Latent syphilis, unspecified as early or late; Latent

syphilis NOS; Positive serological reaction for syphilis

DISEASES
5,500
1,650
A54.1
Gonococcal infection of lower genitourinary tract with

periurethral and accessory gland abscess; Gonococcal
Bartholin's gland abscess
GONOCOCCAL PELVIPERITONITIS AND OTHER
GONOCOCCAL GENITOURINARY INFECTIONS
Gonococcal septicaemia; Gonococcal skin lesions

DISEASES
5,500
1,650

DISEASES
DISEASES
Chlamydial lymphogranuloma (venereum); Climatic or COMPLICATIONS OF SEXUALLY TRANSMITTED
tropical bubo ; Durand-Nicolas-Favre disease;
DISEASES
Esthiomene; Lymphogranuloma inguinale
Chlamydial infection of pelviperitoneum and other
genitourinary organs;
DISEASES
Trichomoniasis
DISEASES
Air embolism (traumatic)
COMPLICATIONS OF TRAUMA
Fat embolism (traumatic)
Traumatic secondary and recurrent haemorrhage
Post-traumatic wound infection, not elsewhere
classified
Traumatic shock; immediate shock following injury;
Delayed shock following injury
Traumatic anuria; Crush syndrome; Renal failure
following
Traumatic
crushing ischaemia of muscle; Compartment
syndrome;
Volkmann's ischaemic contracture
5,500
1,650
5,500
1,650
5,500
1,650
5,500
1,650
5,500
1,650
9,300
9,300
9,300
9,300
2,790
2,790
2,790
2,790
9,300
2,790
9,300
2,790
9,300
2,790
A54.2
A54.8
A55
A56.1
A59
T79.0
T79.1
T79.2
T79.3
T79.4
T79.5
T79.6
T79.7
T79.8
E25.0
P61.2
P61.3
P61.4
D64.4
D74.0
Q80.2
Q80.9
Q81.2
Q81.8
Q81.9
Q82.0
Q82.2
Q82.3
Q82.4
Q82.8
Q84.8
Q50.1
Q50.3
Q50.4
Q50.5
Q50.6
Q51.0
Q51.9
Q65.6
Q67.3
Q67.4
ICD CODE
Traumatic subcutaneous emphysema

Other early complications of trauma
Congenital adrenogenital disorders associated with
enzyme deficiency; Congenital adrenal hyperplasia;
21-Hydroxylase deficiency; Salt-losing congenital
adrenal hyperplasia
Anaemia of prematurity
Congenital anaemia from fetal blood loss
Other congenital anaemias, not elsewhere classified;
Congenital anaemia NOS
Congenital dyserythropoietic anaemia; Congenital
Dyshaematopoietic anaemia
Congenital methaemoglobinaemia
Lamellar ichthyosis; Collodion baby
Congenital ichthyosis, unspecified
Epidermolysis bullosa dystrophica
Other epidermolysis bullosa
Epidermolysis bullosa, unspecified
Hereditary lymphoedema
Mastocytosis; Urticaria pigmentosa
Incontinentia pigmenti
Ectodermal dysplasia (anhidrotic)
Other specified congenital malformations of skin;
Abnormal palmar creases; Accessory skin tags; Benign
familial pemphigus [Hailey-Hailey]; Cutis laxa
(hyperelastica); Dermatoglyphic anomalies; Inherited
keratosis palmaris et
plantaris;
Keratosis
folliculamalformations of
Other
specified
congenital
integument;
Developmental
ovarian cyst
Aplasia cutis congenita
DESCRIPTION
Pectus excavatum; Congenital funnel chest
Q67.7
Pectus carinatum; Congenital pigeon chest
Q68.0
Q78.0
Congenital deformity of sternocleidomastoid muscle;

Congenital, sternomastoid torticollis; Contracture of
sternocleidomastoid muscle; Sternomastoid tumour,
congenital
Congenital scoliosis due to congenital bony
malformation;
Hemivertebra fusion or failure of segmentation with
Osteogenesis
imperfecta; Fragilitas ossium
scoliosis
Q78.2
Osteopetrosis; Albers-Schnberg syndrome
Q78.8
Other specified osteochondrodysplasias;

Osteopoikilosis
Osteochondrodysplasia, unspecified;
Chondrodystrophy
Other
congenital malformation
syndromes with other
NOS; Osteodystrophy
NOS
skeletal changes
Atresia of oesophagus without fistula; Atresia of
oesophagus NOS
Atresia of oesophagus with tracheo-oesophageal
fistula; Atresia of oesophagus with bronchooesophageal fistula
Congenital tracheo-oesophageal fistula without
atresia;
Diverticulum
of oesophagus; Oesophageal
pouch
Congenital tracheo-oesophageal
fistula NOS
Congenital malformation of oesophagus, unspecified
Congenital hypertrophic pyloric stenosis; Congenital or
infantile constriction of pylorus; Congenital or infantile
hypertrophy of pylorus; Congenital or infantile spasm
of pylorus; Congenital or infantile stenosis of pylorus;
Congenital or infantile stric
Congenital hiatus hernia; Displacement of cardia
through
oesophageal hiatus
Q78.9
Q87.5
Q39.0
Q39.1
Q39.2
Q39.6
Q39.9
Q40.0
Q40.1
9,300
9,300
7,800
2,790
2,790
2,340
CONGENITAL ANEMIA
CONGENITAL ANEMIA
CONGENITAL ANEMIA
15,200
15,200
15,200
4,560
4,560
4,560
CONGENITAL BLOOD DISORDERS
4,000
1,200
CONGENITAL
CONGENITAL
CONGENITAL
CONGENITAL
CONGENITAL
CONGENITAL
CONGENITAL
CONGENITAL
CONGENITAL
CONGENITAL
BLOOD DISORDERS
DERMATOLOGIC DISEASES
4,000
11,800
11,800
11,800
11,800
11,800
11,800
11,800
11,800
11,800
1,200
3,540
3,540
3,540
3,540
3,540
3,540
3,540
3,540
3,540
CONGENITAL DERMATOLOGIC DISEASES
11,800
3,540
CONGENITAL DERMATOLOGIC DISEASES
11,800
3,540
THE FEMALE
9,300
2,790
THE FEMALE
9,300
2,790
THE FEMALE
9,300
2,790
THE FEMALE
9,300
2,790
9,300
2,790
THE FEMALE
9,300
2,790
THE FEMALE
9,300
2,790
THE
5,300
1,590
THE
5,300
1,590
THE
5,300
1,590
CONGENITAL DISORDERS OF
GENITAL
Other congenital malformations of ovary; Accessory
TRACT
ovary; Congenital malformation of ovary NOS; Ovarian GENITAL TRACT
streak
Embryonic cyst of fallopian tube; Fimbrial cyst
GENITAL
Embryonic cyst of broad ligament; Cyst epoophoron;
CONGENITAL
DISORDERS OF
TRACT
Gartner's duct Cyst; Parovarian Cyst
GENITAL
Other congenital malformations of fallopian tube and CONGENITAL
DISORDERS OF
TRACT
broad ligament; Absence of fallopian tube or broad
GENITAL TRACT
ligament; Accessory of fallopian tube or broad
ligament; Atresia of fallopian tube or broad ligament;
Congenital
malformation
of fallopian
tube or
bro
Agenesis
and aplasia
of uterus;
Congenital
absence of CONGENITAL DISORDERS OF
uterus
GENITAL
Congenital malformation of uterus and cervix,
CONGENITAL
DISORDERS OF
TRACT
unspecified
GENITAL
Unstable hip; Dislocatable hip; Subluxatable hip
CONGENITAL
DISORDERS OF
TRACT
MUSCULOSKELETAL SYSTEM
Plagiocephaly
Other congenital deformities of skull, face and jaw;
Depressions in skull; Deviation of nasal septum,
congenital; Hemifacial atrophy or hypertrophy;
Squashed or bent nose,
congenital
Q67.6
Q76.3
CONGENITAL ANDROGENITAL DISORDER
THE FEMALE
FIRST CASE RATE

Case Rate
Professional
Fee
CONGENITAL DISORDERS OF THE

5,300
1,590
5,300
1,590
5,300
1,590

5,300
1,590

CONGENITAL GASTROINTESTINAL DISORDERS
5,300
1,590
5,300
1,590
5,300
1,590
5,300
1,590
5,300
1,590
11,300
3,390
11,300
3,390
11,300
3,390

11,300
11,300
3,390
3,390
11,300
3,390
11,300
3,390
GROUP
Q40.2
Q40.9
Q41.0
Q41.1
Q41.2
Q41.9
Q42.0
Q42.1
Q42.2
Q42.3
Q42.9
Q43.0
Q43.1
Q43.2
Q43.3
Q43.4
Q43.5
Q43.6
Q43.7
ICD CODE
Other specified congenital malformations of stomach;

Congenital displacement of stomach; Congenital
diverticulum of stomach; Congenital hourglass
stomach; Duplication of stomach; Megalogastria;
Microgastria
Congenital malformation of upper alimentary tract,
unspecified; Congenital anomaly NOS of upper
alimentary tract; Congenital deformity NOS of upper
alimentary tract
Congenital absence, atresia and stenosis of duodenum CONGENITAL GASTROINTESTINAL DISORDERS
11,300
3,390
11,300
3,390
11,300
3,390
Congenital absence, atresia and stenosis of jejunum;

Apple
Congenital
absence,
atresia and
stenosis of ileum
peel syndrome;
Imperforate
jejunum
Congenital absence, atresia and stenosis of small
intestine,
part unspecified; Congenital absence, atresia and
Congenital
absence, NOS
atresia and stenosis of rectum
stenosis of intestine
with
Congenital
absence,
atresia and stenosis of rectum
fistula
without
Congenital
absence,rectum
atresia and stenosis of anus with
fistula; Imperforate
fistula
Congenital absence, atresia and stenosis of anus
without
Congenital
absence,anus
atresia and stenosis of large
fistula; Imperforate
intestine,
Meckel's
diverticulum; Persistent omphalomesenteric
part unspecified
duct;
Hirschsprung's
disease;
Persistent vitelline
duct Aganglionosis; Congenital
(aganglionic) megacolon
Other congenital functional disorders of colon;
Congenital
Congenital
of intestinal fixation;
dilatation ofmalformations
colon
Congenital anomalous omental adhesions [bands] ;
Congenital peritoneal adhesions [bands]; Jackson's
membrane; Malrotation of colon; Failure of rotation of
caecum and colon; Incomplete rotation of caecum a
11,300
3,390

11,300
11,300
3,390
3,390
11,300
3,390
11,300
3,390
11,300
3,390
11,300
3,390
11,300
3,390
11,300
3,390
11,300
3,390
11,300
3,390
11,300
3,390
Duplication of intestine
Ectopic anus
Congenital fistula of rectum and anus
Persistent cloaca; Cloaca NOS
CONGENITAL
CONGENITAL
CONGENITAL
CONGENITAL
11,300
11,300
11,300
11,300
3,390
3,390
3,390
3,390
Case Rate
Professional
Fee
DESCRIPTION
GASTROINTESTINAL
GASTROINTESTINAL
GASTROINTESTINAL
GASTROINTESTINAL
DISORDERS
DISORDERS
DISORDERS
DISORDERS
GROUP
FIRST CASE RATE
Q43.8
Other specified congenital malformations of intestine; CONGENITAL GASTROINTESTINAL DISORDERS

Congenital blind loop syndrome; Congenital
diverticulitis, colon; Congenital diverticulum, intestine;
Dolichocolon; Megaloappendix; Megaloduodenum;
Microcolon; Transposition of appendix; Transpositio
11,300
3,390
Q43.9
Q44.0
Congenital malformation of intestine, unspecified

Agenesis, aplasia and hypoplasia of gallbladder;
Congenital
Other
congenital
malformations of gallbladder;
absence
of gallbladder
Congenital malformation of gallbladder NOS;
Intrahepatic gallbladder
Atresia of bile ducts
Congenital stenosis and stricture of bile ducts
Choledochal cyst
Other congenital malformations of bile ducts;
Accessory hepatic duct; Congenital malformation of
bile duct NOS; Biliary duct Duplication; Cystic duct
Duplication
Cystic disease of liver; Fibrocystic disease of liver
Other congenital malformations of liver; Accessory
liver; Alagille's syndrome; Congenital absence of liver;
Congenital hepatomegaly; Congenital malformation of
liver NOS
Agenesis, aplasia and hypoplasia of pancreas;
Congenital
Other
specified
congenital malformations of digestive
absence
of pancreas
system; Absence of alimentary tract NOS, complete;
Absence of alimentary tract NOS, partial; Duplication
of digestive organs NOS; Malposition, congenital of
digestive
organs NOSmalformation of digestive system,
Congenital
unspecified; Congenital anomaly NOS of digestive
system ; Congenital deformity NOS of digestive system

11,300
11,300
3,390
3,390
11,300
3,390
CONGENITAL
CONGENITAL
CONGENITAL
CONGENITAL
DISORDERS
DISORDERS
DISORDERS
DISORDERS
11,300
11,300
11,300
11,300
3,390
3,390
3,390
3,390

11,300
11,300
3,390
3,390
11,300
3,390
11,300
3,390
11,300
3,390
Congenital diaphragmatic hernia

Other congenital malformations of diaphragm;
Absence of diaphragm; Congenital malformation of
diaphragm NOS;
Exomphalos;
Eventration ofOmphalocele
diaphragm
Gastroschisis
Prune belly syndrome
Other congenital malformations of abdominal wall
Common arterial trunk; Persistent truncus arteriosus
Double outlet right ventricle; Taussig-Bing syndrome
Double outlet left ventricle
Discordant ventriculoarterial connection;
Dextrotransposition of aorta; Transposition of great
vessels (complete)

11,300
11,300
3,390
3,390
CONGENITAL
CONGENITAL
CONGENITAL
CONGENITAL
CONGENITAL
CONGENITAL
CONGENITAL
CONGENITAL
11,300
11,300
11,300
11,300
11,600
11,600
11,600
11,600
3,390
3,390
3,390
3,390
3,480
3,480
3,480
3,480
Q44.1
Q44.2
Q44.3
Q44.4
Q44.5
Q44.6
Q44.7
Q45.0
Q45.8
Q45.9
Q79.0
Q79.1
Q79.2
Q79.3
Q79.4
Q79.5
Q20.0
Q20.1
Q20.2
Q20.3
GASTROINTESTINAL
GASTROINTESTINAL
GASTROINTESTINAL
GASTROINTESTINAL
GASTROINTESTINAL
GASTROINTESTINAL
GASTROINTESTINAL
GASTROINTESTINAL
HEART DISEASES
HEART DISEASES
HEART DISEASES
HEART DISEASES
DISORDERS
DISORDERS
DISORDERS
DISORDERS
Q20.4
Q20.5
Q20.9
Q21.0
Q21.1
Q21.2
Q21.3
Q21.4
Q21.8
Q21.9
Q22.0
Q22.1
Q22.2
Q22.4
Q22.5
Q22.6
Q22.8
Q23.0
Q23.1
ICD CODE
Q23.2
Q23.3
Double inlet ventricle; Common ventricle; Cor

triloculare
Discordant
biatriatum; atrioventricular
Single ventricle connection; Corrected
transposition; Laevotransposition; Ventricular
inversion
Congenital malformation of cardiac chambers and
connections, unspecified
Ventricular septal defect
Atrial septal defect; Coronary sinus defect; Patent or
persistent foramen ovale; Patent or persistent ostium
secundum defect (type II); Sinus venosus defect
Atrioventricular septal defect; Common
atrioventricular canal; Endocardial cushion defect;
Ostium primum atrial
Tetralogy
of Fallot;
septal defect with
septal defect
(type Ventricular
I)
pulmonary stenosis or atresia, dextroposition of aorta
and
Aortopulmonary
septal
defect; Aortic septal defect;
hypertrophy of right
ventricle.
Aortopulmonary window
Other congenital malformations of cardiac septa;
Eisenmenger's defect; Pentalogy of Fallot
Congenital malformation of cardiac septum,
unspecified;
Pulmonary
valve
atresia
Septal (heart)
defect
NOS
Congenital pulmonary valve stenosis
Congenital pulmonary valve insufficiency; Congenital
pulmonary valve regurgitation
Congenital tricuspid stenosis; Tricuspid atresia
Ebstein's anomaly
Hypoplastic right heart syndrome
Other congenital malformations of tricuspid valve
Congenital stenosis of aortic valve; Congenital aortic
atresia; Congenital aortic stenosis
Congenital insufficiency of aortic valve; Bicuspid aortic
valve; Congenital aortic insufficiency
CONGENITAL HEART DISEASES
11,600
3,480
11,600
3,480
11,600
3,480

11,600
11,600
3,480
3,480
11,600
3,480
11,600
3,480
11,600
3,480
11,600
3,480
11,600
3,480

11,600
11,600
11,600
3,480
3,480
3,480
CONGENITAL
CONGENITAL
CONGENITAL
CONGENITAL
CONGENITAL
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
11,600
11,600
11,600
11,600
11,600
3,480
3,480
3,480
3,480
3,480
11,600
3,480
HEART
HEART
HEART
HEART
HEART
FIRST CASE RATE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Congenital mitral stenosis; Congenital mitral atresia

Congenital mitral insufficiency
Hypoplastic left heart syndrome; Atresia, or marked
hypoplasia of aortic orifice or valve, with hypoplasia of
ascending aorta and defective development of left
ventricle (with mitral valve stenosis or
atresia).
Other congenital malformations of aortic and mitral
valves
Congenital malformation of aortic and mitral valves,
unspecified
Dextrocardia
Cor triatriatum
Pulmonary infundibular stenosis
Congenital subaortic stenosis
Malformation of coronary vessels; Congenital coronary
(artery) aneurysm
Congenital heart block
Other specified congenital malformations of heart;
Congenital diverticulum of left ventricle; Congenital
malformation of myocardium; Congenital malformation
of pericardium; Malposition of heart; Uhl's disease

11,600
11,600
3,480
3,480
11,600
3,480
11,600
3,480
11,600
3,480
CONGENITAL
CONGENITAL
CONGENITAL
CONGENITAL
CONGENITAL
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
11,600
11,600
11,600
11,600
11,600
3,480
3,480
3,480
3,480
3,480
11,600
3,480
11,600
3,480
Congenital malformation of heart, unspecified;

Congenital anomaly NOS of heart; Congenital disease
NOS of heart
Patent ductus arteriosus; Patent ductus Botallo;
Persistent
Coarctation
of aorta; Preductal coarctation of aorta;
ductus arteriosus
Postductal coarctation of aorta
Atresia of aorta
Stenosis of aorta; Supravalvular aortic stenosis
Other congenital malformations of aorta; Absence of
aorta; Aplasia of aorta; Congenital aneurysm of aorta;
Congenital dilatation of aorta; Aneurysm of sinus of
valsalva (rupture); Double aortic arch [vascular ring or
aorta]; Hypoplasia of aorta; Persisten
11,600
3,480
11,600
3,480
11,600
3,480

11,600
11,600
11,600
3,480
3,480
3,480
Q25.5
Q25.6
Q25.7
Atresia of pulmonary artery

Stenosis of pulmonary artery
Other congenital malformations of pulmonary artery; CONGENITAL HEART DISEASES
aberrant pulmonary artery; agenesis of pulmonary
artery; aneurysm, congenital of pulmonary artery;
anomaly of pulmonary artery; hypoplasia of pulmonary
artery; pulmonary arteriovenous aneurysm
11,600
11,600
11,600
3,480
3,480
3,480
Q25.8
Q25.9
Other congenital malformations of great arteries

Congenital malformation of great arteries, unspecified CONGENITAL HEART DISEASES
11,600
11,600
3,480
3,480
Q26.0
Congenital stenosis of vena cava; Congenital stenosis CONGENITAL HEART DISEASES

of inferior vena cava; Congenital stenosis ofsuperior
vena
Total
cava anomalous pulmonary venous connection
Anomalous pulmonary venous connection, unspecified CONGENITAL HEART DISEASES
11,600
3,480
11,600
11,600
3,480
3,480
Q23.4
Q23.8
Q23.9
Q24.0
Q24.2
Q24.3
Q24.4
Q24.5
Q24.6
Q24.8
Q24.9
Q25.0
Q25.1
Q25.2
Q25.3
Q25.4
Q26.2
Q26.4
HEART
HEART
HEART
HEART
HEART
Q01.0
Other congenital malformations of great veins;

Absence of inferior vena cava ; Absence of superior
vena cava ; Azygos continuation of inferior vena cava;
Persistent left posterior cardinal vein; Scimitar
syndrome
Congenital malformation of great vein, unspecified;
Anomaly of inferior vena cava NOS; Anomaly of
superior
Congenital
syndrome, neurological
vena cava iodine-deficiency
NOS
type;
Congenital
hypothyroidism
with diffuse
Endemic cretinism,
neurological
type goitre;
Nontoxic congenital Goitre NOS; Nontoxic ongenital
parenchymatous Goitre
Congenital hypothyroidism without goitre; Aplasia of
thyroid (with myxoedema); Congenital atrophy of
thyroid;
Anencephaly;
Acephaly; Acrania;
Congenital hypothyroidism
NOS Amyelencephaly;
Hemicephaly; Hemicephaly
Frontal encephalocele
Q01.1
Nasofrontal encephalocele
Q01.2
Occipital encephalocele
Q01.8
Encephalocele of other sites
Q02
Microcephaly; Hydromicrocephaly; Micrencephalon
Q26.8
Q26.9
E00.0
E03.0
E03.1
Q00.0
ICD CODE
Q03.0
Q03.1
Q04.0
Q04.2
Q04.3
Q04.4
Q04.6
Q04.8
Q04.9
Q05.1
Q05.2
Q05.4
Q05.6
DESCRIPTION
9,900
2,970
CONGENITAL HYPOTHYROIDISM
9,900
2,970
9,900
2,970
CONGENITAL MALFORMATIONS
BRAIN/NERVOUS SYSTEM
OF THE
13,000
3,900
OF THE
13,000
3,900
OF THE
13,000
3,900
OF THE
13,000
3,900
OF THE
13,000
3,900
OF THE
13,000
3,900
FIRST CASE RATE
GROUP
Case Rate
Professional
Fee
13,000
3,900
OF THE
13,000
3,900
OF THE
13,000
3,900
Other reduction deformities of brain; Absence of part

of brain; Agenesis of part of brain; Aplasia of part of
brain; Hypoplasia of part of brain ; Agyria;
Hydranencephaly; Lissencephaly; Microgyria;
Pachygyria
Septo-optic dysplasia
OF THE
13,000
3,900
OF THE
13,000
3,900
OF THE
13,000
3,900
OF THE
13,000
3,900
13,000
3,900
CONGENITAL MALFORMATIONS OF THE

13,000
3,900
OF THE
13,000
3,900
OF THE
13,000
3,900
OF THE
13,000
3,900
OF THE
13,000
3,900
OF THE
13,000
3,900
OF THE
13,000
3,900
OF THE
13,000
3,900
OF THE
13,000
3,900
OF THE
13,000
3,900
OF THE
13,000
3,900
13,000
3,900
13,000
3,900
13,000
3,900
13,000
3,900
13,000
3,900
13,000
3,900
Congenital cerebral cysts; Porencephaly;

Schizencephaly
Other specified congenital malformations of brain;
Macrogyria
Congenital malformation of brain, unspecified;
Congenital anomaly NOS of brain; Congenital
deformity NOS of brain; Congenital disease of lesion
NOS of brain; Congenital multiple anomalis NOS of
brain
Thoracic spina bifida with hydrocephalus; Dorsal spina
bifida with hydrocephalus; Thoracolumbar spina bifida
with
Lumbar
spina bifida with hydrocephalus; Lumbosacral
hydrocephalus
spina
Unspecified
spina bifida with hydrocephalus
bifida with hydrocephalus
Q06.2
Diastematomyelia
Q06.4
Hydromyelia; Hydrorachis
Q06.8
Other specified congenital malformations of spinal

cord
Congenital malformation of spinal cord, unspecified;
Congenital anomaly NOS of spinal cord or meninges;
Congenital deformity NOS of spinal cord or meninges;
Congenital disease or lesion NOS of spinal cord or
meninges
Arnold-Chiari syndrome
Q75.1
OF THE
Amyelia
Q75.0
3,480
Spina bifida, unspecified
Q74.3
11,600
3,900
Q06.0
Q07.9
13,000
Q05.9
Q07.0
3,480

Q05.8
Q06.9
11,600
Malformations of aqueduct of Sylvius; Anomaly of

aqueduct of sylvius; Obstruction, congenital of
aqueduct of
Atresia
foramina
Magendie
and Luschka; Dandysylvius;of
Stenosis
of of
aqueduct
of sylvius
Walker syndrome
Congenital malformations of corpus callosum;
Agenesis of
Holoprosencephaly
corpus callosum
Thoracic spina bifida without hydrocephalus; Dorsal

NOS
Lumbar
spinaThoracolumbar
bifida without hydrocephalus;
spina bifida;
NOS spina bifida
Lumbosacral
Sacral
spinaNOS
bifida without hydrocephalus
spina bifida
Q05.7
OF THE
OF THE

Congenital malformation of nervous system,

unspecified; Congenital anomaly NOS of nervous
system; Congenital deformity NOS of nervous system;
Congenital disease or
lesion NOS of nervous
system
Arthrogryposis
multiplex
congenita
Craniosynostosis; Acrocephaly; ]Imperfect fusion of
skull;
Craniofacial
Crouzon's disease
Oxycephaly;dysostosis;
Trigonocephaly
Q75.2
Hypertelorism
Q75.4
Mandibulofacial dysostosis; Franceschetti Syndrome;

Treacher Collins Syndrome
Other specified congenital malformations of skull and
face bones; Absence of skull bone, congenital;
Congenital
Congenital
of skull and face bones,
deformity ofmalformation
forehead; Platybasia
unspecified; Congenital anomaly of face bones NOS;
Congenital anomaly of skull NOS
Spina bifida occulta
Q75.8
Q75.9
Q76.0
Q76.4
Other congenital malformations of spine, not

associated with scoliosis; Congenital absence of
vertebra unspecified or not associated with scoliosis;
Congenital fusion of spine unspecified or not
associated with scoliosis; Congenital kyphosis
unspecified o

13,000
3,900
13,000
3,900
13,000
3,900

13,000
3,900

13,000
3,900
13,000
3,900
FIRST CASE RATE

ICD CODE
Q32.0
DESCRIPTION
Congenital tracheomalacia
Q33.2
Other congenital malformations of bronchus; Absence

of bronchus; Agenesis of bronchus; Atresia of
bronchus; Congenital malformation NOS of bronchus;
Diverticulum of bronchus; Congenital malformations of
lung] of bronchus
Congenital cystic lung; Congenital honeycomb lung;
Congenital cystic lung disease; Congenital polycystic
lung disease
Sequestration of lung
Q33.3
Agenesis of lung; Absence of lung, lobe
Q32.4
Q33.0
Q33.4
Q33.6
Q34.1
Q34.8
Q34.9
Q30.0
Q30.1
Q30.2
Q31.3
Q31.5
Q31.8
Q31.9
Q38.2
Q38.5
Q38.6
Q38.8
Q12.2
Q12.4
Q13.4
Q14.0
Q14.1
Q14.9
Q15.0
Q15.8
Q15.9
P96.0
Q60.0
Q60.1
GROUP
Case Rate
Professional
Fee
CONGENITAL MALFORMATIONS OF THE LOWER 21,700

RESPIRATORY TRACT
CONGENITAL MALFORMATIONS OF THE LOWER
RESPIRATORY TRACT
21,700
6,510
CONGENITAL MALFORMATIONS OF THE LOWER 21,700

RESPIRATORY TRACT
6,510

RESPIRATORY TRACT
RESPIRATORY TRACT
Congenital bronchiectasis
RESPIRATORY TRACT
Hypoplasia and dysplasia of lung
RESPIRATORY TRACT
Congenital cyst of mediastinum
RESPIRATORY TRACT
Other specified congenital malformations of
respiratory
RESPIRATORY TRACT
Congenital
malformation
of respiratory system,
system; Atresia
of nasopharynx
unspecified; Congenital absence of respiratory organ ; RESPIRATORY TRACT
Congenital anomaly NOS of respiratory organ
Choanal atresia; Absence of anterior nares; Absence
CONGENITAL MALFORMATIONS OF THE NOSE,
of posterior nares; congenital stenosis of anterior
UPPER RESPIRATORY TRACT
nares;
Agenesis
and
underdevelopment
of nose; Congenital
Congenital
stenosis
of posterior nares
absence of nose
Fissured, notched and cleft nose
Laryngocele
Congenital laryngomalacia
Other congenital malformations of larynx; Absence of CONGENITAL MALFORMATIONS OF THE NOSE,
cricoid cartilage, epiglottis, glottis, larynx or thyroid
cartilage; Agenesis of cricoid cartilage, epiglottis,
glottis, larynx or thyroid cartilage; Atresia of cricoid
cartilage,
epiglottis, glottis,
Congenital
malformation of larynx, unspecified
Macroglossia
CONGENITAL MALFORMATIONS OF THE ORAL
CAVITY
Congenital malformations of palate, not elsewhere
classified; Absence of uvula; Congenital malformation CAVITY
of
Other
palatecongenital
NOS; High malformations
arched palate of mouth; Congenital CONGENITAL MALFORMATIONS OF THE ORAL
malformation of mouth NOS
CAVITY
Other congenital malformations of pharynx;
Congenital
CAVITY
Coloboma
of lens
CONGENITAL OPHTHALMOLOGIC DISORDERS
malformation
of pharynx NOS
Spherophakia
Other congenital corneal malformations; Congenital
malformation of cornea NOS;
Microcornea; Peter's anomaly
Congenital malformation of vitreous humour;
Congenital
Congenital
malformation of retina; Congenital retinal
vitreous opacity
aneurysm
Congenital malformation of posterior segment of eye, CONGENITAL OPHTHALMOLOGIC DISORDERS
unspecified
Congenital glaucoma; Buphthalmos; Glaucoma of
newborn; Hydrophthalmos; Keratoglobus, congenital,
with glaucoma; Macrocornea with glaucoma;
Macrophthalmos in congenital glaucoma;
Megalocornea with glaucoma
Other specified congenital malformations of eye
Congenital malformation of eye, unspecified;
Congenital anomaly NOS of eye; Congenital deformity
NOS of eye
Congenital renal failure; Uraemia of newborn
CONGENITAL RENAL DISORDERS
Renal agenesis, unilateral
Renal agenesis, bilateral
6,510
21,700
6,510
21,700
6,510
21,700
6,510
21,700
6,510
21,700
6,510
21,700
6,510
21,700
6,510
11,000
3,300
11,000
3,300
11,000
3,300
11,000
3,300
11,000
3,300
11,000
3,300
11,000
3,300
4,000
1,200
4,000
1,200
4,000
1,200
4,000
1,200
4,300
4,300
4,300
1,290
1,290
1,290
4,300
1,290
4,300
1,290
4,300
1,290
4,300
1,290
4,300
4,300
1,290
1,290
9,100
9,100
9,100
2,730
2,730
2,730
Q60.2
Q60.3
Q60.5
Q60.6
Q61.0
Q61.1
ICD CODE
Q61.2
Q61.3
Q61.4
Q61.5
Q61.8
Q61.9
Q62.0
Q62.7
Q63.0
Q63.1
Q63.2
Q63.3
Q63.8
A50.0
A50.2
A50.4
A50.5
A50.9
Q62.1
Q62.2
Q62.3
Q62.5
Q62.6
Q64.1
Q64.2
Q64.3
Q64.4
Q64.7
Q64.8
Q64.9
Q27.1
Q27.3
Q27.8
Q27.9
Q28.0
Q28.1
ICD CODE
Renal agenesis, unspecified

Renal hypoplasia, unilateral
Renal hypoplasia, unspecified
Potter's syndrome
Congenital single renal cyst; Congenital cyst of kidney;
Single cyst of kidney
Polycystic kidney, autosomal recessive; Polycystic
kidney,
infantile type
CONGENITAL
CONGENITAL
CONGENITAL
CONGENITAL
CONGENITAL
DISORDERS
DISORDERS
DISORDERS
DISORDERS
DISORDERS
9,100
9,100
9,100
9,100
9,100
2,730
2,730
2,730
2,730
2,730
9,100
2,730
FIRST CASE RATE

Case Rate
Professional
Fee
9,100
2,730
CONGENITAL
CONGENITAL
CONGENITAL
CONGENITAL
DISORDERS
DISORDERS
DISORDERS
DISORDERS
9,100
9,100
9,100
9,100
2,730
2,730
2,730
2,730
9,100
2,730
CONGENITAL
CONGENITAL
CONGENITAL
CONGENITAL
CONGENITAL
DISORDERS
DISORDERS
DISORDERS
DISORDERS
DISORDERS
9,100
9,100
9,100
9,100
9,100
2,730
2,730
2,730
2,730
2,730

9,100
9,100
2,730
2,730
CONGENITAL SYPHILIS
12,800
3,840
CONGENITAL SYPHILIS
12,800
3,840
CONGENITAL SYPHILIS
12,800
3,840
CONGENITAL SYPHILIS
12,800
3,840
CONGENITAL SYPHILIS
CONGENITAL URINARY TRACT DISORDERS
12,800
9,100
3,840
2,730
9,100
2,730
9,100
2,730
9,100
2,730
9,100
2,730
9,100
2,730
9,100
2,730
9,100
2,730
9,100
2,730
9,100
2,730
9,100
2,730
9,100
2,730
CONGENITAL VASCULAR DISEASES

12,000
12,000
3,600
3,600
12,000
3,600
12,000
3,600
12,000
3,600
12,000
3,600
DESCRIPTION
Polycystic kidney, autosomal dominant; Polycystic
kidney,
Polycystic
adult type kidney, unspecified
Renal dysplasia
Medullary cystic kidney; Sponge kidney NOS
Other cystic kidney diseases; Fibrocystic kidney;
Fibrocystic
Cystic
kidney disease,
unspecified; Meckel-Gruber
renal degeneration
or disease
syndrome
Congenital hydronephrosis
Congenital vesico-uretero-renal reflux
Accessory kidney
Lobulated, fused and horseshoe kidney
Ectopic kidney; Congenital displaced kidney;
Malrotation of
Hyperplastic
and giant kidney
kidney
Other specified congenital malformations of kidney;
Congenital renal calculi
Early cutaneous congenital syphilis: , Early
mucocutaneous congenital syphilis, Early visceral
congenital syphilis; Early congenital syphilitic
laryngitis; Early congenital syphilitic oculopathy;
Early congenital syphilitic
osteochondropathy;
Ear unspecified; Congenital
Early
congenital syphilis,
syphilis
Late
congenital
neurosyphilis
neurosyphilis];
NOS less
than two
years after [juvenile
birth.
Dementia paralytica juvenilis; Juvenile general
paresis ; Juvenile tabes dorsalis; Juvenile taboparetic
neurosyphilis
Other late congenital syphilis, symptomatic; Syphilitic
saddle nose
Congenital syphilis, unspecified
Atresia and stenosis of ureter; Congenital occlusion of
ureter; Congenital occlusion of ureteropelvic junction;
Congenital occlusion of ureterovesical orifice;
Impervious
ureter
Congenital
megaloureter; Congenital dilatation of
ureter
Other obstructive defects of renal pelvis and ureter;
Congenital ureterocele
Duplication of ureter; Accessory of ureter, Double of
ureter
Malposition of ureter; Deviation of ureter or ureteric
orifice; Displacement of ureter or ureteric orifice;
Ectopic of ureter of ureteric orifice; Implantation,
anomalous of
ureter
or ureteric
orifice
Exstrophy
of urinary
bladder; Ectopia vesicae;
Extroversion
Congenital
of bladder posterior urethral valves
Other atresia and stenosis of urethra and bladder
neck; Congenital bladder neck obstruction; Congenital
stricture of urethra; Congenital stricture of urinary
meatus; Congenital stricture of vesicourethral orifice;
Impervious
urethra
Malformation
of urachus; Cyst of urachus; Patent
urachus;
Other
congenital
malformations of bladder and
Prolapse
of urachus
urethra; Accessory bladder; Accessory urethra;
Congenital hernia of bladder; Congenital malformation
of bladder or urethra NOS; Congenital prolapse of
bladder (mucosa); Congenital prolapse of urethra;
Congenit
Other specified congenital malformations of urinary
system
Congenital malformation of urinary system,
unspecified; Congenital anomaly NOS of urinary
system; Congenital
Congenital
renal
stenosis
deformity NOS
ofartery
urinary
system
Peripheral arteriovenous malformation; Arteriovenous
aneurysm
Other specified congenital malformations of peripheral
vascular system; Aberrant subclavian artery; Absence
of artery or vein NEC; Atresia of artery or vein NEC;
Congenital aneurysm (peripheral); Congenital
stricture, artery;
varix
Congenital malformation
of peripheral vascular
system,
Arteriovenous
malformation
of precerebral
unspecified; Anomaly
of artery
or vein NOSvessels;
Congenital arteriovenous precerebral aneurysm
(nonruptured)
Other malformations of precerebral vessels;
Congenital malformation of precerebral vessels NOS;
Congenital
precerebral aneurysm (nonruptured)
DESCRIPTION
RENAL
RENAL
RENAL
RENAL
RENAL
GROUP
RENAL
RENAL
RENAL
RENAL
RENAL
RENAL
RENAL
RENAL
RENAL
FIRST CASE RATE

GROUP
ICD CODE
Q28.2
Q28.3
M30.0
M30.1
M30.2
M30.3
M30.8
M31.0
M31.1
M31.2
M31.3
M31.4
M31.6
M31.8
M31.9
M33.0
M33.1
M33.2
M33.9
M34.0
M34.1
M34.2
M34.9
M35.0
M35.1
M35.2
M35.3
M35.4
M35.8
M35.9
G50.0
G50.8
G51.0
G51.1
G51.3
G51.4
G51.8
G51.9
G52.0
G52.1
G52.2
G52.7
G52.8
H46
H47.0
J05.0
E24.0
E24.1
E24.2
E24.3
E24.8
E24.9
E84.0
E84.1
E84.8
E84.9
ICD CODE
Case Rate
Professional
Fee
12,000
3,600
12,000
3,600
CONNECTIVE TISSUE DISEASES

13,800
13,800
4,140
4,140

13,800
13,800
13,800
4,140
4,140
4,140

13,800
13,800
4,140
4,140

13,800
13,800
4,140
4,140

13,800
13,800
13,800
4,140
4,140
4,140
CONNECTIVE
CONNECTIVE
CONNECTIVE
CONNECTIVE
CONNECTIVE
CONNECTIVE
CONNECTIVE
TISSUE
TISSUE
TISSUE
TISSUE
TISSUE
TISSUE
TISSUE
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
13,800
13,800
13,800
13,800
13,800
13,800
13,800
4,140
4,140
4,140
4,140
4,140
4,140
4,140
CONNECTIVE
CONNECTIVE
CONNECTIVE
CONNECTIVE
TISSUE
TISSUE
TISSUE
TISSUE
DISEASES
DISEASES
DISEASES
DISEASES
13,800
13,800
13,800
13,800
4,140
4,140
4,140
4,140
CONNECTIVE
CONNECTIVE
CONNECTIVE
CONNECTIVE
TISSUE
TISSUE
TISSUE
TISSUE
DISEASES
DISEASES
DISEASES
DISEASES
13,800
13,800
13,800
13,800
4,140
4,140
4,140
4,140
13,800
4,140
CRANIAL NERVE DISORDER
7,400
2,220
CRANIAL
CRANIAL
CRANIAL
CRANIAL
CRANIAL
CRANIAL
CRANIAL
CRANIAL
DISORDER
DISORDER
DISORDER
DISORDER
DISORDER
DISORDER
DISORDER
DISORDER
7,400
7,400
7,400
7,400
7,400
7,400
7,400
7,400
2,220
2,220
2,220
2,220
2,220
2,220
2,220
2,220
7,400
2,220
7,400
2,220
7,400
2,220

7,400
7,400
2,220
2,220
7,400
2,220
CROUP
8,200
2,460
CUSHING'S SYNDROME
9,500
2,850
CUSHING'S SYNDROME
CUSHING'S SYNDROME
CUSHING'S SYNDROME
CUSHING'S SYNDROME
CUSHING'S SYNDROME
CYSTIC FIBROSIS
CYSTIC FIBROSIS
CYSTIC FIBROSIS
9,500
9,500
9,500
9,500
9,500
7,300
7,300
7,300
2,850
2,850
2,850
2,850
2,850
2,190
2,190
2,190
CYSTIC FIBROSIS
7,300
2,190
Case Rate
Professional
Fee
10,000
3,000
10,000
3,000
10,000
3,000
DESCRIPTION
Arteriovenous malformation of cerebral vessels;
Arteriovenous malformation of brain NOS;
Congenital arteriovenous cerebral aneurysm
(nonruptured)
Other malformations of cerebral vessels; Congenital
cerebral aneurysm, nonruptured; Congenital
malformation
Polyarteritis
nodosaNOS
of cerebral vessels
Polyarteritis with lung involvement [Churg-Strauss];
Allergic
Juvenile
polyarteritis
granulomatous
angiitis
Mucocutaneous lymph node syndrome [Kawasaki]
Other conditions related to polyarteritis nodosa;
Polyangiitis overlap syndrome
Hypersensitivity angiitis; Goodpasture's syndrome
Thrombotic microangiopathy; Thrombotic
thrombocytopenic purpura
Lethal midline granuloma
Wegener's granulomatosis; Necrotizing respiratory
granulomatosis
Aortic arch syndrome [Takayasu]
Other giant cell arteritis
Other specified necrotizing vasculopathies;
Hypocomplementaemic vasculitis
Necrotizing vasculopathy, unspecified
Juvenile dermatomyositis
Other dermatomyositis
Polymyositis
Dermatopolymyositis, unspecified
Progressive systemic sclerosis
CR(E)ST syndrome; Combination of calcinosis,
Raynaud's phenomenon, (o)esophageal dysfunction,
sclerodactyly, telangiectasia
Systemic sclerosis induced by drugs and chemicals
Systemic sclerosis, unspecified
SICCA SYNDROME [SJGREN]
Other overlap syndromes; Mixed connective tissue
disease
Behet's disease
Polymyalgia rheumatica
Diffuse (eosinophilic) fasciitis
Other specified systemic involvement of connective
tissue
Systemic involvement of connective tissue,
unspecified;
Systemic Autoimmune disease NOS; Collagen
Trigeminal
neuralgia;
Syndrome of paroxysmal facial
(vascular) disease
NOS
pain;
Other
disorders of trigeminal nerve
Tic douloureux
Bell's palsy; Facial palsy
Geniculate ganglionitis
Clonic hemifacial spasm
Facial myokymia
Other disorders of facial nerve
Disorder of facial nerve, unspecified
Disorders of olfactory nerve; Disorder of 1st cranial
nerve
Disorders of glossopharyngeal nerve; Disorder of 9th
cranial nerve; Glossopharyngeal neuralgia
Disorders of vagus nerve; Disorder of pneumogastric
[10th]
Disorders
of multiple cranial nerves; Polyneuritis
nerve
cranialis
Disorders of other specified cranial nerves
Optic neuritis; Optic neuropathy, except ischaemic;
Optic
Disorders
of optic nerve,
not elsewhere
classified;
papillitis; Retrobulbar
neuritis
NOS
Compression of optic nerve; Haemorrhage in optic
nerve
Acute
obstructive
[croup]; Obstructive
sheath;
Ischaemic laryngitis
optic neuropathy
laryngitis
Pituitary-dependent
Cushing's disease; Overproduction
NOS
of pituitary ACTH; Pituitary-dependent
hyperadrenocorticism
Nelson's syndrome
Drug-induced Cushing's syndrome
Ectopic ACTH syndrome
Other Cushing's syndrome
Cushing's syndrome, unspecified
Cystic fibrosis with pulmonary manifestations
Cystic fibrosis with intestinal manifestations
Cystic fibrosis with other manifestations; Cystic fibrosis
with combined manifestations
Cystic fibrosis, unspecified
DESCRIPTION
G30.0
Alzheimer's disease with early onset
G30.1
Alzheimer's disease with late onset
G30.8
Other Alzheimer's disease
GROUP
NERVE
NERVE
NERVE
NERVE
NERVE
NERVE
NERVE
NERVE
FIRST CASE RATE

GROUP
DEGENERATIVE DISEASES OF CENTRAL

NERVOUS
DEGENERATIVE
DISEASES OF CENTRAL
SYSTEM
NERVOUS
DEGENERATIVE
DISEASES OF CENTRAL
SYSTEM
NERVOUS
SYSTEM
G30.9+F00.9*
Dementia in alzheimer's disease, unspecified
G31.0
Circumscribed brain atrophy; Pick's disease;

Progressive
Senile
degeneration
of brain, not elsewhere classified
isolated
aphasia
G31.1
G31.2
G31.8
G32.8*
G35
G36.0
G36.1
G36.8
G36.9
G37.0
G37.1
G37.2
G37.3
Degeneration of nervous system due to alcohol;

Alcoholic cerebellar ataxia; Alcoholic cerebellar
degeneration; Alcoholic cerebral degeneration;
Alcoholic encephalopathy; Dysfunction of autonomic
nervous system due to alcohol
Other specified degenerative diseases of nervous
system; Grey-matter degeneration [Alpers]; Lewy body
(ies) dementia; Lewy body (ies) disease; Subacute
necrotizing
encephalopathy
[Leigh]
Other specified degenerative
disorders of nervous
system
Multiple
sclerosis;
Multiple
sclerosis NOS; Multiple
in diseases
classified
elsewhere
sclerosis of brain stem; Multiple sclerosis of cord;
Multiple sclerosis, disseminated; Multiple sclerosis,
generalized
Neuromyelitis optica [Devic]; Demyelination in optic
neuritis
Acute and subacute haemorrhagic leukoencephalitis
[Hurst]
Other specified acute disseminated demyelination
DEGENERATIVE DISEASES
NERVOUS
DEGENERATIVE
DISEASES
SYSTEM
NERVOUS
DEGENERATIVE
DISEASES
SYSTEM
NERVOUS
DEGENERATIVE
DISEASES
SYSTEM
NERVOUS SYSTEM
OF CENTRAL
10,000
3,000
OF CENTRAL
10,000
3,000
OF CENTRAL
10,000
3,000
10,000
3,000

NERVOUS SYSTEM
10,000
3,000

NERVOUS
DEMYELINATING
DISEASE OF CENTRAL
SYSTEM
NERVOUS SYSTEM
10,000
3,000
11,600
3,480
OF CENTRAL
11,600
3,480
OF CENTRAL
11,600
3,480
OF CENTRAL
11,600
3,480
OF CENTRAL
11,600
3,480
OF CENTRAL
11,600
3,480
OF CENTRAL
11,600
3,480
OF CENTRAL
11,600
3,480
OF CENTRAL
11,600
3,480
DEMYELINATING DISEASE OF CENTRAL

NERVOUS
DEMYELINATING
DISEASE OF CENTRAL
SYSTEM
NERVOUS
DEMYELINATING
DISEASE OF CENTRAL
SYSTEM
NERVOUS
DENGUE
SYSTEM FEVER
DENGUE FEVER
DENGUE, SEVERE
DIABETES INSIPIDUS
DIABETES INSIPIDUS
11,600
3,480
DEMYELINATING DISEASE
NERVOUS
DEMYELINATING
DISEASE
SYSTEM
NERVOUS
DEMYELINATING
DISEASE
SYSTEM
NERVOUS
Acute disseminated demyelination, unspecified
DEMYELINATING
DISEASE
SYSTEM
NERVOUS
Diffuse sclerosis; Periaxial encephalitis; Schilder's
DEMYELINATING
DISEASE
SYSTEM
disease
NERVOUS
Central demyelination of corpus callosum
DEMYELINATING
DISEASE
SYSTEM
NERVOUS
Central pontine myelinolysis
DEMYELINATING
DISEASE
SYSTEM
NERVOUS
Acute transverse myelitis in demyelinating disease of DEMYELINATING
DISEASE
SYSTEM
central nervous system; Acute transverse myelitis NOS NERVOUS SYSTEM
OF CENTRAL
G37.4
Subacute necrotizing myelitis
G37.8
Other specified demyelinating diseases of central

nervous
Demyelinating
disease of central nervous system,
system
unspecified
Dengue without warning signs
Dengue with warning signs
Severe dengue
Diabetes insipidus
Nephrogenic diabetes insipidus
Insulin-dependent diabetes mellitus with coma; Brittle
diabetes (mellitus) with coma; Juvenile-onset diabetes
DIABETES MELLITUS WITH COMA OR KETOSIS
(mellitus) withcoma ; Ketosis-prone diabetes
(mellitus) with coma; Type I diabetes (mellitus) with
coma;
Insulin-dependent diabetes mellitus with acididosis/
ketoacidosis without mention of coma; Diabetic
acididosis without mention of coma; Diabetic
ketoacidosis without
mention of coma;
Non-insulin-dependent
diabetes mellitus with coma;
Nonobese diabetes (mellitus) With coma ; Obese
diabetes mellitus With coma ; Adult-onset diabetes
mellitus With coma ; Maturity-onset diabetes mellitus
With coma ; Nonketotic diabetes mellitus With com
11,600
3,480
11,600
3,480
10,000
10,000
16,000
10,100
10,100
3,000
3,000
4,800
3,030
3,030
15,800
4,740
15,800
4,740
15,800
4,740
E11.1
Non-insulin-dependent diabetes mellitus with

ketoacidosis without mention of coma; ; Nonobese
diabetes (mellitus) With ketoacidosis without mention
of coma; Obese diabetes mellitus With ketoacidosis
without mention of coma; Adult-onset diabetes mellitu
15,800
4,740
E12.0
Malnutrition-related diabetes mellitus with coma;

Insulin- dependent malnutrition-related diabetes
mellitus with coma ; Non-insulin-dependent
malnutrition-related
diabetes
mellitus
with coma
Other
specified
diabetes
mellitus with coma
Other specified diabetes mellitus with acididosis/
ketoacidosis without mention of coma
15,800
4,740

15,800
15,800
4,740
4,740
G37.9
A90
A91.1
A91.3
E23.2
N25.1
E10.0
E10.1
E11.0
E13.0
E13.1
ICD CODE
DESCRIPTION
FIRST CASE RATE

GROUP
Case Rate
Professional
Fee
E14.0
Unspecified diabetes mellitus; diabetes NOS with coma DIABETES MELLITUS WITH COMA OR KETOSIS
15,800
4,740
E14.1
Unspecified diabetes mellitus; diabetes NOS with

acididosis/ ketoacidosis without mention of coma
Insulin-dependent diabetes mellitus with Diabetic
gangrene/ ulcer
INSULIN-DEPENDENT DIABETES MELLITUS WITH OTHER
SPECIFIED COMPLICATIONS
Insulin-dependent diabetes mellitus with multiple
complications
Insulin-dependent diabetes mellitus with unspecified
complications
15,800
4,740
DIABETES MELLITUS WITH COMPLICATIONS

OTHER THAN COMA AND KETOSIS
12,600
3,780
12,600
3,780
12,600
3,780
12,600
3,780
E10.5
E10.6
E10.7
E10.8
E11.5
Non-insulin-dependent diabetes mellitus with Diabetic DIABETES MELLITUS WITH COMPLICATIONS

gangrene/ ulcer; Nonobese diabetes (mellitus) with
Diabetic gangrene/ ulcer; Obese diabetes mellitus
with Diabetic gangrene/ ulcer; Adult-onset diabetes
mellitus with Diabetic gangrene/ ulcer; Mat
12,600
3,780
E11.6
NON-INSULIN-DEPENDENT DIABETES MELLITUS WITH

OTHER SPECIFIED COMPLICATIONS
Non-insulin-dependent diabetes mellitus with multiple
complications ; Nonobese diabetes (mellitus) With
multiple complications ; Obese diabetes mellitus With
multiple complications ; Adult-onset diabetes mellitus
With multiple complications ; Matur

12,600
3,780
12,600
3,780
Malnutrition-related diabetes mellitus with Diabetic

gangrene/ ulcer; Insulin-dependent malnutritionrelated diabetes mellitus with Diabetic gangrene/
ulcer; Non- insulin-dependent malnutrition-related
diabetes mellitus
with Diabetic gangrene/ ulcer
MALNUTRITION-RELTAED
DIABETES MELLITUS WITH
OTHER SPECIFIED COMPLICATIONS
Malnutrition-related diabetes mellitus with unspecified
complications; Insulin-dependent malnutrition-related
diabetes mellitus with unspecified complications;
Non- insulin-dependent malnutrition-related diabetes
mellitus with unspecified complicati

12,600
3,780

12,600
3,780
12,600
3,780

DIPHTHERIA
12,600
3,780
12,600
3,780
12,600
3,780
12,600
3,780
12,600
3,780
8,700
2,610
DIPHTHERIA
DIPHTHERIA
DISEASES OF BLOOD AND BLOOD FORMING
ORGANS
8,700
8,700
12,100
2,610
2,610
3,630
12,100
3,630
12,100
3,630
12,100
3,630
D73.2
Other specified diabetes mellitus with Diabetic

gangrene/
OTHER
ulcer SPECIFIED DIABETES MELLITUS WITH OTHER
SPECIFIED COMPLICATIONS
Unspecified diabetes mellitus; diabetes NOS with
Diabetic
UNSPECIFIED
DIABETES MELLITUS WITH OTHER
gangrene/ ulcer
SPECIFIED
Unspecified
diabetes mellitus; diabetes NOS with
COMPLICATIONS
multiple
Pharyngeal
diphtheria; Diphtheritic membranous
complications
angina;
Cutaneous
diphtheria
Tonsillar diphtheria
Diphtheria, unspecified
Agranulocytosis; Agranulocytic angina; Infantile
genetic agranulocytosis; Kostmann's disease;
Neutropenia NOS; Congenital Neutropenia; Cyclic
Neutropenia; Drug-induced Neutropenia; Periodic
Neutropenia; Primary Splenic Neutropenia; Toxic
Neutropenia;
Functional disorders of polymorphonuclear
neutrophils; Cell membrane receptor complex [CR3]
defect; Chronic (childhood) granulomatous disease;
Congenital dysphagocytosis; Progressive septic
granulomatosis; Other disorders of white blood cells
Genetic anomalies of leukocytes; Alder Granulation
Anomaly or Syndrome; Alder Granulocyte Anomaly or
Syndrome; May-Hegglin Granulation Anomaly or
Syndrome; May-Hegglin Granulocyte Anomaly or
Syndrome; Pelger-Hut Granulocyte Anomaly or
Syndrome; P
Other specified disorders of white blood cells;
Lymphocytic Leukaemoid reaction; Monocytic
Leukaemoid reaction; Myelocytic Leukaemoid reaction;
Leukocytosis; Symptomatic Lymphocytosis;
Lymphopenia; Symptomatic
Monocytosis;
Chronic
congestive splenomegaly
OF BLOOD AND BLOOD FORMING
12,100
3,630
D73.3
Abscess of spleen
12,100
3,630
D73.4
Cyst of spleen
12,100
3,630
D73.5
Infarction of spleen; Nontraumatic Splenic rupture;

Torsion
of spleen
12,100
3,630
E11.7
E12.5
E12.6
E12.8
E13.5
E13.6
E14.5
E14.6
E14.7
A36.0
A36.3
A36.9
D70
D71
D72.0
D72.8
ICD CODE
D73.8
D74.9
D75.0
D75.1
D75.2
D75.8
D76.0
D76.1

ORGANS

ORGANS

ORGANS
DISEASES
ORGANS
DISEASES
ORGANS
DISEASES
ORGANS
DISEASES
ORGANS
DESCRIPTION
Other diseases of spleen; Fibrosis of spleen NOS;
Perisplenitis; Splenitis NOS
Methaemoglobinaemia, unspecified
DISEASES
ORGANS
DISEASES
ORGANS
Familial erythrocytosis; Benign Polycythaemia; Familial DISEASES
Polycythaemia
ORGANS
Secondary polycythaemia; Acquired Polycythaemia
DISEASES
due to erythropoietin; Acquired Polycythaemia due to ORGANS
fall in plasma volume; Acquired Polycythaemia due to
high altitude; Acquired Polycythaemia due to stress;
Emotional
Polycythaemia;
Hypoxaemic Polycytha
Essential
thrombocytosis
DISEASES
ORGANS
Other specified diseases of blood and blood-forming
DISEASES
organs
ORGANS
Langerhans' cell histiocytosis, not elsewhere classified DISEASES
ORGANS
Haemophagocytic lymphohistiocytosis; Eosinophilic
DISEASES
granuloma; Hand-Schller-Christian disease; Chronic
ORGANS
Histiocytosis X
FIRST CASE RATE

Case Rate
Professional
Fee
12,100
3,630
12,100
3,630
12,100
3,630
12,100
3,630
12,100
3,630
12,100
3,630
12,100
3,630
12,100
3,630
GROUP
D76.2
Haemophagocytic syndrome, infection-associated
D76.3
Other histiocytosis syndromes; Reticulohistiocytoma

(giant- cell); Sinus histiocytosis with massive
lymphadenopathy;
Oesophagitis;
Abscess of oesophagus; Oesophagitis
Xanthogranuloma
NOS;
Achalasia
of cardia; Achalasia
Cardiospasm
Chemical oesophagitis;
Peptic NOS;
oesophagitis
Ulcer of oesophagus; Erosion of oesophagus; Ulcer of
oesophagus NOS; Ulcer of oesophagus due to
ingestion of chemicals; Ulcer of oesophagus due to
ingestion of drugs and medicaments; Fungal ulcer of
oesophagus; Peptic ulcer
of oesophagusobstruction; Compression of oesophagus;
Oesophageal
Constriction of oesophagus; Stenosis of oesophagus;
Stricture of oesophagus;
Perforation of oesophagus; Rupture of oesophagus
Dyskinesia of oesophagus; Corksrew oesophagus;
Diffuse
Gastro-oesophageal
oesophageal spasm; laceration-haemorrhage
Spasm of oesophagus
syndrome;
Barrett's
esophagus;
Barret's disease; Barett's
Mallory-Weiss
syndrome
syndrome
Other specified diseases of oesophagus; Haemorrhage
of
Disease
of oesophagus,
unspecified
oesophagus
NOS
Cellulitis of external ear; Cellulitis of auricle; Cellulitis
of
Malignant
otitis externa
external auditory
canal
Other infective otitis externa; diffuse Otitis externa ;
Haemorrhagic Otitis externa ; Swimmer's ear
Cholesteatoma of external ear; Keratosis obturans of
external ear (canal)
Labyrinthitis
Other specified diseases of inner ear
Obstruction of Eustachian tube; Compression of
Eustachian tube; Stenosis of Eustachian tube; Stricture
of Eustachian tube
Eustachian tube disorder, unspecified
Acute mastoiditis; Abscess of mastoid; Empyema of
mastoid
Chronic mastoiditis; Caries of mastoid; Fistula of
mastoid
Petrositis; Acute inflammation of petrous bone; Chronic
inflammation of petrous bone
Other mastoiditis and related conditions
Mastoiditis, unspecified
Cholesteatoma of middle ear; Cholesteatoma tympani;
Perforation of tympanic membrane; Persistent posttraumatic perforation of ear drum; Postinflammatory
perforation of ear drum
Acute myringitis; Acute tympanitis; Bullous myringitis
Chronic myringitis; Chronic tympanitis
Other specified disorders of tympanic membrane
Disorder of tympanic membrane, unspecified
Other specified disorders of middle ear and mastoid
Disorder of middle ear and mastoid, unspecified
Developmental odontogenic cysts; Dentigerous cyst;
Eruption Cyst; Follicular cyst; Gingival cyst; Lateral
periodontal cyst; Primordial cyst; Keratocyst
Developmental (nonodontogenic) cysts of oral region;
Cyst of globulomaxillary; Cyst of incisive canal; Cyst of
median palatal; Cyst of nasopalatine; Cyst of palatine
papilla
K20
K22.0
K22.1
K22.2
K22.3
K22.4
K22.6
K22.7
K22.8
K22.9
H60.1
H60.2
H60.3
H60.4
H83.0
H83.8
H68.1
H69.9
H70.0
H70.1
H70.2
H70.8
H70.9
H71
H73.0
H73.1
H73.8
H73.9
H74.8
H74.9
K09.0
K09.1

ORGANS
ORGANS
12,100
3,630
12,100
3,630
DISEASES OF ESOPHAGUS
8,300
2,490
8,300
2,490
8,300
2,490
8,300
2,490
8,300
8,300
2,490
2,490
8,300
2,490
8,300
2,490
8,300
2,490
DISEASES OF EXTERNAL EAR
8,300
9,000
2,490
2,700

9,000
9,000
2,700
2,700
9,000
2,700
DISEASES OF INNER EAR

DISEASES OF INNER EAR
DISEASES OF MIDDLE EAR AND MASTOID
6,200
6,200
10,400
1,860
1,860
3,120

10,400
10,400
3,120
3,120
10,400
3,120
10,400
3,120

10,400
10,400
10,400
3,120
3,120
3,120
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
AND JAW
10,400
10,400
10,400
10,400
10,400
10,400
8,300
3,120
3,120
3,120
3,120
3,120
3,120
2,490
OF
OF
OF
OF
OF
OF
OF
MIDDLE EAR AND MASTOID

ORAL CAVITY, SALIVARY GLANDS,
DISEASES OF ORAL CAVITY, SALIVARY GLANDS, 8,300

AND JAW
2,490
FIRST CASE RATE

ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
K09.2
Other cysts of jaw; Cyst of jaw NOS; Aneurysmal cyst DISEASES OF ORAL CAVITY, SALIVARY GLANDS, 8,300
of jaw; Haemorrhagic cyst of jaw; Traumatic cyst of jaw AND JAW
2,490
K09.8
Other cysts of oral region, not elsewhere classified;

Dermoid cyst of mouth; Epidermoid cyst of mouth;
Lymphoepithelial cyst of mouth; Epstein's pearl;
Nasoalveolar cyst; Nasolabial cyst
Cyst of oral region, unspecified

AND JAW
2,490

AND JAW
AND JAW
2,490

AND JAW
DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW
8,300
2,490

AND JAW
AND JAW
2,490

AND JAW
AND JAW
2,490
K09.9
K10.0
Developmental disorders of jaws; Latent bone cyst of

jaw; Stafne's cyst; Torus mandibularis; Torus palatinus
K10.1
Giant cell granuloma, central; Giant cell granuloma

NOS
Inflammatory conditions of jaws; Acute osteitis of jaw;
Chronic osteitis of jaw; Supparative osteitis of jaw;
Acute neonatal osteomyelitis of jaw; Chronic neonatal
osteomyelitis of jaw; Supparative neonatal
osteomyelitis of
jaw;
Acuteofosteoradionecrosis
o
Alveolitis
jaws; Alveolar osteitis;
Dry socket
K10.2
K10.3
K10.8
Other specified diseases of jaws; Cherubism of jaw;

Exostosis of jaw; Fibrous dysplasia of jaw; Unilateral
condylar hyperplasia; Unilateral condylar hypoplasia
K11.2
Sialoadenitis
K11.3
Abscess of salivary gland
2,490
2,490
2,490
2,490
K11.4
Fistula of salivary gland
K11.5
K74.4
Sialolithiasis; Calculus of salivary gland or duct; Stone

of
Mucocele
of salivary
salivary gland
or ductgland; Mucous extravasation cyst
of salivary gland; Mucous retention cyst of salivary
gland;
Other
Ranuladiseases of salivary glands; Benign
lymphoepithelial lesion of salivary gland; Mikulicz'
disease; Necrotizing sialometaplasia; Sialectasia;
Stenosis of salivary duct;
Strictureof
ofsalivary
salivarygland,
duct unspecified;
Disease
Sialoadenopathy
Cellulitis
and abscess of mouth; Cellulitis of floor of
NOS
mouth;
Granuloma
and abscess
granuloma-like lesions of oral mucosa;
Submandibular
Eosinophilic granuloma of oral mucosa; Granuloma
pyogenicum of oral mucosa; Verrucous xanthoma of
oral
mucosa
Other and unspecified lesions of oral mucosa; Focal
oral
Adult
hypertrophic pyloric stenosis; Pyloric stenosis
mucinosis
NOS
Hourglass stricture and stenosis of stomach
Pylorospasm, not elsewhere classified
Gastric diverticulum
Obstruction of duodenum; Constriction of duodenum;
Stenosis of duodenum; Stricture of duodenum; Chronic
duodenal ileus
Fistula of stomach and duodenum; Gastrocolic fistula;
Gastrojejunocolic fistula
Polyp of stomach and duodenum
Other specified diseases of stomach and duodenum;
Achlorhydria; Gastroptosis; Hourglass contraction of
stomach
Secondary biliary cirrhosis
K74.5
Biliary cirrhosis, unspecified
K11.6
K11.8
K11.9
K12.2
K13.4
K13.7
K31.1
K31.2
K31.3
K31.4
K31.5

AND JAW
AND JAW
AND JAW
2,490

AND JAW
2,490

AND JAW
AND JAW
AND JAW
2,490

AND JAW
DISEASES OF STOMACH AND DUODENUM
6,600
2,490
DISEASES
DISEASES
DISEASES
DISEASES
2,490
1,980
1,980
1,980
1,980
1,980
6,600
1,980

6,600
6,600
1,980
1,980
DISEASES OF THE GALLBLADDER AND BILIARY

TRACT
TRACT
Calculus of gallbladder without cholecystitis;
Cholecystolithiasis unspecified or without cholecystitis; TRACT
Cholelithiasis unspecified or without cholecystitis;
Recurrent colic of gallbladder unspecified or without
cholecystitis; Impacted gallstone of cystic
9,800
2,940
9,800
2,940
9,800
2,940
K80.5
Calculus of bile duct without cholangitis or

cholecystitis; Choledocholithiasis unspecified or
TRACT
without cholangitis or cholecystitis; Impacted gallstone
of bile duct NOS unspecified or without cholangitis or
cholecystitis; Impacted gallstone of common duct
9,800
2,940
K80.8
Other cholelithiasis
9,800
2,940
K80.2
ICD CODE
K82.0
K82.1
K82.2
K82.3
K82.4
K82.8
K83.0
K83.1
K83.3
K83.4
K83.5
K83.8
K85
K85.0
AND
AND
AND
AND
2,490
6,600
6,600
6,600
6,600
K31.7
K31.8
STOMACH
STOMACH
STOMACH
STOMACH
2,490
DUODENUM
DUODENUM
DUODENUM
DUODENUM
K31.6
OF
OF
OF
OF
2,490

TRACT
DESCRIPTION
Obstruction of gallbladder; Occlusion of cystic duct of DISEASES OF
gallbladder without calculus; Stenosis of cystic duct or TRACT
gallbladder without calculus; Stricture of cystic duct or
gallbladder without calculus
Hydrops of gallbladder; Mucocele of gallbladder
DISEASES OF
TRACT
Perforation of gallbladder; Rupture of cystic duct or
DISEASES OF
gallbladder
TRACT
Fistula of gallbladder; Cholecystocolic fistula;
DISEASES OF
Cholecystoduodenal fistula
TRACT
Cholesterolosis of gallbladder; Strawberry gallbladder DISEASES OF
TRACT
Other specified diseases of gallbladder; Adhesions of
DISEASES OF
cystic duct or gallbladder; Atrophy of cystic duct or
TRACT
gallbladder; Cyst of cystic duct or gallbladder;
Dyskinesia of cystic duct or gallbladder; Hypertrophy
of cystic duct or gallbladder;
Nonfunctionin
Cholangitis;
Cholangitis NOS; Ascending cholangitis;
DISEASES OF
Primary cholangitis; Recurrent cholangitis; Sclerosing TRACT
cholangitis; Secondary cholangitis; Stenosing
cholangitis;
Suppurative of
cholangitis
Obstruction
bile duct; Occlusion of bile duct without DISEASES OF
calculus; Stenosis of bile duct without calculus;
TRACT
Stricture of bile duct without calculus
Fistula of bile duct; Choledochoduodenal fistula
DISEASES OF
TRACT
Spasm of sphincter of Oddi
DISEASES OF
TRACT
Biliary cyst
DISEASES OF
TRACT
Other specified diseases of biliary tract; Adhesions of DISEASES OF
bile
TRACT
duct; Atrophy of bile duct; Hypertrophy of bile duct;
Acute
pancreatitis;
Ulcer of
bile duct Abscess of pancreas; Acute
necrosis of pancreas; Infective necrosis of pancreas;
DISEASES OF
Pancreatitis NOS; Acute recurrent pancreatitis;
Haemorrhagic pancreatitis; Subacute pancreatitis;
Supparative pancreatitis
Idiopathic acute pancreatitis
DISEASES OF
FIRST CASE RATE

Case Rate
Professional
Fee
THE GALLBLADDER AND BILIARY
9,800
2,940
9,800
2,940
9,800
2,940
9,800
2,940
9,800
2,940
9,800
2,940
9,800
2,940
9,800
2,940
9,800
2,940
9,800
2,940
9,800
2,940
9,800
2,940
THE PANCREAS
12,600
3,780
THE PANCREAS
12,600
3,780
GROUP
K85.1
K85.2
K85.8
K85.9
K86.0
K86.1
K86.2
K86.3
K86.8
I28.8
I71.0
I71.9
I74.0
I74.1
I74.2
I74.3
I74.4
I74.5
I74.8
I74.9
I77.4
I77.6
I77.8
I85.0
I87.1
ICD CODE
Biliary acute pancreatitis; Gallstone pancreatitis

Alcohol-induced acute pancreatitis
Other acute pancreatitis
Acute pancreatitis, unspecified; Other diseases of
pancreas
Alcohol-induced chronic pancreatitis
Other chronic pancreatitis; Chronic pancreatitis NOS;
Infectious chronic pancreatitis; Recurrent chronic
pancreatitis; Relapsing chronic pancreatitis
Cyst of pancreas
Pseudocyst of pancreas
Other specified diseases of pancreas; Atrophy of
pancreas; Calculus of pancreas; Cirrhosis of pancreas;
Fibrosis of pancreas; Pancreatic infantilism; Pancreatic
necrosis NOS; Aseptic pancreatic necrosis; Fat necrosis
of pancreas
Other specified diseases of pulmonary vessels;
Rupture of pulmonary vessel; Stenosis of pulmonary
vessel; Stricture
Dissection
of aorta
of pulmonary
vessel[anypart]; Dissecting aneurysm of
aorta
Aortic
aneurysm
of unspecified site without mention of
(ruptured)
[any part]
rupture; Aneurysm of aorta; Dilatation of aorta;
Hyaline
Embolism
thrombosis of abdominal aorta; Aortic
necrosis ofand
aorta
bifurcation syndrome; Leriche's syndrome
Embolism and thrombosis of other and unspecified
parts of
Embolism
and thrombosis of arteries of upper
aorta
extremities
Embolism and thrombosis of arteries of lower
extremities
Embolism and thrombosis of arteries of extremities,
unspecified; Peripheral arterial embolism
Embolism and thrombosis of iliac artery
Embolism and thrombosis of other arteries
Embolism and thrombosis of unspecified artery
Coeliac artery compression syndrome
Arteritis, unspecified; Aortitis NOS; Endarteritis NOS
Other specified disorders of arteries and arterioles
Oesophageal varices with bleeding
Compression of vein; Stricture of vein; Inferior Vena
cava
syndrome; Superior vena cava syndrome
DISEASES
DISEASES
DISEASES
DISEASES
OF
OF
OF
OF
PANCREAS
PANCREAS
PANCREAS
PANCREAS
12,600
12,600
12,600
12,600
3,780
3,780
3,780
3,780
DISEASES OF THE PANCREAS

12,600
12,600
3,780
3,780

12,600
12,600
3,780
3,780
12,600
3,780
DISEASES OF VASCULAR SYSTEM
13,100
3,930
13,100
3,930
13,100
3,930
13,100
3,930
13,100
3,930
13,100
3,930
13,100
3,930
13,100
3,930
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
13,100
13,100
13,100
13,100
13,100
13,100
13,100
13,100
3,930
3,930
3,930
3,930
3,930
3,930
3,930
3,930
OF
OF
OF
OF
OF
OF
OF
OF
THE
THE
THE
THE
VASCULAR
VASCULAR
VASCULAR
VASCULAR
VASCULAR
VASCULAR
VASCULAR
VASCULAR
SYSTEM
SYSTEM
SYSTEM
SYSTEM
SYSTEM
SYSTEM
SYSTEM
SYSTEM
FIRST CASE RATE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
H30.1
Disseminated chorioretinal inflammation;

DISODERS OF CHOROID AND RETINA
Disseminated chorioretinitis; Disseminated choroiditis;
Disseminated retinitis; Disseminated retinochoroiditis
4,600
1,380
H30.8
H31.3
Other chorioretinal inflammations; Harada's disease

Choroidal haemorrhage and rupture; Choroidal
haemorrhage NOS; Choroidal haemorrhage expulsive
Postmenopausal osteoporosis with pathological
fracture
Postoophorectomy osteoporosis with pathological
fracture
Postsurgical malabsorption osteoporosis with
pathological
Postmenopausal
osteoporosis
fracture
Postmenopausal osteoporosis Other
Postoophorectomy osteoporosis
Drug-induced osteoporosis
Drug-induced osteoporosis Multiple site
Idiopathic osteoporosis Pelvic region and thigh
Idiopathic osteoporosis Other
Localized osteoporosis [Lequesne]
Other osteoporosis; Senile osteoporosis
Other osteoporosis; Senile osteoporosis Other
Other osteoporosis; Senile osteoporosis Site
unspecified
Osteoporosis, unspecified
Osteoporosis, unspecified Pelvic region and thigh
Osteoporosis, unspecified Other
Adult osteomalacia due to malabsorption; Postsurgical
malabsorption osteomalacia in adults
Aluminium bone disease
Other adult osteomalacia
Other adult osteomalacia Ankle and foot
Other adult osteomalacia Site unspecified
Adult osteomalacia, unspecified
Adult osteomalacia, unspecified Site unspecified
Fibrous dysplasia (monostotic)
Skeletal fluorosis Multiple site
Hyperostosis of skull
Aneurysmal bone cyst
Aneurysmal bone cyst Pelvic region and thigh
Other cyst of bone
Other cyst of bone Forearm
Other cyst of bone Pelvic region and thigh
Other specified disorders of bone density and
structure;
Other
specified
of bone
density and
Hyperostosis
of disorders
bones, except
skull
structure;
Hypertrophy
of
bone
Other
Hyperostosis of bones, except skull Other
4,600
4,600
1,380
1,380
DISORDER OF BONE DENSITY AND STRUCTURE 7,900
2,370
2,370
2,370
DISORDER
DISORDER
DISORDER
DISORDER
DISORDER
DISORDER
DISORDER
DISORDER
DISORDER
DISORDER
DISORDER
OF
OF
OF
OF
OF
OF
OF
OF
OF
OF
OF
BONE
BONE
BONE
BONE
BONE
BONE
BONE
BONE
BONE
BONE
BONE
DENSITY
DENSITY
DENSITY
DENSITY
DENSITY
DENSITY
DENSITY
DENSITY
DENSITY
DENSITY
DENSITY
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
STRUCTURE
STRUCTURE
STRUCTURE
STRUCTURE
STRUCTURE
STRUCTURE
STRUCTURE
STRUCTURE
STRUCTURE
STRUCTURE
STRUCTURE
7,900
7,900
7,900
7,900
7,900
7,900
7,900
7,900
7,900
7,900
7,900
2,370
2,370
2,370
2,370
2,370
2,370
2,370
2,370
2,370
2,370
2,370
DISORDER
DISORDER
DISORDER
DISORDER
OF
OF
OF
OF
BONE
BONE
BONE
BONE
DENSITY
DENSITY
DENSITY
DENSITY
AND
AND
AND
AND
STRUCTURE
STRUCTURE
STRUCTURE
STRUCTURE
7,900
7,900
7,900
7,900
2,370
2,370
2,370
2,370
DISORDER
DISORDER
DISORDER
DISORDER
DISORDER
DISORDER
DISORDER
DISORDER
DISORDER
DISORDER
DISORDER
DISORDER
DISORDER
DISORDER
DISORDER
OF
OF
OF
OF
OF
OF
OF
OF
OF
OF
OF
OF
OF
OF
OF
BONE
BONE
BONE
BONE
BONE
BONE
BONE
BONE
BONE
BONE
BONE
BONE
BONE
BONE
BONE
DENSITY
DENSITY
DENSITY
DENSITY
DENSITY
DENSITY
DENSITY
DENSITY
DENSITY
DENSITY
DENSITY
DENSITY
DENSITY
DENSITY
DENSITY
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
STRUCTURE
STRUCTURE
STRUCTURE
STRUCTURE
STRUCTURE
STRUCTURE
STRUCTURE
STRUCTURE
STRUCTURE
STRUCTURE
STRUCTURE
STRUCTURE
STRUCTURE
STRUCTURE
STRUCTURE
7,900
7,900
7,900
7,900
7,900
7,900
7,900
7,900
7,900
7,900
7,900
7,900
7,900
7,900
7,900
2,370
2,370
2,370
2,370
2,370
2,370
2,370
2,370
2,370
2,370
2,370
2,370
2,370
2,370
2,370
2,370
2,370
M80.0
M80.1
M80.3
M81.0
M81.08
M81.1
M81.4
M81.40
M81.55
M81.58
M81.6
M81.8
M81.88
M81.89
M81.9
M81.95
M81.98
M83.2
M83.4
M83.8
M83.87
M83.89
M83.9
M83.99
M85.0
M85.1
M85.2
M85.5
M85.55
M85.6
M85.63
M85.65
M85.8
M85.88
M89.38

E75.2
E75.4
E75.5
E75.6
N95.0
E26.0
E26.1
E26.8
E26.9
E27.1
E27.2
E27.3
E27.4
E27.8
E70.0
E70.1
E70.2
ICD CODE
E70.3
Other sphingolipidosis; Fabry(-Anderson) Disease;

Gaucher Disease; Krabbe Disease; Niemann-Pick
Disease; Faber's syndrome; Metachromatic
leukodystrophy; Sulfatase
deficiencyceroid lipofuscinosis; Batten Disease;
Neuronal
Bielschowsky-Jansky Disease; Kufs Disease; pielmeyerVogt
Other
lipid storage disorders; Cerebrotendinous
Disease
cholesterosis [van Bogaert-Scherer-Epstein]; Wolman's
disease
Lipid storage disorder, unspecified
Postmenopausal bleeding
Primary hyperaldosteronism; Conn's syndrome;
Primary aldosteronism due to adrenal hyperplasia
(bilateral)
Secondary hyperaldosteronism
Other hyperaldosteronism; Bartter's syndrome
Hyperaldosteronism, unspecified; Other disorders of
adrenal gland
Primary adrenocortical insufficiency; Addison's
disease;
Addisonian
crisis;
Adrenal crisis; Adrenocortical crisis
Autoimmune
adrenalitis
DISORDER OF LIPID STORAGE
8,100
2,430
8,100
2,430
8,100
2,430

DISORDERS ASSOCIATED WITH MENOPAUSE
DISORDERS OF ADRENAL GLAND
8,100
6,000
9,900
2,430
1,800
2,970

9,900
9,900
9,900
2,970
2,970
2,970
9,900
2,970
9,900
2,970
Drug-induced adrenocortical insufficiency

Other and unspecified adrenocortical insufficiency;
Adrenal haemorrhage; Adrenal infarction;
Adrenocortical insufficiency NOS; Hypoaldosteronism
Other specified disorders of adrenal gland;
Abnormality of
Classical
phenylketonuria
cortisol-binding
globulin
Other hyperphenylalaninaemias
Disorders of tyrosine metabolism; Alkaptonuria;
Hypertyrosinaemia; Ochronosis; Tyrosinaemia;
Tyrosinosis

9,900
9,900
2,970
2,970
9,900
2,970
DISORDERS OF AMINO ACID METABOLISM

10,600
10,600
10,600
3,180
3,180
3,180
FIRST CASE RATE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Albinism; OcularAlbinism; Oculocutaneous Albinism

Chediak(-Steinbrinck)-Higashi Syndrome; Cross
Syndrome;
Other
disorders of aromatic
amino-acid metabolism;
Hermansky-Pudlak
Syndrome
Disorders of histidine metabolism; Disorders of
tryptophan
Maple-syrup-urine
disease
metabolism
Other disorders of branched-chain amino-acid
metabolism; Hyperleucine-isoleucinaemia;
Hypervalinaemia; Isovaleric acidaemia;
Methylmalonic acidaemia; Propionic acidaemia
Disorders of fatty-acid metabolism;
Adrenoleukodystrophy [Addison-Schilder]; Muscle
carnitine palmityltransferase
Disorders
deficiencyof amino-acid transport; Cystinosis;
Cystinuria; Fanconi(-de Toni)(-Debr) syndrome;
Hartnup's disease;
Disorders
of urea cycle metabolism; Argininaemia;
Lowe's syndrome
Argininosuccinic aciduria; Citrullinaemia;
Hyperammonaemia
Disorders of lysine and hydroxylysine metabolism
Disorders of glycine metabolism;
Hyperhydroxyprolinaemia; Hyperprolinaemia (type I) ,
Hyperprolinaemia type II; Non-ketotic
hyperglycinaemia;
Sarcosinaemia
Congenital
lactase deficiency
Glycogen storage disease; Cardiac glycogenosis;
Andersen Disease; Cori Disease; Forbes Disease; Hers
Disease; McArdle Disease; Pompe Disease; Tauri
Disease; von Gierke Disease; Liver phosphorylase
deficiency
Disorders of fructose metabolism; Essential
fructosuria; Fructose-1,6-diphosphatase deficiency;
Hereditary fructose
Disorders
of galactose metabolism; Galactokinase
intolerance
deficiency; Galactosaemia
Other disorders of intestinal carbohydrate absorption;
Glucose-galactose malabsorption; Sucrase deficiency
10,600
3,180
10,600
3,180

10,600
10,600
3,180
3,180
10,600
3,180
10,600
3,180
10,600
3,180

10,600
10,600
3,180
3,180
DISORDERS OF CARBOHYDRATE METABOLISM
5,800
1,740
5,800
1,740
5,800
1,740
5,800
1,740
5,800
1,740
E74.8
Other specified disorders of carbohydrate metabolism
5,800
1,740
E77.8
E76.0
Other disorders of glycoprotein metabolism

Mucopolysaccharidosis, type I; Hurler Syndrome;
HurlerMucopolysaccharidosis,
type
II; Hunter's syndrome
Scheie Syndrome; Scheie
Syndrome
DISORDERS OF
DISORDERS OF
METABOLISM
DISORDERS OF
METABOLISM
DISORDERS OF
METABOLISM
GLYCOPROTEIN METABOLISM
GLYCOSAMINOGLYCAN
10,600
10,900
3,180
3,270
GLYCOSAMINOGLYCAN
10,900
3,270
GLYCOSAMINOGLYCAN
10,900
3,270
DISORDERS OF GLYCOSAMINOGLYCAN
METABOLISM
DISORDERS OF GLYCOSAMINOGLYCAN
METABOLISM
10,900
3,270
10,900
3,270
E70.8
E71.0
E71.1
E71.3
E72.0
E72.2
E72.3
E72.5
E73.0
E74.0
E74.1
E74.2
E74.3
E76.1
E76.2
E76.3
Other mucopolysaccharidoses; -Glucuronidase

deficiency; Mucopolysaccharidosis, type III;
Mucopolysaccharidosis IV, Mucopolysaccharidosis VI,
Mucopolysaccharidosis VII;
Mild Maroteaux-Lamy Syndrome; Severe MaroteauxLamy Syndrome; Morquio-like Syndrome;
Mucopolysaccharidosis, unspecified
E76.8
Other disorders of glucosaminoglycan metabolism
E78.0
E78.1
E78.2
E78.3
E78.4
ICD CODE
E78.6
E78.8
E83.0
E83.1
E83.2
E83.3
E83.4
E83.5
E83.8
H05.0
H05.2
E80.0
E80.2
E80.4
E80.5
E80.6
E79.8
E20.0
E20.8
E20.9
E21.0
E21.4
E21.5
E22.2
E23.0
H43.0
H43.1
H44.0
H44.1
H44.5
Pure hypercholesterolaemia; Familial

DISORDERS OF LIPOPROTEIN METABOLISM
hypercholesterolaemia; Fredrickson's
hyperlipoproteinaemia, type Iia;
Hyperbetalipoproteinaemia; Hyperlipidaemia, group A;
Low- density-lipoprotein-type [LDL]
hyperlipoproteinaemia
Pure hyperglyceridaemia; Endogenous
hyperglyceridaemia; Fredrickson's
hyperlipoproteinaemia, type IV; Hyperlipidaemia,
group B; Hyperprebetalipoproteinaemia'; Very-lowdensity-lipoprotein-type [VLDL] hyperlipoproteinaemia
Mixed hyperlipidaemia; Broad- or floatingbetalipoproteinaemia; Fredrickson's
hyperlipoproteinaemia, type IIb; Fredrickson's
hyperlipoproteinaemia type III;
Hyperbetalipoproteinaemia with
prebetalipoproteinaemia; Hypercholesterolaemia with
endogenous hype
Hyperchylomicronaemia; Fredrickson's
hyperlipoproteinaemia, type I; Fredrickson's
hyperlipoproteinaemia, type V; Hyperlipidaemia,
group D;
Mixed hyperlipidaemia;
hyperglyceridaemia
Other
Familial combined
hyperlipidaemia
6,600
1,980
6,600
1,980
6,600
1,980
6,600
1,980
6,600
1,980
FIRST CASE RATE

Case Rate
Professional
Fee
6,600
1,980
6,600
7,300
1,980
2,190
DISORDERS OF MINERAL METABOLISM

7,300
7,300
2,190
2,190
7,300
2,190
7,300
2,190
7,300
2,190

DISORDERS OF ORBIT
7,300
9,500
2,190
2,850
DISORDERS OF ORBIT
9,500
2,850
DISORDERS OF PORPHYRIN AND BILIRUBIN

METABOLISM
9,800
2,940
PORPHYRIN AND BILIRUBIN
9,800
2,940
9,800
2,940
9,800
2,940
9,800
2,940
PURINE AND PYRIMIDINE
7,000
2,100
THE
THE
THE
THE
9,300
9,300
9,300
9,300
2,790
2,790
2,790
2,790
THE PARATHYROID
THE PARATHYROID
THE PITUITARY GLAND
9,300
9,300
11,800
2,790
2,790
3,540
THE PITUITARY GLAND
11,800
3,540
VITREOUS BODY AND GLOBE

10,400
10,400
10,400
3,120
3,120
3,120
10,400
3,120
10,400
3,120
DESCRIPTION
GROUP
Lipoprotein deficiency; Abetalipoproteinaemia; Highdensity lipoprotein deficiency;

Hypoalphalipoproteinaemia; Familial
Hypobetalipoproteinaemia; Lecithin cholesterol
acyltransferase deficiency; Tangier disease
Other disorders of lipoprotein metabolism
Disorders of copper metabolism; Menkes' kinky hair
disease; Menkes' steely hair disease; Wilson's disease
Disorders of iron metabolism; Haemochromatosis
Disorders of zinc metabolism; Acrodermatitis
enteropathica
Disorders of phosphorus metabolism; Acid
phosphatase deficiency; Familial hypophosphataemia;
Hypophosphatasia; Vitamin-D-resistant osteomalacia;
Vitamin-D-resistant rickets
Disorders of magnesium metabolism;
Hypermagnesaemia;
Disorders
of calcium metabolism; Familial
Hypomagnesaemia
hypocalciuric hypercalcaemia; Idiopathic
hypercalciuria
Other disorders of mineral metabolism
Acute inflammation of orbit; Abscess of orbit;Cellulitis
of
orbit; Osteomyelitis of orbit; Periostitis of orbit,
Exophthalmic
conditions; Displacement of globe
Tenonitis of orbit
(lateral)
Hereditary
erythropoietic
porphyria;
NOS; Haemorrhage
of orbit;
OedemaCongenital
of orbit
erythropoietic porphyria; Erythropoietic protoporphyria
Other porphyria; Hereditary coproporphyria
Porphyria NOS; Acute intermittent (hepatic) Porphyria
Gilbert's syndrome
DISORDERS OF
METABOLISM
DISORDERS OF
METABOLISM
Crigler-Najjar syndrome
DISORDERS OF
METABOLISM
Other disorders of bilirubin metabolism; Dubin-Johnson DISORDERS OF
syndrome; Rotor's syndrome
METABOLISM
Other disorders of purine and pyrimidine metabolism; DISORDERS OF
Hereditary xanthinuria
METABOLISM
Idiopathic hypoparathyroidism
DISORDERS OF
Other hypoparathyroidism
DISORDERS OF
Hypoparathyroidism, unspecified; Parathyroid tetany
DISORDERS OF
Primary hyperparathyroidism; Hyperplasia of
DISORDERS OF
parathyroid; Osteitis fibrosa cystica generalisata [von
Recklinghausen's
Other
specified
DISORDERS OF
disease
of bone]disorders of parathyroid gland
Disorder of parathyroid gland, unspecified
DISORDERS OF
Syndrome of inappropriate secretion of antidiuretic
DISORDERS OF
hormone
Hypopituitarism; Fertile eunuch syndrome;
DISORDERS OF
Hypogonadotropic hypogonadism; Idiopathic growth
hormone deficiency; Isolated deficiency of
gonadotropin; Isolated deficiency of growth hormone;
Isolated deficiency of pituitary hormone; Kallmann's
syndrome; Lorai
Vitreous prolapse
DISORDERS OF
Vitreous haemorrhage
DISORDERS OF
Purulent endophthalmitis; Panophthalmitis; Vitreous
DISORDERS OF
abscess
Other endophthalmitis; Parasitic endophthalmitis NOS; DISORDERS OF
Sympathetic uveitis
Degenerated conditions of globe; Absolute glaucoma; DISORDERS OF
Atrophy of globe; Phthisis bulbi
PARATHYROID
PARATHYROID
PARATHYROID
PARATHYROID
D65
Disseminated intravascular coagulation [defibrination DISSEMINATED INTRAVASCULAR COAGULATION 32,000

syndrome]; Acquired Afibrinogenaemia; Consumption
coagulopathy; Diffuse or disseminated intravascular
coagulation [DIC] ; Acquired Fibrinolytic haemorrhage;
Fibrinolytic Purpura; Purpura fulminans;
9,600
P60
Disseminated intravascular coagulation of fetus and

newborn; Defibrination syndrome of fetus or newborn
Adult osteochondrosis of spine
Spondylolysis cervical region
Spondylolysis cervicothoracic region
Spondylolysis thoracic region
Spondylolysis lumbar region
Spondylolysis lumbosacral region
Spondylolysis site unspecified
Spondylolisthesis Multiple sites in spine
Spondylolisthesis cervical region
Spondylolisthesis thoracolumbar region
Spondylolisthesis lumbar region
Spondylolisthesis lumbosacral region
DISSEMINATED INTRAVASCULAR COAGULATION 32,000
9,600
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
7,600
7,600
7,600
7,600
7,600
7,600
7,600
7,600
7,600
7,600
7,600
7,600
2,280
2,280
2,280
2,280
2,280
2,280
2,280
2,280
2,280
2,280
2,280
2,280
Case Rate
Professional
Fee
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
7,600
7,600
7,600
2,280
2,280
2,280
DORSOPATHIES
7,600
2,280
DORSOPATHIES
7,600
2,280
DORSOPATHIES
7,600
2,280
DORSOPATHIES
7,600
2,280
DORSOPATHIES
7,600
2,280
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
7,600
7,600
7,600
7,600
7,600
7,600
7,600
7,600
2,280
2,280
2,280
2,280
2,280
2,280
2,280
2,280
Other specified deforming dorsopathies thoracolumbar DORSOPATHIES

region
Other specified deforming dorsopathies lumbar region DORSOPATHIES
7,600
2,280
7,600
2,280
Other specified deforming dorsopathies lumbosacral

region
Other specified deforming dorsopathies sacral and
Other specified deforming dorsopathies site
unspecified
Deforming dorsopathy, unspecified; Curvature of spine
NOS
NOS thoracic region
NOS thoracolumbar region
NOS lumbar region
NOS lumbosacral region
NOS site unspecified
Cervicocranial syndrome; Posterior cervical
sympathetic
Cervicobrachial
syndrome
syndrome
Cervicobrachial syndrome cervical region
Cervicobrachial syndrome site unspecified
Spinal instabilities
Spinal instabilities cervical region
Spinal instabilities thoracic region
Spinal instabilities lumbar region
Spinal instabilities lumbosacral region
Spinal instabilities sacral and sacrococcygeal region
Spinal instabilities site unspecified
Coccygodynia
Coccygodynia sacral and sacrococcygeal region
Other specified dorsopathies
Other specified dorsopathies lumbar region
Other specified dorsopathies lumbosacral region
Other specified dorsopathies site unspecified
Dorsopathy, unspecified
Dorsopathy, unspecified cervical region
Dorsopathy, unspecified thoracolumbar region
Dorsalgia
Drowning and nonfatal submersion; Immersion;
Swimmer's
Abdominal
pregnancy
cramp
Tubal pregnancy; Fallopian pregnancy; Rupture of
fallopian
Ovarian
tube duepregnancy
to pregnancy
DORSOPATHIES
7,600
2,280
DORSOPATHIES
7,600
2,280
DORSOPATHIES
7,600
2,280
DORSOPATHIES
7,600
2,280
DORSOPATHIES
7,600
2,280
DORSOPATHIES
7,600
2,280
DORSOPATHIES
7,600
2,280
DORSOPATHIES
7,600
2,280
DORSOPATHIES
7,600
2,280
DORSOPATHIES
7,600
2,280
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DROWNING
7,600
7,600
7,600
7,600
7,600
7,600
7,600
7,600
7,600
7,600
7,600
7,600
7,600
7,600
7,600
7,600
7,600
7,600
7,600
7,600
7,100
2,280
2,280
2,280
2,280
2,280
2,280
2,280
2,280
2,280
2,280
2,280
2,280
2,280
2,280
2,280
2,280
2,280
2,280
2,280
2,280
2,130
ECTOPIC PREGNANCY
ECTOPIC PREGNANCY
7,800
7,800
2,340
2,340
ECTOPIC PREGNANCY
7,800
2,340
M42.1
M43.02
M43.03
M43.04
M43.06
M43.07
M43.09
M43.10
M43.12
M43.15
M43.16
M43.17
ICD CODE
M43.18
M43.19
M43.22
M43.26
M43.27
M43.29
M43.42
M43.49
M43.60
M43.62
M43.64
M43.66
M43.68
M43.69
M43.8
M43.82
M43.85
M43.86
M43.87
M43.88
M43.89
M43.9
M43.94
M43.95
M43.96
M43.97
M43.99
M53.0
M53.1
M53.12
M53.19
M53.2
M53.22
M53.24
M53.26
M53.27
M53.28
M53.29
M53.3
M53.38
M53.8
M53.86
M53.87
M53.89
M53.9
M53.92
M53.95
M54
T75.1
O00.0
O00.1
O00.2
DESCRIPTION
Spondylolisthesis sacral and sacrococcygeal region
Spondylolisthesis site unspecified
Other fusion of spine; Ankylosis of spinal joint cervical
region
Other fusion of spine; Ankylosis of spinal joint lumbar
region
Other fusion of spine; Ankylosis of spinal joint
lumbosacral
Other
regionfusion of spine; Ankylosis of spinal joint site
unspecified
Other recurrent atlantoaxial subluxation cervical
region
Other recurrent atlantoaxial subluxation site
unspecified
Torticollis Multiple sites in spine
Torticollis cervical region
Torticollis thoracic region
Torticollis lumbar region
Torticollis sacral and sacrococcygeal region
Torticollis site unspecified
Other specified deforming dorsopathies
Other specified deforming dorsopathies cervical region
FIRST CASE RATE

GROUP
O00.8
O00.9
O36.7
T75.0
T75.4
ICD CODE
J43.0
J43.1
J43.2
J43.8
J43.9
J98.2
J98.3
B22.0
G92
G93.1
I67.4
N80.0
N80.1
N80.2
N80.3
N80.4
N80.5
N80.8
N80.9
J05.1
G40.0
G40.1
G40.2
G40.3
G40.4
G40.5
G40.6
G40.7
G40.8
G40.9
G21.0
G21.1
G21.8
G21.9
G23.0
G23.1
G23.8
G23.9
G24.0
G24.1
G24.3
G24.4
Other ectopic pregnancy; Cervical pregnancy; Cornual ECTOPIC PREGNANCY

pregnancy; Intraligamentous pregnancy; Mural
pregnancy
Ectopic pregnancy, unspecified
ECTOPIC PREGNANCY
Maternal care for viable fetus in abdominal pregnancy ECTOPIC PREGNANCY
7,800
2,340
7,800
7,800
2,340
2,340
Effects of lightning; Shock from lightning; Struck by

lightning NOS
Effects of electric current; Electrocution; Shock from
electric current
ELECTRICAL SHOCK
5,400
1,620
ELECTRICAL SHOCK
5,400
1,620
FIRST CASE RATE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
MacLeod's syndrome; Unilateral emphysema;

Unilateral
Panlobular
emphysema;
Panacinar emphysema
transparency
of lung
Centrilobular emphysema
Other emphysema
Emphysema, unspecified; Lung emphysema NOS;
Pulmonary emphysema NOS; Bullous lung
emphysema; Bullous pulmonary emphysema; Vesicular
lung emphysema; Vesucular pulmonary emphysema;
Emphysematous bleb
Interstitial emphysema; Mediastinal emphysema
Compensatory emphysema
Human immunodeficiency virus [HIV] disease resulting
in
encephalopathy; Human immunodeficiency virus [HIV]
Toxic
encephalopathy
dementia
Anoxic brain damage, not elsewhere classified
Hypertensive encephalopathy
Endometriosis of uterus; Adenomyosis
Endometriosis of ovary
Endometriosis of fallopian tube
Endometriosis of pelvic peritoneum
Endometriosis of rectovaginal septum and vagina
Endometriosis of intestine
Other endometriosis
Endometriosis, unspecified
Acute epiglottitis; Epiglottitis NOS
Localization-related focal idiopathic epilepsy and
epileptic syndromes with seizures of localized onset;
Localization- related partial idiopathic epilepsy and
epileptic syndromes with seizures of localized onset;
Benign childhood epilepsy
with centrotempor focal symptomatic epilepsy and
Localization-related
epileptic syndromes with simple partial seizures;
Localization-related partial symptomatic epilepsy and
epileptic syndromes with simple partial seizures;
Attacks
without alteration offocal
consciousness
; Sim
Localization-related
symptomatic
epilepsy and
epileptic syndromes with complex partial seizures;
Localization-related partial symptomatic epilepsy and
epileptic syndromes with complex partial seizures;
Attacks with alteration of consciousness, ofte
EMPHYSEMA
11,400
3,420
EMPHYSEMA
EMPHYSEMA
EMPHYSEMA
11,400
11,400
11,400
3,420
3,420
3,420
EMPHYSEMA
11,400
3,420
EMPHYSEMA
EMPHYSEMA
ENCEPHALOPATHY
11,400
11,400
22,200
3,420
3,420
6,660
ENCEPHALOPATHY
ENCEPHALOPATHY
ENCEPHALOPATHY
ENDOMETRIOSIS
ENDOMETRIOSIS
ENDOMETRIOSIS
ENDOMETRIOSIS
ENDOMETRIOSIS
ENDOMETRIOSIS
ENDOMETRIOSIS
ENDOMETRIOSIS
EPIGLOTTITIS
22,200
22,200
22,200
7,700
7,700
7,700
7,700
7,700
7,700
7,700
7,700
9,700
6,660
6,660
6,660
2,310
2,310
2,310
2,310
2,310
2,310
2,310
2,310
2,910
EPILEPSY
7,800
2,340
EPILEPSY
7,800
2,340
EPILEPSY
7,800
2,340
Generalized idiopathic epilepsy and epileptic

syndromes; Benign myoclonic epilepsy in infancy;
Benign familial neonatal convulsions; Childhood
absence epilepsy [pyknolepsy]; Epilepsy with grand
mal seizures on awakening; Juvenile absence epilepsy;
Juveni
Other generalized epilepsy and epileptic syndromes;
Epilepsy with myoclonic absences; Epilepsy with
myoclonic- astatic seizures; Infantile spasms; LennoxGastaut syndrome; Salaam attacks; Symptomatic early
myoclonic;
Encephalopathy;
West's syndrome
Special
epileptic syndromes;
Epilepsia partialis
continua [Kozhevnikof]; Epileptic seizures related to
alcohol; Epileptic seizures related to drugs; Epileptic
seizures related to hormonal changes; Epileptic
seizures related to sleep
deprivation;
Epilepticunspecified (with or without petit
Grand
mal seizures,
mal)
Petit mal, unspecified, without grand mal seizures
Other epilepsy; Epilepsies and epileptic syndromes
undetermined as to whether they are focal or
generalized
Epilepsy, unspecified; Epileptic convulsions NOS;
Epileptic
Malignant
neuroleptic
syndrome
fits NOS; Epileptic
seizures
NOS
Other drug-induced secondary parkinsonism
Other secondary parkinsonism
Secondary parkinsonism, unspecified
Hallervorden-Spatz disease; Pigmentary pallidal
degeneration
Progressive supranuclear ophthalmoplegia [SteeleRichardson-Olszewski]
Other specified degenerative diseases of basal
ganglia;
Degenerative
of basal ganglia, unspecified
Calcification ofdisease
basal ganglia
Carcinomatous neuromyopathy in Drug-induced
dystonia
Idiopathic familial dystonia; Idiopathic dystonia NOS
Spasmodic torticollis
Idiopathic orofacial dystonia; Orofacial dyskinesia
EPILEPSY
7,800
2,340
EPILEPSY
7,800
2,340
EPILEPSY
7,800
2,340
EPILEPSY
7,800
2,340
EPILEPSY
EPILEPSY
7,800
7,800
2,340
2,340
7,800
2,340
8,300
8,300
8,300
8,300
8,300
2,490
2,490
2,490
2,490
2,490
EXTRAPYRAMIDAL AND MOVEMENT DISORDERS 8,300
2,490
2,490

2,490
2,490

2,490
2,490
2,490
EPILEPSY
EXTRAPYRAMIDAL
EXTRAPYRAMIDAL
EXTRAPYRAMIDAL
EXTRAPYRAMIDAL
EXTRAPYRAMIDAL
AND
AND
AND
AND
AND
MOVEMENT
MOVEMENT
MOVEMENT
MOVEMENT
MOVEMENT
DISORDERS
DISORDERS
DISORDERS
DISORDERS
DISORDERS
G24.8
ICD CODE
Other dystonia
2,490
FIRST CASE RATE
DESCRIPTION
GROUP
Dystonia, unspecified; Dyskinesia NOS

Myoclonus; Drug-induced myoclonus
Other chorea; Chorea NOS
Other specified extrapyramidal and movement
disorders; Restless legs syndrome; Stiff-man syndrome
EXTRAPYRAMIDAL
EXTRAPYRAMIDAL
EXTRAPYRAMIDAL
EXTRAPYRAMIDAL
8,300
8,300
8,300
8,300
2,490
2,490
2,490
2,490
G25.9
R56.0
R56.8

FEBRILE SEIZURES
7,000
FEBRILE SEIZURES
7,000
2,490
2,100
2,100
FEEDING PROBLEMS NEWBORN

FEVER OF UNKNOWN ORIGIN
FLUID AND ELECTROLYTE DISTURBANCES
8,700
8,700
8,700
8,700
8,700
7,000
8,500
8,500
2,610
2,610
2,610
2,610
2,610
2,100
2,550
2,550
8,500
2,550

8,500
8,500
2,550
2,550

8,500
8,500
8,500
2,550
2,550
2,550
FRACTURES OF THE BONES OF THE THORAX
8,700
2,610
FRACTURES
FRACTURES
FRACTURES
FRACTURES
FRACTURES
FRACTURES
FRACTURES
FRACTURES
FRACTURES
FRACTURES
FRACTURES
GANGRENE
GANGRENE
8,700
8,700
8,700
8,700
8,700
8,700
8,700
8,700
8,700
8,700
8,700
13,200
13,200
2,610
2,610
2,610
2,610
2,610
2,610
2,610
2,610
2,610
2,610
2,610
3,960
3,960
GANGRENE
GASTROESOPHAGEAL REFLUX DISEASE
13,200
6,100
3,960
1,830
GASTROESOPHAGEAL REFLUX DISEASE
6,100
1,830
P76.0
Extrapyramidal and movement disorder, unspecified

Febrile convulsions
Other and unspecified convulsions; Fit NOS; Seizure
(convulsive) NOS
Regurgitation and rumination in newborn
Slow feeding of newborn
Overfeeding of newborn
Other feeding problems of newborn
Feeding problem of newborn, unspecified
Fever, unspecified; Hyperpyrexia NOS; Pyrexia NOS
Hypo-osmolality and hyponatraemia
Acidosis; Acidosis NOS; Lactic Acidosis; Metabolic
Acidosis;
Alkalosis;
Alkalosis
Respiratory
AcidosisNOS; Metabolic Alkalosis;
Respiratory
Mixed
disorder of acid-base balance
Alkalosis
Hyperkalaemia; Potassium [K] excess; Potassium [K]
overload
Hypokalaemia; Potassium [K] deficiency
Fluid overload
Other disorders of electrolyte and fluid balance, not
elsewhere classified; Electrolyte imbalance NOS;
Hyperchloraemia; Hypochloraemia; Other metabolic
disorders
Fracture of thoracic vertebra; Fracture of thoracic
spine
Multiple
fractures of thoracic spine (closed)
NOS (closed)
Fracture of sternum
Fracture of sternum (closed)
Fracture of rib
Fracture of rib (closed)
Fracture of rib (open)
Multiple fractures of ribs
Multiple fractures of ribs (closed)
Multiple fractures of ribs (open)
Fracture of other parts of bony thorax (closed)
Fracture of bony thorax, part unspecified (closed)
Gangrene and necrosis of lung
Pyoderma gangrenosum; Dermatitis gangrenosa;
Phagedenic pyoderma
Gangrene, not elsewhere classified
Gastro-oesophageal reflux disease with oesophagitis;
Reflux oesophagitis
Gastro-oesophageal reflux disease without
oesophagitis;
Meconium
plug
syndrome
Oesophageal
reflux
NOS
DISORDERS OF THE
11,700
3,510
P76.1
Transitory ileus of newborn
DISORDERS OF THE
11,700
3,510
P76.8
Other specified intestinal obstruction of newborn
DISORDERS OF THE
11,700
3,510
P76.9
Intestinal obstruction of newborn, unspecified
DISORDERS OF THE
11,700
3,510
P77
Necrotizing enterocolitis of fetus and newborn
DISORDERS OF THE
11,700
3,510
P78.0
Perinatal intestinal perforation; Meconium peritonitis
DISORDERS OF THE
11,700
3,510
P78.2
Neonatal haematemesis and melaena due to

swallowed
Noninfective
neonatal diarrhoea; Neonatal diarrhoea
maternal blood
NOS
Other specified perinatal digestive system disorders;
Congenital cirrhosis of liver; Peptic ulcer of newborn
Perinatal digestive system disorder, unspecified
GASTROINTESTINAL
NEWBORN
GASTROINTESTINAL
NEWBORN
GASTROINTESTINAL
NEWBORN
GASTROINTESTINAL
NEWBORN
GASTROINTESTINAL
NEWBORN
GASTROINTESTINAL
NEWBORN
GASTROINTESTINAL
NEWBORN
GASTROINTESTINAL
NEWBORN
GASTROINTESTINAL
NEWBORN
GASTROINTESTINAL
NEWBORN
GLAUCOMA
GLAUCOMA
DISORDERS OF THE
11,700
3,510
DISORDERS OF THE
11,700
3,510
DISORDERS OF THE
11,700
3,510
DISORDERS OF THE
11,700
3,510
6,500
6,500
1,950
1,950
6,500
1,950
6,500
1,950
Case Rate
Professional
Fee
6,500
6,500
6,500
6,500
1,950
1,950
1,950
1,950
E87.3
E87.4
E87.5
E87.6
E87.7
E87.8
S22.00
S22.10
S22.2
S22.20
S22.3
S22.30
S22.31
S22.4
S22.40
S22.41
S22.80
S22.90
J85.0
L88
R02
K21.0
K21.9
P78.3
P78.8
P78.9
H40.0
H40.1
H40.2
H40.3
ICD CODE
H40.4
H40.5
H40.8
H40.9
OF
OF
OF
OF
OF
OF
OF
OF
OF
OF
OF
THE
THE
THE
THE
THE
THE
THE
THE
THE
THE
THE
MOVEMENT
MOVEMENT
MOVEMENT
MOVEMENT
BONES
BONES
BONES
BONES
BONES
BONES
BONES
BONES
BONES
BONES
BONES
OF
OF
OF
OF
OF
OF
OF
OF
OF
OF
OF
Glaucoma suspect; Ocular hypertension

Primary open-angle glaucoma; primary capsular with
pseudoexfoliation of lens glaucoma; Residual stage
capsular with pseudoexfoliation of lens; Primary
chronic simple glaucoma; Residual stage chronic
simple glaucoma; Primary low-tension glaucoma;
Residual
Primary angle-closure glaucoma; Primary acute angleclosure glaucoma ; Acute residual stage angle-closure
glaucoma ; Primary chronic angle-closure glaucoma ; GLAUCOMA
Residual stage chronic angle-closure glaucoma;
Primary
intermittent
angle-cloure
glaucoma;
Glaucoma
secondary
to eye
trauma Residu
GLAUCOMA
DESCRIPTION
Glaucoma secondary to eye inflammation
Glaucoma secondary to other eye disorders
Other glaucoma
Glaucoma, unspecified
THORAX
THORAX
THORAX
THORAX
THORAX
THORAX
THORAX
THORAX
THORAX
THORAX
THORAX
FIRST CASE RATE

GROUP
GLAUCOMA
GLAUCOMA
GLAUCOMA
GLAUCOMA
THE
THE
THE
THE
THE
THE
THE
THE
THE
THE
THE
DISORDERS
DISORDERS
DISORDERS
DISORDERS
Professional
Fee
G24.9
G25.3
G25.5
G25.8
P92.1
P92.2
P92.4
P92.8
P92.9
R50.9
E87.1
E87.2
AND
AND
AND
AND
Case Rate
N00.0
Acute nephritic syndrome including Acute glomerular

disease, Acute glomerulonephritis, Acute nephritis,
Acute renal disease NOS, with Minor glomerular
abnormality
Acute renal disease NOS, with Focal and segmental
glomerular lesions (with focal and segmental
hyalinosis; focal and segmental sclerosis) & Focal glom
GLOMERULAR AND INTERSTITIAL KIDNEY

DISEASES
10,000
3,000

DISEASES
10,000
3,000

Acute renal disease NOS with Diffuse membranous
glomerulonephritis
Acute renal disease NOS with Diffuse mesangial
proliferative
glomerulonephritis
Acute
nephritic syndrome including Acute glomerular
Acute renal disease NOS with Diffuse endocapillary
proliferative
glomerulonephritis
Acute
nephritic syndrome including Acute glomerular
Acute renal disease NOS with Diffuse
mesangiocapillary glomerulonephritis
(Membranoproliferative glomerulonephritis, types 1
and 3, or NOS)
Acute renal disease NOS with Diffuse crescentic
glomerulonephritis (Extracpillary glomerulonephritis)

DISEASES
10,000
3,000

DISEASES
10,000
3,000

DISEASES
10,000
3,000

DISEASES
10,000
3,000
10,000
3,000

Acute renal disease NOS with Other (Proliferative
glomerulonephritis NOS)
Acute
Rapidly
progressive
syndrome;
rapidly
renal disease
NOS, nephritic
Unspecified
renal biopsy
progressive glomerular disease; rapidly progressive
glomerulonephritis; rapidly progressive nephritis,
Minor glomerular abnormality
Rapidly progressive nephritic syndrome; rapidly
glomerulonephritis; rapidly progressive nephritis, Focal
and segmental
glomerular
lesions nephritic syndrome; rapidly
Rapidly
progressive
Diffuse mesangial
proliferative
glomerulonephritis
Rapidly progressive
nephritic syndrome; rapidly
Diffuse mesangiocapillary
glomerulonephritis
Rapidly
progressive nephritic syndrome; rapidly
glomerulonephritis; rapidly progressive nephritis, other

DISEASES
10,000
3,000

DISEASES
10,000
3,000

DISEASES
10,000
3,000

DISEASES
10,000
3,000

DISEASES
10,000
3,000

DISEASES
10,000
3,000

DISEASES
10,000
3,000
Rapidly progressive nephritic syndrome; rapidly

Unspecified
Recurrent and persistent haematuria including Benign
familial Haematuria; Benign familial Haematuria of
childhood; Haematuria with morphological lesion
specified with Minor glomerular abnormality

DISEASES
10,000
3,000

DISEASES
10,000
3,000
N02.1

familial Haematuria; Benign familial Haematuria of GLOMERULAR AND INTERSTITIAL KIDNEY
DISEASES
specified with Focal and segmental glomerular lesions
10,000
3,000
N02.2

DISEASES
specified with Diffuse membranous glomerulonephritis
10,000
3,000
N00.1
N00.2
N00.3
N00.4
N00.5
N00.7
N00.8
N00.9
N01.0
N01.1
N01.3
N01.5
N01.8
N01.9
N02.0

DISEASES
FIRST CASE RATE

ICD CODE
N02.5
N02.8
DESCRIPTION
specified with Diffuse mesangiocapillary
glomerulonephritis
specified with other (Proliferative glomerulonephritis
NOS)
Case Rate
Professional
Fee

DISEASES
10,000
3,000

DISEASES
10,000
3,000
GROUP
N02.9
N03.0

DISEASES
specified with Unspecified renal biopsy
10,000
3,000
Chronic nephritic syndrome including Chronic

glomerular disease, Chronic glomerulonephritis,
Chronic nephritis, chronic renal disease NOS, with
Minor glomerular
abnormality
Chronic
nephritic syndrome including Chronic
Focal and segmental
glomerular
lesionssyndrome including Chronic
Chronic
nephritic
Chronic nephritis, chronic renal disease NOS,
withDiffuse membranous
glomerulonephritis
Chronic
Diffuse mesangial
proliferative
glomerulonephritis
Chronic
nephritic
syndrome including Chronic
Diffuse endocapillary proliferative glomerulonephritis

DISEASES
10,000
3,000

DISEASES
10,000
3,000

DISEASES
10,000
3,000

DISEASES
10,000
3,000
10,000
3,000
Chronic nephritic syndrome including Chronic

Diffuse mesangiocapillary
glomerulonephritis
Chronic
Diffuse crescentic
glomerulonephritis
Chronic
Other (Proliferative
glomerulonephritis
NOS)
Chronic nephritic syndrome
including Chronic
Unspecified renal biopsy
Nephrotic syndrome: Minor glomerular abnormality;
Minimal change lesion
Nephrotic syndrome: Focal and segmental glomerular
lesions; Focal and segmental hyalinosis; Focal and
segmental sclerosis; Focal glomerulonephritis
Nephrotic syndrome: Diffuse membranous
glomerulonephritis
Nephrotic syndrome: Diffuse mesangial proliferative
glomerulonephritis
Nephrotic syndrome: Diffuse endocapillary
proliferative
Nephrotic
syndrome: Diffuse mesangiocapillary
glomerulonephritis
glomerulonephritis; Membranoproliferative
glomerulonephritis, types 1 and 3, or NOS
Nephrotic syndrome: Diffuse crescentic
glomerulonephritis; Extracapillary glomerulonephritis

DISEASES
10,000
3,000

DISEASES
10,000
3,000

DISEASES
10,000
3,000

DISEASES
10,000
3,000

DISEASES
DISEASES
10,000
3,000
10,000
3,000
GLOMERULAR
DISEASES
GLOMERULAR
DISEASES
GLOMERULAR
DISEASES
GLOMERULAR
DISEASES
AND INTERSTITIAL KIDNEY
10,000
3,000
10,000
3,000
10,000
3,000
10,000
3,000

DISEASES
10,000
3,000
N04.8
Nephrotic syndrome: Other
3,000
Nephrotic syndrome:Unspecified
10,000
3,000
N05.0
Unspecified nephritic syndrome including Glomerular

disease, Glomerulonephritis, Nephritis NOS with
Minor glomerular abnormality, minimal change lesion

DISEASES
DISEASES
DISEASES
10,000
N04.9
10,000
3,000
10,000
3,000
N03.1
N03.2
N03.3
N03.4
N03.5
N03.7
N03.8
N03.9
N04.0
N04.1
N04.2
N04.3
N04.4
N04.5
N04.7
N05.1
ICD CODE
N05.2
N05.3
N05.4
N05.5
N05.6

DISEASES

disease, Glomerulonephritis, Nephritis NOS with Focal GLOMERULAR AND INTERSTITIAL KIDNEY
and segmental glomerular lesions (with focal and
DISEASES
segmental hyalinosis; focal and segmental sclerosis) &
Focal
glomerulonephritis
DESCRIPTION
Diffuse
Unspecified
syndrome including Glomerular
membranousnephritic
glomerulonephritis
Diffuse
Unspecified
nephritic syndrome
including Glomerular
mesangial proliferative
glomerulonephritis
Diffuse endocapillary proliferative glomerulonephritis
Diffuse mesangiocapillary glomerulonephritis,
Membranoproliferative glomerulonephritis, types 1
and 3,
or NOS
Unspecified
nephritic syndrome including Glomerular
Dense deposit disease
Membranoproliferative glomerulonephritis, type 2
FIRST CASE RATE

Case Rate
Professional
Fee

DISEASES
10,000
3,000

DISEASES
10,000
3,000

DISEASES
10,000
3,000
10,000
3,000
10,000
3,000
GROUP

DISEASES
DISEASES
N05.7
N05.8
N05.9
N06.0
N06.8
N06.9
N07.0
N07.1
N07.2
N07.3
N07.5
N07.9
N10
N11.9
N12
N14.0
N14.1
N14.2
N14.4
N15.0
N15.8
N15.9
N39.1
N39.2
M23.20
ICD CODE
M23.21
M23.22
M23.25
M23.46
M23.5
M23.80
M23.9
M23.91
M24.08
M24.1
M24.2
M24.4
M24.41
M24.50
M24.54
M24.56

Diffuse crescentic glomerulonephritis, Extracapillary
glomerulonephritis
Other (Proliferative glomerulonephritis NOS)

DISEASES
10,000
3,000

DISEASES
10,000
3,000

Isolated proteinuria with specified morphological lesion
with morphological lesion specified with Minor
glomerular
Isolated
proteinuria with specified morphological lesion
abnormality
with Other
(Proliferative glomerulonephritis NOS)
Isolated proteinuria with specified morphological lesion
with Unspecified renal biopsy
Hereditary nephropathy, not elsewhere classified with
Minor glomerular abnormality
Focal and segmental glomerular lesions (with focal and
segmental hyalinosis; focal and segmental sclerosis) &
Focal
glomerulonephritis
Hereditary
nephropathy, not elsewhere classified with
Diffuse membranous glomerulonephritis
Diffuse mesangial proliferative glomerulonephritis

DISEASES
10,000
3,000

DISEASES
10,000
3,000

DISEASES
10,000
3,000

DISEASES
DISEASES
DISEASES
10,000
3,000
10,000
3,000
10,000
3,000

DISEASES
DISEASES
10,000
3,000
10,000
3,000

Diffuse mesangiocapillary glomerulonephritis,
Membranoproliferative glomerulonephritis, types 1
and 3,
or NOS
Hereditary
nephropathy, not elsewhere classified with
Acute tubulo-interstitial nephritis; pyelonephritis;
Acute infectious interstitial nephritis; Acute pyelitis;
Acute
Chronic
tubulo-interstitial nephritis, unspecified;
pyelonephritis
Chronic interstitial nephritis NOS; Chronic pyelitis NOS;
Chronic
Tubulo-interstitial
nephritis, not specified as acute or
pyelonephritis NOS
chronic; Interstitial nephritis NOS; Pyelitis NOS;
Pyelonephritis NOS
Analgesic nephropathy

DISEASES
10,000
3,000

DISEASES
DISEASES
10,000
3,000
10,000
3,000

DISEASES
10,000
3,000

DISEASES
10,000
3,000

DISEASES
DISEASES
DISEASES
DISEASES
Balkan nephropathy; Balkan endemic nephropathy
DISEASES
Other specified renal tubulo-interstitial diseases
DISEASES
Renal tubulo-interstitial disease, unspecified; Infection GLOMERULAR AND INTERSTITIAL KIDNEY
of
DISEASES
Persistent
proteinuria, unspecified
kidney NOS
DISEASES
Orthostatic proteinuria, unspecified
DISEASES
Derangement of meniscus due to old tear or injury;
HAND, FEET AND JOINT DEFORMITIES
Old
bucket-handle tear multiple sites
10,000
3,000
10,000
3,000
10,000
3,000
10,000
3,000
10,000
3,000
10,000
3,000
10,000
3,000
10,000
3,000
10,000
3,000
9,200
2,760
Nephropathy induced by other drugs, medicaments

and
Nephropathy
induced by unspecified drug,
biological substances
medicament or
Toxic
nephropathy,
biological
substancenot elsewhere classified
DESCRIPTION
GROUP
FIRST CASE RATE

Case Rate
Professional
Fee
Derangement of meniscus due to old tear or injury;

Old bucket-handle tear Anterior cruciate ligament or
Anterior
Derangement
meniscus due to old tear or injury;
horn of medialof
meniscus
Old bucket-handle tear Posterior cruciate ligament or
Posterior
Derangement
meniscus due to old tear or injury;
horn of medialof
meniscus
Old bucket-handle tear Posterior horn of lateral
meniscus
Loose body in kneeOther and unspecified lateral
meniscus
Chronic instability of knee
Other internal derangements of knee; Laxity of
ligament of
Internal
derangement
of knee sites
knee; Snapping
knee multiple
Internal derangement of knee, unspecified Anterior
cruciate ligament or Anterior horn of medial meniscus
9,200
2,760
9,200
2,760
9,200
2,760
9,200
2,760

9,200
9,200
2,760
2,760

9,200
9,200
2,760
2,760
Loose body in joint other sites

Other articular cartilage disorders
Disorder of ligament; Instability secondary to old
ligament
Recurrent
dislocationlaxity
and subluxation
of joint
injury; Ligamentous
NOS
Recurrent dislocation and subluxation of joint shoulder
region
Contracture of joint multiple sites
Contracture of joint hand
Contracture of joint lower leg

9,200
9,200
9,200
2,760
2,760
2,760

9,200
9,200
2,760
2,760

9,200
9,200
9,200
2,760
2,760
2,760
M24.6
M24.65
M24.66
M24.69
M24.7
M24.88
G43.0
G43.1
G43.2
G43.3
G43.8
G43.9
G44.0
G44.1
G44.2
G44.3
G44.4
G44.8
R51
I44.2
I44.3
I44.4
I45.5
I45.6
I45.8
I45.9
I09.9
I50.0
I50.00
ICD CODE
I50.1
I50.9
I34.0
I34.1
I34.2
I34.8
I34.9
I35.0
I35.1
I35.2
I35.8
I35.9
I36.0
I36.1
I36.8
I36.9
I37.0
I37.1
I37.8
I37.9
T67.0
Ankylosis of joint
Ankylosis of joint pelvic region and thigh
Ankylosis of joint lower leg
Ankylosis of joint site unspecified
Protrusio acetabuli
Other specific joint derangements, not elsewhere
classified;
Migraine
without
Irritable hip
otheraura
sites[common migraine]
Migraine with aura [classical migraine]; Migraine aura
without headache; Migraine, basilar; Migraine
equivalents; Familial hemiplegic Migraine; Migraine
with acute-onset aura; Migraine with prolonged aura;
Migraine with typical
aura
Status migrainosus
Complicated migraine
Other migraine; Ophthalmoplegic migraine; Retinal
migraine
Migraine, unspecified
Cluster headache syndrome; Chronic paroxysmal
hemicrania; Chronic cluster headache; Episodic Cluster
headache
Vascular headache, not elsewhere classified; Vascular
headache NOS
Tension-type headache; Chronic tension-type
headache; Episodic tension headache; Tension
headache NOS
Chronic post-traumatic headache
Drug-induced headache, not elsewhere classified
Other specified headache syndromes
Headache; Facial pain NOS
Atrioventricular block, complete; Complete heart block
NOS; Third-degree block
Other and unspecified atrioventricular block;
Atrioventricular block NOS
Left anterior fascicular block
Other specified heart blockl; Sinoatrial NOS;
Sinoauricular
Pre-excitation
syndrome; Anomalous atrioventicular
block
excitation; Atrioventricular conduction, accelerated;
Atrioventicular conduction, accesory; Atrioventicular
conduction pre-excitation; Lown-Ganong-Levine
syndrome;
Wolff-Parkinson-White
Other specified HEARTsyndrome
CONDUCTION DISORDERSs;
Atrioventicular [AV] dissociation; Interference
dissociation
HEART CONDUCTION DISORDERS, unspecified; Heart
block
Rheumatic
heart disease,
unspecified; Rheumatic
NOS; Stokes-Adams
syndrome
carditis;
Congestive
heart failure
failure; Congestive heart disease;
Rheumatic heart
Right venticular failure (secondary to left heart failure)
HAND,
HAND,
HAND,
HAND,
HAND,
HAND,
Advanced congestive heart failure; Grave congestive

heart
failure; Severe congestive heart failure
FEET
FEET
FEET
FEET
FEET
FEET
AND
AND
AND
AND
AND
AND
9,200
9,200
9,200
9,200
9,200
9,200
2,760
2,760
2,760
2,760
2,760
2,760
HEADACHE SYNDROMES
5,500
1,650
HEADACHE SYNDROMES
5,500
1,650
HEADACHE SYNDROMES
HEADACHE SYNDROMES
HEADACHE SYNDROMES
5,500
5,500
5,500
1,650
1,650
1,650
HEADACHE SYNDROMES
HEADACHE SYNDROMES
5,500
5,500
1,650
1,650
HEADACHE SYNDROMES
5,500
1,650
HEADACHE SYNDROMES
5,500
1,650
HEADACHE SYNDROMES
HEADACHE SYNDROMES
HEADACHE SYNDROMES
HEADACHE SYNDROMES
HEART CONDUCTION DISORDERSS
5,500
5,500
5,500
5,500
12,300
1,650
1,650
1,650
1,650
3,690
12,300
3,690

12,300
12,300
3,690
3,690
12,300
3,690
12,300
3,690
12,300
3,690
HEART FAILURE
15,700
4,710
HEART FAILURE
15,700
4,710
HEART FAILURE
15,700
4,710
DEFORMITIES
DEFORMITIES
DEFORMITIES
DEFORMITIES
DEFORMITIES
DEFORMITIES
FIRST CASE RATE

Case Rate
Professional
Fee
HEART FAILURE
15,700
4,710
HEART FAILURE
15,700
4,710
HEART VALVE DISORDERS
8,400
2,520
HEART
HEART
HEART
HEART
HEART
HEART
VALVE
VALVE
VALVE
VALVE
VALVE
VALVE
DISORDERS
DISORDERS
DISORDERS
DISORDERS
DISORDERS
DISORDERS
8,400
8,400
8,400
8,400
8,400
8,400
2,520
2,520
2,520
2,520
2,520
2,520
HEART
HEART
HEART
HEART
HEART
VALVE
VALVE
VALVE
VALVE
VALVE
DISORDERS
DISORDERS
DISORDERS
DISORDERS
DISORDERS
8,400
8,400
8,400
8,400
8,400
2,520
2,520
2,520
2,520
2,520
HEART
HEART
HEART
HEART
VALVE
VALVE
VALVE
VALVE
DISORDERS
DISORDERS
DISORDERS
DISORDERS
8,400
8,400
8,400
8,400
2,520
2,520
2,520
2,520

HEAT EXHAUSTION
8,400
8,400
6,500
2,520
2,520
1,950
DESCRIPTION
Left ventricular failure; Acute oedema of lung with
mention of heart disease NOS or heart failure; Acute
pulmonary oedema with mention of heart disease NOS
or heart failure; Cardiac asthma with mention of heart
disease NOS or heart
failure;failure,
Left heart
fai
Heart
unspecified;
Cardiac, heart or myocardial
failure NOS
Mitral (valve) insufficiency; Incompetence mitral valve
NOS or of specified cause, except rheumatic;
Regurgitation mitral valve NOS or of specified cause,
except rheumatic
Mitral (valve) prolapse; Floppy mitral valve syndrome
Nonrheumatic mitral (valve) stenosis
Other nonrheumatic mitral HEART VALVE DISORDERS
Nonrheumatic mitral valve disorder, unspecified
Aortic (valve) stenosis
Aortic (valve) insufficiency; Incompetence Aortic valve
NOS or of specified cause, except rheumatic; Aortic
valve regurgitation NOS or of specified cause, except
rheumatic
Aortic (valve) stenosis with insufficiency
Other aortic HEART VALVE DISORDERS
Aortic valve disorder, unspecified
Nonrheumatic tricuspid (valve) stenosis
Nonrheumatic tricuspid (valve) insufficiency;
Incompetence tricuspid valve of specified cause,
except rheumatic; Tricuspid valve regurgitation of
specified cause, except
rheumatic
Other
nonrheumatic tricuspid valve disorders
Nonrheumatic tricuspid valve disorder, unspecified
Pulmonary valve stenosis
Pulmonary valve insufficiency; Incompetence
pulmonary valve NOS or specified cause, except
rheumatic; Pulmonary valve regurgitation NOS or of
specified cause, except
rheumatic
Other
pulmonary HEART VALVE DISORDERS
Pulmonary valve disorder, unspecified
Heat stroke and sunstroke; Heat apoplexy; Heat
pyrexia;
Siriasis; Thermoplegia
JOINT
JOINT
JOINT
JOINT
JOINT
JOINT
GROUP
T67.1
T67.2
T67.3
P50.0
Heat syncope; Heat collapse

Heat cramp
Heat exhaustion, anhydrotic; Heat prostration due to
water
Heat
exhaustion due to salt depletion; Heat prostation
depletion
due
Heat
to saltexhaustion,
(and water)unspecified;
depletion Heat prostration NOS
Effect of heat and light, unspecified
Haemarthrosis multiple sites
Haemarthrosis shoulder region
Haemarthrosis pelvic region and thigh
Haemarthrosis lower leg
Haemarthrosis ankle and foot
Haemarthrosis other sites
Haemarthrosis site unspecified
Other instability of joint other sites
Effusion of joint multiple sites
Effusion of joint shoulder region
Effusion of joint lower leg
Effusion of joint ankle and foot
Haemolytic-uraemic syndrome
Delayed or excessive haemorrhage following abortion
and ectopic and molar pregnancy; Afibrinogenaemia;
Defibrination syndrome; Intravascular coagulation
Third-stage haemorrhage; Haemorrhage associated
with
retained, trapped or adherent placenta; Retained
Other
immediate
postpartum haemorrhage;
placenta
NOS
Haemorrhage following delivery of placenta;
Postpartum atomic
Delayed
and secondary
postpartum haemorrhage;
haemorrhage
NOS
Haemorrhage associated with retained portions of
placenta or membranes; Retained products of
concepcion NOS,
following delivery
Postpartum
coagulation defects; Afibrinogenaemia
postpartum; Fibrinolysis postpartum
Retained placenta without haemorrhage; Placenta
accreta
Retained
portions of placenta and membranes without
without haemorrhage
haemorrhage; Retained products of conception
following
Fetal
blood
loss from
vasa praevia
delivery,
without
haemorrhage
P50.1
Fetal blood loss from ruptured cord
T67.4
T67.5
T67.9
M25.00
M25.01
M25.05
M25.06
M25.07
M25.08
M25.09
M25.38
M25.40
M25.41
M25.46
M25.47
D59.3
O08.1
O72.0
O72.1
O72.2
O72.3
O73.0
O73.1
ICD CODE
DESCRIPTION
HEAT EXHAUSTION
HEAT EXHAUSTION
HEAT EXHAUSTION
6,500
6,500
6,500
1,950
1,950
1,950
HEAT EXHAUSTION
6,500
1,950
HEAT EXHAUSTION
HEAT EXHAUSTION
HEMARTHROSIS/JOINT EFFUSION
HEMOLYTIC UREMIC SYNDROME
HEMORRHAGE IN PREGNANCY AND POST
PARTUM PERIOD
6,500
6,500
7,800
7,800
7,800
7,800
7,800
7,800
7,800
7,800
7,800
7,800
7,800
7,800
20,200
7,000
1,950
1,950
2,340
2,340
2,340
2,340
2,340
2,340
2,340
2,340
2,340
2,340
2,340
2,340
6,060
2,100

PARTUM PERIOD
7,000
2,100

PARTUM PERIOD
7,000
2,100

PARTUM PERIOD
7,000
2,100

PARTUM PERIOD
PARTUM PERIOD
PARTUM PERIOD
7,000
2,100
7,000
2,100
7,000
2,100
HEMORRHAGIC AND HEMATOLOGIC DISEASES

OF
HEMORRHAGIC
THE NEWBORN AND HEMATOLOGIC DISEASES
OF
THE NEWBORN
7,800
2,340
7,800
2,340
GROUP
Case Rate
Professional
Fee
P50.2
Fetal blood loss from placenta
HEMATOLOGIC DISEASES
7,800
2,340
P50.9
Fetal blood loss, unspecified; Fetal haemorrhage NOS
7,800
2,340
7,800
2,340
7,800
2,340
7,800
2,340
7,800
2,340
7,800
2,340
7,800
2,340
7,800
2,340
7,800
2,340
7,800
2,340
7,800
2,340
7,800
2,340
7,800
2,340
7,800
2,340
7,800
2,340
7,800
2,340
7,800
2,340
7,800
2,340
7,800
2,340
7,800
2,340
P51.9
P53
P54.0
P54.2
P54.3
P54.4
P54.5
P54.6
P54.8
P54.9
P55.0
P55.1
P55.8
P55.9
P61.0
P61.1
P61.5
P61.6
P61.8
HEMORRHAGIC AND
OF
HEMORRHAGIC
THE NEWBORN AND
OF
Umbilical haemorrhage of newborn, unspecified
HEMORRHAGIC
THE NEWBORN AND
OF
Haemorrhagic disease of fetus and newborn; Vitamin K HEMORRHAGIC
THE NEWBORN AND
deficiency of newborn
OF
Neonatal haematemesis
HEMORRHAGIC
THE NEWBORN AND
OF
Neonatal rectal haemorrhage
HEMORRHAGIC
THE NEWBORN AND
OF
Other neonatal gastrointestinal haemorrhage
HEMORRHAGIC
THE NEWBORN AND
OF
Neonatal adrenal haemorrhage
HEMORRHAGIC
THE NEWBORN AND
OF
Neonatal cutaneous haemorrhage; Bruising in fetus or HEMORRHAGIC
THE NEWBORN AND
newborn; Ecchymoses in fetus or newborn; Petechiae OF THE NEWBORN
in fetus or newborn; Superficial haematomata in fetus
or
newborn vaginal haemorrhage; Pseudomenses
Neonatal
HEMORRHAGIC AND
OF
Other specified neonatal haemorrhages
HEMORRHAGIC
THE NEWBORN AND
OF
Neonatal haemorrhage, unspecified
HEMORRHAGIC
THE NEWBORN AND
OF
Rh isoimmunization of fetus and newborn
HEMORRHAGIC
THE NEWBORN AND
OF
ABO isoimmunization of fetus and newborn
HEMORRHAGIC
THE NEWBORN AND
OF
Other haemolytic diseases of fetus and newborn
HEMORRHAGIC
THE NEWBORN AND
OF
Haemolytic disease of fetus and newborn, unspecified HEMORRHAGIC
THE NEWBORN AND
OF
Transient neonatal thrombocytopenia; neonatal
HEMORRHAGIC
THE NEWBORN AND
thrombocytopenia due to exchange transfusion;
OF THE NEWBORN
Neonatal thrombocytopenia due to idiophatic maternal
thrombocytopenia; Neonatal thrombocytopenia due to
isoimmunization
Polycythaemia neonatorum
HEMORRHAGIC AND
OF
Transient neonatal neutropenia
HEMORRHAGIC
THE NEWBORN AND
OF
Other transient neonatal disorders of coagulation
HEMORRHAGIC
THE NEWBORN AND
OF
Other specified perinatal haematological disorders
HEMORRHAGIC
THE NEWBORN AND
OF
THE NEWBORN
FIRST CASE RATE
P61.9
Perinatal haematological disorder, unspecified
D66
Hereditary factor VIII deficiency; Deficiency factor VIII

(with
functional defect); Haemophilia NOS; Haemophilia A;
Hereditary
factor IX deficiency; Christmas disease;
Classical Haemophilia
Factor IX Deficiency (with functional defect); Plasma
thromboplastin component [PTC] Deficiency;
Haemophilia B
Von Willebrand's disease; Angiohaemophilia; Factor
VIII deficiency with vascular defect; Vascular
haemophilia
Hereditary factor XI deficiency; Haemophilia C Plasma
thromoplastin antecedent [PTA] deficiency
Hereditary deficiency of other clotting factors;
Congenital afibrinogenaemia; AC globulin Deficiency;
Proaccelerin Deficiency; Deficiency of factor I
[fibrinogen]; Deficiency of factor II [prothrombin];
Deficiency of factor V [labile];
Deficiency of fac
Haemorrhagic
disorder due to circulating
anticoagulants; Haemorrhage during long term use of
anticoagulants; Hyperheparinaemia; Increase in
antithrombin; Increase in anti-VIIIa; Increase in antiIxa; Increase in anti-Xa; Increase
in anti-XIacoagulation factor deficiency; Deficiency of
Acquired
coagulation factor due to liver disease; Deficiency of
coagulation factor due to vitamin K deficiency
Other specified coagulation defects; Presence of
systemic
Coagulation
defect, unspecified
lupus erythematosus
[SLE] inhibitor
Allergic purpura; Anaphylactoid Purpura; Henoch(Schnlein) Purpura; Nonthrombocytopenic Purpura;
Haemorrhagic Purpura; Idiopathic Purpura; Vascular
Purpura; AllergicVasculitis
D67
D68.0
D68.1
D68.2
D68.3
D68.4
D68.8
D68.9
D69.0
HEMORRHAGIC AND HEMATOLOGIC DISEASES

OF
HEMORRHAGIC
THE NEWBORN CONDITIONS
7,800
2,340
12,800
3,840
HEMORRHAGIC CONDITIONS
12,800
3,840
12,800
3,840
12,800
3,840
12,800
3,840
12,800
3,840
12,800
3,840
12,800
3,840
12,800
12,800
3,840
3,840
FIRST CASE RATE

ICD CODE
D69.1
D69.2
D69.3
D69.8
K70.4
K72.0
K72.1
K72.9
O01.0
O01.1
O01.9
G91.0
G91.1
G91.2
G91.3
G91.8
G91.9
Q03.8
Q03.9
P56.0
P56.9
P83.2
I10.1
I10.9
I11.0
I11.9
I12.0
I12.9
I13.0
I13.1
I13.2
I13.9
I15.0
I15.1
I15.2
I15.8
I15.9
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Qualitative platelet defects; Bernard-Soulier [giant

platelet] syndrome; Glanzmann's disease; Grey
platelet syndrome; Haemorrhagic Thromboasthenia;
Hereditary
Thromboasthenia;
Thrombocytopathy
;
Other
nonthrombocytopenic
purpura; Purpura
NOS;
Senile
Idiopathic
thrombocytopenic
purpura; Evans'
Purpura; Simplex
Purpura
syndrome
Other specified haemorrhagic conditions; Hereditary
Capillary fragility; Vascular pseudohaemophilia
Alcoholic hepatic failure; Alcoholic hepatic failure NOS;
Acute alcoholic hepatic failure; Chronic alcoholic
hepatic failure; Subacute alcoholic hepatic failure;
Alcoholic hepatic failure with or without hepatic coma
12,800
3,840
12,800
3,840
12,800
3,840
12,800
3,840
HEPATIC FAILURE
20,600
6,180
Acute and subacute hepatic failure

Chronic hepatic failure
Hepatic failure
Classical hydatidiform mole; Complete hydatidiform
mole
Incomplete and partial hydatidiform mole
Hydatidiform mole, unspecified; Trophoblastic disease
NOS; Vesicular mole NOS
Communicating hydrocephalus
Obstructive hydrocephalus
Normal-pressure hydrocephalus
Post-traumatic hydrocephalus, unspecified
Other hydrocephalus
Hydrocephalus, unspecified
Other congenital hydrocephalus
Congenital hydrocephalus, unspecified
Hydrops fetalis due to isoimmunization
Hydrops fetalis due to other and unspecified
haemolytic
Hydrops
disease fetalis not due to haemolytic disease;
Hydrops
Hypertension,
stage II
fetalis NOS
Essential Hypertension; malignant hypertension
Hypertensive heart disease with (congestive) heart
failure;
Hypertensive heart disease
failure without (congestive) heart
failure; Hypertensive heart disease NOS
Hypertensive renal disease with renal failure;
Hypertensive
Hypertensive
renal failure renal disease without renal failure;
Hypertensive renal disease NOS
Hypertensive heart and renal disease with
(congestive)
Hypertensive
heart failure heart and renal disease with renal failure
HEPATIC FAILURE
HEPATIC FAILURE
HEPATIC FAILURE
HYDATIDIFORM MOLE
20,600
20,600
20,600
6,600
6,180
6,180
6,180
1,980
HYDATIDIFORM MOLE
HYDATIDIFORM MOLE
6,600
6,600
1,980
1,980
HYDROCEPHALUS
HYDROCEPHALUS
HYDROCEPHALUS
HYDROCEPHALUS
HYDROCEPHALUS
HYDROCEPHALUS
HYDROCEPHALUS
HYDROCEPHALUS
HYDROPS FETALIS
HYDROPS FETALIS
17,300
17,300
17,300
17,300
17,300
17,300
13,000
13,000
7,400
7,400
5,190
5,190
5,190
5,190
5,190
5,190
3,900
3,900
2,220
2,220
HYDROPS FETALIS
9,300
2,790
HYPERTENSIVE EMERGENCY/URGENCY
9,000
9,000
9,000
2,700
2,700
2,700
9,000
2,700
9,000
2,700
9,000
2,700
9,000
2,700
9,000
2,700
Hypertensive heart and renal disease with both

(congestive) heart failure and renal failure
Hypertensive heart and renal disease, unspecified
Renovascular hypertension
Hypertension secondary to other renal disorders
Hypertension secondary to endocrine disorders
Other secondary hypertension
Secondary hypertension, unspecified
9,000
2,700
HYPERTENSIVE
HYPERTENSIVE
HYPERTENSIVE
HYPERTENSIVE
HYPERTENSIVE
HYPERTENSIVE
9,000
9,000
9,000
9,000
9,000
9,000
2,700
2,700
2,700
2,700
2,700
2,700
EMERGENCY/URGENCY
EMERGENCY/URGENCY
EMERGENCY/URGENCY
EMERGENCY/URGENCY
EMERGENCY/URGENCY
EMERGENCY/URGENCY
E05.0
E05.1
E05.2
E05.3
E05.4
E05.5
E05.8
E05.9
E01.0
E01.1
E01.2
E01.8
E02
E03.2
E03.5
E03.8
E03.9
ICD CODE
D80.0
D80.2
D80.7
D80.8
D80.9
D81.1
D81.6
D81.9
D82.0
D82.1
D82.3
D82.4
D82.9
D83.0
D83.1
D83.9
D84.8
D84.9
D86.1
D86.8
D86.9
D89.0
D89.1
D89.2
D89.8
D89.9
N48.0
N48.1
N48.2
N48.5
N48.6
Thyrotoxicosis with diffuse goitre; Exophthalmic or

toxic
Thyrotoxicosis
with toxic
single
thyroid
nodule;
goitre NOS; Graves'
disease;
Toxic
diffuse
goitre
Thyrotoxicosis with toxic uninodular goitre
Thyrotoxicosis with toxic multinodular goitre; Toxic
nodular
Thyrotoxicosis
from ectopic thyroid tissue
goitre NOS
Thyrotoxicosis factitia
Thyroid crisis or storm
Other thyrotoxicosis; Overproduction of thyroidstimulating
Thyrotoxicosis,
unspecified; Hyperthyroidism NOS;
hormone
Thyroiditis
Iodine-deficiency-related diffuse (endemic) goitre
Iodine-deficiency-related multinodular (endemic)
goitre;
Iodine-deficiency-related (endemic)
goitre, unspecified
nodular goitre
HYPERTHYROIDISM
8,500
2,550
HYPERTHYROIDISM
8,500
2,550
HYPERTHYROIDISM
8,500
2,550
HYPERTHYROIDISM
HYPERTHYROIDISM
HYPERTHYROIDISM
HYPERTHYROIDISM
8,500
8,500
8,500
8,500
2,550
2,550
2,550
2,550
HYPERTHYROIDISM
8,500
2,550
HYPOTHYROIDISM
HYPOTHYROIDISM
8,100
8,100
2,430
2,430
HYPOTHYROIDISM
8,100
2,430
Other iodine-deficiency-related thyroid disorders and

allied
Subclinical
conditions iodine-deficiency hypothyroidism
Hypothyroidism due to medicaments and other
exogenous
Myxoedema
substances coma
Other specified hypothyroidism
Hypothyroidism, unspecified;
HYPOTHYROIDISM
8,100
2,430
HYPOTHYROIDISM
HYPOTHYROIDISM
8,100
8,100
2,430
2,430
HYPOTHYROIDISM
HYPOTHYROIDISM
HYPOTHYROIDISM
8,100
8,100
8,100
2,430
2,430
2,430
Case Rate
Professional
Fee
DESCRIPTION
FIRST CASE RATE

GROUP
Hereditary hypogammaglobulinaemia; Autosomal

recessive agammaglobulinaemia (Swiss type); X-linked
agammaglobulinaemia [Bruton] (with growth hormone
deficiency)
Selective deficiency of immunoglobulin A [IgA]
Transient hypogammaglobulinaemia of infancy
Other immunodeficiencies with predominantly
antibody
Immunodeficiency
predominantly
defects; Kappa lightwith
chain
deficiency antibody
defects,
Severe
combined immunodeficiency [SCID] with low Tunspecified
and
Major
histocompatibility complex class I deficiency;
B-cell numbers
Bare
Combined
unspecified; Severe
lymphocyteimmunodeficiency,
syndrome
combined immunodeficiency disorder [SCID] NOS
Wiskott-Aldrich syndrome; Immunodeficiency with
thrombocytopenia and eczema
Di George's syndrome; Pharyngeal pouch syndrome;
Thymic alymphoplasia; Thymic aplasia or hypoplasia
with
Immunodeficiency
immunodeficiency following hereditary defective
response to Epstein-Barr virus; X-linked
lymphoproliferative disease
Hyperimmunoglobulin E [IgE] syndrome
Immunodeficiency associated with major defect,
unspecified
Common variable immunodeficiency with predominant
abnormalities of B-cell numbers and function
IMMUNODEFICIENCY
11,600
3,480
IMMUNODEFICIENCY
IMMUNODEFICIENCY
IMMUNODEFICIENCY
11,600
11,600
11,600
3,480
3,480
3,480
IMMUNODEFICIENCY
11,600
3,480
IMMUNODEFICIENCY
11,600
3,480
IMMUNODEFICIENCY
11,600
3,480
IMMUNODEFICIENCY
11,600
3,480
IMMUNODEFICIENCY
11,600
3,480
IMMUNODEFICIENCY
11,600
3,480
IMMUNODEFICIENCY
11,600
3,480
IMMUNODEFICIENCY
IMMUNODEFICIENCY
11,600
11,600
3,480
3,480
IMMUNODEFICIENCY
11,600
3,480
Common variable immunodeficiency with predominant

immunoregulatory T-cell disorders
Common variable immunodeficiency, unspecified
Other specified immunodeficiencies
Immunodeficiency, unspecified
Sarcoidosis of lymph nodes
Sarcoidosis of other and combined sites; Uveoparotid
fever
Sarcoidosis,
[Heerfordt] unspecified
Polyclonal hypergammaglobulinaemia; Benign
hypergammaglobulinaemic purpura; Polyclonal
gammopathy NOS
Cryoglobulinaemia; Essential Cryoglobulinaemia;
Idiopathic Cryoglobulinaemia; Mixed
Cryoglobulinaemia; Primary Cryoglobulinaemia;
Secondary Cryoglobulinaemia; Cryoglobulinaemic
purpura; Cryoglobulinaemic vasculitis
Hypergammaglobulinaemia, unspecified
Other specified disorders involving the immune
mechanism, not elsewhere classified
Disorder involving the immune mechanism,
unspecified;
Leukoplakia
of penis;
Immune disease
NOS Balanitis xerotica obliterans;
Kraurosis
Balanoposthitis;
Balanitis
of penis
IMMUNODEFICIENCY
11,600
3,480
IMMUNODEFICIENCY
IMMUNODEFICIENCY
IMMUNODEFICIENCY
IMMUNODEFICIENCY
IMMUNODEFICIENCY
11,600
11,600
11,600
11,600
11,600
3,480
3,480
3,480
3,480
3,480
IMMUNODEFICIENCY
IMMUNODEFICIENCY
11,600
11,600
3,480
3,480
IMMUNODEFICIENCY
11,600
3,480
IMMUNODEFICIENCY
IMMUNODEFICIENCY
11,600
11,600
3,480
3,480
IMMUNODEFICIENCY
11,600
3,480
INFLAMMATION/INFECTION OF THE MALE

GENITAL TRACT
GENITAL TRACT
GENITAL TRACT
9,000
2,700
9,000
2,700
9,000
2,700
9,000
2,700
9,000
2,700
Other inflammatory disorders of penis; Abscess of

corpus cavernosum and penis; Boil of corpus
cavernosum and penis; Carbuncle of corpus
cavernosum and penis; Cellulitis of corpus cavernosum
and penis; Cavernitis (penis) of corpus cavernosum
and penis
Ulcer of penis
GENITAL TRACT
Induratio penis plastica; Peyronie's disease; Plastic
induration of penis
GENITAL TRACT
N49.0
N49.1
N49.2
N49.8
N49.9
ICD CODE
K50.0
K50.1
K50.8
K50.9
K51.0
K51.1
K51.2
K51.3
K51.5
K51.8
K51.9
G04.0
G04.1
G04.2
G04.8
G04.9
G05.8*
G07*
G08
I30.0
I30.1
I30.8
I30.9
I31.0
I31.1
I33.0
I33.9
I38
I40.0
I40.1
I40.8
I40.9
J09
J10.0
Inflammatory disorders of seminal vesicle; Vesiculitis

NOS
Inflammatory disorders of spermatic cord, tunica
vaginalis
Inflammatory
disorders
and vas deferens;
Vasitisof scrotum
INFLAMMATION/INFECTION
GENITAL TRACT
GENITAL TRACT
GENITAL TRACT
Inflammatory disorders of other specified male genital INFLAMMATION/INFECTION
organs; Inflammation of multiple sites in male genital GENITAL TRACT
organs
Inflammatory disorder of unspecified male genital
organ; Abscess of unspecified male genital organ; Boil GENITAL TRACT
of unspecified male genital organ; Carbuncle of
unspecified male genital organ; Cellulitis of unspecified
male genital
organ
Crohn's disease of large intestine; Granulomatous

colitis; Regional colitis; Crohn's disease [regional
enteritis] of colon; Crohn's disease [regional enteritis]
of large bowel; Crohn's disease [regional enteritis] of
rectum
Other Crohn's disease; Crohn's disease of both small
and
Crohn's
disease [regional enteritis], unspecified;
large intestine
Crohn's disease NOS; Regional enteritis NOS;
Granulomatous
Ulcerative
(chronic) enterocolitis
enteritis NOS
Ulcerative (chronic) ileocolitis
Ulcerative (chronic) proctitis
Ulcerative (chronic) rectosigmoiditis
Mucosal proctocolitis
Other ulcerative colitis
Ulcerative colitis, unspecified; Ulcerative enteritis NOS
9,000
2,700
OF THE MALE
9,000
2,700
OF THE MALE
9,000
2,700
OF THE MALE
9,000
2,700
9,000
2,700
OF THE MALE
FIRST CASE RATE

Case Rate
Professional
Fee
INFLAMMATORY BOWEL DISEASE
9,100
2,730
9,100
2,730
9,100
2,730
9,100
2,730
INFLAMMATORY
INFLAMMATORY
INFLAMMATORY
INFLAMMATORY
INFLAMMATORY
INFLAMMATORY
INFLAMMATORY
9,100
9,100
9,100
9,100
9,100
9,100
9,100
2,730
2,730
2,730
2,730
2,730
2,730
2,730
DESCRIPTION
Crohn's disease of small intestine; Crohn's disease
[regional enteritis] of duodenum; Crohn's disease
[regional enteritis] of ileum; Crohn's disease [regional
enteritis] of jejunum; Regional ileitis; Terminal ileitis
OF THE MALE
GROUP
BOWEL
BOWEL
BOWEL
BOWEL
BOWEL
BOWEL
BOWEL
DISEASE
DISEASE
DISEASE
DISEASE
DISEASE
DISEASE
DISEASE
Acute disseminated encephalitis; Postimmunization

[Encephalitis; Postimmunization Encephalomyelitis
Tropical spastic paraplegia
INFLAMMATORY DISEASE
NERVOUS SYSTEM
NERVOUS SYSTEM
Bacterial meningoencephalitis and meningomyelitis,
not
NERVOUS SYSTEM
Other
encephalitis,
elsewhere
classifiedmyelitis and encephalomyelitis;
Postinfectious encephalitis and encephalomyelitis NOS NERVOUS SYSTEM
OF THE CENTRAL
21,600
6,480
OF THE CENTRAL
21,600
6,480
OF THE CENTRAL
21,600
6,480
OF THE CENTRAL
21,600
6,480
Encephalitis, myelitis and encephalomyelitis,

unspecified;
Encephalitis,
myelitis and
Ventriculitis (cerebral)
NOSencephalomyelitis in other
diseases classified elsewhere
INTRACRANIAL AND INTRASPINAL ABSCESS AND
GRANULOMA IN DISEASES CLASSIFIED ELSEWHERE
Intracranial and intraspinal phlebitis and
thrombophlebitis; Septic [embolism, endophlebitis,
phlebitis, thrombophlebitis, thrombosis] of intracranial
or intraspinal
venousnonspecific
sinuses and
veins
Acute
idiopathic
pericarditis
Infective pericarditis; Pneumococcal pericarditis;
Purulent pericarditis; Staphylococcal pericarditis;
Streptococcal pericarditis; Viral pericarditis;
Pyopericarditis
Other forms of acute pericarditis
Acute pericarditis, unspecified
Chronic adhesive pericarditis; Accretio cordis; Adherent
pericardium; Adhesive mediastinopericarditis
OF THE CENTRAL
21,600
6,480
OF THE CENTRAL
21,600
6,480
OF THE CENTRAL
21,600
6,480
OF THE CENTRAL
21,600
6,480
INFLAMMATORY DISEASES OF THE HEART

14,400
14,400
4,320
4,320

14,400
14,400
14,400
4,320
4,320
4,320
Chronic constrictive pericarditis; Concretio cordis;

Pericardial calcification
Acute and subacute infective endocarditis; Acute
bacterial endocarditis; Subacute bacterial endocarditis;
Acute infective endocarditis NOS; Subacute infective
endocarditis NOS; Acute lenta endocarditis; Subacute
lenta endocarditis; Acute malignant endocar
14,400
4,320
14,400
4,320
Acute endocarditis, unspecified; Endocarditis, acute or

subacute; Myoendocarditis, acute or subacute;
Periendocarditis, acute or subacute
Endocarditis, valve unspecified; Chronic Endocarditis
NOS; Valvular incompetence of unspecified valve NOS
or of specified cause, except rheumatic or congenital;
Valvular insufficiency of unspecified valve NOS or of
specified cause,
except rheumatic
or con
Infective
myocarditis;
Septic myocarditis
Isolated myocarditis
Other acute myocarditis
Acute myocarditis, unspecified
Influenza A H5N1 (Avian influenza)
Influenza with pneumonia, influenza virus identified;
Influenzal (broncho) pneumonia, influenza virus
indentified
14,400
4,320
14,400
4,320
INFLAMMATORY
INFLAMMATORY
INFLAMMATORY
INFLAMMATORY
INFLUENZA
INFLUENZA
14,400
14,400
14,400
14,400
6,600
6,600
4,320
4,320
4,320
4,320
1,980
1,980
NERVOUS SYSTEM
NERVOUS SYSTEM
NERVOUS SYSTEM
NERVOUS SYSTEM
DISEASES
DISEASES
DISEASES
DISEASES
OF
OF
OF
OF
THE
THE
THE
THE
HEART
HEART
HEART
HEART
J10.1
ICD CODE
J10.8
J11.0
J11.1
J11.8
J11.8+ I41.1*
T66
T67.6
T67.8
T68
T69.0
T69.9
T70.0
T70.2
T70.3
T70.4
T70.8
T70.9
T75.2
T75.8
S14.0
S34.0
S16
S39.0
S43.0
S43.4
S43.5
S43.7
S46.0
S46.1
S46.2
S46.7
S46.8
S46.9
S53.4
S56.0
ICD CODE
Influenza with other respiratory manifestations,

influenza virus identified; Influenza, influenza virus
identified; Acute upper respiratory influenzal infection, INFLUENZA
influenza virus identified; Influenzal laryngitis,
influenza virus identified;
Influenzal pha
FIRST CASE RATE
Professional
Fee
INFLUENZA
6,600
1,980
INFLUENZA
6,600
1,980
INFLUENZA
6,600
1,980
INFLUENZA
6,600
1,980
6,600
9,300
1,980
2,790
9,300
2,790
9,300
2,790
9,300
2,790
9,300
2,790
9,300
2,790
9,300
2,790
9,300
2,790
9,300
2,790
9,300
2,790
9,300
2,790
9,300
2,790
9,300
2,790
9,300
2,790
18,400
18,400
7,200
5,520
5,520
2,160
7,200
2,160
7,200
2,160
7,200
2,160
7,200
2,160
7,200
2,160
7,200
2,160
7,200
2,160
7,200
2,160
7,200
2,160
7,200
2,160
7,200
2,160
7,200
2,160
7,200
2,160
GROUP
INFLUENZA
INJURIES DUE TO ENVIRONMENTAL AND OTHER
EXTERNAL FACTORS CAUSES
Heat fatigue, transient
Other effects of heat and light
Hypothermia
Immersion hand and foot; Trench foot
Effect of reduced temperature, unspecified
Otitic barotrauma; Aero-otitis media; Effects of change INJURIES DUE TO ENVIRONMENTAL AND OTHER
in
Other
and
unspecifiedpressure
effects ofonhigh
altitude; Alpine
ambient
atmospheric
sinuses
sickness; Anoxia due to high altitude; Barotrauma
NOS; Hypobaropathy; Mountain sickness
Caisson disease [decompression sickness];
Compressed-air
Effects
high-pressure
Traumatic jet injection INJURIES DUE TO ENVIRONMENTAL AND OTHER
disease;ofDiver's
palsy orfluids;
paralysis
(industrial)
Other effects of air pressure and water pressure; Blast INJURIES DUE TO ENVIRONMENTAL AND OTHER
injury syndrome
Effect of air pressure and water pressure, unspecified INJURIES DUE TO ENVIRONMENTAL AND OTHER
Effects of vibration; Pneumatic hammer syndrome;
Traumatic vasospastic syndrome; Vartigo from
infrasound
Other specified INJURIES DUE TO ENVIRONMENTAL
AND OTHER EXTERNAL FACTORS causes; Effects of
abnormal gravitation [G] forces; Effects of
weightlessness
Concussion and oedema of cervical spinal cord
INJURIES TO NEURAL STRUCTURES AND
Concussion and oedema of lumbar spinal cord
INJURIES
NERVES TO NEURAL STRUCTURES AND
Injury of muscle and tendon at neck level
INJURIES
NERVES TO THE MUSCLES AND TENDONS AND
JOINTS
Injury of muscle and tendon of abdomen, lower back
INJURIES TO THE MUSCLES AND TENDONS AND
and
JOINTS
Dislocation
of shoulder joint; Dislocation of
pelvis
Glenohumeral
JOINTS
Sprain
and
strain
of
shoulder
joint;
sprain
and
strain
of
joint
Coracohumeral (ligament); Sprain and strain of Rotator JOINTS
cuff
Sprain
capsuleand strain of acromioclavicular joint; sprain and INJURIES TO THE MUSCLES AND TENDONS AND
strain of Acromioclavicular ligament
JOINTS
Sprain and strain of other and unspecified parts of
shoulder girdle; Sprain and strain of shoulder girdle
JOINTS
NOS
Injury of tendon of the rotator cuff of shoulder
JOINTS
Injury of muscle and tendon of long head of biceps
JOINTS
Injury of muscle and tendon of other parts of biceps
JOINTS
Injury of multiple muscles and tendons at shoulder and INJURIES TO THE MUSCLES AND TENDONS AND
upper arm level
JOINTS
Injury of other muscles and tendons at shoulder and
upper
JOINTS
Injury
of unspecified muscle and tendon at shoulder
arm level
and
JOINTS
Sprain
and level
strain of elbow
upper arm
JOINTS
Injury of flexor muscle and tendon of thumb at forearm INJURIES TO THE MUSCLES AND TENDONS AND
level
JOINTS
DESCRIPTION
1,980
Case Rate
DESCRIPTION
Influenza with other manifestations, influenza virus
identified; Encephalopathy due to influenza, influenza
virus identified; Influenzal gastroenteritis, influenza
virus identified; Acute influenzal myocarditis, influenza
virus
identified with pneumonia, virus not identified;
Influenza
Influenzal
(broncho) pneumonia, unspecified or specific virus not
Influenza
identified with other respiratory manifestations, virus
not identified; Influenza NOS; Influenzal Acute upper
respiratory infection, unspecified or specific virus not
identified; Influenzal laryngitis, unspecified or specific
virus
not identified;
Influenza
with Influen
other manifestations, virus not
identified; Encephalopathy due to influenza,
unspecified or specific virus not identified; Influenzal
gastroentiritis, unspecified or specific virus not
identified; Acute influenzal myocarditis,
unspecified
o
Acute
influenzal
myocarditis, virus not identified
Unspecified effects of radiation
6,600
GROUP
FIRST CASE RATE

Case Rate
Professional
Fee
S56.1
S56.2
S56.3
S63.5
S63.6
S63.7
S66.1
S66.3
S66.5
S66.6
S66.8
S66.9
S73.1
S76.1
S76.2
S76.3
S76.4
S83.4
S83.5
S83.6
S86.8
S86.9
S93.4
S93.5
S93.6
S96.0
S96.9
T03.9
J81
J82
J84.0
J84.1
J84.8
J84.9
K55.0
ICD CODE
K55.1
K55.2
K55.9
Injury of long flexor muscle and tendon of other

finger(s) at
Injury
of level
other flexor muscle and tendon at forearm
forearm
level
Injury of extensor or abductor muscles and tendons of
thumb at forearm level
Sprain and strain of wrist; Sprain and strain of Carpal
joint; Sprain and strain of Radiocarpal joint; Sprain
and strain of
Sprain
and strain
of finger(s); Sprain and strain of
Radiocarpal
ligament
Interphalangeal joint, hand; Sprain and strain
Metacarpophalangeal joint; Sprain and strain of
Phalanx,
hand; Sprain
and strain
of and
Thumb
Sprain
and strain
of other
unspecified parts of
hand
Injury of flexor muscle and tendon of other finger at
wrist
Injury
of extensor
muscle and tendon of other finger at
and hand
level
wrist and hand level
Injury of intrinsic muscle and tendon of other finger at
wrist
Injury
of multiple
and hand
level flexor muscles and tendons at wrist
and
Injury
of other muscles and tendons at wrist and hand
hand level
level
Injury of unspecified muscle and tendon at wrist and
hand
Sprain
level and strain of hip
INJURIES
JOINTS
INJURIES
JOINTS
INJURIES
JOINTS
INJURIES
JOINTS
TO THE MUSCLES AND TENDONS AND 7,200
2,160
2,160
2,160
2,160
INJURIES TO THE MUSCLES AND TENDONS AND 7,200

JOINTS
2,160
INJURIES
JOINTS
INJURIES
JOINTS
INJURIES
JOINTS
INJURIES
JOINTS
INJURIES
JOINTS
INJURIES
JOINTS
INJURIES
JOINTS
INJURIES
JOINTS
Injury of quadriceps muscle and tendon; injury of
INJURIES
Patellar
JOINTS
Injury
of adductor
INJURIES
ligament
(tendon) muscle and tendon of thigh
JOINTS
Injury of muscle and tendon of the posterior muscle
INJURIES
group
JOINTS
Injury
of
other
and
unspecified
muscles
and
tendons
at
INJURIES
at thigh level
thigh level
JOINTS
Sprain and strain involving fibular collateral ligament INJURIES
of knee; Sprain and strain involving tibial collateral
JOINTS
ligament of
Sprain
knee and strain involving anterior cruciate ligament INJURIES
of
JOINTS
knee; Sprain and strain involving posterior cruciate
Sprain
and
strain
of
other
and
unspecified
parts
of
INJURIES
ligament of knee
knee
JOINTS
Injury of other muscles and tendons at lower leg level INJURIES
JOINTS
Injury of unspecified muscle and tendon at lower leg
INJURIES
level
JOINTS
Sprain and strain of ankle including Calcaneofibular
INJURIES
(ligament), Deltoid (ligament), Internal collateral
JOINTS
(ligament), Talofibular (ligament), Tibiofibular , distal
(ligament)
Sprain and strain of toe(s) including Interphalangeal
INJURIES
(joint(s), metatarsophalangeal (joint(s)
JOINTS
Sprain and strain of other and unspecified parts of foot INJURIES
including Tarsal (ligament), Tarsometatarsal (ligament) JOINTS
Injury of muscle and tendon of long flexor muscle of
toe at
Injury
of unspecified
ankle and
foot level muscle and tendon at ankle and
foot
Multiple
dislocations, sprains and strains, unspecified
level
Pulmonary oedema; Acute oedema of lung; Passive
pulmonary congestion; Lung dropsy
Pulmonary eosinophilia, not elsewhere classified;
Eosinophilic asthma; Loffler's pneumonia; Tropical
pulmonary eosinophilia NOS
Alveolar and parietoalveolar conditions; Alveolar
proteinosis; Pulmonary alveolar microlithiasis
Other interstitial pulmonary diseases with fibrosis;
Diffuse pulmonary fibrosis; Cryptogenic fibrosing
alveolitis; Hamman-Rich syndrome; Idiopathic
pulmonary fibrosis
Other specified interstitial pulmonary diseases
Interstitial pulmonary disease, unspecified; Interstitial
pneumonia NOS
Acute vascular disorders of intestine; Acute fulminant
ischaemic colitis; Acute intestinal infarction; Acute
small intestine ischaemia; Mesentric artery embolism;
Mesentric vein embolism; Mesentric artery infarction;
Mesentric vein
infarction; Mesentric a
DESCRIPTION
Chronic vascular disorders of intestine; Chronic
ischaemic colitis; Chronic ischaemic enteritis; Chronic
ischaemic enterocolitis; Ischaemic stricture of
intestine; Mesentric atherosclerosis; Mesentric
vascular insufficiency
Angiodysplasia of colon
Vascular disorder of intestine, unspecified; Ischaemic
colitis NOS; Ischaemic enteritis NOS; Ischaemic
enterocolitis NOS
2,160
2,160
2,160
2,160
2,160
2,160
2,160
2,160
2,160
2,160
2,160
2,160
2,160
2,160
2,160
2,160
2,160
2,160
2,160
2,160

JOINTS
JOINTS
JOINTS
INTERSTITIAL PULMONARY DISEASE
14,000
2,160
14,000
4,200
14,000
4,200
14,000
4,200

14,000
14,000
4,200
4,200
INTESTINAL DISORDERS
9,500
2,850
2,160
2,160
4,200
FIRST CASE RATE

Case Rate
Professional
Fee
9,500
2,850
9,500
9,500
2,850
2,850
GROUP
K57.0
K57.1
K57.2
K57.3
K57.4
K57.5
K57.8
K57.9
K59.3
K59.8
K59.9
K63.0
K63.1
K63.2
K63.3
K63.4
K63.5
K63.8
K63.9
K90.0
K90.1
K90.2
K90.3
K90.4
K90.8
K90.9
K56.0
K56.1
K56.2
K56.3
K56.4
K56.5
K56.6
K56.7
ICD CODE
G06.0
G06.1
G06.2
S04.0
S04.1
S04.4
S04.5
S04.6
Diverticular disease of small intestine with perforation INTESTINAL DISORDERS

and
abscess; Diverticular disease of small intestine with
Diverticular
peritonitis disease of small intestine without
perforation or abscess; Diverticular disease of small
intestine NOS
Diverticular disease of large intestine with perforation INTESTINAL DISORDERS
and abscess; Diverticular disease/ Diverticulitis/
Diverticulosis/ Diverticulum of colon with peritonitis
9,500
2,850
9,500
2,850
9,500
2,850
Diverticular disease of large intestine without

perforation or abscess; Diverticular disease of colon
NOS
Diverticular disease of both small and large intestine
with perforation and abscess; Diverticular disease of
both small
Diverticular
diseasewith
of both
small and large intestine
and large intestine
peritonitis
without perforation or abscess; Diverticular disease of
both small and large intestine NOS
Diverticular disease of intestine, part unspecified, with
perforation and abscess; Diverticular disease of
intestine
Diverticular
disease of intestine, part unspecified,
NOS with peritonitis
without
perforation or abscess; Diverticular disease of
Megacolon,
not elsewhere classified; Dilatation of
intestine NOS
colon;
Other
specified functional intestinal disorders; Atony of
Toxic megacolon
colon
Functional intestinal disorder, unspecified
Abscess of intestine
Nontraumatic perforation of intestine
Fistula of intestine
Ulcer of intestine; Primary ulcer of small intestine
Enteroptosis
Polyp of colon
Other specified diseases of intestine
Disease of intestine, unspecified
Coeliac disease; Gluten-sensitive enteropathy;
Idiopathic
Tropical
sprue;Nontropical
Sprue NOS;sprue
Tropical steatorrhoea
steatorrhoea;
Blind loop syndrome, not elsewhere classified; Blind
loop
Pancreatic
steatorrhoea
syndrome NOS
Malabsorption due to intolerance, not elsewhere
classified; Malabsorption due to intolerance to
carbohydrate; Malabsorption due to intolerance to fat;
Malabsorption due to intolerance to protein;
Malabsorption due to
intolerance
to starch
Other
intestinal
malabsorption
Intestinal malabsorption, unspecified
Paralytic ileus; Paralysis of bowel; Paralysis of colon;
Paralysis of intestine
Intussusception; Intussusception or invagination of
bowel; Intussusception or invagination of colon;
Intussusception or invagination of intestine;
Intussusception or invagination of
rectum Strangulation of colon or intestine; Torsion of
Volvulus;
colon or intestine; Twist of colon or intestine
Gallstone ileus; Obstruction of intestine by gallstone
Other impaction of intestine; Enterolith; Impaction of
colon; Imfaction of faecal
Intestinal adhesions [bands] with obstruction;
Peritoneal adhesions [bands] with intestinal
obstruction
Other and unspecified intestinal obstruction;
Enterotenosis; Obstructive ileus NOS; Occlusion of
colon or intestine; Stenosis of colon or intestine;
Stricture of colon
or intestine
Ileus,
unspecified
9,500
2,850
9,500
2,850
9,500
2,850
9,500
2,850
9,500
2,850
9,500
2,850
9,500
2,850
INTESTINAL
INTESTINAL
INTESTINAL
INTESTINAL
INTESTINAL
INTESTINAL
INTESTINAL
INTESTINAL
INTESTINAL
INTESTINAL
DISORDERS
DISORDERS
DISORDERS
DISORDERS
DISORDERS
DISORDERS
DISORDERS
DISORDERS
DISORDERS
MALABSORPTION
9,500
9,500
9,500
9,500
9,500
9,500
9,500
9,500
9,500
4,100
2,850
2,850
2,850
2,850
2,850
2,850
2,850
2,850
2,850
1,230
INTESTINAL MALABSORPTION
4,100
4,100
1,230
1,230
4,100
1,230
4,100
1,230
INTESTINAL OBSTRUCTION
4,100
4,100
10,100
1,230
1,230
3,030
10,100
3,030
10,100
3,030
10,100
10,100
3,030
3,030
10,100
3,030
10,100
3,030
10,100
3,030
Case Rate
Professional
Fee
27,900
8,370
27,900
8,370
DESCRIPTION
GROUP
Intracranial abscess and granuloma; Abscess (embolic) INTRACRANIAL AND INTRASPINAL ABSCESS
(of) brain [any part]; Abscess (embolic)(of) cerebellar; AND GRANULOMA
Abscess (embolic)(of) cerebral; Abscess (embolic)(of)
otogenic; IIntracranial abscess or granuloma, epidural;
Intracranial abscess or granulom
Intraspinal abscess and granuloma; Abscess (embolic) INTRACRANIAL AND INTRASPINAL ABSCESS
of spinal cord [any part]; Intraspinal abscess or
AND GRANULOMA
granuloma epidural; Intraspinal abscess or granuloma
extradural; Intraspinal abscess or granuloma subdural
FIRST CASE RATE
Encephalitis, myelitis and encephalomyelitis in

Extradural
Injury
of opticabscess,
nerve and
pathways; Injury of Optic
and subdural
unspecified
chiasm; Injury of 2nd cranial nerve; Injury of Visual
cortex
Injury of oculomotor nerve; injury of 3rd cranial nerve
INTRACRANIAL AND INTRASPINAL ABSCESS

AND
INTRACRANIAL
GRANULOMA INJURIES
27,900
8,370
8,800
2,640
INTRACRANIAL INJURIES
8,800
2,640
Injury of abducent nerve; injury of 6th cranial nerve

Injury of facial nerve; injury of 7th cranial nerve
Injury of acoustic nerve; injury of Auditory nerve;
injury of
8th cranial nerve
8,800
8,800
8,800
2,640
2,640
2,640
S04.8
S04.9
S05.0
S06.00
S06.01
S06.10
S06.20
S06.21
S06.30
S06.31
S06.40
S06.41
S06.50
S06.51
S06.60
S06.61
S06.70
S06.80
S06.81
S06.90
S06.91
S09.0
S09.1
S09.2
S09.7
S09.8
S09.9
P52.0
ICD CODE
P52.1
P52.3
P52.4
P52.5
P52.6
P52.8
P52.9
I21.0
Injury of other cranial nerves; injury of

Glossopharyngeal [9th] nerve; injury of Hypoglossal
[12th] nerve; injury of; injury of Olfactory [1st] nerve;
injury of Vagus [10th] nerve
Injury of unspecified cranial nerve
Injury of conjunctiva and corneal abrasion without
mention
Concussion;
Commotio cerebri (without open
of foreign body
intracranial
Concussion;
Commotio cerebri (with open intracranial
wound)
wound)
Traumatic cerebral oedema (without open intracranial
wound)
Diffuse brain injury; Cerebral contusion NOS; Cerebral
laceration NOS; Traumatic compression of brain NOS
(without open intracranial wound)
Diffuse brain injury; Cerebral contusion NOS; Cerebral
laceration NOS; Traumatic compression of brain NOS
Focal brain injury; Focal cerebral; Focal cerebral
contusion; Focal cerebral laceration; Focal traumatic
intracerebral haemorrhage (without open intracranial
wound)
Focal brain injury; Focal cerebral; Focal cerebral
contusion; Focal cerebral laceration; Focal traumatic
intracerebral haemorrhage (with open intracranial
wound)
Epidural haemorrhage; Extradural haemorrhage,
traumatic
Epidural
Extradural
(without haemorrhage;
open intracranial
wound) haemorrhage,
traumatic
Traumatic
haemorrhage
(without open
(with opensubdural
intracranial
wound)
intracranial wound)
Traumatic subdural haemorrhage (with open
intracranial
Traumatic
subarachnoid haemorrhage (without open
wound)
intracranial wound)
Traumatic subarachnoid haemorrhage (with open
intracranial wound)
Intracranial injury with prolonged coma (without open
intracranial wound)
Other intracranial injuries; traumatic haemorrhage
cerebellar; traumatic haemorrhage intracranial NOS
Other intracranial injuries; traumatic haemorrhage
cerebellar; traumatic haemorrhage intracranial NOS
(with
Intracranial
injury,wound)
unspecified; brain injury NOS
open intracranial
(without
Intracranial
injury,wound)
unspecified; brain injury NOS (with
open intracranial
open
Injury
of blood
vessels of head, not elsewhere
intracranial
wound)
classified
Injury of muscle and tendon of head
Traumatic rupture of ear drum
Multiple injuries of head
Other specified injuries of head
Unspecified injury of head; Injury of face NOS; Injury of
ear
Intraventricular
(nontraumatic)
haemorrhage, grade 1,
NOS; Injury of nose
NOS
of fetus and newborn; Subependymal haemorrhage
(without
intraventricular extension)
DESCRIPTION
8,800
2,640
8,800
8,800
2,640
2,640
8,800
2,640
8,800
2,640
8,800
2,640
8,800
2,640
8,800
2,640
8,800
2,640
8,800
2,640
8,800
2,640
8,800
2,640
8,800
2,640
8,800
2,640
8,800
2,640
8,800
2,640
8,800
2,640
8,800
2,640
8,800
2,640
8,800
2,640
8,800
2,640
8,800
2,640
INTRACRANIAL
INTRACRANIAL
INTRACRANIAL
INTRACRANIAL
INTRACRANIAL
8,800
8,800
8,800
8,800
8,800
2,640
2,640
2,640
2,640
2,640
INJURIES
INJURIES
INJURIES
INJURIES
INJURIES
INTRAVENTRICULAR
25,600
HEMORRHAGE/INTRACRANIAL HEMORRHAGE IN
THE NEWBORN
7,680
FIRST CASE RATE
GROUP
Intraventricular (nontraumatic) haemorrhage, grade 2, INTRAVENTRICULAR

of fetus and newborn; Subependymal haemorrhage
with
THE NEWBORN
Unspecified
intraventricular
INTRAVENTRICULAR
intraventricular
extension (nontraumatic)
haemorrhage of fetus and newborn
THE NEWBORN
Intracerebral (nontraumatic) haemorrhage of fetus and INTRAVENTRICULAR
newborn
THE NEWBORN
Subarachnoid (nontraumatic) haemorrhage of fetus
INTRAVENTRICULAR
and newborn
THE NEWBORN
Cerebellar (nontraumatic) and posterior fossa
INTRAVENTRICULAR
haemorrhage of fetus and newborn
THE NEWBORN
Other intracranial (nontraumatic) haemorrhages of
INTRAVENTRICULAR
fetus and newborn
THE NEWBORN
Intracranial (nontraumatic) haemorrhage of fetus and INTRAVENTRICULAR
newborn, unspecified
THE NEWBORN
Acute transmural myocardial infarction of anterior wall ISCHEMIC HEART DISEASE WITH MYOCARDIAL
[or duration of <4 weeks] KILLIPS stage unspecified;
INFARCTION
Acute transmural infarction of anterior wall NOS [or
duration of
<4 weeks] KILLIPS stage unspecified; Acute
anteroapical transmural infarction [or
Case Rate
Professional
Fee
25,600
7,680
25,600
7,680
25,600
7,680
25,600
7,680
25,600
7,680
25,600
7,680
25,600
7,680
18,900
5,670
I21.1
I21.2
I21.3
I21.4
I21.9
I22.0
I22.1
I22.8
I22.9
I23.0
I23.1
I23.2
I23.3
I23.4
I23.5
I23.8
I24.1
I20.0
ICD CODE
I20.1
Acute transmural myocardial infarction of inferior wall ISCHEMIC HEART DISEASE WITH MYOCARDIAL
[or duration of <4 weeks] KILLIPS I; Acute transmural
INFARCTION
infarction of diaphragmatic wall [or duration of <4
weeks] KILLIPS I; Acute transmural infarction of inferior
wall NOS [or duration of <4 weeks]
18,900
5,670
Acute subendocardial myocardial infarction;

Nontransmural myocardial infarction NOS
Acute myocardial infarction, unspecified [or duration of
<4 weeks] KILLIPS I; Acute myocardial infarction NOS
[or
Subsequent
myocardial
infarction
of anterior wall;
duration of <4
weeks] KILLIPS
I
Acute Subsequent infarction of anterior wall NOS;
Acute subsequent infarction of anteroapical wall; Acute
subsequent infarction of anterolateral wall; Acute
subsequent infarction of anteroseptal wall
Subsequent myocardial infarction of inferior wall;
Acute subsequent infarction of diaphragmatic wall;
Acute subsequent infarction of inferior wall NOS; Acute
subsequent infarction of inferolateral wall; Acute
subsequent infarction of inferoposterior wall
Subsequent myocardial infarction of other sites; Acute
myocardial infarction of apical-lateral wall; Acute
myocardial infarction of basal-lateral wall; Acute
myocardial infarction of high lateral wall; Acute
myocardial
infarction of myocardial
lateral wall infarction
NOS; Acutof unspecified site
Subsequent
ISCHEMIC HEART DISEASE WITH MYOCARDIAL

INFARCTION
INFARCTION
18,900
5,670
18,900
5,670
18,900
5,670
18,900
5,670
18,900
5,670
DISEASE WITH MYOCARDIAL
18,900
5,670
18,900
5,670
18,900
5,670
18,900
5,670
18,900
5,670
WITH MYOCARDIAL
18,900
5,670
WITH MYOCARDIAL
18,900
5,670
WITH MYOCARDIAL
18,900
5,670
WITH MYOCARDIAL
18,900
5,670
WITHOUT
12,000
3,600
Haemopericardium as current complication following

acute
Atrial
septalinfarction
defect as current complication following
myocardial
acute
Ventricular
defect as current complication
myocardial septal
infarction
following
Rupture
of
cardiac
wall without haemopericardium as
acute myocardial infarction
current complication following acute myocardial
infarction
Rupture of chordae tendineae as current complication
following acute myocardial infarction
Rupture of papillary muscle as current complication
following acute myocardial infarction
Other current complications following acute
myocardial
Dressler's
infarction syndrome; Postmyocardial infarction
syndrome
Unstable angina; Angina crescendo; Angina de novo
effort;
Angina worsening effort; Intermediate coronary
syndrome; Preinfarction syndrome
Silent myocardial ischaemia

Other forms of chronic ischaemic heart disease
I25.9
Chronic ischaemic heart disease, unspecified; Chronic

Ischaemic heart disease NOS
Kernicterus due to isoimmunization
Other specified kernicterus
Kernicterus, unspecified
Neonatal jaundice due to bleeding
Neonatal jaundice due to infection
Neonatal jaundice due to polycythaemia
Neonatal jaundice due to drugs or toxins transmitted
from
Neonatal
to other specified excessive
mother orjaundice
given todue
newborn
haemolysis
Neonatal jaundice due to excessive haemolysis,
unspecified
Neonatal jaundice associated with preterm delivery;
Hyperbilirubinaemia of prematurity; Jaundice due to
delayed conjucation associated with preterm delivery
P57.0
P57.8
P57.9
P58.1
P58.2
P58.3
P58.4
P58.8
P58.9
P59.0

INFARCTION

INFARCTION

INFARCTION
ISCHEMIC HEART
INFARCTION
ISCHEMIC HEART
INFARCTION
ISCHEMIC HEART
INFARCTION
ISCHEMIC HEART
INFARCTION
ISCHEMIC HEART
INFARCTION
ISCHEMIC HEART DISEASE

INFARCTION
INFARCTION
INFARCTION
INFARCTION
MYOCARDIAL INFARCTION
FIRST CASE RATE

Case Rate
Professional
Fee
ISCHEMIC HEART DISEASE WITHOUT

12,000
3,600
ISCHEMIC HEART DISEASE WITHOUT

MYOCARDIAL
ISCHEMIC
HEART DISEASE WITHOUT
INFARCTION
MYOCARDIAL
ISCHEMIC
HEART DISEASE WITHOUT
INFARCTION
12,000
3,600
12,000
3,600
12,000
3,600
ISCHEMIC HEART
MYOCARDIAL
ISCHEMIC
HEART
INFARCTION
MYOCARDIAL
ISCHEMIC
HEART
INFARCTION
MYOCARDIAL
ISCHEMIC
HEART
INFARCTION
MYOCARDIAL
ISCHEMIC
HEART
INFARCTION
MYOCARDIAL
JAUNDICE
IN THE
INFARCTION
JAUNDICE IN THE
JAUNDICE IN THE
JAUNDICE IN THE
JAUNDICE IN THE
JAUNDICE IN THE
JAUNDICE IN THE
DISEASE WITHOUT
12,000
3,600
DISEASE WITHOUT
12,000
3,600
DISEASE WITHOUT
12,000
3,600
DISEASE WITHOUT
12,000
3,600
DISEASE WITHOUT
12,000
3,600
NEWBORN
NEWBORN
NEWBORN
NEWBORN
NEWBORN
NEWBORN
NEWBORN
7,400
7,400
7,400
7,400
7,400
7,400
7,400
2,220
2,220
2,220
2,220
2,220
2,220
2,220
JAUNDICE IN THE NEWBORN
7,400
2,220
7,400
2,220
7,400
2,220
DESCRIPTION
I25.8
I24.8
5,670

INFARCTION
I25.6
I24.0
18,900

INFARCTION
I25.5
I20.9
5,670
Acute transmural myocardial infarction of other sites

[or duration of <4 weeks] KILLIPS II; Acute apicallateral transmural infarction [or duration of <4 weeks]
KILLIPS II; Acute basal-lateral transmural infarction [or
duration of <4
weeks]transmural
KILLIPS I myocardial infarction of unspecified
Acute
site; Transmural myocardial infarction NOS
Angina pectoris with documented spasm; Angiospastic

Angina ; Prinzmetal Angina ; spasm-induced Angina ;
Variant Angina
Other forms of angina pectoris; Angina of effort;
Stenocardia
Angina pectoris, unspecified; Angina NOS; Cardiac
Angina ;
Coronary
thrombosis
not resulting
myocardial
Anginal syndrome;
Ischaemic
chestinpain
infarction; Coronary artery embolism not resulting in
myocardial infaction; Coronary vein embolism not
resulting in myocardial infarction; Coronary artery
occlusion not
resulting
in myocardial
infarction;
Co disease;
Other
forms
of acute ischaemic
heart
Coronary
Ischaemic
cardiomyopathy
failure; Coronary
insufficiency
I20.8
18,900
GROUP
P59.1
P59.2
P59.3
P59.8
P59.9
A30.0
A30.1
A30.2
A30.4
A30.5
A30.8
A30.9
A27.0
A27.8
A27.9
K70.0
K70.1
K70.2
K70.3
K70.9
K71.0
K71.1
K71.2
K71.3
K71.5
K71.6
K71.8
K71.9
K73.0
ICD CODE
K73.2
K73.8
K73.9
K74.1
K74.6+I98.2*
K75.0
K75.1
K75.2
K75.3
K75.4
K75.8
K75.9
K76.0
K76.8
K76.9
K71.4
K71.7
K74.0
K74.2
K74.6
K76.1
K76.2
K76.3
K76.4
K76.6
K76.7
I88.0
I89.1
I89.8
Inspissated bile syndrome

Neonatal jaundice from other and unspecified
hepatocellular damage
Neonatal jaundice from breast milk inhibitor
Neonatal jaundice from other specified causes
Neonatal jaundice, unspecified; Intense physiological
jaundice, NOS; Prolonged physiological jaundice, NOS

7,400
7,400
2,220
2,220

7,400
7,400
7,400
2,220
2,220
2,220
Hansen's disease: Indeterminate leprosy; I leprosy

Hansen's disease : Tuberculoid leprosy; TT leprosy
Hansen's disease: Borderline tuberculoid leprosy; BT
leprosy
Hansen's disease: Borderline lepromatous leprosy; BL
leprosy
Hansen's disease: Lepromatous leprosy; LL leprosy
Other forms of leprosy
Leprosy, unspecified
Leptospirosis icterohaemorrhagica; Leptospirosis due
to Leptospira interrogans serovar icterohaemorrhagiae
LEPROSY
LEPROSY
LEPROSY
8,800
8,800
8,800
2,640
2,640
2,640
LEPROSY
8,800
2,640
LEPROSY
LEPROSY
LEPROSY
LEPTOSPIROSIS MODERATE TO SEVERE
8,800
8,800
8,800
11,000
2,640
2,640
2,640
3,300
Other forms of leptospirosis

Leptospirosis, unspecified
Alcoholic fatty liver
Alcoholic hepatitis
Alcoholic fibrosis and sclerosis of liver
Alcoholic cirrhosis of liver; Alcoholic cirrhosis NOS;
Laennec's cirrhosis
Alcoholic liver disease, unspecified
Toxic liver disease with cholestasis; Cholestatis with
hepatocyte injury; Pure cholestasis
Toxic liver disease with hepatic necrosis; Acute hepatic
failure due to drugs; Chronic hepatic failure due to
drugs
Toxic liver disease with acute hepatitis
Toxic liver disease with chronic persistent hepatitis
Toxic liver disease with chronic active hepatitis; Toxic
liver
Toxic
liver
disease
hepatitis, not elsewhere
disease
with
lupoidwith
hepatitis
classified
Toxic liver disease with other disorders of liver; Toxic
liver disease with focal nodular hyperplasia; Toxic liver
disease with hepatic granulomas; Toxic liver disease
with peliosis hepatis; Toxic liver disease with venoocclusive disease of
liver liver disease, unspecified
Toxic
Chronic persistent hepatitis, not elsewhere classified

LIVER DISEASES I
LIVER DISEASES I
LIVER DISEASES I
LIVER DISEASES I
11,000
11,000
11,800
11,800
11,800
11,800
3,300
3,300
3,540
3,540
3,540
3,540
LIVER DISEASES I
LIVER DISEASES I
11,800
11,800
3,540
3,540
LIVER DISEASES I
11,800
3,540
LIVER DISEASES I
LIVER DISEASES I
LIVER DISEASES I
11,800
11,800
11,800
3,540
3,540
3,540
LIVER DISEASES I
11,800
3,540
LIVER DISEASES I
11,800
3,540
LIVER DISEASES I
LIVER DISEASES I
11,800
11,800
3,540
3,540
Case Rate
Professional
Fee
DESCRIPTION
FIRST CASE RATE

GROUP
Chronic active hepatitis, not elsewhere classified;

Lupoid
Other
chronic
hepatitis
NEC hepatitis, not elsewhere classified
Chronic hepatitis, unspecified
Hepatic sclerosis
Oesophageal varices in other and unspecified cirrhosis
of
Abscess
of liver; Hepatic abscess NOS; Cholangitic
liver
hepatic abscess; Haematogenic hepatic abscess;
Lymphogenic hepatic abscess; Pylephlebitic hepatic
abscess
Phlebitis of portal vein; Pylephlebitis
Nonspecific reactive hepatitis
Granulomatous hepatitis, not elsewhere classified
Autoimmune hepatitis
Other specified inflammatory liver diseases
Inflammatory liver disease, unspecified; Hepatitis NOS
LIVER DISEASES I
11,800
3,540
LIVER
LIVER
LIVER
LIVER
I
I
I
I
11,800
11,800
11,800
11,800
3,540
3,540
3,540
3,540
LIVER DISEASES I
11,800
3,540
LIVER
LIVER
LIVER
LIVER
LIVER
LIVER
I
I
I
I
I
I
11,800
11,800
11,800
11,800
11,800
11,800
3,540
3,540
3,540
3,540
3,540
3,540
Fatty (change of) liver, not elsewhere classified

Other specified diseases of liver; Focal nodular
hyperplasia
Liver
disease,
unspecified
of liver;
Hepatoptosis
Toxic liver disease with chronic lobular hepatitis
Toxic liver disease with fibrosis and cirrhosis of liver
Hepatic fibrosis
Hepatic fibrosis with hepatic sclerosis
Other and unspecified cirrhosis of liver; Cirrhosis of
liver NOS; Cryptogenic cirrhosis of liver; Macronodular
cirrhosis of liver; Micronodular cirrhosis of liver; Mixed
type cirrhosis of liver; Portal cirrhosis of liver;
Postnecrotic cirrhosis of
liver;
Chronic
passive congestion of liver; Cardiac cirrhosis
(soCentral
haemorrhagic
ofof
liver
called) of
liver; Cardiacnecrosis
sclerosis
liver
Infarction of liver
Peliosis hepatis; Hepatic angiomatosis
Portal hypertension
Hepatorenal syndrome
Nonspecific mesenteric lymphadenitis; Acute
Mesenteric lymphadenitis; Chronic Mesenteric
lymphadenitis
Lymphangitis; Lymphangitis NOS; Chronic
Lymphangitis;
Other
specified
noninfective disorders of lymphatic
Subacute
Lymphangitis
vessels
and lymph nodes; Chylocele (nonfilarial);
Lipomelanotic reticulosis
LIVER DISEASES I
LIVER DISEASES I
11,800
11,800
3,540
3,540
LIVER
LIVER
LIVER
LIVER
LIVER
I
II
II
II
II
11,800
15,100
15,100
15,100
15,100
3,540
4,530
4,530
4,530
4,530
LIVER DISEASES II
15,100
4,530
LIVER DISEASES II
15,100
4,530
LIVER DISEASES
LIVER DISEASES
LIVER DISEASES
LIVER DISEASES
LIVER DISEASES
LYMPHADENITIS
15,100
15,100
15,100
15,100
15,100
6,800
4,530
4,530
4,530
4,530
4,530
2,040
LYMPHATIC VESSELS DISORDER
8,900
2,670
8,900
2,670
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
II
II
II
II
II
I89.9
C40.1
Noninfective disorder of lymphatic vessels and lymph

nodes, unspecified; Disease of lymphatic vessels NOS
Malignant neoplasm of kidney, except renal pelvis &
renal
Malignant
neoplasm of renal pelvis; Malignant
calyces
neoplasm of Pelviureteric junction; Malignant
neoplasm of Renal calyces
Malignant neoplasm of ureter
Malignant neoplasm of Trigone of bladder
Malignant neoplasm of Dome of bladder
Malignant neoplasm of Lateral wall of bladder
Malignant neoplasm of Anterior wall of bladder
Malignant neoplasm of Bladder neck; Malignant
neoplasm
Malignant
of Ureteric orifice
of Internal neoplasm
urethral orifice
Malignant neoplasm of Urachus
Malignant neoplasm of Overlapping lesion of bladder
Malignant neoplasm of Bladder, unspecified
Malignant neoplasm of Urethra
Malignant neoplasm of Urinary organ, unspecified;
Malignant neoplasm of Urinary system NOS
Secondary malignant neoplasm of kidney and renal
pelvis
Secondary malignant neoplasm of bladder and other
and
Malignant
of Scapula and long bones of
unspecifiedneoplasm
urinary organs
upper
Malignant
neoplasm of Short bones of upper limb
limb
C40.2
Malignant neoplasm of Long bones of lower limb
C40.3
Malignant neoplasm of Short bones of lower limb
C40.9
Malignant neoplasm of Bone and articular cartilage of

limb,
Malignant
unspecifiedneoplasm of Bones of skull and face;
Malignant
neoplasm o f Superior maxilla; Malignant neoplasm of
Orbital bone
C64
C65
C66
C67.0
C67.1
C67.2
C67.3
C67.5
C67.6
C67.7
C67.8
C67.9
C68.0
C68.9
C79.0
C79.1
C40.0
C41.0
ICD CODE
C41.1
8,900
2,670
MALIGNANT NEOPLASM OF URINARY TRACT
14,100
4,230
14,100
4,230
MALIGNANT
MALIGNANT
MALIGNANT
MALIGNANT
MALIGNANT
MALIGNANT
NEOPLASM
NEOPLASM
NEOPLASM
NEOPLASM
NEOPLASM
NEOPLASM
OF
OF
OF
OF
OF
OF
URINARY
URINARY
URINARY
URINARY
URINARY
URINARY
TRACT
TRACT
TRACT
TRACT
TRACT
TRACT
14,100
14,100
14,100
14,100
14,100
14,100
4,230
4,230
4,230
4,230
4,230
4,230
MALIGNANT
MALIGNANT
MALIGNANT
MALIGNANT
MALIGNANT
MALIGNANT
NEOPLASM
NEOPLASM
NEOPLASM
NEOPLASM
NEOPLASM
NEOPLASM
OF
OF
OF
OF
OF
OF
URINARY
URINARY
URINARY
URINARY
URINARY
URINARY
TRACT
TRACT
TRACT
TRACT
TRACT
TRACT
14,100
14,100
14,100
14,100
14,100
14,100
4,230
4,230
4,230
4,230
4,230
4,230
14,100
4,230
14,100
4,230
MALIGNANT NEOPLASMS
ARTICULAR CARTILAGE
MALIGNANT NEOPLASMS
ARTICULAR CARTILAGE
MALIGNANT NEOPLASMS
ARTICULAR CARTILAGE
MALIGNANT NEOPLASMS
ARTICULAR CARTILAGE
MALIGNANT NEOPLASMS
ARTICULAR CARTILAGE
MALIGNANT NEOPLASMS
ARTICULAR CARTILAGE
OF BONE AND
16,500
4,950
OF BONE AND
16,500
4,950
OF BONE AND
16,500
4,950
OF BONE AND
16,500
4,950
OF BONE AND
16,500
4,950
OF BONE AND
16,500
4,950
FIRST CASE RATE
DESCRIPTION
GROUP
Professional
Fee
MALIGNANT NEOPLASMS
ARTICULAR CARTILAGE
MALIGNANT NEOPLASMS
ARTICULAR CARTILAGE
Malignant neoplasm of Ribs, sternum and clavicle
MALIGNANT NEOPLASMS
ARTICULAR CARTILAGE
Malignant neoplasm of Pelvic bones, sacrum and
MALIGNANT NEOPLASMS
coccyx
ARTICULAR CARTILAGE
Malignant neoplasm of Overlapping lesion of bone and MALIGNANT NEOPLASMS
articular cartilage
ARTICULAR CARTILAGE
Malignant neoplasm of Bone and articular cartilage,
MALIGNANT NEOPLASMS
unspecified
ARTICULAR CARTILAGE
Secondary malignant neoplasm of bone and bone
MALIGNANT NEOPLASMS
marrow
ARTICULAR CARTILAGE
Malignant neoplasm of Cerebral meninges
MALIGNANT NEOPLASMS
NERVOUS
Malignant neoplasm of Spinal meninges
MALIGNANT
NEOPLASMS
SYSTEM
NERVOUS
Malignant neoplasm of Meninges, unspecified
MALIGNANT
NEOPLASMS
SYSTEM
NERVOUS
Malignant neoplasm of Cerebrum, except lobes and
MALIGNANT
NEOPLASMS
SYSTEM
ventricles; Malignant neoplasm of Supratentorial NOS NERVOUS SYSTEM
OF BONE AND
16,500
4,950
OF BONE AND
16,500
4,950
OF BONE AND
16,500
4,950
OF BONE AND
16,500
4,950
OF BONE AND
16,500
4,950
OF BONE AND
16,500
4,950
OF BONE AND
16,500
4,950
OF CENTRAL
16,900
5,070
OF CENTRAL
16,900
5,070
OF CENTRAL
16,900
5,070
OF CENTRAL
16,900
5,070
C71.1
Malignant neoplasm of Frontal lobe
OF CENTRAL
16,900
5,070
C71.2
Malignant neoplasm of Temporal lobe
OF CENTRAL
16,900
5,070
C71.3
Malignant neoplasm of Parietal lobe
OF CENTRAL
16,900
5,070
C71.4
Malignant neoplasm of Occipital lobe
OF CENTRAL
16,900
5,070
C71.5
Malignant neoplasm of Cerebral ventricle
OF CENTRAL
16,900
5,070
C71.6
Malignant neoplasm of Cerebellum
OF CENTRAL
16,900
5,070
C71.7
OF CENTRAL
16,900
5,070
C71.8
Malignant neoplasm of Brain stem; Malignant

neoplasm of Fourth Ventricle; Malignant neoplasm of
Infratentorial NOS
Malignant neoplasm of Overlapping lesion of brain
NEOPLASMS OF CENTRAL
16,900
5,070
C71.9
Malignant neoplasm of Brain, unspecified
16,900
5,070
C72.0
Malignant neoplasm of Spinal cord
16,900
5,070
C72.1
Malignant neoplasm of Cauda equina
16,900
5,070
C72.2
16,900
5,070
C72.3
Malignant neoplasm of Olfactory nerve; Malignant

neoplasm of Olfactory bulb
Malignant neoplasm of Optic nerve
16,900
5,070
C72.4
Malignant neoplasm of Acoustic nerve
16,900
5,070
C72.5
Malignant neoplasm of Other and unspecified cranial

nerves; Malignant neoplasm of Cranial nerve NOS
16,900
5,070
C41.2
C41.3
C41.4
C41.8
C41.9
C79.5
C70.0
C70.1
C70.9
C71.0
Malignant neoplasm of Mandible; Malignant neoplasm

of
Malignant
of Vertebral column
Lower jaw neoplasm
bone
Case Rate
MALIGNANT NEOPLASMS
NERVOUS
MALIGNANT
NEOPLASMS
SYSTEM
NERVOUS
MALIGNANT
NEOPLASMS
SYSTEM
NERVOUS
MALIGNANT
NEOPLASMS
SYSTEM
NERVOUS
MALIGNANT
NEOPLASMS
SYSTEM
NERVOUS
MALIGNANT
NEOPLASMS
SYSTEM
NERVOUS
MALIGNANT
NEOPLASMS
SYSTEM
NERVOUS SYSTEM
MALIGNANT
NERVOUS
MALIGNANT
SYSTEM
NERVOUS
MALIGNANT
SYSTEM
NERVOUS
MALIGNANT
SYSTEM
NERVOUS
MALIGNANT
SYSTEM
NERVOUS
MALIGNANT
SYSTEM
NERVOUS
MALIGNANT
SYSTEM
NERVOUS
MALIGNANT
SYSTEM
NERVOUS
SYSTEM
C72.8
C15.0
Malignant neoplasm of Overlapping lesion of brain and

other parts of central nervous system
Malignant neoplasm of Central nervous system,
unspecified; Malignant neoplasm of Nervous system
NOS
Secondary malignant neoplasm of brain and cerebral
meninges
Secondary malignant neoplasm of other and
unspecified
Malignant
neoplasm
of Cervical part of oesophagus
parts of nervous
system
C15.2
Malignant neoplasm of Abdominal part of oesophagus
C15.3
Malignant neoplasm of Upper third of oesophagus
C15.4
Malignant neoplasm of Middle third of oesophagus
C15.5
Malignant neoplasm of Lower third of oesophagus
C15.8
Malignant neoplasm of Overlapping lesion of

oesophagus
Malignant neoplasm of Oesophagus, unspecified
C72.9
C79.3
C79.4
C15.9
C16
C16.0
Dermato(poly)myositis in Malignant neoplasm of

stomach
Malignant neoplasm of Cardia; Malignant neoplasm of
Cardiac orifice; Malignant neoplasm of Cardiooesophageal junction; Malignant neoplasm of
Gastro-oesophageal junction; Malignant neoplasm of
Oesophagus and stomach
MALIGNANT NEOPLASMS OF CENTRAL

NERVOUS
MALIGNANT
SYSTEM
NERVOUS SYSTEM
16,900
5,070
16,900
5,070
MALIGNANT
NERVOUS
MALIGNANT
SYSTEM
NERVOUS
MALIGNANT
SYSTEM
ORGANS
MALIGNANT
ORGANS
MALIGNANT
ORGANS
MALIGNANT
ORGANS
MALIGNANT
ORGANS
MALIGNANT
ORGANS
MALIGNANT
ORGANS
MALIGNANT
ORGANS
16,900
5,070
16,900
5,070
NEOPLASMS OF DIGESTIVE
14,200
4,260
14,200
4,260
14,200
4,260
14,200
4,260
14,200
4,260
14,200
4,260
14,200
4,260
14,200
4,260
MALIGNANT NEOPLASMS OF DIGESTIVE

ORGANS
14,200
4,260
E RATE
E RATE
Health Care
Institution
Fee
8,400
8,400
8,400
8,400
8,400
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
Health Care
Institution
Fee
4,200
4,200
E RATE
4,200
4,200
13,510
13,510
13,510
13,510
13,510
13,510
22,400
4,340
4,340
4,340
4,340
4,340
4,340
7,000
4,200
4,200
4,200
4,200
4,200
4,200
7,770
5,320
5,320
5,320
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
Health Care
Institution
Fee
7,000
7,000
7,000
7,000
E RATE
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
Health Care
Institution
Fee
7,000
7,000
6,790
6,790
6,790
6,790
6,790
6,790
6,790
6,790
6,790
6,790
E RATE
6,790
6,790
6,790
6,790
6,790
6,790
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
Health Care
Institution
Fee
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
E RATE
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
5,670
5,670
5,670
5,670
5,670
5,670
5,670
4,900
Health Care
Institution
Fee
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
E RATE
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
6,300
6,300
6,300
6,300
6,300
9,660
4,480
4,480
4,480
Health Care
Institution
Fee
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
E RATE
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
4,480
6,300
6,300
6,300
Health Care
Institution
Fee
6,300
6,300
6,300
6,300
6,300
6,300
3,360
15,680
5,530
5,530
5,530
5,530
5,530
5,530
8,260
8,260
8,260
8,260
8,260
8,260
8,260
8,260
8,400
8,400
8,400
8,400
8,400
8,400
8,400
8,400
8,400
8,400
8,400
8,400
8,400
E RATE
8,400
8,400
8,400
8,400
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
Health Care
Institution
Fee
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
E RATE
7,420
7,420
7,420
7,420
7,420
11,270
11,270
11,270
11,270
11,270
11,270
8,540
Health Care
Institution
Fee
8,540
8,540
8,540
8,540
8,540
8,540
8,540
8,540
8,540
8,540
8,540
8,540
9,380
9,380
9,380
9,380
9,380
9,380
9,380
9,380
9,380
9,380
15,890
15,890
15,890
15,890
15,890
6,160
6,720
6,720
6,720
6,720
6,720
6,720
6,720
6,720
6,720
6,650
6,650
6,650
6,650
6,650
E RATE
E RATE
6,650
6,650
9,240
Health Care
Institution
Fee
9,240
7,910
7,910
7,910
7,910
7,910
7,910
8,890
8,890
8,890
8,890
8,890
8,890
8,890
8,890
8,890
8,890
8,890
8,890
8,890
8,890
8,890
8,890
8,890
8,890
8,890
8,890
10,150
10,150
10,150
10,150
8,540
8,540
8,540
8,540
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,740
Health Care
Institution
Fee
E RATE
5,740
5,740
5,740
8,400
8,400
8,400
8,400
8,400
8,400
8,400
7,350
7,350
7,350
7,350
7,350
7,350
7,350
7,350
7,350
7,350
6,090
6,090
6,090
6,090
6,090
6,090
6,090
6,090
6,090
6,090
6,090
6,090
6,090
6,090
6,090
6,090
6,090
6,090
6,090
Health Care
Institution
Fee
6,090
6,090
6,090
6,090
E RATE
6,090
6,720
6,720
6,720
6,720
6,720
6,720
6,720
6,720
6,720
6,720
6,720
6,720
6,720
6,720
5,390
5,390
5,390
5,390
10,360
10,360
10,360
10,360
10,360
10,360
10,360
10,360
10,360
10,360
10,360
6,650
6,650
6,650
Health Care
Institution
Fee
6,650
6,650
6,650
6,650
6,650
6,650
E RATE
6,650
6,650
5,810
5,810
5,810
5,810
5,810
10,080
10,080
10,080
10,080
10,080
10,080
10,080
6,300
6,300
7,070
7,070
7,070
7,070
7,070
7,070
7,070
7,070
3,850
3,850
3,850
Health Care
Institution
Fee
3,850
3,850
3,850
3,850
3,850
3,850
3,850
6,510
6,510
6,510
6,510
6,510
6,510
6,510
E RATE
6,510
6,510
5,460
10,640
10,640
10,640
2,800
2,800
8,260
8,260
8,260
8,260
8,260
8,260
8,260
8,260
8,260
8,260
8,260
6,510
6,510
6,510
6,510
6,510
6,510
6,510
3,710
3,710
3,710
Health Care
Institution
Fee
3,710
3,710
3,710
3,710
3,710
3,710
3,710
3,710
3,710
7,910
7,910
7,910
7,910
7,910
7,910
7,910
E RATE
7,910
7,910
7,910
7,910
7,910
7,910
7,910
7,910
7,910
7,910
7,910
7,910
7,910
7,910
7,910
7,910
7,910
7,910
7,910
Health Care
Institution
Fee
7,910
7,910
7,910
7,910
7,910
7,910
7,910
7,910
7,910
7,910
7,910
7,910
7,910
7,910
7,910
7,910
7,910
7,910
7,910
8,120
8,120
8,120
8,120
E RATE
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
Health Care
Institution
Fee
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
E RATE
8,120
8,120
6,930
6,930
6,930
9,100
9,100
9,100
9,100
9,100
9,100
Health Care
Institution
Fee
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
E RATE
9,100
9,100
9,100
9,100
9,100
9,100
Health Care
Institution
Fee
15,190
15,190
15,190
15,190
15,190
15,190
15,190
15,190
15,190
15,190
7,700
7,700
7,700
7,700
7,700
7,700
7,700
2,800
2,800
2,800
2,800
3,010
3,010
3,010
3,010
3,010
3,010
3,010
3,010
3,010
6,370
6,370
6,370
E RATE
E RATE
6,370
6,370
6,370
6,370
6,370
6,370
Health Care
Institution
Fee
6,370
6,370
6,370
6,370
6,370
6,370
6,370
6,370
6,370
6,370
6,370
6,370
6,370
8,960
8,960
8,960
8,960
8,960
6,370
6,370
6,370
6,370
6,370
6,370
6,370
6,370
6,370
6,370
6,370
6,370
8,400
8,400
8,400
8,400
8,400
8,400
E RATE
Health Care
Institution
Fee
8,400
8,400
9,660
9,660
9,660
9,660
9,660
9,660
9,660
9,660
9,660
9,660
9,660
9,660
9,660
9,660
9,660
9,660
9,660
9,660
9,660
9,660
9,660
9,660
9,660
9,660
9,660
9,660
9,660
9,660
5,180
5,180
5,180
5,180
5,180
5,180
5,180
5,180
5,180
5,180
5,180
5,180
5,180
5,180
5,180
5,740
6,650
6,650
6,650
6,650
6,650
6,650
5,110
5,110
5,110
5,110
Health Care
Institution
Fee
7,000
7,000
7,000
E RATE
7,000
7,000
7,000
7,000
7,000
7,000
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
7,000
7,000
11,200
7,070
7,070
11,060
11,060
11,060
11,060
11,060
11,060
11,060
Health Care
Institution
Fee
11,060
11,060
8,820
8,820
8,820
8,820
E RATE
8,820
8,820
8,820
8,820
8,820
8,820
8,820
8,820
8,820
8,820
8,820
6,090
6,090
6,090
8,470
8,470
8,470
8,470
8,470
8,470
8,470
8,470
Health Care
Institution
Fee
8,470
8,470
8,470
8,470
8,470
8,470
8,470
8,470
E RATE
8,470
8,470
5,810
5,810
5,810
5,810
5,810
5,810
5,810
5,810
5,810
5,810
6,300
6,300
6,300
6,300
4,340
4,340
7,280
7,280
7,280
7,280
7,280
7,280
7,280
7,280
7,280
7,280
7,280
7,280
7,280
7,280
5,810
5,810
Health Care
Institution
Fee
5,810
5,810
5,810
5,810
5,810
5,810
5,810
5,810
5,810
5,810
E RATE
5,810
5,810
5,810
5,810
5,810
5,810
5,810
5,810
4,620
4,620
4,620
4,620
4,620
4,620
4,620
4,620
6,860
6,860
6,860
6,860
6,860
Health Care
Institution
Fee
6,860
6,860
6,860
6,860
6,860
6,860
6,860
6,860
6,860
6,860
6,860
6,860
8,820
8,820
E RATE
8,820
8,820
8,820
8,820
8,820
8,820
8,820
8,820
8,820
9,170
9,170
9,170
9,170
9,170
9,170
9,170
9,170
9,170
9,170
9,170
9,170
9,170
9,170
9,170
9,170
Health Care
Institution
Fee
3,220
3,220
3,220
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
E RATE
5,670
5,670
5,670
5,670
4,200
6,930
6,930
6,930
6,930
6,930
6,930
6,930
6,930
6,930
7,420
7,420
7,420
Health Care
Institution
Fee
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
4,060
4,060
4,060
4,060
4,060
4,060
7,420
7,630
7,630
7,630
7,630
7,630
E RATE
4,620
4,620
4,620
4,620
4,620
Health Care
Institution
Fee
4,620
4,620
5,110
5,110
5,110
5,110
5,110
5,110
5,110
6,650
6,650
6,860
6,860
6,860
6,860
6,860
4,900
6,510
6,510
6,510
6,510
6,510
6,510
8,260
8,260
7,280
7,280
7,280
7,280
7,280
E RATE
22,400
22,400
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
Health Care
Institution
Fee
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
4,970
5,460
5,460
5,460
E RATE
5,460
5,460
5,460
3,780
3,780
Health Care
Institution
Fee
7,980
7,980
7,980
7,980
7,980
7,980
7,980
15,540
15,540
15,540
15,540
5,390
5,390
5,390
5,390
5,390
5,390
5,390
5,390
6,790
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,810
5,810
5,810
5,810
5,810
5,810
5,810
5,810
5,810
5,810
5,810
5,810
E RATE
E RATE
5,810
Health Care
Institution
Fee
5,810
5,810
5,810
5,810
5,810
4,900
4,900
6,090
6,090
6,090
6,090
6,090
4,900
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
6,090
6,090
6,090
6,090
6,090
6,090
6,090
6,090
6,090
6,090
6,090
6,090
9,240
9,240
9,240
4,270
4,270
8,190
8,190
8,190
8,190
8,190
8,190
8,190
8,190
8,190
8,190
4,550
4,550
4,550
4,550
Health Care
Institution
Fee
4,550
4,550
4,550
4,550
E RATE
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
Health Care
Institution
Fee
7,000
7,000
E RATE
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
Health Care
Institution
Fee
7,000
7,000
7,000
7,000
7,000
E RATE
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
7,000
6,440
Health Care
Institution
Fee
6,440
6,440
6,440
6,440
6,440
6,440
6,440
6,440
6,440
6,440
6,440
6,440
6,440
6,440
6,440
6,440
E RATE
6,440
6,440
6,440
6,440
6,440
6,440
3,850
3,850
3,850
3,850
3,850
3,850
3,850
3,850
3,850
3,850
3,850
3,850
3,850
8,610
8,610
8,610
8,610
8,610
8,610
8,610
10,990
10,990
10,990
Health Care
Institution
Fee
10,990
10,990
5,880
5,880
5,880
5,880
5,880
5,880
5,880
5,880
5,880
5,880
5,880
5,880
5,880
5,880
5,880
5,880
5,880
5,880
4,550
E RATE
4,550
4,550
4,550
4,550
4,550
4,550
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
14,140
4,900
4,900
4,900
4,900
4,900
4,900
4,900
5,460
5,460
Health Care
Institution
Fee
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
E RATE
5,460
8,960
8,960
8,960
8,960
8,960
8,960
8,960
8,960
8,960
8,960
Health Care
Institution
Fee
8,960
8,960
8,960
8,960
14,420
14,420
14,420
14,420
4,620
4,620
4,620
12,110
12,110
12,110
12,110
12,110
12,110
9,100
9,100
5,180
5,180
6,510
6,300
6,300
6,300
6,300
6,300
6,300
6,300
6,300
6,300
6,300
6,300
6,300
6,300
6,300
6,300
E RATE
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,670
5,670
5,670
5,670
5,670
5,670
5,670
5,670
5,670
Health Care
Institution
Fee
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
8,120
6,300
6,300
6,300
6,300
6,300
E RATE
6,300
6,300
6,300
6,300
6,300
Health Care
Institution
Fee
6,370
6,370
6,370
6,370
6,370
6,370
6,370
6,370
6,370
6,370
6,370
15,120
15,120
15,120
15,120
15,120
15,120
15,120
15,120
10,080
10,080
10,080
10,080
10,080
10,080
10,080
10,080
10,080
10,080
10,080
10,080
10,080
4,620
4,620
E RATE
E RATE
4,620
Health Care
Institution
Fee
4,620
4,620
4,620
4,620
4,620
6,510
6,510
6,510
6,510
6,510
6,510
6,510
6,510
6,510
6,510
6,510
6,510
6,510
6,510
12,880
12,880
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
Health Care
Institution
Fee
E RATE
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
5,040
9,800
9,800
9,800
9,800
9,800
9,800
6,650
Health Care
Institution
Fee
6,650
6,650
6,650
E RATE
6,650
6,650
6,650
6,650
6,650
6,650
6,650
6,650
6,650
6,650
6,650
6,650
6,650
6,650
6,650
6,650
6,650
6,650
6,650
2,870
2,870
2,870
2,870
2,870
2,870
2,870
7,070
7,070
7,070
7,070
7,070
7,070
7,070
7,070
Health Care
Institution
Fee
19,530
19,530
19,530
6,160
6,160
6,160
6,160
6,160
E RATE
6,160
6,160
6,160
6,160
6,160
6,160
6,160
6,160
6,160
6,160
6,160
6,160
6,160
6,160
6,160
6,160
6,160
6,160
6,160
6,160
6,160
6,160
6,160
6,160
6,160
6,160
6,160
17,920
Health Care
Institution
Fee
17,920
17,920
17,920
17,920
17,920
17,920
17,920
13,230
E RATE
13,230
13,230
13,230
13,230
13,230
13,230
13,230
13,230
13,230
13,230
13,230
13,230
13,230
13,230
13,230
13,230
13,230
8,400
Health Care
Institution
Fee
8,400
8,400
8,400
8,400
8,400
8,400
8,400
8,400
8,400
5,180
5,180
5,180
5,180
5,180
5,180
5,180
5,180
5,180
5,180
E RATE
5,180
5,180
5,180
5,180
5,180
6,160
6,160
6,160
6,160
6,160
6,160
6,160
7,700
7,700
7,700
8,260
8,260
8,260
8,260
8,260
8,260
8,260
8,260
8,260
8,260
8,260
8,260
8,260
8,260
Health Care
Institution
Fee
8,260
8,260
8,260
8,260
8,260
8,260
8,260
8,260
8,260
8,260
8,260
8,260
8,260
8,260
8,260
10,570
10,570
10,570
10,570
10,570
10,570
10,570
10,570
10,570
10,570
10,570
4,760
6,230
6,230
E RATE
6,230
9,870
9,870
9,870
9,870
9,870
9,870
9,870
9,870
9,870
9,870
9,870
9,870
9,870
9,870
9,870
9,870
11,550
11,550
11,550
11,550
11,550
11,550
Health Care
Institution
Fee
11,550
11,550
11,550
11,550
11,550
11,550
11,550
11,830
11,830
11,830
11,830
11,830
11,830
11,830
11,830
11,830
11,830
11,830
11,830
11,830
11,830
11,830
11,830
11,830
11,830
11,830
11,830
11,830
11,830
11,830
9,940
9,940
9,940
9,940
9,940
9,940
9,940
9,940
9,940

Annex1 ListOfMedicalCaseRates

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Neonatal cerebral irritability

ABNORMAL SENSORIUM IN THE NEWBORN

ABSCESS OF RESPIRATORY TRACT

ABSCESS OF RESPIRATORY TRACT

ABSCESS OF RESPIRATORY TRACT

ABSCESS OF RESPIRATORY TRACT

ABSCESS OF RESPIRATORY TRACT

ABSCESS OF RESPIRATORY TRACT

ABSCESS OF RESPIRATORY TRACT

Peritonsillar abscess; Abscess of tonsil; Peritonsillar

Shigellosis due to Shigella boydii; Group C shigellosis

Protozoal intestinal disease, unspecified;Flagellate

Allergic and dietetic gastroenteritis and colitis; Food

FIRST CASE RATE

Noninfective gastroenteritis and colitis, unspecified;

ACUTE RENAL FAILURE

ACUTE RENAL FAILURE

Other acute renal failure

ACUTE RENAL FAILURE

ADULT RESPIRATORY DISTRESS SYNDROME

Angioneurotic oedema; Giant urticaria; Quinke's

FIRST CASE RATE

Mediterranean anaemia; Mediterranean anaemia with ANEMIA

Sickle-cell trait; Hb-S trait ; Heterozygous

Hereditary sideroblastic anaemia; Sex-linked

FIRST CASE RATE

Pyogenic arthritis, unspecified; Infective arthritis NOS

Inflammatory polyarthropathy, site unspecified

Urate tophus of heart ankle and foot

FIRST CASE RATE

Gout due to impairment of renal function multiple sites ARTHRITIS NONINFECTIOUS

Gout due to impairment of renal function lower leg

Other specific arthropathies, not elsewhere classified;

Monoarthritis, not elsewhere classified other sites

ARTHROPOD BORNE VIRAL FEVER

ARTHROPOD BORNE VIRAL FEVER

ARTHROPOD BORNE VIRAL FEVER

ARTHROPOD BORNE VIRAL FEVER

Chikungunya virus disease; Chikungunya

FIRST CASE RATE

Post-traumatic arthrosis of other joints; Post-traumatic

ASTHMA IN ACUTE EXACERBATION

ASTHMA IN ACUTE EXACERBATION

BACK PAIN, RADICULOPATHY, SCIATICA

BACK PAIN, RADICULOPATHY, SCIATICA

BACK PAIN, RADICULOPATHY, SCIATICA

FIRST CASE RATE

BACK PAIN, RADICULOPATHY, SCIATICA

BACK PAIN, RADICULOPATHY, SCIATICA

BACK PAIN, RADICULOPATHY, SCIATICA

BACK PAIN, RADICULOPATHY, SCIATICA

BACK PAIN, RADICULOPATHY, SCIATICA

BACK PAIN, RADICULOPATHY, SCIATICA

BACK PAIN, RADICULOPATHY, SCIATICA

BACK PAIN, RADICULOPATHY, SCIATICA

BACK PAIN, RADICULOPATHY, SCIATICA

Lumbago with sciatica thoracic region

BACK PAIN, RADICULOPATHY, SCIATICA

BACK PAIN, RADICULOPATHY, SCIATICA

BACK PAIN, RADICULOPATHY, SCIATICA

BACK PAIN, RADICULOPATHY, SCIATICA

BACK PAIN, RADICULOPATHY, SCIATICA