Philhealth Case Rates

ANNEX 1.
LIST OF MEDICAL CASE RATES

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
P91.3
P91.4
P91.6
Neonatal cerebral irritability

Neonatal cerebral depression
Hypoxic ischemic encephalopathy of newborn
ABNORMAL SENSORIUM IN THE NEWBORN

12,000
12,000
12,000
Professional
Fee
3,600
3,600
3,600
P91.8
Other specified disturbances of cerebral status of newborn ABNORMAL SENSORIUM IN THE NEWBORN
12,000
3,600
8,400
P91.9
Disturbance of cerebral status of newborn, unspecified
12,000
3,600
8,400
ABSCESS OF RESPIRATORY TRACT
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
Case Rate
Health Care
Institution Fee
8,400
8,400
8,400
J85.1
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;
Oedema of pharynx or nasopharynx
Abscess of lung with pneumonia
J85.2
Abscess of lung without pneumonia; Abscess of lung NOS
10,000
3,000
7,000
J85.3
J86.0
Abscess of mediastinum
Pyothorax with fistula
Pyothorax without fistula; Abscess of pleura; Abscess of
thorax; Empyema; Pyopneumothorax
Cholera due to Vibrio cholerae 01, biovar cholerae
Cholera due to Vibrio cholerae 01, biovar eltor
Cholera, unspecified
Shigellosis due to Shigella dysenteriae; Group A shigellosis
[Shiga-Kruse dysentery]

10,000
10,000
3,000
3,000
7,000
7,000
A03.1
Shigellosis due to Shigella flexneri;Group B shigellosis
A03.2
J36
J38.7
J39.0
J39.1
J39.2
J86.9
10,000
3,000
7,000
ACUTE GASTROENTERITIS
6,000
6,000
6,000
1,800
1,800
1,800
4,200
4,200
4,200
6,000
1,800
4,200
6,000
1,800
4,200
Shigellosis due to Shigella boydii; Group C shigellosis
6,000
1,800
4,200
A03.3
Shigellosis due to Shigella sonnei; Group D shigellosis
6,000
1,800
4,200
A03.8
A03.9
A04.0
A04.1
A04.2
A04.3
A04.4
A04.5
A04.6
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
NOS
Foodborne staphylococcal intoxication
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
hominis; Intestinal coccidiosis; Isosporosis
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
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
4,200
6,000
1,800
4,200
6,000
1,800
4,200
6,000
1,800
4,200
6,000
1,800
4,200
6,000
1,800
4,200
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
4,200
4,200
4,200
4,200
4,200
4,200
4,200
6,000
1,800
4,200
6,000
1,800
4,200
6,000
1,800
4,200
6,000
1,800
4,200
6,000
1,800
4,200
6,000
6,000
1,800
1,800
4,200
4,200
A00.0
A00.1
A00.9
A03.0
A04.7
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
Other specified protozoal intestinal diseases; Intestinal

trichomoniasis; Sarcocystosis; Sarcosporidiosis
Protozoal intestinal disease, unspecified;Flagellate
diarrhoea; Protozoal colitis; Protozoal diarrhoea; Protozoal
dysentery
Rotaviral enteritis
Acute gastroenteropathy due to Norwalk agent; Small
round structured virus enteritis
Adenoviral enteritis
Other viral enteritis
A08.4
Viral intestinal infection, unspecified; Viral enteritis NOS;

Viral gastroenteritis NOS; Viral gastroenteropathy NOS
6,000
1,800
4,200
A08.5
A09.0
A09.9
K52.0
K52.1
Other specified intestinal infections

Infectious diarrhea
Acute gastroenteritis
Gastroenteritis and colitis due to radiation
Toxic gastroenteritis and colitis
6,000
6,000
6,000
6,000
6,000
1,800
1,800
1,800
1,800
1,800
4,200
4,200
4,200
4,200
4,200
Page 1 of 112
ANNEX 1. LIST OF MEDICAL CASE RATES

FIRST CASE RATE
ICD CODE
K52.2
K52.8
K52.9
K58.0
DESCRIPTION
Allergic and dietetic gastroenteritis and colitis; Food
hypersensitivity gastroenteritis or colitis
Other specified noninfective gastroenteritis and colitis;
Eosinophilic gastritis or gastroenteritis
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
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
6,000
1,800
4,200
6,000
1,800
4,200
6,000
1,800
4,200
6,000
1,800
4,200
N17.0
Acute renal failure with tubular necrosis; Tubular necrosis

NOS; Acute Tubular necrosis ; Renal Tubular necrosis
ACUTE RENAL FAILURE
19,300
5,790
13,510
N17.1
Acute renal failure with acute cortical necrosis; Cortical

necrosis NOS; Acute Cortical necrosis ; Renal Cortical
necrosis
ACUTE RENAL FAILURE
19,300
5,790
13,510
N17.2
Acute renal failure with medullary necrosis; Medullary

papillary necrosis, NOS; Acute medullary papillary necrosis; ACUTE RENAL FAILURE
Renal medullary papillary necrosis
19,300
5,790
13,510
N17.8
N17.9
Other acute renal failure

Acute renal failure, unspecified;
ACUTE RENAL FAILURE

ACUTE RENAL FAILURE
19,300
19,300
5,790
5,790
13,510
13,510
O08.4
Renal failure following abortion and ectopic and molar

pregnancy; Oliguria Acute renal failure; Oliguria renal
ACUTE RENAL FAILURE
shutdown; Oliguria renal tubular necrosis; Oliguria Uraemia
19,300
5,790
13,510
J80
Adult respiratory distress syndrome; Adult hyaline

membrane disease
ADULT RESPIRATORY DISTRESS SYNDROME
32,000
9,600
22,400
T78.1
Other adverse food reactions, not elsewhere classified
ALLERGIC REACTIONS
6,200
1,860
4,340
T78.3
Angioneurotic oedema; Giant urticaria; Quinke's oedema
ALLERGIC REACTIONS
6,200
1,860
4,340
6,200
1,860
4,340
6,200
6,200
1,860
1,860
4,340
4,340
6,200
1,860
4,340
10,000
3,000
7,000
6,000
1,800
4,200
6,000
6,000
6,000
6,000
6,000
11,100
7,600
1,800
1,800
1,800
1,800
1,800
3,330
2,280
4,200
4,200
4,200
4,200
4,200
7,770
5,320
7,600
2,280
5,320
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
Allergy, unspecified; Allergic reaction NOS; Hypersensitivity

ALLERGIC REACTIONS
NOS; Idiosyncracy NOS
Other adverse effects, not elsewhere classified
ALLERGIC REACTIONS
Adverse effect, unspecified
ALLERGIC REACTIONS
Unspecified adverse effect of drug or medicament; Adverse
effect of correct drug or medicament properly
ALLERGIC REACTIONS
administered; Allergic reactiion to correct drug or
medicament properly administered; Hypersensitivity to
correct drug or medicament properly administe
Amoebic liver abscess; Hepatic amoebiasis
AMOEBIASIS, HEPATIC
Acute amoebic dysentery; Acute amoebiasis; Intestinal
AMOEBIASIS, NONHEPATIC
amoebiasis NOS
Chronic intestinal amoebiasis
Amoebic nondysenteric colitis
Amoeboma of intestine; Amoeboma NOS
Cutaneous amoebiasis
Amoebic Appendicitis
Other amyloidosis; Localized amyloidosis
AMYLOIDOSIS
Anaphylactic shock due to adverse food reaction
ANAPHYLACTIC SHOCK
Anaphylactic shock, unspecified; Allergic shock NOS;
ANAPHYLACTIC SHOCK
Anaphylactic reaction NOS; Anaphylaxis NOS
Anaphylactic shock due to adverse effect of correct drug or
ANAPHYLACTIC SHOCK
medicament properly administered
Iron deficiency anaemia secondary to blood loss (chronic);
ANEMIA
Posthaemorrhagic anaemia (chronic)
Sideropenic dysphagia; Kelly-Paterson syndrome; PlummerANEMIA
Vinson syndrome
Other iron deficiency anaemias
ANEMIA
Iron deficiency anaemia, unspecified
ANEMIA
Vitamin B12 deficiency anaemia due to intrinsic factor
deficiency; Addison Anaemia; Biermer Anaemia;
ANEMIA
CongenitalPernicious Anaemia; Congenital intrinsic factor
deficiency
Other vitamin B12 deficiency anaemias
ANEMIA
Vitamin B12 deficiency anaemia, unspecified
ANEMIA
Drug-induced folate deficiency anaemia
ANEMIA
Folate deficiency anaemia, unspecified; Folic acid
ANEMIA
deficiency anaemia NOS
Protein deficiency anaemia; Amino-acid deficiency
ANEMIA
anaemia; Orotaciduric anaemia
Other megaloblastic anaemias, not elsewhere classified;
ANEMIA
Megaloblastic anaemia NOS
Scorbutic anaemia
ANEMIA
Other specified nutritional anaemias; Anaemia associated
with deficiency of copper; Anaemia associated with
ANEMIA
deficiency of molybdenum; Anaemia associated with
deficiency of zinc
7,600
2,280
5,320
10,000
3,000
7,000
10,000
3,000
7,000
10,000
10,000
3,000
3,000
7,000
7,000
10,000
3,000
7,000
10,000
10,000
10,000
3,000
3,000
3,000
7,000
7,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
D53.9
Nutritional anaemia, unspecified; Simple chronic anaemia
ANEMIA
10,000
3,000
7,000
D55.0
Anaemia due to glucose-6-phosphate dehydrogenase

[G6PD] deficiency; Favism;
G6PD deficiency anaemia
ANEMIA
10,000
3,000
7,000
Page 2 of 112

FIRST CASE RATE
ICD CODE
D55.1
D55.2
D55.8
D55.9
D56.9
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
Mediterranean anaemia; Mediterranean anaemia with
other haemoglobinopathy; Thalassaemia minor with other
haemoglobinopathy; Thalassaemia mixed with other
haemoglobinopathy;
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
ANEMIA
10,000
3,000
7,000
ANEMIA
10,000
3,000
7,000
ANEMIA
ANEMIA
10,000
10,000
3,000
3,000
7,000
7,000
ANEMIA
10,000
3,000
7,000
D57.0
Sickle-cell anaemia with crisis; Hb-SS disease with crisis
ANEMIA
10,000
3,000
7,000
D57.1
Sickle-cell anaemia without crisis; Sickle-cell anaemia NOS;

ANEMIA
Sickle-cell disease NOS ; Sickle-cell disorder NOS
10,000
3,000
7,000
D57.3
Sickle-cell trait; Hb-S trait ; Heterozygous Haemoglobin S
ANEMIA
10,000
3,000
7,000
D57.8
Other sickle-cell disorders

Hereditary spherocytosis; Acholuric (familial) jaundice;
Congenital (spherocytic) haemolytic icterus; MinkowskiChauffard syndrome
Hereditary elliptocytosis; Congenital Elliptocytosis;
Congenital Ovalocytosis; Hereditary Ovalocytosis
ANEMIA
10,000
3,000
7,000
ANEMIA
10,000
3,000
7,000
ANEMIA
10,000
3,000
7,000
Other haemoglobinopathies; Abnormal haemoglobin NOS;

Congenital Heinz body anaemia; Hb-C Disease; Hb-C
ANEMIA
Disease; Hb-D Disease; Hb-E Disease; Haemoglobinopathy
NOS; Unstable haemoglobin haemolytic disease
10,000
3,000
7,000
ANEMIA
10,000
3,000
7,000
ANEMIA
10,000
3,000
7,000
ANEMIA
10,000
3,000
7,000
ANEMIA
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
D58.0
D58.1
D58.2
D58.8
D58.9
D59.0
D59.1
D59.2
D59.4
D59.5
D59.6
D59.8
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; DrugANEMIA

induced enzyme deficiency anaemia
Other nonautoimmune haemolytic anaemias; Mechanical
ANEMIA
Haemolytic anaemia; Microangiopathic Haemolytic
anaemia; Toxic Haemolytic anaemia
Paroxysmal nocturnal haemoglobinuria [MarchiafavaANEMIA
Micheli]
Haemoglobinuria due to haemolysis from other external
causes; Haemoglobinuria from exertion; Haemoglobinuria ANEMIA
march; Haemoglobinuria paroxysmal cold
ANEMIA
10,000
3,000
7,000
ANEMIA
10,000
3,000
7,000
ANEMIA
10,000
3,000
7,000
ANEMIA
10,000
3,000
7,000
ANEMIA
ANEMIA
ANEMIA
ANEMIA
10,000
10,000
10,000
10,000
3,000
3,000
3,000
3,000
7,000
7,000
7,000
7,000
ANEMIA
10,000
3,000
7,000
D62
D63.0*
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;
Medullary hypoplasia; Panmyelophthisis
Acute posthaemorrhagic anaemia
Anaemia in neoplastic disease
ANEMIA
ANEMIA
10,000
10,000
3,000
3,000
7,000
7,000
D63.8*
Anaemia in other chronic diseases classified elsewhere
ANEMIA
10,000
3,000
7,000
ANEMIA
10,000
3,000
7,000
ANEMIA
10,000
3,000
7,000
D59.9
D60.1
D61.0
D61.1
D61.2
D61.3
D61.8
D61.9
D64.1
Hereditary sideroblastic anaemia; Sex-linked hypochromic

sideroblastic anaemia
Secondary sideroblastic anaemia due to disease
D64.2
Secondary sideroblastic anaemia due to drugs and toxins
ANEMIA
10,000
3,000
7,000
D64.3
Other sideroblastic anaemias; Sideroblastic anaemia NOS;

pyridoxine-responsive NEC Sideroblastic anaemia
ANEMIA
10,000
3,000
7,000
D64.0
Page 3 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
D64.9
M00.16
Other specified anaemias; Infantile pseudoleukaemia;

Leukoerythroblastic anaemia
Anaemia, unspecified
Pneumococcal arthritis and polyarthritis, Lower leg
M00.19
Pneumococcal arthritis and polyarthritis, Site unspecified
D64.8
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
ANEMIA
10,000
3,000
7,000
ANEMIA
ARTHRITIS INFECTIOUS
10,000
9,700
3,000
2,910
7,000
6,790
9,700
2,910
6,790
9,700
2,910
6,790
9,700
2,910
6,790
9,700
2,910
6,790
9,700
2,910
6,790
9,700
2,910
6,790
9,700
2,910
6,790
9,700
2,910
6,790
9,700
2,910
6,790
9,700
2,910
6,790
9,700
2,910
6,790
9,700
2,910
6,790
9,700
9,700
2,910
2,910
6,790
6,790
9,700
2,910
6,790
ARTHRITIS NONINFECTIOUS
7,000
2,100
4,900
7,000
2,100
4,900
7,000
7,000
7,000
2,100
2,100
2,100
4,900
4,900
4,900
M06.01
M06.09
M06.36
Other streptococcal arthritis and polyarthritis, Site

unspecified
Arthritis and polyarthritis due to other specified bacterial
agents upper arm
Pyogenic arthritis, unspecified; Infective arthritis NOS
multiple sites
shoulder region
forearm
hand
pelvic region and thigh
lower leg
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
site unspecified
Reactive arthropathy, unspecified, site unspecified
Seropositive rheumatoid arthritis, unspecified, site
unspecified
Seronegative rheumatoid arthritis, shoulder region
Seronegative rheumatoid arthritis, site unspecified
Rheumatoid nodule, lower leg
M06.45
Inflammatory polyarthropathy, pelvic region and thigh
7,000
2,100
4,900
M06.49
M06.81
M06.86
M06.87
M06.89
M06.90
M06.91
M06.93
M06.94
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
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
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
4,900
M06.95
Rheumatoid arthritis, unspecified, pelvic region and thigh
7,000
2,100
4,900
M06.96
M06.97
M06.98
M06.99
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
with or without rheumatoid factor lower leg
7,000
7,000
7,000
7,000
2,100
2,100
2,100
2,100
4,900
4,900
4,900
4,900
7,000
2,100
4,900
M08.07

with or without rheumatoid factor ankle and foot
7,000
2,100
4,900
M08.09

with or without rheumatoid factor site unspecified
7,000
2,100
4,900
M08.19
M08.86
M08.89
M08.91
M08.96
M08.99
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
7,000
7,000
7,000
7,000
7,000
7,000
2,100
2,100
2,100
2,100
2,100
2,100
4,900
4,900
4,900
4,900
4,900
4,900
M10.00
Idiopathic gout; Gouty bursitis; Primary gout multiple sites ARTHRITIS NONINFECTIOUS
7,000
2,100
4,900
M10.01
M10.02
M10.03
M10.04
M10.05
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
7,000
7,000
7,000
7,000
7,000
2,100
2,100
2,100
2,100
2,100
4,900
4,900
4,900
4,900
4,900
M10.06
Idiopathic gout; Gouty bursitis; Primary gout lower leg
7,000
2,100
4,900
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
7,000
7,000
7,000
7,000
7,000
2,100
2,100
2,100
2,100
2,100
4,900
4,900
4,900
4,900
4,900
M00.29
M00.82
M00.90
M00.91
M00.93
M00.94
M00.95
M00.96
M00.97
M00.98
M00.99
M02.39
M06.19
M08.29
M02.99
M05.99
M08.06
Page 4 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
M10.30
Gout due to impairment of renal function multiple sites
7,000
2,100
4,900
M10.36
Gout due to impairment of renal function lower leg
7,000
2,100
4,900
M10.39
Gout due to impairment of renal function site unspecified
7,000
2,100
4,900
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
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
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
7,000
2,100
4,900
7,000
2,100
4,900
M13.00
M13.01
M13.02
M13.06
M13.09
M13.13
M13.16
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
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
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
4,900
4,900
4,900
4,900
4,900
4,900
4,900
M13.17
Monoarthritis, not elsewhere classified ankle and foot
7,000
2,100
4,900
M13.18
Monoarthritis, not elsewhere classified other sites
7,000
2,100
4,900
M13.80
Other specified arthritis; Allergic arthritis multiple sites
7,000
2,100
4,900
M13.81
Other specified arthritis; Allergic arthritis shoulder region
7,000
2,100
4,900
7,000
2,100
4,900
7,000
2,100
4,900
M12.86
M12.89
M13.86
Other specified arthritis; Allergic arthritis pelvic region and

thigh
Other specified arthritis; Allergic arthritis lower leg
M13.87
Other specified arthritis; Allergic arthritis ankle and foot
7,000
2,100
4,900
M13.88
Other specified arthritis; Allergic arthritis other sites
7,000
2,100
4,900
M13.89
Other specified arthritis; Allergic arthritis site unspecified
7,000
2,100
4,900
M13.90
Arthritis, unspecified; Arthropathy NOS multiple sites
7,000
2,100
4,900
M13.91
Arthritis, unspecified; Arthropathy NOS shoulder region
7,000
2,100
4,900
M13.92
M13.93
M13.94
7,000
7,000
7,000
2,100
2,100
2,100
4,900
4,900
4,900
7,000
2,100
4,900
M13.96
M13.97
M13.98
Arthritis, unspecified; Arthropathy NOS upper arm

Arthritis, unspecified; Arthropathy NOS forearm
Arthritis, unspecified; Arthropathy NOS hand
Arthritis, unspecified; Arthropathy NOS pelvic region and
thigh
Arthritis, unspecified; Arthropathy NOS lower leg
Arthritis, unspecified; Arthropathy NOS ankle and foot
Arthritis, unspecified; Arthropathy NOS other sites
7,000
7,000
7,000
2,100
2,100
2,100
4,900
4,900
4,900
M13.99
Arthritis, unspecified; Arthropathy NOS site unspecified
7,000
2,100
4,900
ARTHROPOD BORNE VIRAL FEVER
8,100
2,430
5,670
8,100
2,430
5,670
A92.2
Venezuelan equine fever; Venezuelan equine encephalitis;

Venezuelan encephalomyelitis virus disease
8,100
2,430
5,670
A92.8
A93.1
Other specified mosquito-borne viral fevers

Sandfly fever; Pappataci fever; Phlebotomus fever

8,100
8,100
2,430
2,430
5,670
5,670
A93.8
Other specified arthropod-borne viral fevers; Piry virus

disease; Vesicular stomatitis virus disease [Indiana fever]
8,100
2,430
5,670
8,100
2,430
5,670
7,000
2,100
4,900
M13.85
M13.95
A92.0
A92.1
A94
M15.0
Chikungunya virus disease; Chikungunya (haemorrhagic)

fever
O'nyong-nyong fever
Unspecified arthropod-borne viral fever; Unspecified

arthropod-borne viral fever; Arboviral fever NOS; Arbovirus ARTHROPOD BORNE VIRAL FEVER
infection NOS
Primary generalized (osteo)arthrosis
ARTHROSIS
Page 5 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
M15.2
Bouchard's nodes (with arthropathy)
ARTHROSIS
7,000
Professional
Fee
2,100
M15.3
Secondary multiple arthrosis; Post-traumatic polyarthrosis
ARTHROSIS
7,000
2,100
4,900
M15.4
M15.8
Erosive (osteo)arthrosis
Other polyarthrosis
ARTHROSIS
ARTHROSIS
7,000
7,000
2,100
2,100
4,900
4,900
M15.9
Polyarthrosis, unspecified; Generalized osteoarthritis NOS
ARTHROSIS
7,000
2,100
4,900
M16.0
Primary coxarthrosis, bilateral

Other primary coxarthrosis; Primary coxarthrosis NOS;
Primary coxarthrosis unilateral
Coxarthrosis resulting from dysplasia, bilateral
Other dysplastic coxarthrosis; Dysplastic coxarthrosis NOS;
Dysplastic coxarthrosis unilateral
Coxarthrosis, unspecified
Primary gonarthrosis, bilateral
Other primary gonarthrosis; Primary gonarthrosis NOS;
Primary gonarthrosis unilateral
Post-traumatic gonarthrosis, bilateral
ARTHROSIS
7,000
2,100
4,900
ARTHROSIS
7,000
2,100
4,900
ARTHROSIS
7,000
2,100
4,900
ARTHROSIS
7,000
2,100
4,900
ARTHROSIS
ARTHROSIS
7,000
7,000
2,100
2,100
4,900
4,900
ARTHROSIS
7,000
2,100
4,900
ARTHROSIS
7,000
2,100
4,900
ARTHROSIS
7,000
2,100
4,900
ARTHROSIS
7,000
2,100
4,900
ARTHROSIS
7,000
2,100
4,900
M16.1
M16.2
M16.3
M16.9
M17.0
M17.1
M17.2
M17.3
Other post-traumatic gonarthrosis; Post-traumatic

gonarthrosis NOS; Post-traumatic gonarthrosis unilateral
Case Rate
Health Care
Institution Fee
4,900
M17.9
Other secondary gonarthrosis; Secondary gonarthrosis

NOS; Secondary gonarthrosis unilateral
Gonarthrosis, unspecified
M18.0
Primary arthrosis of first carpometacarpal joints, bilateral
ARTHROSIS
7,000
2,100
4,900
M18.9
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
Primary arthrosis of other joints; Primary arthrosis NOSsite
unspecified
Post-traumatic arthrosis of other joints; Post-traumatic
arthrosis NOS multiple sites
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
unspecified
Other specified arthrosis shoulder region
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
syndrome
Panniculitis affecting regions of neck and back occipitoatlanto-axial region
Panniculitis affecting regions of neck and back lumbar
region
Panniculitis affecting regions of neck and back sacral and
sacrococcygeal region
ARTHROSIS
7,000
2,100
4,900
ARTHROSIS
7,000
2,100
4,900
ARTHROSIS
7,000
2,100
4,900
ARTHROSIS
7,000
2,100
4,900
ARTHROSIS
7,000
2,100
4,900
ARTHROSIS
7,000
2,100
4,900
ARTHROSIS
7,000
2,100
4,900
ARTHROSIS
7,000
2,100
4,900
ARTHROSIS
7,000
2,100
4,900
ARTHROSIS
7,000
2,100
4,900
ARTHROSIS
7,000
2,100
4,900
ARTHROSIS
7,000
2,100
4,900
ARTHROSIS
7,000
2,100
4,900
ARTHROSIS
ARTHROSIS
ARTHROSIS
ARTHROSIS
ARTHROSIS
ARTHROSIS
ARTHROSIS
ARTHROSIS
ARTHROSIS
ARTHROSIS
ARTHROSIS
ARTHROSIS
ARTHROSIS
ARTHROSIS
ARTHROSIS
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
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
ASTHMA IN ACUTE EXACERBATION
9,000
2,700
6,300
9,000
2,700
6,300

9,000
9,000
9,000
2,700
2,700
2,700
6,300
6,300
6,300
13,800
4,140
9,660
BACK PAIN, RADICULOPATHY, SCIATICA
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
M17.5
M19.00
M19.02
M19.05
M19.06
M19.08
M19.09
M19.10
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
ATELECTASIS
Page 6 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
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
M54.44
M54.46
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
Lumbago with sciatica thoracic region
Lumbago with sciatica lumbar region
M54.48
Lumbago with sciatica sacral and sacrococcygeal region
6,400
1,920
4,480
M54.49
Lumbago with sciatica site unspecified
6,400
1,920
4,480
M54.5
Low back pain; Loin pain; Low back strain; Lumbago NOS
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480

6,400
6,400
1,920
1,920
4,480
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
M54.10
M54.11
M54.12
M54.14
M54.15
M54.16
M54.17
M54.18
M54.19
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480

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
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
1,920
1,920
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
M54.96
Multiple sites in spine
occipito-atlanto-axial region
cervical region
Other dorsalgia thoracic region
Other dorsalgia sacral and sacrococcygeal region
Dorsalgia, unspecified; Backache NOS occipito-atlanto-axial
region
Dorsalgia, unspecified; Backache NOS cervicothoracic
region
Dorsalgia, unspecified; Backache NOS lumbar region
M54.97
Dorsalgia, unspecified; Backache NOS lumbosacral region
6,400
1,920
4,480
M54.98
Dorsalgia, unspecified; Backache NOS sacral and

6,400
1,920
4,480
M54.99
Dorsalgia, unspecified; Backache NOS site unspecified
6,400
1,920
4,480
N31.0
Uninhibited neuropathic bladder, not elsewhere classified
BLADDER DYSFUNCTION
9,000
2,700
6,300
N31.1
Reflex neuropathic bladder, not elsewhere classified
BLADDER DYSFUNCTION
9,000
2,700
6,300
N31.2
Flaccid neuropathic bladder, not elsewhere classified;

Atonic Motor Neuropathic bladder; Sensory Atonic Motor
BLADDER DYSFUNCTION
Neuropathic bladder; Autonomous Neuropathic bladder ;
Nonreflex Neuropathic bladder
9,000
2,700
6,300
M54.50
M54.51
M54.52
M54.84
M54.88
M54.91
M54.93
Page 7 of 112

FIRST CASE RATE
ICD CODE
N31.8
N31.9
N32.9
N39.3
N39.4
R32
A05.1
G93.5
DESCRIPTION
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
(stem)
GROUP
BLADDER DYSFUNCTION
9,000
Professional
Fee
2,700
BLADDER DYSFUNCTION
9,000
2,700
6,300
BLADDER DYSFUNCTION
BLADDER DYSFUNCTION
9,000
9,000
2,700
2,700
6,300
6,300
BLADDER DYSFUNCTION
9,000
2,700
6,300
BLADDER DYSFUNCTION
9,000
2,700
6,300
BOTULISM
4,800
1,440
3,360
Case Rate
Health Care
Institution Fee
6,300
BRAIN HERNIATION
22,400
6,720
15,680
N61
Inflammatory disorders of breast; Acute abscess of non

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
BREAST INFECTIONS
7,900
2,370
5,530
O91.0
Infection of nipple associated with childbirth; Gestational

abscess of nipple; Puerperal abscess of nipple
BREAST INFECTIONS
7,900
2,370
5,530
BREAST INFECTIONS
7,900
2,370
5,530
BREAST INFECTIONS
7,900
2,370
5,530
BREAST INFECTIONS
7,900
2,370
5,530
BREAST INFECTIONS
7,900
2,370
5,530
BREAST MALIGNANCY
BREAST MALIGNANCY
11,800
11,800
3,540
3,540
8,260
8,260
C50.0
C50.1
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
gestational or puerperal
Retracted nipple associated with childbirth
Cracked nipple associated with childbirth; Fissure of nipple,
gestational or puerperal
Malignant neoplasm of Nipple and areola, breast
Malignant neoplasm of Central portion of breast
C50.2
Malignant neoplasm of Upper-inner quadrant of breast
BREAST MALIGNANCY
11,800
3,540
8,260
C50.3
Malignant neoplasm of Lower-inner quadrant of breast
BREAST MALIGNANCY
11,800
3,540
8,260
C50.4
Malignant neoplasm of Upper-outer quadrant of breast
BREAST MALIGNANCY
11,800
3,540
8,260
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
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
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
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
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
BULLOUS DISORDERS
12,000
3,600
8,400
BULLOUS DISORDERS
12,000
3,600
8,400
L12.3
L12.8
L13.0
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
herpetiformis
Acquired epidermolysis bullosa
Other pemphigoid
Dermatitis herpetiformis; Duhring's disease
BULLOUS DISORDERS
BULLOUS DISORDERS
BULLOUS DISORDERS
12,000
12,000
12,000
3,600
3,600
3,600
8,400
8,400
8,400
L13.1
Subcorneal pustular dermatitis; Sneddon-Wilkinson disease BULLOUS DISORDERS
12,000
3,600
8,400
L13.9
T20.4
T21.0
T21.2
T21.5
T21.6
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
wrist and hand
Corrosion of first degree of shoulder and upper limb,
except wrist and hand
Corrosion of second degree of shoulder and upper limb,
except wrist and hand
Burn of second degree of wrist and hand
Corrosion of unspecified degree of wrist and hand
Burn of second degree of hip and lower limb, except ankle
and foot
Corrosion of first degree of hip and lower limb, except
ankle and foot
Corrosion of second degree of hip and lower limb, except
ankle and foot
Burn of second degree of ankle and foot
12,000
8,500
8,500
8,500
8,500
8,500
3,600
2,550
2,550
2,550
2,550
2,550
8,400
5,950
5,950
5,950
5,950
5,950
BURN A
8,500
2,550
5,950
BURN A
8,500
2,550
5,950
BURN A
8,500
2,550
5,950
BURN A
BURN A
8,500
8,500
2,550
2,550
5,950
5,950
BURN A
8,500
2,550
5,950
BURN A
8,500
2,550
5,950
BURN A
8,500
2,550
5,950
BURN A
8,500
2,550
5,950
O91.1
O91.2
O92.0
O92.1
L12.1
L12.2
T22.2
T22.5
T22.6
T23.2
T23.4
T24.2
T24.5
T24.6
T25.2
BULLOUS DISORDERS
BURN A
BURN A
BURN A
BURN A
BURN A
Page 8 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
BURN A
BURN A
BURN A
BURN A
BURN A
BURN A
BURN A
8,500
8,500
8,500
8,500
8,500
8,500
8,500
BURN A
8,500
2,550
5,950
BURN A
8,500
2,550
5,950
BURN A
8,500
2,550
5,950
BURN A
8,500
2,550
5,950
BURN A
8,500
2,550
5,950
BURN A
8,500
2,550
5,950
BURN A
8,500
2,550
5,950
BURN A
8,500
2,550
5,950
BURN A
BURN A
BURN A
BURN A
BURN A
8,500
8,500
8,500
8,500
8,500
2,550
2,550
2,550
2,550
2,550
5,950
5,950
5,950
5,950
5,950
BURN A
8,500
2,550
5,950
BURN A
8,500
2,550
5,950
BURN B
BURN B
BURN B
10,600
10,600
10,600
3,180
3,180
3,180
7,420
7,420
7,420
BURN B
10,600
3,180
7,420
BURN B
BURN B
BURN B
10,600
10,600
10,600
3,180
3,180
3,180
7,420
7,420
7,420
BURN B
10,600
3,180
7,420
BURN B
10,600
3,180
7,420
T25.3
T26.1
T26.2
T26.3
T26.6
T27.0
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
mentioned
Burn of unspecified body region, unspecified degree; Burn
NOS
Burn of second degree, body region unspecified; Secodndegree burn NOS
Burn of third degree, body region unspecified; Third-degree
burn NOS
Corrosion of unspecified body region, unspecified degree;
Corrosion NOS
Corrosion of first degree, body region unspecified; Firstdegree corrosion NOS
Corrosion of second degree, body region unspecified;
Second-degree corrosion NOS
Corrosion of third degree, body region unspecified; Thriddegree corrosion NOS
Burns involving less than 10% of body surface
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
wrist and hand
Burn of third degree of wrist 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
and foot
Corrosion 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
Professional
Fee
2,550
2,550
2,550
2,550
2,550
2,550
2,550
BURN B
BURN B
BURN B
BURN B
BURN B
BURN B
10,600
10,600
10,600
10,600
10,600
10,600
3,180
3,180
3,180
3,180
3,180
3,180
7,420
7,420
7,420
7,420
7,420
7,420
T27.2
Burn of other parts of respiratory tract; Thoracic cavity
BURN B
10,600
3,180
7,420
T28.0
T28.1
T28.2
T28.3
T28.5
T28.6
T28.7
T28.8
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
mentioned
Corrosions of multiple regions, no more than seconddegree corrosions mentioned
BURN B
BURN B
BURN B
BURN B
BURN B
BURN B
BURN B
BURN B
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
7,420
7,420
7,420
7,420
7,420
7,420
7,420
7,420
BURN B
10,600
3,180
7,420
BURN B
10,600
3,180
7,420
BURN B
10,600
3,180
7,420
BURN B
BURN B
BURN B
BURN B
BURN B
BURN B
BURN 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
7,420
7,420
7,420
7,420
7,420
7,420
7,420
T34.9
Frostbite with tissue necrosis of other and unspecified

sites; Frosbite with tissue necrosis NOS; Frosbite with tissue BURN B
of leg NOS; Frosbite with tissue necrosis of trunk NOS
10,600
3,180
7,420
T21.3
T31.6
T31.7
T31.8
T31.9
T32.9
I47.0
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
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
11,270
11,270
11,270
11,270
11,270
11,270
8,540
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
T29.2
T29.3
T29.6
T31.2
T31.3
T31.4
T31.5
T32.2
T32.3
T32.4
BURN C
BURN C
BURN C
BURN C
BURN C
BURN C
CARDIAC ARRHYTHMIA
Page 9 of 112
Case Rate
Health Care
Institution Fee
5,950
5,950
5,950
5,950
5,950
5,950
5,950

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
I48
I49.0
Supraventricular tachycardia; Atrial Paroxysmal

tachycardia; Atrioventricular [AV] Paroxysmal tachycardia;
Junctional Paroxysmal tachycardia; Nodal Paroxysmal
tachycardia
Ventricular tachycardia
Paroxysmal tachycardia, unspecified; Bouveret (-Hoffmann)
syndrome
ATRIAL FIBRILLATION AND FLUTTER
Ventricular fibrillation and flutter
I49.1
Atrial premature depolarization; Atrial premature beats
CARDIAC ARRHYTHMIA
12,200
3,660
8,540
I49.2
I49.3
Junctional premature depolarization

Ventricular premature depolarization
CARDIAC ARRHYTHMIA
CARDIAC ARRHYTHMIA
12,200
12,200
3,660
3,660
8,540
8,540
I49.4
Other and unspecified premature depolarization; Ectopic

beats; Extrasystoles; Extrasystolic arrhythmias; Premature
beats NOS; Premature contractions
CARDIAC ARRHYTHMIA
12,200
3,660
8,540
I49.5
Sick sinus syndrome; Tachycardia-bradycardia syndrome
CARDIAC ARRHYTHMIA
12,200
3,660
8,540
I49.8
Other specified cardiac arrhythmias; Coronary sinus rhythm

CARDIAC ARRHYTHMIA
disorder; Ectopic rhythm disorder; nodal rhythm disorder
12,200
3,660
8,540
I49.9
Cardiac arrhythmia, unspecified; Cardiac arrhythmia NOS
CARDIAC ARRHYTHMIA
12,200
3,660
8,540
I42.0
Dilated cardiomyopathy; Congestive cardiomyopathy

Obstructive hypertrophic cardiomyopathy; Hypertrophic
subaortic stenosis
Other hypertrophic cardiomyopathy; Nonobstructive
hypertrophic cardiomyopathy
CARDIOMYOPATHY
13,400
4,020
9,380
CARDIOMYOPATHY
13,400
4,020
9,380
CARDIOMYOPATHY
13,400
4,020
9,380
I47.1
I47.2
I47.9
I42.1
I42.2
CARDIAC ARRHYTHMIA
12,200
3,660
8,540
CARDIAC ARRHYTHMIA
12,200
3,660
8,540
CARDIAC ARRHYTHMIA
12,200
3,660
8,540
CARDIAC ARRHYTHMIA
CARDIAC ARRHYTHMIA
12,200
12,200
3,660
3,660
8,540
8,540
I42.3
Endomyocardial (eosinophilic) disease; Endomyocardial

(tropical) fibrosis; Lffler's endocarditis
CARDIOMYOPATHY
13,400
4,020
9,380
I42.4
Endocardial fibroelastosis; Congenital cardiomyopathy
CARDIOMYOPATHY
13,400
4,020
9,380
I42.5
I42.6
Other restrictive cardiomyopathy

Alcoholic cardiomyopathy
CARDIOMYOPATHY
CARDIOMYOPATHY
13,400
13,400
4,020
4,020
9,380
9,380
I42.7
Cardio myopathy due to drugs and other external agents
CARDIOMYOPATHY
13,400
4,020
9,380
I42.8
Other cardiomyopathies
CARDIOMYOPATHY
13,400
4,020
9,380
I42.9
Cardio myopathy, unspecified; Primary cardiomyopathy

NOS; Secondary cardiomyopathy NOS
CARDIOMYOPATHY
13,400
4,020
9,380
P29.0
Neonatal cardiac failure
22,700
6,810
15,890
P29.1
Neonatal cardiac dysrhythmia
22,700
6,810
15,890
P29.2
Neonatal hypertension
22,700
6,810
15,890
P29.4
Transient myocardial ischaemia of newborn
22,700
6,810
15,890
22,700
6,810
15,890
8,800
2,640
6,160
9,600
2,880
6,720
9,600
2,880
6,720
CELLULITIS
9,600
2,880
6,720
CELLULITIS
9,600
2,880
6,720
CELLULITIS
9,600
2,880
6,720
CELLULITIS
9,600
2,880
6,720
CELLULITIS
9,600
2,880
6,720
CELLULITIS
CELLULITIS
9,600
9,600
2,880
2,880
6,720
6,720
CEREBRAL PALSY
9,500
2,850
6,650
CEREBRAL PALSY
CEREBRAL PALSY
9,500
9,500
2,850
2,850
6,650
6,650
CEREBRAL PALSY
9,500
2,850
6,650
CEREBRAL PALSY
9,500
2,850
6,650
CEREBRAL PALSY
9,500
2,850
6,650
9,500
2,850
6,650
13,200
3,960
9,240
CARDIOVASCULAR COMPLICATIONS IN THE

NEWBORN
NEWBORN
NEWBORN
NEWBORN
NEWBORN
A46
Other cardiovascular disorders originating in the perinatal

period
Cauda equina syndrome; Neurogenic bladder due to cauda
CAUDA EQUINA SYNDROME
equina syndrome
Excludes: cord bladder NOS (G95.8)
Erysipelas
CELLULITIS
A48.0
Gas gangrene; Clostridial cellulitis; Clostridial myonecrosis CELLULITIS
P29.8
G83.4
L03.0
L03.1
L03.2
L03.3
L03.8
L03.9
L98.3
G80.0
G80.1
G80.2
G80.3
G80.4
G80.8
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
Cellulitis of other sites; Cellulitis of Head [any part, except
face];Cellulitis of Scalp
Cellulitis, unspecified
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
cerebral palsy
Ataxic cerebral palsy
Other infantile cerebral palsy; Mixed cerebral palsy
syndromes
G80.9
Infantile cerebral palsy, unspecified; Cerebral palsy NOS
CEREBRAL PALSY
K74.3
Primary biliary cirrhosis; Chronic nonsupparative

destructive cholangitis
CHOLANGITIS
Page 10 of 112

FIRST CASE RATE
ICD CODE
K80.3
DESCRIPTION
Calculus of bile duct with cholangitis; Any condition listed
in K80.5 with cholangitis
Calculus of gallbladder with acute cholecystitis; Any
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
in K80.5 with cholecystitis (with cholangitis)
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
CHOLANGITIS
13,200
3,960
9,240
CHOLECYSTITIS
11,300
3,390
7,910
CHOLECYSTITIS
11,300
3,390
7,910
CHOLECYSTITIS
11,300
3,390
7,910
K81.0
Acute cholecystitis; Abscess of gallbladder without calculus;

Angiocholecystitis without calculus; Acute emphysematous
cholecystitis without calculus; Gangrenous cholecystitis
CHOLECYSTITIS
without calculus; Supparative cholecystitis without
calculus; Empyema of gallbl
11,300
3,390
7,910
K81.1
K81.8
Q90.0
Q90.2
Q90.9
Q91.0
Q91.2
Q91.3
Q91.7
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
CHOLECYSTITIS
CHOLECYSTITIS
CHROMOSOMAL ABNORMALITIES
11,300
11,300
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
7,910
7,910
8,890
8,890
8,890
8,890
8,890
8,890
8,890
Q92.9
Trisomy and partial trisomy of autosomes, unspecified
12,700
3,810
8,890
12,700
3,810
8,890
12,700
3,810
8,890
12,700
3,810
8,890
12,700
3,810
8,890
K80.0
K80.1
K80.4
Q93.7
Q93.9
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
12,700
12,700
3,810
3,810
8,890
8,890
Q95.9
Balanced rearrangement and structural marker, unspecified CHROMOSOMAL ABNORMALITIES
12,700
3,810
8,890
Q96.9
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
12,700
3,810
8,890
12,700
3,810
8,890
CHRONIC KIDNEY DISEASE
12,700
12,700
12,700
14,500
14,500
14,500
14,500
3,810
3,810
3,810
4,350
4,350
4,350
4,350
8,890
8,890
8,890
10,150
10,150
10,150
10,150
Q93.1
Q93.2
Q93.4
Q93.5
Q97.9
Q98.4
Q99.2
Q99.8
N18.0
N18.8
N18.9
N19
J44.0
Chronic obstructive/ asthmatic/ emphysematous

pulmonary disease with acute lower respiratory infection
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
12,200
3,660
8,540
J44.1
Chronic obstructive/ asthmatic/ emphysematous

pulmonary disease with acute exacerbation, unspecified
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
7,800
2,340
5,460
CLEFT LIP AND PALATE

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
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
COGNITIVE DYSFUNCTION
8,200
2,460
5,740
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
Chronic asthmatic (obstructive) bronchitis NOS; Chronic

emphysematous bronchitis NOS; Chronic obstructive
bronchitis NOS
Chronic obstructive pulmonary disease, unspecified;
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
with cleft lip NOS
Cleft soft palate with bilateral cleft lip
Cleft soft palate with unilateral cleft lip; Cleft soft palate
with cleft lip NOS
Cleft hard and soft palate with bilateral cleft lip
Cleft hard and soft palate with unilateral cleft lip; Cleft hard
and soft palate with cleft lip NOS
Unspecified cleft palate with bilateral cleft lip
Unspecified cleft palate with unilateral cleft lip; Cleft palate
with cleft lip NOS
Vascular dementia of acute onset
Page 11 of 112

FIRST CASE RATE
ICD CODE
R41.0
R41.3
R54
D34
D35.0
D35.1
D35.2
D35.3
D35.4
D35.9
D16.0
D16.1
D16.2
D16.3
D16.4
D16.5
D16.6
D16.7
D16.8
D16.9
D12.0
D12.1
DESCRIPTION
GROUP
8,200
8,200
Professional
Fee
2,460
2,460
Health Care
Institution Fee
5,740
5,740
8,200
2,460
5,740
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
10,500
3,150
7,350
10,500
3,150
7,350
10,500
3,150
7,350
10,500
3,150
7,350
10,500
3,150
7,350
10,500
3,150
7,350
10,500
3,150
7,350
10,500
3,150
7,350
10,500
3,150
7,350
10,500
3,150
7,350
8,700
2,610
6,090
8,700
2,610
6,090
8,700
2,610
6,090
8,700
2,610
6,090
8,700
2,610
6,090
COMPLICATIONS OF BENIGN NEOPLASMS OF THE

DIGESTIVE SYSTEM
8,700
2,610
6,090

DIGESTIVE SYSTEM
8,700
2,610
6,090
8,700
2,610
6,090
8,700
2,610
6,090
8,700
2,610
6,090
8,700
2,610
6,090
8,700
2,610
6,090
8,700
2,610
6,090
8,700
2,610
6,090
8,700
2,610
6,090
8,700
2,610
6,090
8,700
2,610
6,090
Disorientation, unspecified; Confusion NOS

Other amnesia; Amnesia NOS
Senility; Old age without mention of psychosis; Senescence
without mention of psychosis; Senile asthenia; Senile
debility
COMPLICATIONS OF BENIGN NEOPLASMS OF
Benign neoplasm of thyroid gland
ENDOCRINE GLANDS
Benign neoplasm of Adrenal gland
ENDOCRINE GLANDS
Benign neoplasm of Parathyroid gland
ENDOCRINE GLANDS
Benign neoplasm of Pituitary gland
ENDOCRINE GLANDS
Benign neoplasm of Craniopharyngeal duct
ENDOCRINE GLANDS
Benign neoplasm of Pineal gland
ENDOCRINE GLANDS
Benign neoplasm of Endocrine gland, unspecified
ENDOCRINE GLANDS
Benign neoplasm of Scapula and long bones of upper limb
BONES
Benign neoplasm of Short bones of upper limb
BONES
Benign neoplasm ofLong bones of lower limb
BONES
Benign neoplasm of Short bones of lower limb
BONES
Benign neoplasm of Bones of skull and face; Benign
neoplasm of Superior Maxilla; Benign neoplasm of Orbital
BONES
bone
Benign neoplasm of Lower jaw bone
BONES
Benign neoplasm of Vertebral column
BONES
Benign neoplasm of Ribs, sternum and clavicle
BONES
Benign neoplasm of Pelvic bones, sacrum and coccyx
BONES
Benign neoplasm of Bone and articular cartilage,
unspecified
BONES
Benign neoplasm of Caecum;Benign neoplasm of
Ileocaecal valve
DIGESTIVE SYSTEM
Benign neoplasm of Appendix
DIGESTIVE SYSTEM
D12.3
Benign neoplasm of Transverse colon; Benign neoplasm of COMPLICATIONS OF BENIGN NEOPLASMS OF THE
Hepatic flexure; Benign neoplasm of Splenic flexure
DIGESTIVE SYSTEM
D12.4
Benign neoplasm of Descending colon
D12.5
Benign neoplasm of Sigmoid colon
D12.6
D12.7
D12.8
D12.9
D13.0
D13.1
D13.2
D13.3
D13.4
D13.5
D13.6
D13.7
Benign neoplasm of Colon, unspecified; Adenomatosis of

colon; Benign neoplasm of Large intestine NOS; Hereditary
Polyposis of colon
Benign neoplasm of Rectosigmoid junction; Adenomatosis
of colon; Benign neoplasm of Large intestine NOS;
Hereditary Polyposis of colon

DIGESTIVE SYSTEM
DIGESTIVE SYSTEM

DIGESTIVE SYSTEM
Benign neoplasm of Anus and anal canal
DIGESTIVE SYSTEM
Benign neoplasm of Oesophagus
DIGESTIVE SYSTEM
Benign neoplasm of Stomach
DIGESTIVE SYSTEM
Benign neoplasm of Duodenum
DIGESTIVE SYSTEM
Benign neoplasm of Other and unspecified parts of small
intestine
DIGESTIVE SYSTEM
Benign neoplasm of Liver; Benign neoplasm of Intrahepatic COMPLICATIONS OF BENIGN NEOPLASMS OF THE
bile ducts
DIGESTIVE SYSTEM
Benign neoplasm of Extrahepatic bile ducts
DIGESTIVE SYSTEM
Benign neoplasm of Pancreas
DIGESTIVE SYSTEM
Benign neoplasm of Endocrine pancreas; Benign neoplasm
of Islet cell tumour; Benign neoplasm of Islets of
DIGESTIVE SYSTEM
Langerhans
Benign neoplasm of Rectum
Case Rate
D13.9
Benign neoplasm of Ill-defined sites within the digestive

system; Benign neoplasm of Digestive system NOS; Benign
DIGESTIVE SYSTEM
neoplasm of Intestine NOS; Benign neoplasm of Spleen
8,700
2,610
6,090
D17.5
Benign lipomatous neoplasm of intra-abdominal organs

DIGESTIVE SYSTEM
8,700
2,610
6,090
Page 12 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
D17.6
Benign lipomatous neoplasm of spermatic cord

DIGESTIVE SYSTEM
8,700
2,610
6,090
D17.7
Benign lipomatous neoplasm of other sites; Benign

lipomatous neoplasm of Peritoneum; Benign lipomatous
neoplasm of Retroperitoneum

DIGESTIVE SYSTEM
8,700
2,610
6,090
D20.0
Benign neoplasm of of soft tissue of Retroperitoneum
8,700
2,610
6,090
8,700
2,610
6,090
8,700
2,610
6,090
9,600
2,880
6,720
9,600
2,880
6,720
9,600
2,880
6,720
9,600
2,880
6,720
9,600
2,880
6,720
9,600
2,880
6,720
9,600
2,880
6,720
9,600
2,880
6,720
9,600
2,880
6,720
9,600
2,880
6,720
9,600
2,880
6,720
9,600
2,880
6,720
9,600
2,880
6,720
9,600
2,880
6,720
7,700
2,310
5,390
7,700
2,310
5,390
7,700
2,310
5,390
D20.1
Benign neoplasm of of soft tissue of Peritoneum
D21.4
Benign neoplasm of Connective and other soft tissue of

abdomen
D25.0
Submucous leiomyoma of uterus
D25.1
Intramural leiomyoma of uterus
D25.2
Subserosal leiomyoma of uterus
D25.9
Leiomyoma of uterus, unspecified
D26.0
Other Benign neoplasm of Cervix uteri
D26.1
Other Benign neoplasm of Corpus uteri
D26.7
Other Benign neoplasm of Other parts of uterus
D26.9
Other Benign neoplasm of Uterus, unspecified
D27
Benign neoplasm of ovary
D28.0
Benign neoplasm of Vulva
D28.1
Benign neoplasm of Vagina
D28.2
Benign neoplasm of Uterine tubes and ligaments; Benign

neoplasm of Fallopian Tubes; Benign neoplasm of Uterine
Broad Ligament; Benign neoplasm of Uterine round
ligament
D28.7
Benign neoplasm of Other specified female genital organs
D28.9
Benign neoplasm of Female genital organ, unspecified
D29.0
Benign neoplasm of Penis
D29.1
Benign neoplasm of Prostate
D29.2
Benign neoplasm of Testis
D29.4
Benign neoplasm of Scrotum; Benign neoplasm of Skin of

scrotum
D32.0
Benign neoplasm of Cerebral meninges
D32.1
Benign neoplasm of Spinal meninges
D32.9
D33.0
D33.1
D33.2
D33.3
D33.4
D33.7
D33.9
D36.1
D10.0
D10.1
D10.3
Benign neoplasm of Meninges, unspecified; Meningioma

NOS
Benign neoplasm of Brain, supratentorial; Benign neoplasm
of Cerebral ventricle; Benign neoplasm of Cerebrum;
Benign neoplasm of Frontal lobe; Benign neoplasm of
Occipital lobe; Benign neoplasm of Parietal lobe; Benign
neoplasm of Temporal lobe
Benign neoplasm of Brain, infratentorial; Benign neoplasm
of Brain stem; Benign neoplasm of Cerebellum; Benign
neoplasm of Fourth ventricle

DIGESTIVE SYSTEM
DIGESTIVE SYSTEM
DIGESTIVE SYSTEM
FEMALE GENITAL TRACT
MALE GENITAL TRACT
MALE GENITAL TRACT
MALE GENITAL TRACT
MALE GENITAL TRACT
NERVOUS SYSTEM
NERVOUS SYSTEM
NERVOUS SYSTEM
7,700
2,310
5,390
14,800
4,440
10,360
14,800
4,440
10,360
14,800
4,440
10,360

NERVOUS SYSTEM
14,800
4,440
10,360

NERVOUS SYSTEM
14,800
4,440
10,360
14,800
4,440
10,360
14,800
4,440
10,360
14,800
4,440
10,360
14,800
4,440
10,360
14,800
4,440
10,360
14,800
4,440
10,360
9,500
2,850
6,650
9,500
2,850
6,650
9,500
2,850
6,650

NERVOUS SYSTEM
Benign neoplasm of Cranial nerves; Benign neoplasm of
Olfactory bulb
NERVOUS SYSTEM
Benign neoplasm of Spinal cord
NERVOUS SYSTEM
Benign neoplasm of Other specified parts of central
nervous system
NERVOUS SYSTEM
Benign neoplasm of Central nervous system, unspecified; COMPLICATIONS OF BENIGN NEOPLASMS OF THE
Central Nervous system NOS
NERVOUS SYSTEM
Benign neoplasm of Peripheral nerves and autonomic
nervous system
NERVOUS SYSTEM
Benign neoplasm of Lip; Benign neoplasm of frenulum of
Lip; Benign neoplasm of Inner aspect of lip; Benign
ORAL CAVITY, PHARYNX, LARYNX, SALIVARY
neoplasm of Mucosa of Lip; Vermilion border of Lip
GLANDS
Benign neoplasm of Tongue;Benign neoplasm of Lingual
tonsil
GLANDS
Benign neoplasm of Other and unspecified parts of mouth;
Benign neoplasm of Minor salivary gland NOS
GLANDS
Benign neoplasm of Brain, unspecified
Page 13 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
D10.6
Benign neoplasm of Nasopharynx; Benign neoplasm of

Pharyngeal tonsil; Benign neoplasm of Posterior margin of
septum and choanae
D10.7
Benign neoplasm of Hypopharynx
D10.9
Benign neoplasm of Pharynx, unspecified
D11.0
Benign neoplasm of Parotid gland
D11.7
Benign neoplasm of Other major salivary glands
D11.9
Benign neoplasm of Major salivary gland, unspecified
D14.1
Benign neoplasm of Larynx; Benign neoplasm of

suprahyoid portion of Epiglottis
D14.2
Benign neoplasm of Trachea
D30.0
Benign neoplasm of Kidney
D30.1
Benign neoplasm of Renal pelvis
D30.3
Benign neoplasm of Bladder; Benign neoplasm of Urethral

orifice of bladder; Benign neoplasm of ureteric orifice of
bladder
D30.4
D30.9
I51.0
Benign neoplasm of Urethra

Benign neoplasm of Urinary organ, unspecified; Benign
neoplasm of Urinary system NOS
Cardiac septal defect, acquired; Acquired atrial septal
defect old; Acquired auricular septal defect old ; Acquired
ventricular septal defect old
GROUP
GLANDS
GLANDS
GLANDS
GLANDS
GLANDS
GLANDS
GLANDS
GLANDS
URINARY SYSTEM
URINARY SYSTEM
Case Rate
Professional
Fee
Health Care
Institution Fee
9,500
2,850
6,650
9,500
2,850
6,650
9,500
2,850
6,650
9,500
2,850
6,650
9,500
2,850
6,650
9,500
2,850
6,650
9,500
2,850
6,650
9,500
2,850
6,650
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
COMPLICATIONS OF HEART DISEASES
14,400
4,320
10,080

URINARY SYSTEM
URINARY SYSTEM
URINARY SYSTEM
I51.1
Rupture of chordae tendineae, not elsewhere classified
14,400
4,320
10,080
I51.2
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
NOS; Chronic interstitial myocarditis
Myocardial degeneration; Fatty Degeneration of heart or
myocardium fatty; Senile Degeneration of heart or
myocardium; Myocardial disease
14,400
4,320
10,080
14,400
4,320
10,080
14,400
4,320
10,080
14,400
4,320
10,080
14,400
4,320
10,080
9,000
2,700
6,300
9,000
2,700
6,300
10,100
3,030
7,070
10,100
3,030
7,070
10,100
3,030
7,070
10,100
3,030
7,070
10,100
3,030
7,070
10,100
3,030
7,070
10,100
3,030
7,070
COMPLICATIONS OF INTRATHORACIC BENIGN

NEOPLASMS
10,100
3,030
7,070
I51.3
I51.4
I51.5
I51.8
Other ill-defined heart diseases; Acute carditis; Chronic

Carditis; Acute pancarditis; Chronic pancarditis
D18.0
Haemangioma, any site; Angioma NOS
D18.1
Lymphangioma, any site
D14.3
Benign neoplasm of Bronchus and lung
D14.4
Benign neoplasm of Respiratory system, unspecified
D15.0
Benign neoplasm of Thymus
D15.1
Benign neoplasm of Heart
D15.2
Benign neoplasm of Mediastinum
D15.9
Benign neoplasm of Intrathoracic organ, unspecified
D17.4
Benign lipomatous neoplasm of intrathoracic organs
D21.3
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
A52.1
Late Symptomatic neurosyphilis; Tabes dorsalis
COMPLICATIONS OF SEXUALLY TRANSMITTED

DISEASES
5,500
1,650
3,850
A52.3
Neurosyphilis, unspecified; Syphilitic Gumma of central

nervous system NOS; Late Syphilis of central nervous
system NOS; Syphiloma of central nervous system NOS

DISEASES
5,500
1,650
3,850
A52.7
Other symptomatic late syphilis

DISEASES
5,500
1,650
3,850
COMPLICATIONS OF HEMANGIOMA AND

LYMPHANGIOMA
COMPLICATIONS OF HEMANGIOMA AND
LYMPHANGIOMA
NEOPLASMS
NEOPLASMS
NEOPLASMS
NEOPLASMS
NEOPLASMS
NEOPLASMS
NEOPLASMS
Page 14 of 112

FIRST CASE RATE
ICD CODE
A53.0
A54.1
A54.2
A54.8
A55
DESCRIPTION
Latent syphilis, unspecified as early or late; Latent syphilis
NOS; Positive serological reaction for syphilis
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
Chlamydial lymphogranuloma (venereum); Climatic or
tropical bubo ; Durand-Nicolas-Favre disease; Esthiomene;
Lymphogranuloma inguinale
Chlamydial infection of pelviperitoneum and other
genitourinary organs;
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee

DISEASES
5,500
1,650
3,850

DISEASES
5,500
1,650
3,850
5,500
1,650
3,850
5,500
1,650
3,850
5,500
1,650
3,850
5,500
1,650
3,850
5,500
1,650
3,850
9,300
9,300
9,300
2,790
2,790
2,790
6,510
6,510
6,510

DISEASES
DISEASES
DISEASES
A59
Trichomoniasis
T79.0
T79.1
T79.2
Air embolism (traumatic)

Fat embolism (traumatic)
Traumatic secondary and recurrent haemorrhage

DISEASES
DISEASES
COMPLICATIONS OF TRAUMA
T79.3
Post-traumatic wound infection, not elsewhere classified
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510
9,300
9,300
2,790
2,790
6,510
6,510
7,800
2,340
5,460
CONGENITAL ANEMIA
CONGENITAL ANEMIA
15,200
15,200
4,560
4,560
10,640
10,640
CONGENITAL ANEMIA
15,200
4,560
10,640
A56.1
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
Traumatic shock; immediate shock following injury;

Delayed shock following injury
Traumatic anuria; Crush syndrome; Renal failure following
crushing
Traumatic ischaemia of muscle; Compartment syndrome;
Volkmann's ischaemic contracture
Traumatic subcutaneous emphysema
Other early complications of trauma
Congenital adrenogenital disorders associated with enzyme

deficiency; Congenital adrenal hyperplasia; 21-Hydroxylase CONGENITAL ANDROGENITAL DISORDER
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 follicula
Other specified congenital malformations of integument;
Aplasia cutis congenita
4,000
1,200
2,800
CONGENITAL BLOOD DISORDERS

CONGENITAL 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
2,800
8,260
8,260
8,260
8,260
8,260
8,260
8,260
8,260
8,260
11,800
3,540
8,260
CONGENITAL BLOOD DISORDERS
11,800
3,540
8,260
Q50.1
Developmental ovarian cyst
CONGENITAL DISORDERS OF THE FEMALE GENITAL

TRACT
9,300
2,790
6,510
Q50.3
Other congenital malformations of ovary; Accessory ovary; CONGENITAL DISORDERS OF THE FEMALE GENITAL
Congenital malformation of ovary NOS; Ovarian streak
TRACT
9,300
2,790
6,510
Q50.4
Embryonic cyst of fallopian tube; Fimbrial cyst
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510
5,300
1,590
3,710
5,300
1,590
3,710
5,300
1,590
3,710
Q50.5
Q50.6
Q51.0
Embryonic cyst of broad ligament; Cyst epoophoron;

Gartner's duct Cyst; Parovarian Cyst
Other congenital malformations of fallopian tube and
broad ligament; Absence of fallopian tube or broad
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
uterus

TRACT
TRACT
TRACT
TRACT
TRACT
CONGENITAL DISORDERS OF THE
MUSCULOSKELETAL SYSTEM
Q51.9
Congenital malformation of uterus and cervix, unspecified
Q65.6
Unstable hip; Dislocatable hip; Subluxatable hip
Q67.3
Plagiocephaly
Q67.4
Other congenital deformities of skull, face and jaw;

Depressions in skull; Deviation of nasal septum, congenital; CONGENITAL DISORDERS OF THE
Hemifacial atrophy or hypertrophy; Squashed or bent nose, MUSCULOSKELETAL SYSTEM
congenital
Page 15 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
Q67.6
Pectus excavatum; Congenital funnel chest
Q67.7
Pectus carinatum; Congenital pigeon chest
Q68.0
Q76.3
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
scoliosis
Q78.0
Osteogenesis imperfecta; Fragilitas ossium
Q78.2
Osteopetrosis; Albers-Schnberg syndrome
Q78.8
Other specified osteochondrodysplasias; Osteopoikilosis
Q78.9
Q87.5
Q39.0
Q39.1
Q39.2
Q39.6
Q39.9
Q40.0
Q40.1
Osteochondrodysplasia, unspecified; Chondrodystrophy

NOS; Osteodystrophy NOS
Other congenital malformation syndromes with other
skeletal changes
Atresia of oesophagus without fistula; Atresia of
oesophagus NOS
Atresia of oesophagus with tracheo-oesophageal fistula;
Atresia of oesophagus with broncho-oesophageal fistula
Congenital tracheo-oesophageal fistula without atresia;
Congenital tracheo-oesophageal fistula NOS
Diverticulum of oesophagus; Oesophageal pouch
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
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
5,300
1,590
3,710
5,300
1,590
3,710

5,300
1,590
3,710

5,300
1,590
3,710
5,300
1,590
3,710
5,300
1,590
3,710
5,300
1,590
3,710
5,300
1,590
3,710
5,300
1,590
3,710
CONGENITAL GASTROINTESTINAL DISORDERS
11,300
3,390
7,910
11,300
3,390
7,910
11,300
3,390
7,910

11,300
11,300
3,390
3,390
7,910
7,910
11,300
3,390
7,910

11,300
3,390
7,910
Q40.2
Other specified congenital malformations of stomach;

Congenital displacement of stomach; Congenital
diverticulum of stomach; Congenital hourglass stomach;
Duplication of stomach; Megalogastria; Microgastria
11,300
3,390
7,910
Q40.9
Congenital malformation of upper alimentary tract,

unspecified; Congenital anomaly NOS of upper alimentary
tract; Congenital deformity NOS of upper alimentary tract
11,300
3,390
7,910
Q41.0
Congenital absence, atresia and stenosis of duodenum
11,300
3,390
7,910
11,300
3,390
7,910
11,300
3,390
7,910
11,300
3,390
7,910
11,300
3,390
7,910
11,300
3,390
7,910
11,300
3,390
7,910
11,300
3,390
7,910
11,300
3,390
7,910
11,300
3,390
7,910
11,300
3,390
7,910
Q41.1
Q41.2
Q41.9
Q42.0
Q42.1
Q42.2
Q42.3
Q42.9
Q43.0
Q43.1
Q43.2
Congenital absence, atresia and stenosis of jejunum; Apple

peel syndrome; Imperforate jejunum
Congenital absence, atresia and stenosis of ileum
Congenital absence, atresia and stenosis of small intestine,
part unspecified; Congenital absence, atresia and stenosis
of intestine NOS
Congenital absence, atresia and stenosis of rectum with
fistula
Congenital absence, atresia and stenosis of rectum without
fistula; Imperforate rectum
Congenital absence, atresia and stenosis of anus with
fistula
Congenital absence, atresia and stenosis of anus without
fistula; Imperforate anus
Congenital absence, atresia and stenosis of large intestine,
part unspecified
Meckel's diverticulum; Persistent omphalomesenteric duct;
Persistent vitelline duct
Hirschsprung's disease; Aganglionosis; Congenital
(aganglionic) megacolon
Other congenital functional disorders of colon; Congenital
dilatation of colon
11,300
3,390
7,910
Q43.3
Congenital malformations of intestinal fixation; 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
7,910
Q43.4
Q43.5
Q43.6
Q43.7
Duplication of intestine
Ectopic anus
Congenital fistula of rectum and anus
Persistent cloaca; Cloaca NOS

11,300
11,300
11,300
11,300
3,390
3,390
3,390
3,390
7,910
7,910
7,910
7,910
Page 16 of 112

FIRST CASE RATE
ICD CODE
Q43.8
Q43.9
Q44.0
DESCRIPTION
Other specified congenital malformations of intestine;
Congenital blind loop syndrome; Congenital diverticulitis,
colon; Congenital diverticulum, intestine; Dolichocolon;
Megaloappendix; Megaloduodenum;
Microcolon; Transposition of appendix; Transpositio
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
11,300
3,390
7,910
Congenital malformation of intestine, unspecified

Agenesis, aplasia and hypoplasia of gallbladder; Congenital
absence of gallbladder
11,300
3,390
7,910
11,300
3,390
7,910
Q44.1
Other congenital malformations of gallbladder; Congenital

malformation of gallbladder NOS; Intrahepatic gallbladder
11,300
3,390
7,910
Q44.2
Q44.3
Q44.4
Atresia of bile ducts

Congenital stenosis and stricture of bile ducts
Choledochal cyst

11,300
11,300
11,300
3,390
3,390
3,390
7,910
7,910
7,910
Q44.5
Other congenital malformations of bile ducts; Accessory

hepatic duct; Congenital malformation of bile duct NOS;
Biliary duct Duplication; Cystic duct Duplication
11,300
3,390
7,910
Q44.6
Cystic disease of liver; Fibrocystic disease of liver
11,300
3,390
7,910
Q44.7
Other congenital malformations of liver; Accessory liver;

Alagille's syndrome; Congenital absence of liver; Congenital CONGENITAL GASTROINTESTINAL DISORDERS
hepatomegaly; Congenital malformation of liver NOS
11,300
3,390
7,910
11,300
3,390
7,910
11,300
3,390
7,910
11,300
3,390
7,910
11,300
3,390
7,910
11,300
3,390
7,910

CONGENITAL HEART DISEASES
11,300
11,300
11,300
11,300
11,600
11,600
11,600
3,390
3,390
3,390
3,390
3,480
3,480
3,480
7,910
7,910
7,910
7,910
8,120
8,120
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120

11,600
11,600
3,480
3,480
8,120
8,120
11,600
3,480
8,120

11,600
11,600
11,600
11,600
3,480
3,480
3,480
3,480
8,120
8,120
8,120
8,120
11,600
3,480
8,120
11,600
3,480
8,120
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
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
Agenesis, aplasia and hypoplasia of pancreas; Congenital

absence of pancreas
Other specified congenital malformations of digestive
system; Absence of alimentary tract NOS, complete;
Absence of alimentary tract NOS, partial; Duplication of
digestive organs NOS; Malposition, congenital of digestive
organs NOS
Congenital malformation of digestive system, unspecified;
Congenital anomaly NOS of digestive system ; Congenital
deformity NOS of digestive system
Congenital diaphragmatic hernia
Other congenital malformations of diaphragm; Absence of
diaphragm; Congenital malformation of diaphragm NOS;
Eventration of diaphragm
Exomphalos; Omphalocele
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)
Double inlet ventricle; Common ventricle; Cor triloculare
biatriatum; Single ventricle
Discordant atrioventricular 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
septal defect (type I)
Tetralogy of Fallot; Ventricular septal defect with
pulmonary stenosis or atresia, dextroposition of aorta and
hypertrophy of right ventricle.
Aortopulmonary septal defect; Aortic septal defect;
Aortopulmonary window
Other congenital malformations of cardiac septa;
Eisenmenger's defect; Pentalogy of Fallot
Congenital malformation of cardiac septum, unspecified;
Septal (heart) defect NOS
Pulmonary valve atresia
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
Page 17 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
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 CONGENITAL HEART DISEASES
(with mitral valve stenosis or
atresia).
11,600
11,600
Professional
Fee
3,480
3,480
11,600
3,480
8,120
Other congenital malformations of aortic and mitral valves CONGENITAL HEART DISEASES
11,600
3,480
8,120
11,600
3,480
8,120

11,600
11,600
11,600
11,600
3,480
3,480
3,480
3,480
8,120
8,120
8,120
8,120
11,600
3,480
8,120
11,600
3,480
8,120
Q24.8
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
3,480
8,120
Q24.9
Congenital malformation of heart, unspecified; Congenital

anomaly NOS of heart; Congenital disease NOS of heart
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120

11,600
11,600
3,480
3,480
8,120
8,120
Q25.4
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); CONGENITAL HEART DISEASES
Double aortic arch [vascular ring or aorta]; Hypoplasia of
aorta; Persisten
11,600
3,480
8,120
Q25.5
Q25.6
Atresia of pulmonary artery

Stenosis of pulmonary artery

11,600
11,600
3,480
3,480
8,120
8,120
Q25.7
Other congenital malformations of pulmonary artery;

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
3,480
8,120
Q25.8
Other congenital malformations of great arteries
11,600
3,480
8,120
Q25.9
Congenital malformation of great arteries, unspecified
11,600
3,480
8,120
11,600
3,480
8,120
Q23.2
Q23.3
Q23.4
Q23.8
Q23.9
Q24.0
Q24.2
Q24.3
Q24.4
Q24.5
Q24.6
Q25.0
Q25.1
Q25.2
Q25.3
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
Patent ductus arteriosus; Patent ductus Botallo; Persistent

ductus arteriosus
Coarctation of aorta; Preductal coarctation of aorta;
Postductal coarctation of aorta
Atresia of aorta
Stenosis of aorta; Supravalvular aortic stenosis
Case Rate
Health Care
Institution Fee
8,120
8,120
Q26.2
Congenital stenosis of vena cava; Congenital stenosis of

inferior vena cava; Congenital stenosis ofsuperior vena
cava
Total anomalous pulmonary venous connection
11,600
3,480
8,120
Q26.4
Anomalous pulmonary venous connection, unspecified
11,600
3,480
8,120
Q26.8
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
11,600
3,480
8,120
11,600
3,480
8,120
CONGENITAL HYPOTHYROIDISM
9,900
2,970
6,930
9,900
2,970
6,930
9,900
2,970
6,930
13,000
3,900
9,100
13,000
3,900
9,100
13,000
3,900
9,100
13,000
3,900
9,100
13,000
3,900
9,100
13,000
3,900
9,100
Q26.0
Q26.9
E00.0
E03.0
E03.1
Q00.0
Congenital malformation of great vein, unspecified;

Anomaly of inferior vena cava NOS; Anomaly of superior
vena cava NOS
Congenital iodine-deficiency syndrome, neurological type;
Endemic cretinism, neurological type
Congenital hypothyroidism with diffuse goitre; Nontoxic
congenital Goitre NOS; Nontoxic ongenital
parenchymatous Goitre
Congenital hypothyroidism without goitre; Aplasia of
thyroid (with myxoedema); Congenital atrophy of thyroid;
Congenital hypothyroidism NOS
Anencephaly; Acephaly; Acrania; Amyelencephaly;
Hemicephaly; Hemicephaly
Q01.0
Frontal encephalocele
Q01.1
Nasofrontal encephalocele
Q01.2
Occipital encephalocele
Q01.8
Encephalocele of other sites
Q02
Microcephaly; Hydromicrocephaly; Micrencephalon
CONGENITAL MALFORMATIONS OF THE

BRAIN/NERVOUS SYSTEM
Page 18 of 112

FIRST CASE RATE
ICD CODE
Q03.0
Q03.1
Q04.0
DESCRIPTION
Malformations of aqueduct of Sylvius; Anomaly of
aqueduct of sylvius; Obstruction, congenital of aqueduct of
sylvius; Stenosis of aqueduct of sylvius
Atresia of foramina of Magendie and Luschka; DandyWalker syndrome
Congenital malformations of corpus callosum; Agenesis of
corpus callosum
Q04.2
Holoprosencephaly
Q04.3
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
Q04.4
Septo-optic dysplasia
Q04.6
Congenital cerebral cysts; Porencephaly; Schizencephaly
Q04.8
Other specified congenital malformations of brain;

Macrogyria
Q04.9
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
Q05.1
Q05.2
Q05.4
Q05.6
Q05.7
Thoracic spina bifida with hydrocephalus; Dorsal spina

bifida with hydrocephalus; Thoracolumbar spina bifida with
hydrocephalus
Lumbar spina bifida with hydrocephalus; Lumbosacral spina
bifida with hydrocephalus
Unspecified spina bifida with hydrocephalus
Thoracic spina bifida without hydrocephalus; Dorsal NOS
spina bifida; Thoracolumbar NOS spina bifida
Lumbar spina bifida without hydrocephalus; Lumbosacral
spina bifida NOS
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
13,000
3,900
9,100
13,000
3,900
9,100
13,000
3,900
9,100
13,000
3,900
9,100
13,000
3,900
9,100
13,000
3,900
9,100
13,000
3,900
9,100
13,000
3,900
9,100

13,000
3,900
9,100

13,000
3,900
9,100
13,000
3,900
9,100
13,000
3,900
9,100
13,000
3,900
9,100
13,000
3,900
9,100
13,000
3,900
9,100
13,000
3,900
9,100
13,000
3,900
9,100
13,000
3,900
9,100
13,000
3,900
9,100


Q05.8
Sacral spina bifida without hydrocephalus
Q05.9
Spina bifida, unspecified
Q06.0
Amyelia
Q06.2
Diastematomyelia
Q06.4
Hydromyelia; Hydrorachis
Q06.8
Other specified congenital malformations of spinal cord
13,000
3,900
9,100
Q06.9
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
13,000
3,900
9,100
Q07.0
Arnold-Chiari syndrome

13,000
3,900
9,100
Q07.9
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

13,000
3,900
9,100
Q74.3
Arthrogryposis multiplex congenita
13,000
3,900
9,100
Q75.0
Craniosynostosis; Acrocephaly; ]Imperfect fusion of skull;

Oxycephaly; Trigonocephaly
13,000
3,900
9,100
Q75.1
Craniofacial dysostosis; Crouzon's disease
13,000
3,900
9,100
13,000
3,900
9,100
13,000
3,900
9,100

13,000
3,900
9,100

13,000
3,900
9,100
Q75.2
Q75.4
Q75.8
Q75.9
Hypertelorism
Mandibulofacial dysostosis; Franceschetti Syndrome;
Treacher Collins Syndrome
Other specified congenital malformations of skull and face
bones; Absence of skull bone, congenital; Congenital
deformity of forehead; Platybasia
Congenital malformation of skull and face bones,
unspecified; Congenital anomaly of face bones NOS;
Congenital anomaly of skull NOS

Q76.0
Spina bifida occulta

13,000
3,900
9,100
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
9,100
Page 19 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
Q32.0
Congenital tracheomalacia
CONGENITAL MALFORMATIONS OF THE LOWER

RESPIRATORY TRACT
21,700
6,510
15,190
Q32.4
Other congenital malformations of bronchus; Absence of

bronchus; Agenesis of bronchus; Atresia of bronchus;
Congenital malformation NOS of bronchus; Diverticulum of RESPIRATORY TRACT
bronchus; Congenital malformations of lung] of bronchus
21,700
6,510
15,190
Q33.0
Congenital cystic lung; Congenital honeycomb lung;

Congenital cystic lung disease; Congenital polycystic lung
disease
21,700
6,510
15,190
Q33.2
Sequestration of lung
21,700
6,510
15,190
Q33.3
Agenesis of lung; Absence of lung, lobe
21,700
6,510
15,190
Q33.4
Congenital bronchiectasis
21,700
6,510
15,190
Q33.6
Hypoplasia and dysplasia of lung
21,700
6,510
15,190
Q34.1
Congenital cyst of mediastinum
21,700
6,510
15,190
21,700
6,510
15,190

RESPIRATORY TRACT
21,700
6,510
15,190
CONGENITAL MALFORMATIONS OF THE NOSE,

UPPER RESPIRATORY TRACT
11,000
3,300
7,700
11,000
3,300
7,700
11,000
3,300
7,700
11,000
3,300
7,700
11,000
3,300
7,700
11,000
3,300
7,700
11,000
3,300
7,700
4,000
1,200
2,800
4,000
1,200
2,800
4,000
1,200
2,800
4,000
1,200
2,800
4,300
4,300
1,290
1,290
3,010
3,010
CONGENITAL OPHTHALMOLOGIC DISORDERS
4,300
1,290
3,010
4,300
1,290
3,010
4,300
1,290
3,010
4,300
1,290
3,010
Q15.0
Congenital glaucoma; Buphthalmos; Glaucoma of newborn;

Hydrophthalmos; Keratoglobus, congenital, with glaucoma;
Macrocornea with glaucoma; Macrophthalmos in
congenital glaucoma; Megalocornea with glaucoma
4,300
1,290
3,010
Q15.8
Other specified congenital malformations of eye
4,300
1,290
3,010
Q15.9
Congenital malformation of eye, unspecified; Congenital

anomaly NOS of eye; Congenital deformity NOS of eye
4,300
1,290
3,010
CONGENITAL RENAL DISORDERS

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
6,370
6,370
6,370
6,370
6,370
6,370
6,370
9,100
2,730
6,370
9,100
2,730
6,370
Q34.8
Q34.9
Q30.0
Q30.1
Other specified congenital malformations of respiratory

system; Atresia of nasopharynx
Congenital malformation of respiratory system,
unspecified; Congenital absence of respiratory organ ;
Congenital anomaly NOS of respiratory organ
Choanal atresia; Absence of anterior nares; Absence of
posterior nares; congenital stenosis of anterior nares;
Congenital stenosis of posterior nares
Agenesis and underdevelopment of nose; Congenital
absence of nose
Q30.2
Fissured, notched and cleft nose
Q31.3
Laryngocele
Q31.5
Congenital laryngomalacia
Q31.8
Other congenital malformations of larynx; Absence of

cricoid cartilage, epiglottis, glottis, larynx or thyroid
cartilage; Agenesis of cricoid cartilage, epiglottis, glottis,
larynx or thyroid cartilage; Atresia of cricoid cartilage,
epiglottis, glottis,
Q31.9
Congenital malformation of larynx, unspecified
Q38.2
Macroglossia
Q38.5
Q38.6
Q38.8
Q12.2
Q12.4
Q13.4
Q14.0
Q14.1
Q14.9
P96.0
Q60.0
Q60.1
Q60.2
Q60.3
Q60.5
Q60.6
Q61.0
Q61.1
Congenital malformations of palate, not elsewhere

classified; Absence of uvula; Congenital malformation of
palate NOS; High arched palate
Other congenital malformations of mouth; Congenital
malformation of mouth NOS
Other congenital malformations of pharynx; Congenital
malformation of pharynx NOS
Coloboma of lens
Spherophakia
Other congenital corneal malformations; Congenital
malformation of cornea NOS;
Microcornea; Peter's anomaly
Congenital malformation of vitreous humour; Congenital
vitreous opacity
Congenital malformation of retina; Congenital retinal
aneurysm
Congenital malformation of posterior segment of eye,
unspecified
Congenital renal failure; Uraemia of newborn

Renal agenesis, unilateral
Renal agenesis, bilateral
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

RESPIRATORY TRACT
RESPIRATORY TRACT
RESPIRATORY TRACT
RESPIRATORY TRACT
RESPIRATORY TRACT
RESPIRATORY TRACT
RESPIRATORY TRACT

CONGENITAL MALFORMATIONS OF THE ORAL
CAVITY
CAVITY
CAVITY
CAVITY
Page 20 of 112

FIRST CASE RATE
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
DESCRIPTION
Polycystic kidney, autosomal dominant; Polycystic kidney,
adult type
Polycystic kidney, unspecified
Renal dysplasia
Medullary cystic kidney; Sponge kidney NOS
Other cystic kidney diseases; Fibrocystic kidney; Fibrocystic
renal degeneration or disease
Cystic kidney disease, unspecified; Meckel-Gruber
syndrome
Congenital hydronephrosis
Congenital vesico-uretero-renal reflux
Accessory kidney
Lobulated, fused and horseshoe kidney
Ectopic kidney; Congenital displaced kidney; Malrotation of
kidney
Hyperplastic and giant 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
Early congenital syphilis, unspecified; Congenital syphilis
NOS less than two years after birth.
Late congenital neurosyphilis [juvenile neurosyphilis];
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
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
9,100
2,730
6,370

9,100
9,100
9,100
2,730
2,730
2,730
6,370
6,370
6,370
9,100
2,730
6,370
9,100
2,730
6,370

9,100
9,100
9,100
9,100
2,730
2,730
2,730
2,730
6,370
6,370
6,370
6,370
9,100
2,730
6,370
9,100
2,730
6,370
9,100
2,730
6,370
CONGENITAL SYPHILIS
12,800
3,840
8,960
CONGENITAL SYPHILIS
12,800
3,840
8,960
CONGENITAL SYPHILIS
12,800
3,840
8,960
CONGENITAL SYPHILIS
12,800
3,840
8,960
CONGENITAL SYPHILIS
12,800
3,840
8,960
CONGENITAL URINARY TRACT DISORDERS
9,100
2,730
6,370
Q62.2
Congenital megaloureter; Congenital dilatation of ureter
9,100
2,730
6,370
Q62.3
Other obstructive defects of renal pelvis and ureter;

Congenital ureterocele
9,100
2,730
6,370
Q62.5
Duplication of ureter; Accessory of ureter, Double of ureter CONGENITAL URINARY TRACT DISORDERS
9,100
2,730
6,370
9,100
2,730
6,370
9,100
2,730
6,370
9,100
2,730
6,370
9,100
2,730
6,370
9,100
2,730
6,370
Q64.7
Other congenital malformations of bladder and 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
9,100
2,730
6,370
Q64.8
Other specified congenital malformations of urinary system CONGENITAL URINARY TRACT DISORDERS
9,100
2,730
6,370
Q62.6
Q64.1
Q64.2
Q64.3
Q64.4
Q64.9
Q27.1
Q27.3
Q27.8
Q27.9
Q28.0
Q28.1
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
of bladder
Congenital 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;
Prolapse of urachus
Congenital malformation of urinary system, unspecified;

Congenital anomaly NOS of urinary system; Congenital
deformity NOS of urinary system
Congenital renal artery stenosis
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;
Congenital varix
Congenital malformation of peripheral vascular system,
unspecified; Anomaly of artery or vein NOS
Arteriovenous malformation of precerebral vessels;
Congenital arteriovenous precerebral aneurysm
(nonruptured)
Other malformations of precerebral vessels; Congenital
malformation of precerebral vessels NOS; Congenital
precerebral aneurysm (nonruptured)
9,100
2,730
6,370
CONGENITAL VASCULAR DISEASES
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
Page 21 of 112

FIRST CASE RATE
ICD CODE
Q28.2
DESCRIPTION
GROUP
Arteriovenous malformation of cerebral vessels;

Arteriovenous malformation of brain NOS;
Congenital arteriovenous cerebral aneurysm (nonruptured)
Case Rate
Professional
Fee
Health Care
Institution Fee
12,000
3,600
8,400
12,000
3,600
8,400
CONNECTIVE TISSUE DISEASES
13,800
4,140
9,660
13,800
4,140
9,660

13,800
13,800
4,140
4,140
9,660
9,660
13,800
4,140
9,660
13,800
4,140
9,660
13,800
4,140
9,660
13,800
4,140
9,660
13,800
4,140
9,660

13,800
13,800
4,140
4,140
9,660
9,660
13,800
4,140
9,660

13,800
13,800
13,800
13,800
13,800
13,800
4,140
4,140
4,140
4,140
4,140
4,140
9,660
9,660
9,660
9,660
9,660
9,660
13,800
4,140
9,660
M34.2
M34.9
M35.0
Other malformations of cerebral vessels; Congenital

cerebral aneurysm, nonruptured; Congenital malformation
of cerebral vessels NOS
Polyarteritis nodosa
Polyarteritis with lung involvement [Churg-Strauss]; Allergic
granulomatous angiitis
Juvenile polyarteritis
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]

13,800
13,800
13,800
4,140
4,140
4,140
9,660
9,660
9,660
M35.1
Other overlap syndromes; Mixed connective tissue disease CONNECTIVE TISSUE DISEASES
13,800
4,140
9,660
M35.2
M35.3
M35.4
Behet's disease
Polymyalgia rheumatica
Diffuse (eosinophilic) fasciitis

13,800
13,800
13,800
4,140
4,140
4,140
9,660
9,660
9,660
M35.8
Other specified systemic involvement of connective tissue
13,800
4,140
9,660
13,800
4,140
9,660
CRANIAL NERVE DISORDER
7,400
2,220
5,180

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
5,180
5,180
5,180
5,180
5,180
5,180
5,180
7,400
2,220
5,180
7,400
2,220
5,180
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
G50.8
G51.0
G51.1
G51.3
G51.4
G51.8
G51.9
Systemic involvement of connective tissue, unspecified;

Systemic Autoimmune disease NOS; Collagen (vascular)
disease NOS
Trigeminal neuralgia; Syndrome of paroxysmal facial pain;
Tic douloureux
Other disorders of trigeminal nerve
Bell's palsy; Facial palsy
Geniculate ganglionitis
Clonic hemifacial spasm
Facial myokymia
Other disorders of facial nerve
Disorder of facial nerve, unspecified
G52.0
Disorders of olfactory nerve; Disorder of 1st cranial nerve
M35.9
G50.0
G52.1
Disorders of glossopharyngeal nerve; Disorder of 9th

cranial nerve; Glossopharyngeal neuralgia
Disorders of vagus nerve; Disorder of pneumogastric [10th]
nerve
7,400
2,220
5,180
G52.7
Disorders of multiple cranial nerves; Polyneuritis cranialis
7,400
2,220
5,180
G52.8
Disorders of other specified cranial nerves

Optic neuritis; Optic neuropathy, except ischaemic; Optic
papillitis; Retrobulbar neuritis NOS
Disorders of optic nerve, not elsewhere classified;
Compression of optic nerve; Haemorrhage in optic nerve
sheath; Ischaemic optic neuropathy
Acute obstructive laryngitis [croup]; Obstructive laryngitis
NOS
7,400
2,220
5,180
7,400
2,220
5,180
7,400
2,220
5,180
CROUP
8,200
2,460
5,740
9,500
2,850
6,650
CUSHING'S SYNDROME
CUSHING'S SYNDROME
CUSHING'S SYNDROME
CUSHING'S SYNDROME
CUSHING'S SYNDROME
CYSTIC FIBROSIS
CYSTIC FIBROSIS
9,500
9,500
9,500
9,500
9,500
7,300
7,300
2,850
2,850
2,850
2,850
2,850
2,190
2,190
6,650
6,650
6,650
6,650
6,650
5,110
5,110
CYSTIC FIBROSIS
7,300
2,190
5,110
CYSTIC FIBROSIS
7,300
2,190
5,110
G52.2
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
Pituitary-dependent Cushing's disease; Overproduction of

CUSHING'S SYNDROME
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
Page 22 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
DEGENERATIVE DISEASES OF CENTRAL NERVOUS
SYSTEM
SYSTEM
SYSTEM
SYSTEM
SYSTEM
SYSTEM
G30.0
Alzheimer's disease with early onset
G30.1
Alzheimer's disease with late onset
G30.8
Other Alzheimer's disease
G30.9+F00.9*
Dementia in alzheimer's disease, unspecified
G31.0
Circumscribed brain atrophy; Pick's disease; Progressive

isolated aphasia
G31.1
Senile degeneration of brain, not elsewhere classified
G31.2
Degeneration of nervous system due to alcohol; Alcoholic

cerebellar ataxia; Alcoholic cerebellar degeneration;
Alcoholic cerebral degeneration; Alcoholic encephalopathy; SYSTEM
Dysfunction of autonomic nervous system due to alcohol
G31.8
G32.8*
G35
G36.0
G36.1
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
in diseases classified elsewhere
Multiple sclerosis; Multiple sclerosis NOS; Multiple
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]
G36.8
Other specified acute disseminated demyelination
G36.9
Acute disseminated demyelination, unspecified
G37.0
Diffuse sclerosis; Periaxial encephalitis; Schilder's disease
G37.1
Central demyelination of corpus callosum
G37.2
Central pontine myelinolysis
G37.3
Acute transverse myelitis in demyelinating disease of

central nervous system; Acute transverse myelitis NOS
G37.4
G37.8
G37.9
A90
A91.1
A91.3
E23.2
N25.1
E10.0
E10.1
E11.0
E11.1
E12.0
E13.0
E13.1
Subacute necrotizing myelitis

Other specified demyelinating diseases of central nervous
system
Demyelinating disease of central nervous 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
(mellitus) withcoma ; Ketosis-prone diabetes (mellitus)
with coma; Type I diabetes (mellitus) with coma;
Professional
Fee
Health Care
Institution Fee
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000

SYSTEM
10,000
3,000
7,000

SYSTEM
10,000
3,000
7,000
DEMYELINATING DISEASE OF CENTRAL NERVOUS

SYSTEM
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
10,000
10,000
16,000
10,100
10,100
3,000
3,000
4,800
3,030
3,030
7,000
7,000
11,200
7,070
7,070
15,800
4,740
11,060
15,800
4,740
11,060
15,800
4,740
11,060
15,800
4,740
11,060
DIABETES MELLITUS WITH COMA OR KETOSIS
15,800
4,740
11,060
15,800
4,740
11,060
15,800
4,740
11,060

SYSTEM
SYSTEM
SYSTEM
SYSTEM
SYSTEM
SYSTEM
SYSTEM
SYSTEM
SYSTEM
SYSTEM
SYSTEM
DENGUE FEVER
DENGUE FEVER
DENGUE, SEVERE
DIABETES INSIPIDUS
DIABETES INSIPIDUS
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
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
Malnutrition-related diabetes mellitus with coma; Insulindependent 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
Case Rate
Page 23 of 112

FIRST CASE RATE
ICD CODE
E14.0
E14.1
E10.5
E10.6
E10.7
E10.8
DESCRIPTION
Unspecified diabetes mellitus; diabetes NOS with coma
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
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
15,800
4,740
11,060
15,800
4,740
11,060
12,600
3,780
8,820
12,600
3,780
8,820
12,600
3,780
8,820
12,600
3,780
8,820
DIABETES MELLITUS WITH COMPLICATIONS

OTHER THAN COMA AND KETOSIS
E11.5
Non-insulin-dependent diabetes mellitus with Diabetic

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
8,820
E11.6
NON-INSULIN-DEPENDENT DIABETES MELLITUS WITH

OTHER SPECIFIED COMPLICATIONS

12,600
3,780
8,820
E11.7
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
8,820

12,600
3,780
8,820

12,600
3,780
8,820

12,600
3,780
8,820
12,600
3,780
8,820
12,600
3,780
8,820
12,600
3,780
8,820
12,600
3,780
8,820
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
D73.2
D73.3
D73.4
D73.5
Malnutrition-related diabetes mellitus with Diabetic

gangrene/ ulcer; Insulin-dependent malnutrition-related
diabetes mellitus with Diabetic gangrene/ ulcer; Noninsulin-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; Noninsulin-dependent malnutrition-related diabetes mellitus
with unspecified complicati
Other specified diabetes mellitus with Diabetic gangrene/
ulcer
OTHER SPECIFIED DIABETES MELLITUS WITH OTHER
SPECIFIED COMPLICATIONS
Unspecified diabetes mellitus; diabetes NOS with Diabetic
gangrene/ ulcer
UNSPECIFIED DIABETES MELLITUS WITH OTHER SPECIFIED
COMPLICATIONS
Unspecified diabetes mellitus; diabetes NOS with multiple
complications
Pharyngeal diphtheria; Diphtheritic membranous angina;
Tonsillar diphtheria
Cutaneous 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;

12,600
3,780
8,820
DIPHTHERIA
8,700
2,610
6,090
DIPHTHERIA
DIPHTHERIA
8,700
8,700
2,610
2,610
6,090
6,090
DISEASES OF BLOOD AND BLOOD FORMING

ORGANS
12,100
3,630
8,470

ORGANS
12,100
3,630
8,470

ORGANS
12,100
3,630
8,470

ORGANS
12,100
3,630
8,470
12,100
3,630
8,470
12,100
3,630
8,470
12,100
3,630
8,470
12,100
3,630
8,470

ORGANS
Abscess of spleen
ORGANS
Cyst of spleen
ORGANS
Infarction of spleen; Nontraumatic Splenic rupture; Torsion DISEASES OF BLOOD AND BLOOD FORMING
of spleen
ORGANS
Chronic congestive splenomegaly
Page 24 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
D73.8
Other diseases of spleen; Fibrosis of spleen NOS;

Perisplenitis; Splenitis NOS
D74.9
Methaemoglobinaemia, unspecified
D75.0
D75.1
D75.2
D75.8
D76.0
D76.1
D76.2
D76.3
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
GROUP
ORGANS
ORGANS
ORGANS
Case Rate
Professional
Fee
Health Care
Institution Fee
12,100
3,630
8,470
12,100
3,630
8,470
12,100
3,630
8,470
12,100
3,630
8,470
12,100
3,630
8,470
12,100
3,630
8,470
12,100
3,630
8,470
12,100
3,630
8,470
12,100
3,630
8,470
12,100
3,630
8,470
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
DISEASES OF ESOPHAGUS
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
DISEASES OF EXTERNAL EAR
9,000
2,700
6,300
9,000
2,700
6,300
9,000
2,700
6,300
9,000
2,700
6,300
DISEASES OF INNER EAR

DISEASES OF INNER EAR
6,200
6,200
1,860
1,860
4,340
4,340
DISEASES OF MIDDLE EAR AND MASTOID
10,400
3,120
7,280
10,400
3,120
7,280
10,400
3,120
7,280
10,400
3,120
7,280
10,400
3,120
7,280

10,400
10,400
3,120
3,120
7,280
7,280
10,400
3,120
7,280

10,400
10,400
10,400
10,400
10,400
10,400
3,120
3,120
3,120
3,120
3,120
3,120
7,280
7,280
7,280
7,280
7,280
7,280
DISEASES OF ORAL CAVITY, SALIVARY GLANDS,

AND JAW
8,300
2,490
5,810
Developmental (nonodontogenic) cysts of oral region; Cyst

of globulomaxillary; Cyst of incisive canal; Cyst of median
AND JAW
palatal; Cyst of nasopalatine; Cyst of palatine papilla
8,300
2,490
5,810
Familial erythrocytosis; Benign Polycythaemia; Familial

Polycythaemia
Secondary polycythaemia; Acquired Polycythaemia due to
erythropoietin; Acquired Polycythaemia due to fall in
plasma volume; Acquired Polycythaemia due to high
ORGANS
altitude; Acquired Polycythaemia due to stress; Emotional
Polycythaemia; Hypoxaemic Polycytha
Essential thrombocytosis
ORGANS
Other specified diseases of blood and blood-forming organs
ORGANS
Langerhans' cell histiocytosis, not elsewhere classified
ORGANS
Haemophagocytic lymphohistiocytosis; Eosinophilic
granuloma; Hand-Schller-Christian disease; Chronic
ORGANS
Histiocytosis X
Haemophagocytic syndrome, infection-associated
ORGANS
Other histiocytosis syndromes; Reticulohistiocytoma (giantDISEASES OF BLOOD AND BLOOD FORMING
cell); Sinus histiocytosis with massive lymphadenopathy;
ORGANS
Xanthogranuloma
Oesophagitis; Abscess of oesophagus; Oesophagitis NOS;
Chemical oesophagitis; Peptic oesophagitis
Achalasia of cardia; Achalasia NOS; Cardiospasm
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 oesophagus
Oesophageal obstruction; Compression of oesophagus;
Constriction of oesophagus; Stenosis of oesophagus;
Stricture of oesophagus;
Perforation of oesophagus; Rupture of oesophagus
Dyskinesia of oesophagus; Corksrew oesophagus; Diffuse
oesophageal spasm; Spasm of oesophagus
Gastro-oesophageal laceration-haemorrhage syndrome;
Mallory-Weiss syndrome
Barrett's esophagus; Barret's disease; Barett's syndrome
Other specified diseases of oesophagus; Haemorrhage of
oesophagus NOS
Disease of oesophagus, unspecified
Cellulitis of external ear; Cellulitis of auricle; Cellulitis of
external auditory canal
Malignant otitis externa
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
Page 25 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
K09.2
Other cysts of jaw; Cyst of jaw NOS; Aneurysmal cyst of

jaw; Haemorrhagic cyst of jaw; Traumatic cyst of jaw

AND JAW
8,300
2,490
5,810
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

AND JAW
8,300
2,490
5,810
K09.9
Cyst of oral region, unspecified

AND JAW
8,300
2,490
5,810
K10.0
Developmental disorders of jaws; Latent bone cyst of jaw;

Stafne's cyst; Torus mandibularis; Torus palatinus

AND JAW
8,300
2,490
5,810
K10.1
Giant cell granuloma, central; Giant cell granuloma NOS
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810

AND JAW
8,300
2,490
5,810

AND JAW
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810

AND JAW
8,300
2,490
5,810

AND JAW
8,300
2,490
5,810
K10.2
K10.3

AND JAW
Inflammatory conditions of jaws; Acute osteitis of jaw;
Chronic osteitis of jaw; Supparative osteitis of jaw; Acute
neonatal osteomyelitis of jaw; Chronic neonatal
AND JAW
osteomyelitis of jaw; Supparative neonatal osteomyelitis of
jaw; Acute osteoradionecrosis o
Alveolitis of jaws; Alveolar osteitis; Dry socket
AND JAW
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
K11.4
Fistula of salivary gland
K11.5
K11.6
K11.8
K11.9
K12.2
K13.4
K13.7
Sialolithiasis; Calculus of salivary gland or duct; Stone of

salivary gland or duct
Mucocele of salivary gland; Mucous extravasation cyst of
salivary gland; Mucous retention cyst of salivary gland;
Ranula
Other diseases of salivary glands; Benign lymphoepithelial
lesion of salivary gland; Mikulicz' disease; Necrotizing
sialometaplasia; Sialectasia; Stenosis of salivary duct;
Stricture of salivary duct
Disease of salivary gland, unspecified; Sialoadenopathy
NOS
Cellulitis and abscess of mouth; Cellulitis of floor of mouth;
Submandibular abscess
Granuloma and granuloma-like lesions of oral mucosa;
Eosinophilic granuloma of oral mucosa; Granuloma
pyogenicum of oral mucosa; Verrucous xanthoma of oral
mucosa
Other and unspecified lesions of oral mucosa; Focal oral
mucinosis

AND JAW
AND JAW
AND JAW
AND JAW
AND JAW

AND JAW
AND JAW
K31.1
Adult hypertrophic pyloric stenosis; Pyloric stenosis NOS
DISEASES OF STOMACH AND DUODENUM
6,600
1,980
4,620
K31.2
K31.3
K31.4
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

6,600
6,600
6,600
1,980
1,980
1,980
4,620
4,620
4,620
6,600
1,980
4,620
6,600
1,980
4,620
6,600
1,980
4,620
6,600
1,980
4,620
9,800
2,940
6,860
9,800
2,940
6,860
K31.5
K31.6
K31.7
K31.8
DISEASES OF THE GALLBLADDER AND BILIARY

TRACT
TRACT
K74.4
Secondary biliary cirrhosis
K74.5
Biliary cirrhosis, unspecified
K80.2
Calculus of gallbladder without cholecystitis;

Cholecystolithiasis unspecified or without cholecystitis;
Cholelithiasis unspecified or without cholecystitis;
Recurrent colic of gallbladder unspecified or without
cholecystitis; Impacted gallstone of cystic

TRACT
9,800
2,940
6,860
K80.5
Calculus of bile duct without cholangitis or cholecystitis;

Choledocholithiasis unspecified or without cholangitis or
cholecystitis; Impacted gallstone of bile duct NOS
unspecified or without cholangitis or cholecystitis;
Impacted gallstone of common duct

TRACT
9,800
2,940
6,860
K80.8
Other cholelithiasis

TRACT
9,800
2,940
6,860
Page 26 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
K82.0
Obstruction of gallbladder; Occlusion of cystic duct of

gallbladder without calculus; Stenosis of cystic duct or
gallbladder without calculus; Stricture of cystic duct or
gallbladder without calculus
K82.1
Hydrops of gallbladder; Mucocele of gallbladder
K82.2
K82.3
K82.4
K82.8
K83.0
K83.1
Perforation of gallbladder; Rupture of cystic duct or

gallbladder
Fistula of gallbladder; Cholecystocolic fistula;
Cholecystoduodenal fistula
Cholesterolosis of gallbladder; Strawberry gallbladder
Other specified diseases of gallbladder; Adhesions of cystic
duct or gallbladder; Atrophy of cystic duct or 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;
Primary cholangitis; Recurrent cholangitis; Sclerosing
cholangitis; Secondary cholangitis; Stenosing cholangitis;
Suppurative cholangitis
Obstruction of bile duct; Occlusion of bile duct without
calculus; Stenosis of bile duct without calculus; Stricture of
bile duct without calculus
GROUP

TRACT
Case Rate
Professional
Fee
Health Care
Institution Fee
9,800
2,940
6,860
9,800
2,940
6,860
9,800
2,940
6,860
9,800
2,940
6,860
9,800
2,940
6,860

TRACT
9,800
2,940
6,860

TRACT
9,800
2,940
6,860

TRACT
9,800
2,940
6,860
9,800
2,940
6,860
9,800
2,940
6,860
9,800
2,940
6,860
9,800
2,940
6,860

TRACT
TRACT
TRACT
TRACT

TRACT
TRACT
TRACT
K83.3
Fistula of bile duct; Choledochoduodenal fistula
K83.4
Spasm of sphincter of Oddi
K83.5
Biliary cyst
K83.8
Other specified diseases of biliary tract; Adhesions of bile

duct; Atrophy of bile duct; Hypertrophy of bile duct; Ulcer
of bile duct

TRACT
K85
Acute pancreatitis; Abscess of pancreas; Acute necrosis of

pancreas; Infective necrosis of pancreas; Pancreatitis NOS;
Acute recurrent pancreatitis; Haemorrhagic pancreatitis;
Subacute pancreatitis; Supparative pancreatitis
DISEASES OF THE PANCREAS
12,600
3,780
8,820
K85.0
K85.1
K85.2
K85.8
Idiopathic acute pancreatitis

Biliary acute pancreatitis; Gallstone pancreatitis
Alcohol-induced acute pancreatitis
Other acute pancreatitis

12,600
12,600
12,600
12,600
3,780
3,780
3,780
3,780
8,820
8,820
8,820
8,820
K85.9
Acute pancreatitis, unspecified; Other diseases of pancreas DISEASES OF THE PANCREAS
12,600
3,780
8,820
K86.0
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
12,600
3,780
8,820
12,600
3,780
8,820

12,600
12,600
3,780
3,780
8,820
8,820
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
12,600
3,780
8,820
DISEASES OF VASCULAR SYSTEM
13,100
3,930
9,170
13,100
3,930
9,170
13,100
3,930
9,170
13,100
3,930
9,170
13,100
3,930
9,170
K86.1
K86.2
K86.3
K86.8
I28.8
I71.0
I71.9
I74.0
I74.1
Other specified diseases of pulmonary vessels; Rupture of

pulmonary vessel; Stenosis of pulmonary vessel; Stricture
of pulmonary vessel
Dissection of aorta [anypart]; Dissecting aneurysm of aorta
(ruptured) [any part]
Aortic aneurysm of unspecified site without mention of
rupture; Aneurysm of aorta; Dilatation of aorta; Hyaline
necrosis of aorta
Embolism and thrombosis of abdominal aorta; Aortic
bifurcation syndrome; Leriche's syndrome
Embolism and thrombosis of other and unspecified parts of
aorta
I74.2
Embolism and thrombosis of arteries of upper extremities
13,100
3,930
9,170
I74.3
Embolism and thrombosis of arteries of lower extremities
13,100
3,930
9,170
13,100
3,930
9,170

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
9,170
9,170
9,170
9,170
9,170
9,170
9,170
13,100
3,930
9,170
I74.4
I74.5
I74.8
I74.9
I77.4
I77.6
I77.8
I85.0
I87.1
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
Page 27 of 112

FIRST CASE RATE
ICD CODE
H30.1
H30.8
H31.3
DESCRIPTION
Disseminated chorioretinal inflammation; Disseminated
chorioretinitis; Disseminated choroiditis; Disseminated
retinitis; Disseminated retinochoroiditis
Other chorioretinal inflammations; Harada's disease
Choroidal haemorrhage and rupture; Choroidal
haemorrhage NOS; Choroidal haemorrhage expulsive
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
DISODERS OF CHOROID AND RETINA
4,600
1,380
3,220
4,600
1,380
3,220
4,600
1,380
3,220
2,370
5,530
M80.0
Postmenopausal osteoporosis with pathological fracture
DISORDER OF BONE DENSITY AND STRUCTURE
7,900
M80.1
Postoophorectomy osteoporosis with pathological fracture DISORDER OF BONE DENSITY AND STRUCTURE
7,900
2,370
5,530
7,900
2,370
5,530

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
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
5,530
M81.0
M81.08
M81.1
M81.4
M81.40
M81.55
M81.58
M81.6
M81.8
M81.88
Postsurgical malabsorption osteoporosis with pathological

fracture
Postmenopausal osteoporosis
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
M81.89
Other osteoporosis; Senile osteoporosis Site unspecified
7,900
2,370
5,530
M81.9
M81.95
M81.98
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;
Hyperostosis of bones, except skull
Other specified disorders of bone density and structure;
Hyperostosis of bones, except skull Other
Hypertrophy of bone Other
Other sphingolipidosis; Fabry(-Anderson) Disease; Gaucher
Disease; Krabbe Disease; Niemann-Pick Disease; Faber's
syndrome; Metachromatic leukodystrophy; Sulfatase
deficiency
Neuronal ceroid lipofuscinosis; Batten Disease;
Bielschowsky-Jansky Disease; Kufs Disease; pielmeyer-Vogt
Disease
Other lipid storage disorders; Cerebrotendinous
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;
Autoimmune adrenalitis

7,900
7,900
7,900
2,370
2,370
2,370
5,530
5,530
5,530
7,900
2,370
5,530

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
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
7,900
2,370
5,530
7,900
2,370
5,530
7,900
2,370
5,530
DISORDER OF LIPID STORAGE
8,100
2,430
5,670
8,100
2,430
5,670
8,100
2,430
5,670

DISORDERS ASSOCIATED WITH MENOPAUSE
8,100
6,000
2,430
1,800
5,670
4,200
DISORDERS OF ADRENAL GLAND
9,900
2,970
6,930

9,900
9,900
2,970
2,970
6,930
6,930
9,900
2,970
6,930
9,900
2,970
6,930
E27.2
Addisonian crisis; Adrenal crisis; Adrenocortical crisis
9,900
2,970
6,930
E27.3
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
cortisol-binding globulin
Classical phenylketonuria
Other hyperphenylalaninaemias
9,900
2,970
6,930
9,900
2,970
6,930
M80.3
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
E27.4
E27.8
E70.0
E70.1
E70.2
Disorders of tyrosine metabolism; Alkaptonuria;

Hypertyrosinaemia; Ochronosis; Tyrosinaemia; Tyrosinosis
9,900
2,970
6,930
DISORDERS OF AMINO ACID METABOLISM

10,600
10,600
3,180
3,180
7,420
7,420
10,600
3,180
7,420
Page 28 of 112

FIRST CASE RATE
ICD CODE
E70.3
E70.8
E71.0
E71.1
E71.3
E72.0
E72.2
E72.3
E72.5
E73.0
E74.0
E74.1
E74.2
DESCRIPTION
Albinism; OcularAlbinism; Oculocutaneous Albinism
Chediak(-Steinbrinck)-Higashi Syndrome; Cross Syndrome;
Hermansky-Pudlak Syndrome
Other disorders of aromatic amino-acid metabolism;
Disorders of histidine metabolism; Disorders of tryptophan
metabolism
Maple-syrup-urine disease
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
deficiency
Disorders of amino-acid transport; Cystinosis; Cystinuria;
Fanconi(-de Toni)(-Debr) syndrome; Hartnup's disease;
Lowe's syndrome
Disorders of urea cycle metabolism; Argininaemia;
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
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
10,600
3,180
7,420
10,600
3,180
7,420
10,600
3,180
7,420
10,600
3,180
7,420
10,600
3,180
7,420
10,600
3,180
7,420
10,600
3,180
7,420
10,600
3,180
7,420
10,600
3,180
7,420
DISORDERS OF CARBOHYDRATE METABOLISM
5,800
1,740
4,060
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
5,800
1,740
4,060
5,800
1,740
4,060
5,800
1,740
4,060
5,800
1,740
4,060
Disorders of fructose metabolism; Essential fructosuria;

Fructose-1,6-diphosphatase deficiency; Hereditary fructose DISORDERS OF CARBOHYDRATE METABOLISM
intolerance
Disorders of galactose metabolism; Galactokinase
deficiency; Galactosaemia
E74.3
Other disorders of intestinal carbohydrate absorption;

Glucose-galactose malabsorption; Sucrase deficiency
E74.8
Other specified disorders of carbohydrate metabolism
5,800
1,740
4,060
E77.8
Other disorders of glycoprotein metabolism

Mucopolysaccharidosis, type I; Hurler Syndrome; HurlerScheie Syndrome; Scheie Syndrome
DISORDERS OF GLYCOPROTEIN METABOLISM

DISORDERS OF GLYCOSAMINOGLYCAN
METABOLISM
METABOLISM
10,600
3,180
7,420
10,900
3,270
7,630
10,900
3,270
7,630
10,900
3,270
7,630
10,900
3,270
7,630
10,900
3,270
7,630
E76.0
E76.1
Mucopolysaccharidosis, type II; Hunter's syndrome
E76.2
Other mucopolysaccharidoses; -Glucuronidase deficiency;

Mucopolysaccharidosis, type III; Mucopolysaccharidosis IV,
Mucopolysaccharidosis VI, Mucopolysaccharidosis VII;
METABOLISM
Mild Maroteaux-Lamy Syndrome; Severe Maroteaux-Lamy
Syndrome; Morquio-like Syndrome;
E76.3
Mucopolysaccharidosis, unspecified
E76.8
Other disorders of glucosaminoglycan metabolism
E78.0
Pure hypercholesterolaemia; Familial

hypercholesterolaemia; Fredrickson's
hyperlipoproteinaemia, type Iia;
DISORDERS OF LIPOPROTEIN METABOLISM
Hyperbetalipoproteinaemia; Hyperlipidaemia, group A; Lowdensity-lipoprotein-type [LDL] hyperlipoproteinaemia
6,600
1,980
4,620
E78.1
Pure hyperglyceridaemia; Endogenous hyperglyceridaemia;

Fredrickson's hyperlipoproteinaemia, type IV;
Hyperlipidaemia, group B; Hyperprebetalipoproteinaemia'; DISORDERS OF LIPOPROTEIN METABOLISM
Very-low-density-lipoprotein-type [VLDL]
hyperlipoproteinaemia
6,600
1,980
4,620
E78.2
Mixed hyperlipidaemia; Broad- or floatingbetalipoproteinaemia; Fredrickson's

hyperlipoproteinaemia, type IIb; Fredrickson's
hyperlipoproteinaemia type III; Hyperbetalipoproteinaemia
with prebetalipoproteinaemia; Hypercholesterolaemia with
endogenous hype
6,600
1,980
4,620
E78.3
Hyperchylomicronaemia; Fredrickson's
hyperlipoproteinaemia, type I; Fredrickson's
hyperlipoproteinaemia, type V; Hyperlipidaemia, group D;
Mixed hyperglyceridaemia
6,600
1,980
4,620
E78.4
Other hyperlipidaemia; Familial combined hyperlipidaemia DISORDERS OF LIPOPROTEIN METABOLISM
6,600
1,980
4,620
METABOLISM
METABOLISM
Page 29 of 112

FIRST CASE RATE
ICD CODE
E78.6
E78.8
DESCRIPTION
Lipoprotein deficiency; Abetalipoproteinaemia;
High-density lipoprotein deficiency;
Hypoalphalipoproteinaemia; Familial
Hypobetalipoproteinaemia; Lecithin cholesterol
acyltransferase deficiency; Tangier disease
Other disorders of lipoprotein metabolism
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
6,600
1,980
4,620
6,600
1,980
4,620
E83.0
Disorders of copper metabolism; Menkes' kinky hair

disease; Menkes' steely hair disease; Wilson's disease
DISORDERS OF MINERAL METABOLISM
7,300
2,190
5,110
E83.1
Disorders of iron metabolism; Haemochromatosis
7,300
2,190
5,110
E83.2
Disorders of zinc metabolism; Acrodermatitis enteropathica DISORDERS OF MINERAL METABOLISM
7,300
2,190
5,110
7,300
2,190
5,110
7,300
2,190
5,110
7,300
2,190
5,110
Other disorders of mineral metabolism

Acute inflammation of orbit; Abscess of orbit;Cellulitis of
orbit; Osteomyelitis of orbit; Periostitis of orbit, Tenonitis of DISORDERS OF ORBIT
orbit
Exophthalmic conditions; Displacement of globe (lateral)
DISORDERS OF ORBIT
NOS; Haemorrhage of orbit; Oedema of orbit
7,300
2,190
5,110
9,500
2,850
6,650
9,500
2,850
6,650
9,800
2,940
6,860
9,800
2,940
6,860
9,800
2,940
6,860
9,800
2,940
6,860
9,800
2,940
6,860
7,000
2,100
4,900
9,300
9,300
9,300
2,790
2,790
2,790
6,510
6,510
6,510
DISORDERS OF THE PARATHYROID
9,300
2,790
6,510

9,300
9,300
2,790
2,790
6,510
6,510
DISORDERS OF THE PITUITARY GLAND
11,800
3,540
8,260
Hypopituitarism; Fertile eunuch syndrome;

Hypogonadotropic hypogonadism; Idiopathic growth
hormone deficiency; Isolated deficiency of gonadotropin; DISORDERS OF THE PITUITARY GLAND
Isolated deficiency of growth hormone; Isolated deficiency
of pituitary hormone; Kallmann's syndrome; Lorai
11,800
3,540
8,260
DISORDERS OF VITREOUS BODY AND GLOBE

10,400
10,400
3,120
3,120
7,280
7,280
10,400
3,120
7,280
10,400
3,120
7,280
10,400
3,120
7,280
DISSEMINATED INTRAVASCULAR COAGULATION
32,000
9,600
22,400
DISSEMINATED INTRAVASCULAR COAGULATION
32,000
9,600
22,400
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
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
5,320
E83.3
E83.4
E83.5
E83.8
H05.0
H05.2
Disorders of phosphorus metabolism; Acid phosphatase

deficiency; Familial hypophosphataemia;
Hypophosphatasia; Vitamin-D-resistant osteomalacia;
Vitamin-D-resistant rickets
Disorders of magnesium metabolism; Hypermagnesaemia;
Hypomagnesaemia
Disorders of calcium metabolism; Familial hypocalciuric
hypercalcaemia; Idiopathic hypercalciuria
E80.0
Hereditary erythropoietic porphyria; Congenital

erythropoietic porphyria; Erythropoietic protoporphyria
DISORDERS OF PORPHYRIN AND BILIRUBIN

METABOLISM
E80.2
Other porphyria; Hereditary coproporphyria

Porphyria NOS; Acute intermittent (hepatic) Porphyria
E80.4
Gilbert's syndrome
E80.5
Crigler-Najjar syndrome

METABOLISM
METABOLISM
METABOLISM
METABOLISM
DISORDERS OF PURINE AND PYRIMIDINE
METABOLISM
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
D65
P60
M42.1
M43.02
M43.03
M43.04
M43.06
M43.07
M43.09
M43.10
M43.12
M43.15
M43.16
M43.17
Other disorders of bilirubin metabolism; Dubin-Johnson

syndrome; Rotor's syndrome
Other disorders of purine and pyrimidine metabolism;
Hereditary xanthinuria
Idiopathic hypoparathyroidism
Other hypoparathyroidism
Hypoparathyroidism, unspecified; Parathyroid tetany
Primary hyperparathyroidism; Hyperplasia of parathyroid;
Osteitis fibrosa cystica generalisata [von Recklinghausen's
disease of bone]
Other specified disorders of parathyroid gland
Disorder of parathyroid gland, unspecified
Syndrome of inappropriate secretion of antidiuretic
hormone
Vitreous prolapse
Vitreous haemorrhage
Purulent endophthalmitis; Panophthalmitis; Vitreous
abscess
Other endophthalmitis; Parasitic endophthalmitis NOS;
Sympathetic uveitis
Degenerated conditions of globe; Absolute glaucoma;
Atrophy of globe; Phthisis bulbi
Disseminated intravascular coagulation [defibrination
syndrome]; Acquired Afibrinogenaemia; Consumption
coagulopathy; Diffuse or disseminated intravascular
coagulation [DIC] ; Acquired Fibrinolytic haemorrhage;
Fibrinolytic Purpura; Purpura fulminans;
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
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
Page 30 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
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
region
Other fusion of spine; Ankylosis of spinal joint site
unspecified
DORSOPATHIES
DORSOPATHIES
7,600
7,600
Professional
Fee
2,280
2,280
DORSOPATHIES
7,600
2,280
5,320
DORSOPATHIES
7,600
2,280
5,320
DORSOPATHIES
7,600
2,280
5,320
DORSOPATHIES
7,600
2,280
5,320
M43.42
Other recurrent atlantoaxial subluxation cervical region
DORSOPATHIES
7,600
2,280
5,320
M43.49
Other recurrent atlantoaxial subluxation site unspecified
DORSOPATHIES
7,600
2,280
5,320
M43.60
M43.62
M43.64
M43.66
M43.68
M43.69
M43.8
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
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
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
5,320
5,320
5,320
5,320
5,320
5,320
5,320
M43.82
Other specified deforming dorsopathies cervical region
DORSOPATHIES
7,600
2,280
5,320
M43.85
Other specified deforming dorsopathies thoracolumbar

region
DORSOPATHIES
7,600
2,280
5,320
M43.86
Other specified deforming dorsopathies lumbar region
DORSOPATHIES
7,600
2,280
5,320
M43.87
Other specified deforming dorsopathies lumbosacral region DORSOPATHIES
7,600
2,280
5,320
M43.88
Other specified deforming dorsopathies sacral and

DORSOPATHIES
7,600
2,280
5,320
M43.89
Other specified deforming dorsopathies site unspecified
DORSOPATHIES
7,600
2,280
5,320
DORSOPATHIES
7,600
2,280
5,320
DORSOPATHIES
7,600
2,280
5,320
DORSOPATHIES
7,600
2,280
5,320
DORSOPATHIES
7,600
2,280
5,320
DORSOPATHIES
7,600
2,280
5,320
DORSOPATHIES
7,600
2,280
5,320
DORSOPATHIES
7,600
2,280
5,320
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
DORSOPATHIES
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
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
2,280
2,280
2,280
2,280
2,280
2,280
2,280
2,280
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
DROWNING
7,100
2,130
4,970
ECTOPIC PREGNANCY
7,800
2,340
5,460
ECTOPIC PREGNANCY
7,800
2,340
5,460
ECTOPIC PREGNANCY
7,800
2,340
5,460
M43.18
M43.19
M43.22
M43.26
M43.27
M43.29
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
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
syndrome
Cervicobrachial 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
cramp
Abdominal pregnancy
Tubal pregnancy; Fallopian pregnancy; Rupture of fallopian
tube due to pregnancy
Ovarian pregnancy
Case Rate
Health Care
Institution Fee
5,320
5,320
O00.8
Other ectopic pregnancy; Cervical pregnancy; Cornual

pregnancy; Intraligamentous pregnancy; Mural pregnancy
ECTOPIC PREGNANCY
7,800
2,340
5,460
O00.9
Ectopic pregnancy, unspecified
ECTOPIC PREGNANCY
7,800
2,340
5,460
O36.7
Maternal care for viable fetus in abdominal pregnancy
ECTOPIC PREGNANCY
7,800
2,340
5,460
ELECTRICAL SHOCK
5,400
1,620
3,780
ELECTRICAL SHOCK
5,400
1,620
3,780
T75.0
T75.4
Effects of lightning; Shock from lightning; Struck by

lightning NOS
Effects of electric current; Electrocution; Shock from
electric current
Page 31 of 112

FIRST CASE RATE
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
DESCRIPTION
MacLeod's syndrome; Unilateral emphysema; Unilateral
transparency of lung
Panlobular emphysema; Panacinar emphysema
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]
dementia
Toxic encephalopathy
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; Localizationrelated partial idiopathic epilepsy and epileptic syndromes
with seizures of localized onset; Benign childhood epilepsy
with centrotempor
Localization-related focal symptomatic epilepsy and
epileptic syndromes with simple partial seizures;
Localization-related partial symptomatic epilepsy and
epileptic syndromes with simple partial seizures; Attacks
without alteration of consciousness ; Sim
Localization-related focal 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
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
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
EMPHYSEMA
11,400
3,420
7,980
EMPHYSEMA
EMPHYSEMA
EMPHYSEMA
11,400
11,400
11,400
3,420
3,420
3,420
7,980
7,980
7,980
EMPHYSEMA
11,400
3,420
7,980
EMPHYSEMA
EMPHYSEMA
11,400
11,400
3,420
3,420
7,980
7,980
ENCEPHALOPATHY
22,200
6,660
15,540
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
15,540
15,540
15,540
5,390
5,390
5,390
5,390
5,390
5,390
5,390
5,390
6,790
EPILEPSY
7,800
2,340
5,460
EPILEPSY
7,800
2,340
5,460
EPILEPSY
7,800
2,340
5,460
EPILEPSY
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
Other generalized epilepsy and epileptic syndromes;

Epilepsy with myoclonic absences; Epilepsy with myoclonicEPILEPSY
astatic seizures; Infantile spasms; Lennox-Gastaut
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 EPILEPSY
to hormonal changes; Epileptic seizures related to sleep
deprivation; Epileptic
G40.6
Grand mal seizures, unspecified (with or without petit mal) EPILEPSY
7,800
2,340
5,460
G40.7
Petit mal, unspecified, without grand mal seizures
EPILEPSY
7,800
2,340
5,460
G40.8
Other epilepsy; Epilepsies and epileptic syndromes

undetermined as to whether they are focal or generalized
EPILEPSY
7,800
2,340
5,460
EPILEPSY
7,800
2,340
5,460
EXTRAPYRAMIDAL AND MOVEMENT DISORDERS

8,300
8,300
8,300
8,300
2,490
2,490
2,490
2,490
5,810
5,810
5,810
5,810
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
G23.9
Epilepsy, unspecified; Epileptic convulsions NOS; Epileptic

fits NOS; Epileptic seizures NOS
Malignant neuroleptic syndrome
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;
Calcification of basal ganglia
Degenerative disease of basal ganglia, unspecified
G24.0
Carcinomatous neuromyopathy in Drug-induced dystonia
8,300
2,490
5,810
G24.1
G24.3
G24.4
G24.8
Idiopathic familial dystonia; Idiopathic dystonia NOS

Spasmodic torticollis
Idiopathic orofacial dystonia; Orofacial dyskinesia
Other dystonia

8,300
8,300
8,300
8,300
2,490
2,490
2,490
2,490
5,810
5,810
5,810
5,810
G40.9
G21.0
G21.1
G21.8
G21.9
G23.0
G23.1
G23.8
Page 32 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
G24.9
G25.3
G25.5
Dystonia, unspecified; Dyskinesia NOS

Myoclonus; Drug-induced myoclonus
Other chorea; Chorea NOS

8,300
8,300
8,300
Professional
Fee
2,490
2,490
2,490
G25.8
Other specified extrapyramidal and movement disorders;

Restless legs syndrome; Stiff-man syndrome
8,300
2,490
5,810

FEBRILE SEIZURES
8,300
7,000
2,490
2,100
5,810
4,900
FEBRILE SEIZURES
7,000
2,100
4,900
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
2,610
2,610
2,610
2,610
2,610
2,100
2,550
6,090
6,090
6,090
6,090
6,090
4,900
5,950
8,500
2,550
5,950
8,500
2,550
5,950
8,500
2,550
5,950
8,500
2,550
5,950

8,500
8,500
2,550
2,550
5,950
5,950
8,500
2,550
5,950
FRACTURES OF THE BONES OF THE THORAX
8,700
2,610
6,090

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
2,610
2,610
2,610
2,610
2,610
2,610
2,610
2,610
2,610
2,610
2,610
3,960
6,090
6,090
6,090
6,090
6,090
6,090
6,090
6,090
6,090
6,090
6,090
9,240
GANGRENE
13,200
3,960
9,240
GANGRENE
13,200
3,960
9,240
GASTROESOPHAGEAL REFLUX DISEASE
6,100
1,830
4,270
GASTROESOPHAGEAL REFLUX DISEASE
6,100
1,830
4,270
11,700
3,510
8,190
11,700
3,510
8,190
11,700
3,510
8,190
11,700
3,510
8,190
11,700
3,510
8,190
11,700
3,510
8,190
11,700
3,510
8,190
11,700
3,510
8,190
11,700
3,510
8,190
11,700
3,510
8,190
6,500
1,950
4,550
GLAUCOMA
6,500
1,950
4,550
GLAUCOMA
6,500
1,950
4,550
GLAUCOMA
6,500
1,950
4,550
G25.9
R56.0
R56.8
P92.1
P92.2
P92.4
P92.8
P92.9
R50.9
E87.1
E87.2
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
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;
Respiratory Acidosis
Alkalosis; Alkalosis NOS; Metabolic Alkalosis; Respiratory
Alkalosis
Mixed disorder of acid-base balance
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
NOS (closed)
Multiple fractures of thoracic spine (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;
Oesophageal reflux NOS
P76.0
Meconium plug syndrome
P76.1
Transitory ileus of newborn
P76.8
Other specified intestinal obstruction of newborn
P76.9
Intestinal obstruction of newborn, unspecified
P77
Necrotizing enterocolitis of fetus and newborn
P78.0
Perinatal intestinal perforation; Meconium peritonitis
P78.2
Neonatal haematemesis and melaena due to swallowed

maternal blood
P78.3
Noninfective neonatal diarrhoea; Neonatal diarrhoea NOS
P78.8
Other specified perinatal digestive system disorders;

Congenital cirrhosis of liver; Peptic ulcer of newborn
P78.9
Perinatal digestive system disorder, unspecified
H40.0
Glaucoma suspect; Ocular hypertension
H40.1
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
H40.2
H40.3
Primary angle-closure glaucoma; Primary acute angleclosure glaucoma ; Acute residual stage angle-closure
glaucoma ; Primary chronic angle-closure glaucoma ;
Residual stage chronic angle-closure glaucoma; Primary
intermittent angle-cloure glaucoma; Residu
Glaucoma secondary to eye trauma
GASTROINTESTINAL DISORDERS OF THE

NEWBORN
NEWBORN
NEWBORN
NEWBORN
NEWBORN
NEWBORN
NEWBORN
NEWBORN
NEWBORN
NEWBORN
GLAUCOMA
Page 33 of 112
Case Rate
Health Care
Institution Fee
5,810
5,810
5,810

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
6,500
6,500
6,500
6,500
Professional
Fee
1,950
1,950
1,950
1,950
Health Care
Institution Fee
4,550
4,550
4,550
4,550
Case Rate
H40.4
H40.5
H40.8
H40.9
Glaucoma secondary to eye inflammation

Glaucoma secondary to other eye disorders
Other glaucoma
Glaucoma, unspecified
GLAUCOMA
GLAUCOMA
GLAUCOMA
GLAUCOMA
N00.0
Acute nephritic syndrome including Acute glomerular

disease, Acute glomerulonephritis, Acute nephritis, Acute
renal disease NOS, with Minor glomerular abnormality
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES
10,000
3,000
7,000
N00.1

renal disease NOS, with Focal and segmental glomerular
lesions (with focal and segmental hyalinosis; focal and
segmental sclerosis) & Focal glom
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
N00.2
N00.3
N00.4
N00.5
N00.7
N00.8
N00.9
N01.0
N01.1
N01.3
N01.5

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

renal disease NOS with Other (Proliferative
glomerulonephritis NOS)
disease, Acute glomerulonephritis, Acute nephritis, Acute GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES
renal disease NOS, Unspecified renal biopsy
Rapidly progressive nephritic syndrome; rapidly progressive
glomerular disease; rapidly progressive glomerulonephritis; GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES
rapidly progressive nephritis, Minor glomerular abnormality
glomerular disease; rapidly progressive glomerulonephritis;
rapidly progressive nephritis, Focal and segmental
glomerular lesions
rapidly progressive nephritis, Diffuse mesangial
proliferative glomerulonephritis
rapidly progressive nephritis, Diffuse mesangiocapillary
glomerulonephritis
N01.8

rapidly progressive nephritis, other
10,000
3,000
7,000
N01.9

rapidly progressive nephritis, Unspecified
10,000
3,000
7,000
N02.0
Recurrent and persistent haematuria including Benign

familial Haematuria; Benign familial Haematuria of
childhood; Haematuria with morphological lesion specified
with Minor glomerular abnormality
10,000
3,000
7,000
N02.1

with Focal and segmental glomerular lesions
10,000
3,000
7,000
N02.2

with Diffuse membranous glomerulonephritis
10,000
3,000
7,000
Page 34 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
N02.5

with Diffuse mesangiocapillary glomerulonephritis
10,000
3,000
7,000
N02.8

with other (Proliferative glomerulonephritis NOS)
10,000
3,000
7,000
N02.9

with Unspecified renal biopsy
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
N03.0
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
Chronic nephritic syndrome including Chronic glomerular

disease, Chronic glomerulonephritis, Chronic nephritis,
chronic renal disease NOS, with Minor glomerular
abnormality
chronic renal disease NOS, with Focal and segmental
glomerular lesions
chronic renal disease NOS, withDiffuse membranous
glomerulonephritis
chronic renal disease NOS, with Diffuse mesangial
chronic renal disease NOS, with Diffuse endocapillary
chronic renal disease NOS, with Diffuse mesangiocapillary
glomerulonephritis
chronic renal disease NOS, with Diffuse crescentic
glomerulonephritis
chronic renal disease NOS, with Other (Proliferative
glomerulonephritis NOS)
chronic renal disease NOS, with 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
glomerulonephritis
Nephrotic syndrome: Diffuse mesangiocapillary
glomerulonephritis; Membranoproliferative
glomerulonephritis, types 1 and 3, or NOS
N04.7
Nephrotic syndrome: Diffuse crescentic

glomerulonephritis; Extracapillary glomerulonephritis
10,000
3,000
7,000
N04.8
Nephrotic syndrome: Other
10,000
3,000
7,000
N04.9
Nephrotic syndrome:Unspecified
10,000
3,000
7,000
N05.0
Unspecified nephritic syndrome including Glomerular

disease, Glomerulonephritis, Nephritis NOS with Minor
glomerular abnormality, minimal change lesion
10,000
3,000
7,000
N05.1

disease, Glomerulonephritis, Nephritis NOS with Focal and
segmental glomerular lesions (with focal and segmental
hyalinosis; focal and segmental sclerosis) & Focal
glomerulonephritis
10,000
3,000
7,000
Page 35 of 112

FIRST CASE RATE
ICD CODE
N05.2
N05.3
N05.4
N05.5
N05.6
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
DESCRIPTION
disease, Glomerulonephritis, Nephritis NOS with Diffuse
membranous glomerulonephritis
mesangial proliferative glomerulonephritis
endocapillary proliferative glomerulonephritis
mesangiocapillary glomerulonephritis,
Membranoproliferative glomerulonephritis, types 1 and 3,
or NOS
disease, Glomerulonephritis, Nephritis NOS with Dense
deposit disease
Membranoproliferative glomerulonephritis, type 2
crescentic glomerulonephritis, Extracapillary
glomerulonephritis
disease, Glomerulonephritis, Nephritis NOS with Other
(Proliferative glomerulonephritis NOS)
disease, Glomerulonephritis, Nephritis NOS with
Unspecified renal biopsy
Isolated proteinuria with specified morphological lesion
with morphological lesion specified with Minor glomerular
abnormality
with Other
(Proliferative glomerulonephritis NOS)
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
Diffuse membranous glomerulonephritis
Diffuse mesangial proliferative glomerulonephritis
Diffuse mesangiocapillary glomerulonephritis,
Membranoproliferative glomerulonephritis, types 1 and 3,
or NOS
Unspecified renal biopsy
Acute tubulo-interstitial nephritis; pyelonephritis; Acute
infectious interstitial nephritis; Acute pyelitis; Acute
pyelonephritis
Chronic tubulo-interstitial nephritis, unspecified; Chronic
interstitial nephritis NOS; Chronic pyelitis NOS; Chronic
pyelonephritis NOS
Tubulo-interstitial nephritis, not specified as acute or
chronic; Interstitial nephritis NOS; Pyelitis NOS;
Pyelonephritis NOS
Analgesic nephropathy
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
10,000
3,000
7,000
Nephropathy induced by other drugs, medicaments and

biological substances
Nephropathy induced by unspecified drug, medicament or
biological substance
10,000
3,000
7,000
N14.4
Toxic nephropathy, not elsewhere classified
10,000
3,000
7,000
N15.0
Balkan nephropathy; Balkan endemic nephropathy
10,000
3,000
7,000
N15.8
Other specified renal tubulo-interstitial diseases
10,000
3,000
7,000
N15.9
Renal tubulo-interstitial disease, unspecified; Infection of

kidney NOS
10,000
3,000
7,000
N39.1
Persistent proteinuria, unspecified
10,000
3,000
7,000
N39.2
Orthostatic proteinuria, unspecified
10,000
3,000
7,000
M23.20
Derangement of meniscus due to old tear or injury; Old

bucket-handle tear multiple sites
HAND, FEET AND JOINT DEFORMITIES
9,200
2,760
6,440
Page 36 of 112

FIRST CASE RATE
ICD CODE
M23.21
M23.22
DESCRIPTION
GROUP

bucket-handle tear Anterior cruciate ligament or Anterior HAND, FEET AND JOINT DEFORMITIES
horn of medial meniscus
bucket-handle tear Posterior cruciate ligament or Posterior HAND, FEET AND JOINT DEFORMITIES
horn of medial meniscus
Case Rate
Professional
Fee
Health Care
Institution Fee
9,200
2,760
6,440
9,200
2,760
6,440
M23.25

bucket-handle tear Posterior horn of lateral meniscus
9,200
2,760
6,440
M23.46
Loose body in kneeOther and unspecified lateral meniscus
9,200
2,760
6,440
M23.5
Chronic instability of knee

Other internal derangements of knee; Laxity of ligament of
knee; Snapping knee multiple sites
Internal derangement of knee
9,200
2,760
6,440
9,200
2,760
6,440
9,200
2,760
6,440
9,200
2,760
6,440

9,200
9,200
2,760
2,760
6,440
6,440
9,200
2,760
6,440
9,200
2,760
6,440
9,200
2,760
6,440

9,200
9,200
9,200
9,200
9,200
9,200
9,200
9,200
2,760
2,760
2,760
2,760
2,760
2,760
2,760
2,760
6,440
6,440
6,440
6,440
6,440
6,440
6,440
6,440
9,200
2,760
6,440
HEADACHE SYNDROMES
5,500
1,650
3,850
HEADACHE SYNDROMES
5,500
1,650
3,850
HEADACHE SYNDROMES
HEADACHE SYNDROMES
5,500
5,500
1,650
1,650
3,850
3,850
HEADACHE SYNDROMES
5,500
1,650
3,850
HEADACHE SYNDROMES
5,500
1,650
3,850
HEADACHE SYNDROMES
5,500
1,650
3,850
HEADACHE SYNDROMES
5,500
1,650
3,850
HEADACHE SYNDROMES
5,500
1,650
3,850
HEADACHE SYNDROMES
HEADACHE SYNDROMES
HEADACHE SYNDROMES
HEADACHE SYNDROMES
5,500
5,500
5,500
5,500
1,650
1,650
1,650
1,650
3,850
3,850
3,850
3,850
HEART CONDUCTION DISORDERSS
12,300
3,690
8,610
12,300
3,690
8,610
12,300
3,690
8,610
12,300
3,690
8,610
12,300
3,690
8,610
12,300
3,690
8,610
12,300
3,690
8,610
15,700
4,710
10,990
M23.80
M23.9
M23.91
M24.08
M24.1
M24.2
M24.4
M24.41
M24.50
M24.54
M24.56
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
Internal derangement of knee, unspecified Anterior

cruciate ligament or Anterior horn of medial meniscus
Loose body in joint other sites
Other articular cartilage disorders
Disorder of ligament; Instability secondary to old ligament
injury; Ligamentous laxity NOS
Recurrent dislocation and subluxation of joint
Recurrent dislocation and subluxation of joint shoulder
region
Contracture of joint multiple sites
Contracture of joint hand
Contracture of joint lower leg
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;
Irritable hip other sites
Migraine without aura [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
block
Pre-excitation syndrome; Anomalous atrioventicular
excitation; Atrioventricular conduction, accelerated;
Atrioventicular conduction, accesory; Atrioventicular
conduction pre-excitation; Lown-Ganong-Levine syndrome;
Wolff-Parkinson-White syndrome
Other specified HEART CONDUCTION DISORDERSs;
Atrioventicular [AV] dissociation; Interference dissociation
HEART CONDUCTION DISORDERS, unspecified; Heart block

NOS; Stokes-Adams syndrome
Rheumatic heart disease, unspecified; Rheumatic carditis;
HEART FAILURE
Rheumatic heart failure
I50.0
Congestive heart failure; Congestive heart disease; Right

venticular failure (secondary to left heart failure)
HEART FAILURE
15,700
4,710
10,990
I50.00
Advanced congestive heart failure; Grave congestive heart

failure; Severe congestive heart failure
HEART FAILURE
15,700
4,710
10,990
Page 37 of 112

FIRST CASE RATE
ICD CODE
I50.1
I50.9
DESCRIPTION
GROUP
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; HEART FAILURE
Cardiac asthma with mention of heart disease NOS or heart
failure; Left heart fai
Heart failure, unspecified; Cardiac, heart or myocardial
HEART FAILURE
failure NOS
Case Rate
Professional
Fee
Health Care
Institution Fee
15,700
4,710
10,990
15,700
4,710
10,990
I34.0
Mitral (valve) insufficiency; Incompetence mitral valve NOS

or of specified cause, except rheumatic; Regurgitation
HEART VALVE DISORDERS
mitral valve NOS or of specified cause, except rheumatic
8,400
2,520
5,880
I34.1
I34.2
I34.8
I34.9
I35.0
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

8,400
8,400
8,400
8,400
8,400
2,520
2,520
2,520
2,520
2,520
5,880
5,880
5,880
5,880
5,880
I35.1
Aortic (valve) insufficiency; Incompetence Aortic valve NOS

or of specified cause, except rheumatic; Aortic valve
regurgitation NOS or of specified cause, except rheumatic
8,400
2,520
5,880

8,400
8,400
8,400
8,400
2,520
2,520
2,520
2,520
5,880
5,880
5,880
5,880
8,400
2,520
5,880

8,400
8,400
8,400
2,520
2,520
2,520
5,880
5,880
5,880
8,400
2,520
5,880

8,400
8,400
2,520
2,520
5,880
5,880
HEAT EXHAUSTION
6,500
1,950
4,550
HEAT EXHAUSTION
HEAT EXHAUSTION
6,500
6,500
1,950
1,950
4,550
4,550
HEAT EXHAUSTION
6,500
1,950
4,550
HEAT EXHAUSTION
6,500
1,950
4,550
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
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
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
HEMORRHAGE IN PREGNANCY AND POST

PARTUM PERIOD
7,000
2,100
4,900

PARTUM PERIOD
7,000
2,100
4,900

PARTUM PERIOD
7,000
2,100
4,900

PARTUM PERIOD
7,000
2,100
4,900
7,000
2,100
4,900
7,000
2,100
4,900
7,000
2,100
4,900
7,800
2,340
5,460
7,800
2,340
5,460
I35.2
I35.8
I35.9
I36.0
I36.1
I36.8
I36.9
I37.0
I37.1
I37.8
I37.9
T67.0
T67.1
T67.2
T67.3
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
P50.0
P50.1
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
Heat syncope; Heat collapse
Heat cramp
Heat exhaustion, anhydrotic; Heat prostration due to water
depletion
Heat exhaustion due to salt depletion; Heat prostation due
to salt (and water) depletion
Heat exhaustion, unspecified; 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 placenta
NOS
Other immediate postpartum haemorrhage; Haemorrhage
following delivery of placenta; Postpartum atomic
haemorrhage NOS
Delayed and secondary postpartum haemorrhage;
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
without haemorrhage
Retained portions of placenta and membranes without
haemorrhage; Retained products of conception following
delivery, without haemorrhage
Fetal blood loss from vasa praevia
Fetal blood loss from ruptured cord
HEAT EXHAUSTION
HEAT EXHAUSTION
HEMARTHROSIS/JOINT EFFUSION
HEMOLYTIC UREMIC SYNDROME

PARTUM PERIOD
PARTUM PERIOD
PARTUM PERIOD
HEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN
THE NEWBORN
Page 38 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
THE NEWBORN
THE NEWBORN
THE NEWBORN
THE NEWBORN
THE NEWBORN
THE NEWBORN
THE NEWBORN
THE NEWBORN
P50.2
Fetal blood loss from placenta
P50.9
Fetal blood loss, unspecified; Fetal haemorrhage NOS
P51.9
Umbilical haemorrhage of newborn, unspecified
P53
Haemorrhagic disease of fetus and newborn; Vitamin K

deficiency of newborn
P54.0
Neonatal haematemesis
P54.2
Neonatal rectal haemorrhage
P54.3
Other neonatal gastrointestinal haemorrhage
P54.4
Neonatal adrenal haemorrhage
P54.5
Neonatal cutaneous haemorrhage; Bruising in fetus or

newborn; Ecchymoses in fetus or newborn; Petechiae in
fetus or newborn; Superficial haematomata in fetus or
newborn
P54.6
Neonatal vaginal haemorrhage; Pseudomenses
P54.8
Other specified neonatal haemorrhages
P54.9
Neonatal haemorrhage, unspecified
P55.0
Rh isoimmunization of fetus and newborn
P55.1
ABO isoimmunization of fetus and newborn
P55.8
Other haemolytic diseases of fetus and newborn
P55.9
Haemolytic disease of fetus and newborn, unspecified
P61.0
Transient neonatal thrombocytopenia; neonatal

thrombocytopenia due to exchange transfusion; Neonatal
thrombocytopenia due to idiophatic maternal
thrombocytopenia; Neonatal thrombocytopenia due to
isoimmunization
P61.1
Polycythaemia neonatorum
P61.5
Transient neonatal neutropenia
P61.6
Other transient neonatal disorders of coagulation
P61.8
Other specified perinatal haematological disorders
P61.9
Perinatal haematological disorder, unspecified
D66
Hereditary factor VIII deficiency; Deficiency factor VIII (with

HEMORRHAGIC CONDITIONS
functional defect); Haemophilia NOS; Haemophilia A;
Classical Haemophilia
D67
D68.0
D68.1
D68.2
D68.3
D68.4
D68.8
D68.9
D69.0
Case Rate
Professional
Fee
Health Care
Institution Fee
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
12,800
3,840
8,960
Hereditary factor IX deficiency; Christmas disease; Factor IX

Deficiency (with functional defect); Plasma thromboplastin HEMORRHAGIC CONDITIONS
component [PTC] Deficiency; Haemophilia B
12,800
3,840
8,960
Von Willebrand's disease; Angiohaemophilia; Factor VIII

deficiency with vascular defect; Vascular haemophilia
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
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 anti-Ixa; Increase in anti-Xa; Increase
in anti-XIa
Acquired coagulation factor deficiency; Deficiency of
coagulation factor due to liver disease; Deficiency of
coagulation factor due to vitamin K deficiency
Other specified coagulation defects; Presence of systemic
lupus erythematosus [SLE] inhibitor
Coagulation defect, unspecified
Allergic purpura; Anaphylactoid Purpura; Henoch(Schnlein) Purpura; Nonthrombocytopenic Purpura;
Haemorrhagic Purpura; Idiopathic Purpura; Vascular
Purpura; AllergicVasculitis

THE NEWBORN
THE NEWBORN
THE NEWBORN
THE NEWBORN
THE NEWBORN
THE NEWBORN
THE NEWBORN
THE NEWBORN
THE NEWBORN
THE NEWBORN
THE NEWBORN
THE NEWBORN
THE NEWBORN
THE NEWBORN
Page 39 of 112

FIRST CASE RATE
ICD CODE
D69.1
D69.2
DESCRIPTION
GROUP
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
Purpura; Simplex Purpura
Case Rate
Professional
Fee
Health Care
Institution Fee
12,800
3,840
8,960
12,800
3,840
8,960
D69.3
Idiopathic thrombocytopenic purpura; Evans' syndrome
12,800
3,840
8,960
D69.8
Other specified haemorrhagic conditions; Hereditary

Capillary fragility; Vascular pseudohaemophilia
12,800
3,840
8,960
K70.4
Alcoholic hepatic failure; Alcoholic hepatic failure NOS;

Acute alcoholic hepatic failure; Chronic alcoholic hepatic
HEPATIC FAILURE
failure; Subacute alcoholic hepatic failure; Alcoholic hepatic
failure with or without hepatic coma
20,600
6,180
14,420
K72.0
K72.1
K72.9
Acute and subacute hepatic failure

Chronic hepatic failure
Hepatic failure
HEPATIC FAILURE
HEPATIC FAILURE
HEPATIC FAILURE
20,600
20,600
20,600
6,180
6,180
6,180
14,420
14,420
14,420
O01.0
Classical hydatidiform mole; Complete hydatidiform mole
HYDATIDIFORM MOLE
6,600
1,980
4,620
O01.1
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
disease
Hydrops fetalis not due to haemolytic disease; Hydrops
fetalis NOS
Hypertension, stage II
Essential Hypertension; malignant hypertension
Hypertensive heart disease with (congestive) heart failure;
Hypertensive heart failure
Hypertensive heart disease
Hypertensive heart disease without (congestive) heart
failure; Hypertensive heart disease NOS
Hypertensive renal disease with renal failure; Hypertensive
renal failure
Hypertensive renal disease without renal failure;
Hypertensive renal disease NOS
Hypertensive heart and renal disease with (congestive)
heart failure
HYDATIDIFORM MOLE
6,600
1,980
4,620
HYDATIDIFORM MOLE
6,600
1,980
4,620
HYDROCEPHALUS
HYDROCEPHALUS
HYDROCEPHALUS
HYDROCEPHALUS
HYDROCEPHALUS
HYDROCEPHALUS
HYDROCEPHALUS
HYDROCEPHALUS
HYDROPS FETALIS
17,300
17,300
17,300
17,300
17,300
17,300
13,000
13,000
7,400
5,190
5,190
5,190
5,190
5,190
5,190
3,900
3,900
2,220
12,110
12,110
12,110
12,110
12,110
12,110
9,100
9,100
5,180
HYDROPS FETALIS
7,400
2,220
5,180
HYDROPS FETALIS
9,300
2,790
6,510
HYPERTENSIVE EMERGENCY/URGENCY
9,000
9,000
2,700
2,700
6,300
6,300
9,000
2,700
6,300
9,000
2,700
6,300
9,000
2,700
6,300
9,000
2,700
6,300
9,000
2,700
6,300
9,000
2,700
6,300
Hypertensive heart and renal disease with renal failure
9,000
2,700
6,300
9,000
2,700
6,300
9,000
9,000
9,000
9,000
9,000
9,000
2,700
2,700
2,700
2,700
2,700
2,700
6,300
6,300
6,300
6,300
6,300
6,300
HYPERTHYROIDISM
8,500
2,550
5,950
HYPERTHYROIDISM
8,500
2,550
5,950
HYPERTHYROIDISM
8,500
2,550
5,950
HYPERTHYROIDISM
HYPERTHYROIDISM
HYPERTHYROIDISM
8,500
8,500
8,500
2,550
2,550
2,550
5,950
5,950
5,950
HYPERTHYROIDISM
8,500
2,550
5,950
HYPERTHYROIDISM
8,500
2,550
5,950
HYPOTHYROIDISM
8,100
2,430
5,670
HYPOTHYROIDISM
8,100
2,430
5,670
HYPOTHYROIDISM
8,100
2,430
5,670
HYPOTHYROIDISM
8,100
2,430
5,670
HYPOTHYROIDISM
8,100
2,430
5,670
HYPOTHYROIDISM
8,100
2,430
5,670
HYPOTHYROIDISM
HYPOTHYROIDISM
8,100
8,100
2,430
2,430
5,670
5,670
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
I11.9
I12.0
I12.9
I13.0
I13.1
I13.2
I13.9
I15.0
I15.1
I15.2
I15.8
I15.9
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
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
Thyrotoxicosis with diffuse goitre; Exophthalmic or toxic
goitre NOS; Graves' disease; Toxic diffuse goitre
Thyrotoxicosis with toxic single thyroid nodule;
Thyrotoxicosis with toxic uninodular goitre
Thyrotoxicosis with toxic multinodular goitre; Toxic nodular
goitre NOS
Thyrotoxicosis from ectopic thyroid tissue
Thyrotoxicosis factitia
Thyroid crisis or storm
Other thyrotoxicosis; Overproduction of thyroid-stimulating
hormone
Thyrotoxicosis, unspecified; Hyperthyroidism NOS;
Thyroiditis
Iodine-deficiency-related diffuse (endemic) goitre
Iodine-deficiency-related multinodular (endemic) goitre;
Iodine-deficiency-related nodular goitre
Iodine-deficiency-related (endemic) goitre, unspecified
Other iodine-deficiency-related thyroid disorders and allied
conditions
Subclinical iodine-deficiency hypothyroidism
Hypothyroidism due to medicaments and other exogenous
substances
Myxoedema coma
Other specified hypothyroidism
Page 40 of 112

FIRST CASE RATE
ICD CODE
E03.9
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
DESCRIPTION
GROUP
8,100
Professional
Fee
2,430
Health Care
Institution Fee
5,670
IMMUNODEFICIENCY
11,600
3,480
8,120
IMMUNODEFICIENCY
IMMUNODEFICIENCY
11,600
11,600
3,480
3,480
8,120
8,120
IMMUNODEFICIENCY
11,600
3,480
8,120
IMMUNODEFICIENCY
11,600
3,480
8,120
IMMUNODEFICIENCY
11,600
3,480
8,120
IMMUNODEFICIENCY
11,600
3,480
8,120
IMMUNODEFICIENCY
11,600
3,480
8,120
IMMUNODEFICIENCY
11,600
3,480
8,120
IMMUNODEFICIENCY
11,600
3,480
8,120
Immunodeficiency following hereditary defective response

IMMUNODEFICIENCY
to Epstein-Barr virus; X-linked lymphoproliferative disease
11,600
3,480
8,120
IMMUNODEFICIENCY
11,600
3,480
8,120
IMMUNODEFICIENCY
11,600
3,480
8,120
IMMUNODEFICIENCY
11,600
3,480
8,120
IMMUNODEFICIENCY
11,600
3,480
8,120
IMMUNODEFICIENCY
IMMUNODEFICIENCY
IMMUNODEFICIENCY
IMMUNODEFICIENCY
11,600
11,600
11,600
11,600
3,480
3,480
3,480
3,480
8,120
8,120
8,120
8,120
IMMUNODEFICIENCY
11,600
3,480
8,120
IMMUNODEFICIENCY
11,600
3,480
8,120
IMMUNODEFICIENCY
11,600
3,480
8,120
Cryoglobulinaemia; Essential Cryoglobulinaemia; Idiopathic

Cryoglobulinaemia; Mixed Cryoglobulinaemia; Primary
IMMUNODEFICIENCY
Cryoglobulinaemia; Secondary Cryoglobulinaemia;
Cryoglobulinaemic purpura; Cryoglobulinaemic vasculitis
11,600
3,480
8,120
IMMUNODEFICIENCY
11,600
3,480
8,120
IMMUNODEFICIENCY
11,600
3,480
8,120
IMMUNODEFICIENCY
11,600
3,480
8,120
9,000
2,700
6,300
9,000
2,700
6,300
9,000
2,700
6,300
9,000
2,700
6,300
9,000
2,700
6,300
9,000
2,700
6,300
9,000
2,700
6,300
9,000
2,700
6,300
INFLAMMATION/INFECTION OF THE MALE

GENITAL TRACT
9,000
2,700
6,300

GENITAL TRACT
9,000
2,700
6,300
Hypothyroidism, unspecified;
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
defects; Kappa light chain deficiency
Immunodeficiency with predominantly antibody defects,
unspecified
Severe combined immunodeficiency [SCID] with low T- and
B-cell numbers
Major histocompatibility complex class I deficiency; Bare
lymphocyte syndrome
Combined immunodeficiency, unspecified; Severe
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
Hyperimmunoglobulin E [IgE] syndrome

Immunodeficiency associated with major defect,
unspecified
Common variable immunodeficiency with predominant
abnormalities of B-cell numbers and function
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
[Heerfordt]
Sarcoidosis, unspecified
Polyclonal hypergammaglobulinaemia; Benign
hypergammaglobulinaemic purpura; Polyclonal
gammopathy NOS
Hypergammaglobulinaemia, unspecified
Other specified disorders involving the immune
mechanism, not elsewhere classified
Disorder involving the immune mechanism, unspecified;
Immune disease NOS
Leukoplakia of penis; Balanitis xerotica obliterans; Kraurosis
of penis
HYPOTHYROIDISM

GENITAL TRACT
GENITAL TRACT
N48.1
Balanoposthitis; Balanitis
N48.2
Other inflammatory disorders of penis; Abscess of corpus

cavernosum and penis; Boil of corpus cavernosum and
penis; Carbuncle of corpus cavernosum and penis; Cellulitis
GENITAL TRACT
of corpus cavernosum and penis; Cavernitis (penis) of
corpus cavernosum and penis
N48.5
Ulcer of penis
N48.6
Induratio penis plastica; Peyronie's disease; Plastic

induration of penis
N49.0
Inflammatory disorders of seminal vesicle; Vesiculitis NOS
N49.1
Inflammatory disorders of spermatic cord, tunica vaginalis

and vas deferens; Vasitis
N49.2
Inflammatory disorders of scrotum
N49.8
N49.9
Inflammatory disorders of other specified male genital

organs; Inflammation of multiple sites in male genital
organs
Inflammatory disorder of unspecified male genital organ;
Abscess of unspecified male genital organ; Boil of
unspecified male genital organ; Carbuncle of unspecified
male genital organ; Cellulitis of unspecified male genital
organ

GENITAL TRACT
GENITAL TRACT
GENITAL TRACT
GENITAL TRACT
GENITAL TRACT
Page 41 of 112
Case Rate

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
K50.0
Crohn's disease of small intestine; Crohn's disease [regional

enteritis] of duodenum; Crohn's disease [regional enteritis]
INFLAMMATORY BOWEL DISEASE
of ileum; Crohn's disease [regional enteritis] of jejunum;
Regional ileitis; Terminal ileitis
9,100
2,730
6,370
K50.1
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
9,100
2,730
6,370
9,100
2,730
6,370
9,100
2,730
6,370

9,100
9,100
9,100
9,100
9,100
9,100
2,730
2,730
2,730
2,730
2,730
2,730
6,370
6,370
6,370
6,370
6,370
6,370
9,100
2,730
6,370
21,600
6,480
15,120
21,600
6,480
15,120
21,600
6,480
15,120
21,600
6,480
15,120
21,600
6,480
15,120
21,600
6,480
15,120
21,600
6,480
15,120
INFLAMMATORY DISEASE OF THE CENTRAL

NERVOUS SYSTEM
21,600
6,480
15,120
K51.0
K51.1
K51.2
K51.3
K51.5
K51.8
Other Crohn's disease; Crohn's disease of both small and

large intestine
Crohn's disease [regional enteritis], unspecified; Crohn's
disease NOS; Regional enteritis NOS; Granulomatous
enteritis NOS
Ulcerative (chronic) enterocolitis
Ulcerative (chronic) ileocolitis
Ulcerative (chronic) proctitis
Ulcerative (chronic) rectosigmoiditis
Mucosal proctocolitis
Other ulcerative colitis
K51.9
Ulcerative colitis, unspecified; Ulcerative enteritis NOS
G04.0
Acute disseminated encephalitis; Postimmunization

[Encephalitis; Postimmunization Encephalomyelitis
G04.1
Tropical spastic paraplegia
G04.2
Bacterial meningoencephalitis and meningomyelitis, not

elsewhere classified

NERVOUS SYSTEM
NERVOUS SYSTEM
NERVOUS SYSTEM
G04.8
Other encephalitis, myelitis and encephalomyelitis;

Postinfectious encephalitis and encephalomyelitis NOS

NERVOUS SYSTEM
Encephalitis, myelitis and encephalomyelitis, unspecified;

Ventriculitis (cerebral) NOS
Encephalitis, myelitis and encephalomyelitis 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
venous sinuses and veins
Acute nonspecific idiopathic pericarditis

NERVOUS SYSTEM
NERVOUS SYSTEM
NERVOUS SYSTEM
K50.8
K50.9
G04.9
G05.8*
G07*
G08
I30.0
INFLAMMATORY DISEASES OF THE HEART
14,400
4,320
10,080
I30.1
Infective pericarditis; Pneumococcal pericarditis; Purulent

pericarditis; Staphylococcal pericarditis; Streptococcal
pericarditis; Viral pericarditis; Pyopericarditis
14,400
4,320
10,080
I30.8
I30.9
Other forms of acute pericarditis

Acute pericarditis, unspecified

14,400
14,400
4,320
4,320
10,080
10,080
I31.0
Chronic adhesive pericarditis; Accretio cordis; Adherent

pericardium; Adhesive mediastinopericarditis
14,400
4,320
10,080
I31.1
Chronic constrictive pericarditis; Concretio cordis;

Pericardial calcification
14,400
4,320
10,080
I33.0
Acute and subacute infective endocarditis; Acute bacterial

endocarditis; Subacute bacterial endocarditis; Acute
infective endocarditis NOS; Subacute infective endocarditis INFLAMMATORY DISEASES OF THE HEART
NOS; Acute lenta endocarditis; Subacute lenta endocarditis;
Acute malignant endocar
14,400
4,320
10,080
14,400
4,320
10,080
14,400
4,320
10,080

INFLUENZA
14,400
14,400
14,400
14,400
6,600
4,320
4,320
4,320
4,320
1,980
10,080
10,080
10,080
10,080
4,620
I33.9
I38
I40.0
I40.1
I40.8
I40.9
J09
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)
J10.0
Influenza with pneumonia, influenza virus identified;

INFLUENZA
Influenzal (broncho) pneumonia, influenza virus indentified
6,600
1,980
4,620
J10.1
Influenza with other respiratory manifestations, influenza

virus identified; Influenza, influenza virus identified; Acute
upper respiratory influenzal infection, influenza virus
identified; Influenzal laryngitis, influenza virus identified;
Influenzal pha
6,600
1,980
4,620
INFLUENZA
Page 42 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
J11.8+ I41.1*
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
Influenza with pneumonia, virus not identified; Influenzal
(broncho) pneumonia, unspecified or specific virus not
identified
Influenza 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; Influen
Influenza with 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
T66
Unspecified effects of radiation
T67.6
Heat fatigue, transient
T67.8
Other effects of heat and light
T68
Hypothermia
T69.0
Immersion hand and foot; Trench foot
T69.9
Effect of reduced temperature, unspecified
J10.8
J11.0
J11.1
J11.8
T70.0
T70.2
T70.3
T70.4
T70.8
Otitic barotrauma; Aero-otitis media; Effects of change in

ambient atmospheric pressure on sinuses
Other and unspecified effects of high altitude; Alpine
sickness; Anoxia due to high altitude; Barotrauma NOS;
Hypobaropathy; Mountain sickness
Caisson disease [decompression sickness]; Compressed-air
disease; Diver's palsy or paralysis
Effects of high-pressure fluids; Traumatic jet injection
(industrial)
Other effects of air pressure and water pressure; Blast
injury syndrome
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
INFLUENZA
6,600
1,980
4,620
INFLUENZA
6,600
1,980
4,620
INFLUENZA
6,600
1,980
4,620
INFLUENZA
6,600
1,980
4,620
INFLUENZA
INJURIES DUE TO ENVIRONMENTAL AND OTHER
EXTERNAL FACTORS CAUSES
6,600
1,980
4,620
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510

T70.9
Effect of air pressure and water pressure, unspecified
T75.2
Effects of vibration; Pneumatic hammer syndrome;

Traumatic vasospastic syndrome; Vartigo from infrasound

9,300
2,790
6,510
T75.8
Other specified INJURIES DUE TO ENVIRONMENTAL AND

OTHER EXTERNAL FACTORS causes; Effects of abnormal
gravitation [G] forces; Effects of weightlessness

9,300
2,790
6,510
S14.0
S34.0
Concussion and oedema of cervical spinal cord

Concussion and oedema of lumbar spinal cord
18,400
18,400
5,520
5,520
12,880
12,880
S16
Injury of muscle and tendon at neck level
7,200
2,160
5,040
7,200
2,160
5,040
S39.0
S43.0
Injury of muscle and tendon of abdomen, lower back and

pelvis
Dislocation of shoulder joint; Dislocation of Glenohumeral
joint
Sprain and strain of shoulder joint; sprain and strain of
Coracohumeral (ligament); Sprain and strain of Rotator cuff
capsule
Sprain and strain of acromioclavicular joint; sprain and
strain of Acromioclavicular ligament
INJURIES TO NEURAL STRUCTURES AND NERVES

INJURIES TO NEURAL STRUCTURES AND NERVES
INJURIES TO THE MUSCLES AND TENDONS AND
JOINTS
JOINTS
JOINTS
7,200
2,160
5,040

JOINTS
7,200
2,160
5,040

JOINTS
7,200
2,160
5,040
S43.7
Sprain and strain of other and unspecified parts of shoulder INJURIES TO THE MUSCLES AND TENDONS AND
girdle; Sprain and strain of shoulder girdle NOS
JOINTS
7,200
2,160
5,040
S46.0
Injury of tendon of the rotator cuff of shoulder
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
S43.4
S43.5
S46.1
S46.2
S46.7
S46.8
S46.9
S53.4
S56.0

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
upper arm level
JOINTS
Injury of other muscles and tendons at shoulder and upper INJURIES TO THE MUSCLES AND TENDONS AND
arm level
JOINTS
Injury of unspecified muscle and tendon at shoulder and
upper arm level
JOINTS
Sprain and strain of elbow
JOINTS
Injury of flexor muscle and tendon of thumb at forearm
level
JOINTS
Page 43 of 112

FIRST CASE RATE
ICD CODE
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
DESCRIPTION
GROUP
Injury of long flexor muscle and tendon of other finger(s) at INJURIES TO THE MUSCLES AND TENDONS AND
forearm level
JOINTS
Injury of other flexor muscle and tendon at forearm level
JOINTS
Injury of extensor or abductor muscles and tendons of
thumb at forearm level
JOINTS
Sprain and strain of wrist; Sprain and strain of Carpal joint;
Sprain and strain of Radiocarpal joint; Sprain and strain of
JOINTS
Radiocarpal ligament
Sprain and strain of finger(s); Sprain and strain of
Interphalangeal joint, hand; Sprain and strain
JOINTS
Metacarpophalangeal joint; Sprain and strain of Phalanx,
hand; Sprain and strain of Thumb
Sprain and strain of other and unspecified parts of hand
JOINTS
Injury of flexor muscle and tendon of other finger at wrist INJURIES TO THE MUSCLES AND TENDONS AND
and hand level
JOINTS
Injury of extensor muscle and tendon of other finger at
wrist and hand level
JOINTS
Injury of intrinsic muscle and tendon of other finger at wrist INJURIES TO THE MUSCLES AND TENDONS AND
and hand level
JOINTS
Injury of multiple flexor muscles and tendons at wrist and INJURIES TO THE MUSCLES AND TENDONS AND
hand level
JOINTS
Injury of other muscles and tendons at wrist and hand level
JOINTS
Injury of unspecified muscle and tendon at wrist and hand INJURIES TO THE MUSCLES AND TENDONS AND
level
JOINTS
Sprain and strain of hip
JOINTS
Injury of quadriceps muscle and tendon; injury of Patellar INJURIES TO THE MUSCLES AND TENDONS AND
ligament (tendon)
JOINTS
Injury of adductor muscle and tendon of thigh
JOINTS
Injury of muscle and tendon of the posterior muscle group INJURIES TO THE MUSCLES AND TENDONS AND
at thigh level
JOINTS
Injury of other and unspecified muscles and tendons at
thigh level
JOINTS
Sprain and strain involving fibular collateral ligament of
knee; Sprain and strain involving tibial collateral ligament of
JOINTS
knee
Sprain and strain involving anterior cruciate ligament of
knee; Sprain and strain involving posterior cruciate
JOINTS
ligament of knee
Sprain and strain of other and unspecified parts of knee
JOINTS
Injury of other muscles and tendons at lower leg level
JOINTS
Injury of unspecified muscle and tendon at lower leg level
JOINTS
Case Rate
Professional
Fee
Health Care
Institution Fee
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
S93.4
Sprain and strain of ankle including Calcaneofibular

(ligament), Deltoid (ligament), Internal collateral (ligament),
JOINTS
Talofibular (ligament), Tibiofibular , distal (ligament)
7,200
2,160
5,040
S93.5
Sprain and strain of toe(s) including Interphalangeal

(joint(s), metatarsophalangeal (joint(s)

JOINTS
7,200
2,160
5,040
S93.6
Sprain and strain of other and unspecified parts of foot

including Tarsal (ligament), Tarsometatarsal (ligament)

JOINTS
7,200
2,160
5,040
Injury of muscle and tendon of long flexor muscle of toe at

ankle and foot level
Injury of unspecified muscle and tendon at ankle and foot
level

JOINTS
JOINTS
JOINTS
7,200
2,160
5,040
7,200
2,160
5,040
7,200
2,160
5,040
INTERSTITIAL PULMONARY DISEASE
14,000
4,200
9,800
14,000
4,200
9,800
14,000
4,200
9,800
14,000
4,200
9,800
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 INTESTINAL DISORDERS
vein embolism; Mesentric artery infarction; Mesentric vein
infarction; Mesentric a
14,000
4,200
9,800
14,000
4,200
9,800
9,500
2,850
6,650
S96.0
S96.9
T03.9
J81
J82
J84.0
J84.1
J84.8
J84.9
K55.0
Multiple dislocations, sprains and strains, unspecified

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
Page 44 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
K55.1
Chronic vascular disorders of intestine; Chronic ischaemic

colitis; Chronic ischaemic enteritis; Chronic ischaemic
enterocolitis; Ischaemic stricture of intestine; Mesentric
atherosclerosis; Mesentric vascular insufficiency
INTESTINAL DISORDERS
9,500
2,850
6,650
K55.2
Angiodysplasia of colon
9,500
2,850
6,650
K55.9
Vascular disorder of intestine, unspecified; Ischaemic colitis

NOS; Ischaemic enteritis NOS; Ischaemic enterocolitis NOS
9,500
2,850
6,650
K57.0
Diverticular disease of small intestine with perforation and

abscess; Diverticular disease of small intestine with
peritonitis
9,500
2,850
6,650
K57.1
Diverticular disease of small intestine without perforation

or abscess; Diverticular disease of small intestine NOS
9,500
2,850
6,650
K57.2
Diverticular disease of large intestine with perforation and

abscess; Diverticular disease/ Diverticulitis/ Diverticulosis/
Diverticulum of colon with peritonitis
9,500
2,850
6,650
K57.3
Diverticular disease of large intestine without perforation

or abscess; Diverticular disease of colon NOS
9,500
2,850
6,650
9,500
2,850
6,650
9,500
2,850
6,650
9,500
2,850
6,650
9,500
2,850
6,650
9,500
2,850
6,650
9,500
2,850
6,650
9,500
9,500
9,500
9,500
9,500
9,500
9,500
9,500
9,500
2,850
2,850
2,850
2,850
2,850
2,850
2,850
2,850
2,850
6,650
6,650
6,650
6,650
6,650
6,650
6,650
6,650
6,650
INTESTINAL MALABSORPTION
4,100
1,230
2,870
4,100
1,230
2,870
4,100
1,230
2,870
4,100
1,230
2,870
4,100
1,230
2,870
4,100
4,100
1,230
1,230
2,870
2,870
INTESTINAL OBSTRUCTION
10,100
3,030
7,070
10,100
3,030
7,070
10,100
3,030
7,070
10,100
3,030
7,070
10,100
3,030
7,070
10,100
3,030
7,070
10,100
3,030
7,070
10,100
3,030
7,070
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
Diverticular disease of both small and large intestine with

perforation and abscess; Diverticular disease of both small
and large intestine with peritonitis
Diverticular disease of both small and large intestine
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
NOS with peritonitis
Diverticular disease of intestine, part unspecified, without
perforation or abscess; Diverticular disease of intestine
NOS
Megacolon, not elsewhere classified; Dilatation of colon;
Toxic megacolon
Other specified functional intestinal disorders; Atony of
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
steatorrhoea; Nontropical sprue
Tropical sprue; Sprue NOS; Tropical steatorrhoea
Blind loop syndrome, not elsewhere classified; Blind loop
syndrome NOS
Pancreatic steatorrhoea
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
Volvulus; Strangulation of colon or intestine; Torsion of
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
Page 45 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
G06.0
Intracranial abscess and granuloma; Abscess (embolic)(of)

brain [any part]; Abscess (embolic)(of) cerebellar; Abscess
(embolic)(of) cerebral; Abscess (embolic)(of) otogenic;
GRANULOMA
IIntracranial abscess or granuloma, epidural; Intracranial
abscess or granulom
27,900
8,370
19,530
G06.1
Intraspinal abscess and granuloma; Abscess (embolic) of

spinal cord [any part]; Intraspinal abscess or granuloma
epidural; Intraspinal abscess or granuloma extradural;
Intraspinal abscess or granuloma subdural

GRANULOMA
27,900
8,370
19,530
G06.2
Encephalitis, myelitis and encephalomyelitis in Extradural

and subdural abscess, unspecified

GRANULOMA
27,900
8,370
19,530
S04.0
Injury of optic nerve and pathways; Injury of Optic chiasm;

INTRACRANIAL INJURIES
Injury of 2nd cranial nerve; Injury of Visual cortex
8,800
2,640
6,160
S04.1
Injury of oculomotor nerve; injury of 3rd cranial nerve
8,800
2,640
6,160
S04.4
S04.5
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
2,640
2,640
6,160
6,160
8,800
2,640
6,160
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
8,800
2,640
6,160
8,800
2,640
6,160
8,800
2,640
6,160
8,800
2,640
6,160
8,800
2,640
6,160
8,800
2,640
6,160
8,800
2,640
6,160
8,800
2,640
6,160
S06.30
Focal brain injury; Focal cerebral; Focal cerebral contusion;

Focal cerebral laceration; Focal traumatic intracerebral
haemorrhage (without open intracranial wound)
8,800
2,640
6,160
S06.31
Focal brain injury; Focal cerebral; Focal cerebral contusion;

Focal cerebral laceration; Focal traumatic intracerebral
haemorrhage (with open intracranial wound)
8,800
2,640
6,160
8,800
2,640
6,160
8,800
2,640
6,160
8,800
2,640
6,160
8,800
2,640
6,160
8,800
2,640
6,160
8,800
2,640
6,160
8,800
2,640
6,160
8,800
2,640
6,160
8,800
2,640
6,160
8,800
2,640
6,160
8,800
2,640
6,160
S04.6
S04.8
S04.9
S05.0
S06.00
S06.01
S06.10
S06.20
S06.21
S06.40
S06.41
S06.50
S06.51
S06.60
S06.61
S06.70
S06.80
S06.81
S06.90
S06.91
Injury of unspecified cranial nerve

Injury of conjunctiva and corneal abrasion without mention
of foreign body
Concussion; Commotio cerebri (without open intracranial
wound)
Concussion; Commotio cerebri (with open intracranial
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
Epidural haemorrhage; Extradural haemorrhage, traumatic

Epidural haemorrhage; Extradural haemorrhage, traumatic
(with open intracranial wound)
Traumatic subdural haemorrhage (without open
intracranial wound)
Traumatic subdural haemorrhage (with open intracranial
wound)
Traumatic subarachnoid haemorrhage (without open
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
open intracranial wound)
Intracranial injury, unspecified; brain injury NOS (without
open intracranial wound)
Intracranial injury, unspecified; brain injury NOS (with open
intracranial wound)
S09.0
Injury of blood vessels of head, not elsewhere classified
8,800
2,640
6,160
S09.1
S09.2
S09.7
S09.8
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
NOS; Injury of nose NOS
Intraventricular (nontraumatic) haemorrhage, grade 1, of
fetus and newborn; Subependymal haemorrhage (without
intraventricular extension)
8,800
8,800
8,800
8,800
2,640
2,640
2,640
2,640
6,160
6,160
6,160
6,160
8,800
2,640
6,160
25,600
7,680
17,920
S09.9
P52.0
INTRAVENTRICULAR
HEMORRHAGE/INTRACRANIAL HEMORRHAGE IN
THE NEWBORN
Page 46 of 112

FIRST CASE RATE
ICD CODE
P52.1
DESCRIPTION
GROUP
Intraventricular (nontraumatic) haemorrhage, grade 2, of

fetus and newborn; Subependymal haemorrhage with
intraventricular extension
INTRAVENTRICULAR
THE NEWBORN
INTRAVENTRICULAR
Unspecified intraventricular (nontraumatic) haemorrhage
of fetus and newborn
THE NEWBORN
INTRAVENTRICULAR
Intracerebral (nontraumatic) haemorrhage of fetus and
newborn
THE NEWBORN
INTRAVENTRICULAR
Subarachnoid (nontraumatic) haemorrhage of fetus and
newborn
THE NEWBORN
INTRAVENTRICULAR
Cerebellar (nontraumatic) and posterior fossa haemorrhage
of fetus and newborn
THE NEWBORN
INTRAVENTRICULAR
Other intracranial (nontraumatic) haemorrhages of fetus
and newborn
THE NEWBORN
INTRAVENTRICULAR
Intracranial (nontraumatic) haemorrhage of fetus and
newborn, unspecified
THE NEWBORN
Case Rate
Professional
Fee
Health Care
Institution Fee
25,600
7,680
17,920
25,600
7,680
17,920
25,600
7,680
17,920
25,600
7,680
17,920
25,600
7,680
17,920
25,600
7,680
17,920
25,600
7,680
17,920
I21.0
Acute transmural myocardial infarction of anterior wall [or

duration of <4 weeks] KILLIPS stage unspecified; Acute
ISCHEMIC HEART DISEASE WITH MYOCARDIAL
transmural infarction of anterior wall NOS [or duration of
INFARCTION
<4 weeks] KILLIPS stage unspecified; Acute anteroapical
transmural infarction [or
18,900
5,670
13,230
I21.1
Acute transmural myocardial infarction of inferior wall [or

duration of <4 weeks] KILLIPS I; Acute transmural infarction
of diaphragmatic wall [or duration of <4 weeks] KILLIPS I;
INFARCTION
Acute transmural infarction of inferior wall NOS [or
duration of <4 weeks]
18,900
5,670
13,230
I21.2
Acute transmural myocardial infarction of other sites [or

duration of <4 weeks] KILLIPS II; Acute apical-lateral
transmural infarction [or duration of <4 weeks] KILLIPS II; INFARCTION
Acute basal-lateral transmural infarction [or duration of <4
weeks] KILLIPS I
18,900
5,670
13,230
I21.3
Acute transmural myocardial infarction of unspecified site; ISCHEMIC HEART DISEASE WITH MYOCARDIAL
Transmural myocardial infarction NOS
INFARCTION
18,900
5,670
13,230

INFARCTION
18,900
5,670
13,230

INFARCTION
18,900
5,670
13,230

INFARCTION
18,900
5,670
13,230

INFARCTION
18,900
5,670
13,230

INFARCTION
18,900
5,670
13,230
18,900
5,670
13,230
18,900
5,670
13,230
18,900
5,670
13,230
18,900
5,670
13,230
18,900
5,670
13,230
18,900
5,670
13,230
18,900
5,670
13,230
18,900
5,670
13,230
18,900
5,670
13,230
18,900
5,670
13,230
P52.3
P52.4
P52.5
P52.6
P52.8
P52.9
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
Acute subendocardial myocardial infarction;

Nontransmural myocardial infarction NOS
Acute myocardial infarction, unspecified [or duration of <4
weeks] KILLIPS I; Acute myocardial infarction NOS [or
duration of <4 weeks] KILLIPS I
Subsequent myocardial infarction of anterior wall; 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 lateral wall NOS; Acut

INFARCTION
Haemopericardium as current complication following acute ISCHEMIC HEART DISEASE WITH MYOCARDIAL
myocardial infarction
INFARCTION
Atrial septal defect as current complication following acute ISCHEMIC HEART DISEASE WITH MYOCARDIAL
myocardial infarction
INFARCTION
Ventricular septal defect as current complication following ISCHEMIC HEART DISEASE WITH MYOCARDIAL
acute myocardial infarction
INFARCTION
Subsequent myocardial infarction of unspecified site
Rupture of cardiac wall without haemopericardium as

current complication following acute myocardial infarction 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
infarction
I24.1
Dressler's syndrome; Postmyocardial infarction syndrome
I25.8
Chronic myocardial infarction or with stated duration of

over 4 weeks

INFARCTION
INFARCTION
INFARCTION
INFARCTION
INFARCTION
Page 47 of 112

FIRST CASE RATE
ICD CODE
I20.0
I20.1
I20.8
I20.9
I24.0
I24.8
DESCRIPTION
Unstable angina; Angina crescendo; Angina de novo effort;
Angina worsening effort; Intermediate coronary syndrome;
Preinfarction syndrome
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 ;
Anginal syndrome; Ischaemic chest pain
Coronary thrombosis not resulting in myocardial 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
Other forms of acute ischaemic heart disease; Coronary
failure; Coronary insufficiency
I25.5
Ischaemic cardiomyopathy
I25.6
Silent myocardial ischaemia
I25.8
Other forms of chronic ischaemic heart disease
I25.9
P57.0
P57.8
P57.9
P58.1
P58.2
P58.3
P58.4
P58.8
P58.9
P59.0
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
GROUP
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
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
Health Care
Institution Fee
12,000
3,600
8,400
ISCHEMIC HEART DISEASE WITHOUT MYOCARDIAL

INFARCTION
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
7,400
7,400
7,400
7,400
7,400
7,400
2,220
2,220
2,220
2,220
2,220
2,220
5,180
5,180
5,180
5,180
5,180
5,180
7,400
2,220
5,180
7,400
2,220
5,180
7,400
2,220
5,180
JAUNDICE IN THE NEWBORN
7,400
2,220
5,180
7,400
2,220
5,180
7,400
2,220
5,180

7,400
7,400
2,220
2,220
5,180
5,180
7,400
2,220
5,180
LEPROSY
LEPROSY
8,800
8,800
2,640
2,640
6,160
6,160
LEPROSY
8,800
2,640
6,160
LEPROSY
8,800
2,640
6,160
LEPROSY
LEPROSY
LEPROSY
8,800
8,800
8,800
2,640
2,640
2,640
6,160
6,160
6,160
LEPTOSPIROSIS MODERATE TO SEVERE
11,000
3,300
7,700

LIVER DISEASES I
LIVER DISEASES I
LIVER DISEASES I
11,000
11,000
11,800
11,800
11,800
3,300
3,300
3,540
3,540
3,540
7,700
7,700
8,260
8,260
8,260
LIVER DISEASES I
11,800
3,540
8,260
LIVER DISEASES I
11,800
3,540
8,260
LIVER DISEASES I
11,800
3,540
8,260

INFARCTION
INFARCTION
INFARCTION
INFARCTION
INFARCTION
INFARCTION
INFARCTION
INFARCTION
Neonatal jaundice due to excessive haemolysis, unspecified JAUNDICE IN THE NEWBORN
Neonatal jaundice, unspecified; Intense physiological

jaundice, NOS; Prolonged physiological jaundice, NOS
Professional
Fee

INFARCTION
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
mother or given to newborn
Neonatal jaundice due to other specified excessive
haemolysis
Neonatal jaundice associated with preterm delivery;

Hyperbilirubinaemia of prematurity; Jaundice due to
delayed conjucation associated with preterm delivery
Inspissated bile syndrome
Neonatal jaundice from other and unspecified
hepatocellular damage
Neonatal jaundice from breast milk inhibitor
Neonatal jaundice from other specified causes
Case Rate
LIVER DISEASES I
11,800
3,540
8,260
Toxic liver disease with acute hepatitis

Toxic liver disease with chronic persistent hepatitis
Toxic liver disease with chronic active hepatitis; Toxic liver
disease with lupoid hepatitis
LIVER DISEASES I
LIVER DISEASES I
11,800
11,800
3,540
3,540
8,260
8,260
LIVER DISEASES I
11,800
3,540
8,260
K71.6
Toxic liver disease with hepatitis, not elsewhere classified
LIVER DISEASES I
11,800
3,540
8,260
K71.8
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 veno-occlusive disease of
liver
LIVER DISEASES I
11,800
3,540
8,260
K71.2
K71.3
K71.5
Page 48 of 112

FIRST CASE RATE
ICD CODE
K71.9
K73.0
K73.2
K73.8
K73.9
K74.1
K74.6+I98.2*
DESCRIPTION
Toxic liver disease, unspecified
Chronic persistent hepatitis, not elsewhere classified
Chronic active hepatitis, not elsewhere classified; Lupoid
hepatitis NEC
Other chronic hepatitis, not elsewhere classified
Chronic hepatitis, unspecified
Hepatic sclerosis
Oesophageal varices in other and unspecified cirrhosis of
liver
GROUP
LIVER DISEASES I
LIVER DISEASES I
11,800
11,800
Professional
Fee
3,540
3,540
LIVER DISEASES I
11,800
3,540
8,260
LIVER DISEASES I
LIVER DISEASES I
LIVER DISEASES I
11,800
11,800
11,800
3,540
3,540
3,540
8,260
8,260
8,260
Case Rate
Health Care
Institution Fee
8,260
8,260
LIVER DISEASES I
11,800
3,540
8,260
K75.0
Abscess of liver; Hepatic abscess NOS; Cholangitic hepatic

abscess; Haematogenic hepatic abscess; Lymphogenic
hepatic abscess; Pylephlebitic hepatic abscess
LIVER DISEASES I
11,800
3,540
8,260
K75.1
K75.2
K75.3
K75.4
K75.8
Phlebitis of portal vein; Pylephlebitis

Nonspecific reactive hepatitis
Granulomatous hepatitis, not elsewhere classified
Autoimmune hepatitis
Other specified inflammatory liver diseases
LIVER DISEASES I
LIVER DISEASES I
LIVER DISEASES I
LIVER DISEASES I
LIVER DISEASES I
11,800
11,800
11,800
11,800
11,800
3,540
3,540
3,540
3,540
3,540
8,260
8,260
8,260
8,260
8,260
K75.9
Inflammatory liver disease, unspecified; Hepatitis NOS
LIVER DISEASES I
11,800
3,540
8,260
K76.0
Fatty (change of) liver, not elsewhere classified

Other specified diseases of liver; Focal nodular hyperplasia
of liver; Hepatoptosis
Liver disease, unspecified
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 (socalled) of liver; Cardiac sclerosis of liver
Central haemorrhagic necrosis of liver
Infarction of liver
Peliosis hepatis; Hepatic angiomatosis
Portal hypertension
Hepatorenal syndrome
LIVER DISEASES I
11,800
3,540
8,260
LIVER DISEASES I
11,800
3,540
8,260
LIVER DISEASES I
LIVER DISEASES II
LIVER DISEASES II
LIVER DISEASES II
LIVER DISEASES II
11,800
15,100
15,100
15,100
15,100
3,540
4,530
4,530
4,530
4,530
8,260
10,570
10,570
10,570
10,570
LIVER DISEASES II
15,100
4,530
10,570
LIVER DISEASES II
15,100
4,530
10,570
LIVER DISEASES II
LIVER DISEASES II
LIVER DISEASES II
LIVER DISEASES II
LIVER DISEASES II
15,100
15,100
15,100
15,100
15,100
4,530
4,530
4,530
4,530
4,530
10,570
10,570
10,570
10,570
10,570
LYMPHADENITIS
6,800
2,040
4,760
LYMPHATIC VESSELS DISORDER
8,900
2,670
6,230
8,900
2,670
6,230
8,900
2,670
6,230
MALIGNANT NEOPLASM OF URINARY TRACT
14,100
4,230
9,870
Malignant neoplasm of renal pelvis; Malignant neoplasm of

Pelviureteric junction; Malignant neoplasm of Renal calyces
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
I89.9
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
C40.1
C40.2
C40.3
C40.9
Nonspecific mesenteric lymphadenitis; Acute Mesenteric

lymphadenitis; Chronic Mesenteric lymphadenitis
Lymphangitis; Lymphangitis NOS; Chronic Lymphangitis;
Subacute Lymphangitis
Other specified noninfective disorders of lymphatic vessels
and lymph nodes; Chylocele (nonfilarial); Lipomelanotic
reticulosis
Noninfective disorder of lymphatic vessels and lymph
nodes, unspecified; Disease of lymphatic vessels NOS
Malignant neoplasm of kidney, except renal pelvis & renal
calyces
14,100
4,230
9,870
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
of Internal urethral orifice
Malignant neoplasm of Ureteric 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

14,100
14,100
14,100
14,100
14,100
4,230
4,230
4,230
4,230
4,230
9,870
9,870
9,870
9,870
9,870
14,100
4,230
9,870

14,100
14,100
14,100
14,100
14,100
4,230
4,230
4,230
4,230
4,230
9,870
9,870
9,870
9,870
9,870
14,100
4,230
9,870
Secondary malignant neoplasm of kidney and renal pelvis
14,100
4,230
9,870
14,100
4,230
9,870
16,500
4,950
11,550
16,500
4,950
11,550
16,500
4,950
11,550
16,500
4,950
11,550
16,500
4,950
11,550
Secondary malignant neoplasm of bladder and other and

unspecified urinary organs
Malignant neoplasm of Scapula and long bones of upper
limb
MALIGNANT NEOPLASMS OF BONE AND

ARTICULAR CARTILAGE
Malignant neoplasm of Short bones of upper limb
ARTICULAR CARTILAGE
Malignant neoplasm of Long bones of lower limb
ARTICULAR CARTILAGE
Malignant neoplasm of Short bones of lower limb
ARTICULAR CARTILAGE
Malignant neoplasm of Bone and articular cartilage of limb, MALIGNANT NEOPLASMS OF BONE AND
unspecified
ARTICULAR CARTILAGE
Page 49 of 112

FIRST CASE RATE
ICD CODE
C41.0
C41.1
C41.2
DESCRIPTION
Malignant neoplasm of Bones of skull and face; Malignant
neoplasm o f Superior maxilla; Malignant neoplasm of
Orbital bone
Malignant neoplasm of Mandible; Malignant neoplasm of
Lower jaw bone
Malignant neoplasm of Vertebral column
C41.3
Malignant neoplasm of Ribs, sternum and clavicle
C41.4
Malignant neoplasm of Pelvic bones, sacrum and coccyx
C41.8
C41.9
Malignant neoplasm of Overlapping lesion of bone and

articular cartilage
Malignant neoplasm of Bone and articular cartilage,
unspecified
C79.5
Secondary malignant neoplasm of bone and bone marrow
C70.0
Malignant neoplasm of Cerebral meninges
C70.1
Malignant neoplasm of Spinal meninges
C70.9
Malignant neoplasm of Meninges, unspecified
C71.0
Malignant neoplasm of Cerebrum, except lobes and

ventricles; Malignant neoplasm of Supratentorial NOS
GROUP
ARTICULAR CARTILAGE
ARTICULAR CARTILAGE
ARTICULAR CARTILAGE
ARTICULAR CARTILAGE
ARTICULAR CARTILAGE
ARTICULAR CARTILAGE
ARTICULAR CARTILAGE
ARTICULAR CARTILAGE
MALIGNANT NEOPLASMS OF CENTRAL NERVOUS
SYSTEM
SYSTEM
SYSTEM
SYSTEM
SYSTEM
SYSTEM
SYSTEM
SYSTEM
SYSTEM
SYSTEM
C71.1
Malignant neoplasm of Frontal lobe
C71.2
Malignant neoplasm of Temporal lobe
C71.3
Malignant neoplasm of Parietal lobe
C71.4
Malignant neoplasm of Occipital lobe
C71.5
Malignant neoplasm of Cerebral ventricle
C71.6
Malignant neoplasm of Cerebellum
C71.7
Malignant neoplasm of Brain stem; Malignant neoplasm of MALIGNANT NEOPLASMS OF CENTRAL NERVOUS
Fourth Ventricle; Malignant neoplasm of Infratentorial NOS SYSTEM
C71.8
Malignant neoplasm of Overlapping lesion of brain
C71.9
Malignant neoplasm of Brain, unspecified
C72.0
Malignant neoplasm of Spinal cord
C72.1
Malignant neoplasm of Cauda equina
C72.2
Malignant neoplasm of Olfactory nerve; Malignant

neoplasm of Olfactory bulb
C72.3
Malignant neoplasm of Optic nerve
C72.4
Malignant neoplasm of Acoustic nerve
Case Rate
Professional
Fee
Health Care
Institution Fee
16,500
4,950
11,550
16,500
4,950
11,550
16,500
4,950
11,550
16,500
4,950
11,550
16,500
4,950
11,550
16,500
4,950
11,550
16,500
4,950
11,550
16,500
4,950
11,550
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
Malignant neoplasm of Other and unspecified cranial

nerves; Malignant neoplasm of Cranial nerve NOS
Malignant neoplasm of Overlapping lesion of brain and
other parts of central nervous system

SYSTEM
SYSTEM
SYSTEM
SYSTEM
SYSTEM
SYSTEM
SYSTEM
SYSTEM
SYSTEM
Malignant neoplasm of Central nervous system,

unspecified; Malignant neoplasm of Nervous system NOS

SYSTEM
Secondary malignant neoplasm of brain and cerebral

meninges
Secondary malignant neoplasm of other and unspecified
parts of nervous system

SYSTEM
SYSTEM
16,900
5,070
11,830
C15.0
Malignant neoplasm of Cervical part of oesophagus
MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS
14,200
4,260
9,940
C15.2
Malignant neoplasm of Abdominal part of oesophagus
14,200
4,260
9,940
C15.3
Malignant neoplasm of Upper third of oesophagus
14,200
4,260
9,940
C15.4
Malignant neoplasm of Middle third of oesophagus
14,200
4,260
9,940
C15.5
Malignant neoplasm of Lower third of oesophagus
14,200
4,260
9,940
C15.8
Malignant neoplasm of Overlapping lesion of oesophagus
14,200
4,260
9,940
C15.9
Malignant neoplasm of Oesophagus, unspecified
14,200
4,260
9,940
C16
Dermato(poly)myositis in Malignant neoplasm of stomach
10,600
3,180
7,420
C72.5
C72.8
C72.9
C79.3
C79.4
Page 50 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
C16.0
Malignant neoplasm of Cardia; Malignant neoplasm of

Cardiac orifice; Malignant neoplasm of Cardio-oesophageal
junction; Malignant neoplasm of
Gastro-oesophageal junction; Malignant neoplasm of
Oesophagus and stomach
14,200
4,260
9,940
C16.1
Malignant neoplasm of Fundus of stomach
14,200
4,260
9,940
14,200
4,260
9,940
14,200
4,260
9,940
14,200
4,260
9,940
14,200
4,260
9,940
14,200
4,260
9,940
C16.2
C16.3
C16.4
C16.5
C16.6
Malignant neoplasm of Body of stomach

Malignant neoplasm of Pyloric antrum; Malignant
neoplasm of Gastric antrum
Malignant neoplasm of Pylorus; Malignant neoplasm of
Prepylorus; Malignant neoplasm of pyloric canal
Malignant neoplasm of Lesser curvature of stomach,
unspecified
Malignant neoplasm of Greater curvature of stomach,
unspecified
C16.9
Malignant neoplasm of Stomach, unspecified
14,200
4,260
9,940
C17.0
Malignant neoplasm of Duodenum
14,200
4,260
9,940
C17.1
Malignant neoplasm of Jejunum
14,200
4,260
9,940
C17.2
Malignant neoplasm of Ileum
14,200
4,260
9,940
C17.9
Malignant neoplasm of Small intestine, unspecified
14,200
4,260
9,940
C18.0
Malignant neoplasm of Caecum; Malignant neoplasm of

Ileocaecal valve
14,200
4,260
9,940
C18.1
Malignant neoplasm of Appendix
14,200
4,260
9,940
C18.2
Malignant neoplasm of Ascending colon
14,200
4,260
9,940
C18.3
Malignant neoplasm of Hepatic flexure
14,200
4,260
9,940
C18.4
Malignant neoplasm of Transverse colon
14,200
4,260
9,940
C18.5
Malignant neoplasm of Splenic flexure
14,200
4,260
9,940
C18.6
Malignant neoplasm of Descending colon
14,200
4,260
9,940
C18.7
Malignant neoplasm of Sigmoid colon; Malignant neoplasm

of Sigmoid flexure
14,200
4,260
9,940
C18.8
Malignant neoplasm of Overlapping lesion of colon
14,200
4,260
9,940
14,200
4,260
9,940
14,200
4,260
9,940
14,200
4,260
9,940
14,200
4,260
9,940
4,260
9,940
C18.9
C19
C20
Malignant neoplasm of Colon, unspecified; Malignant

neoplasm of Large intestine NOS
Malignant neoplasm of rectosigmoid junction; Malignant
neoplasm of Colon with rectum; Malignant neoplasm of
Rectosigmoid colon
Malignant neoplasm of rectum; Malignant neoplasm of
Rectal ampulla
C21.0
Malignant neoplasm of Anus, unspecified
C21.1
Malignant neoplasm of Anal canal; Malignant neoplasm of

Anal sphincter
14,200
C21.8
Malignant neoplasm of Overlapping lesion of rectum, anus

and anal canal; Malignant neoplasm of Anorectal junction; MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS
Malignant neoplasm of Anorectum
14,200
4,260
9,940
C22.0
Liver cell carcinoma; Hepatocellular carcinoma

Hepatoma
14,200
4,260
9,940
C22.1
Intrahepatic bile duct carcinoma; Cholangiocarcinoma
14,200
4,260
9,940
C22.2
Hepatoblastoma
14,200
4,260
9,940
C22.3
Angiosarcoma of liver; Kupffer cell sarcoma
14,200
4,260
9,940
C22.4
Other sarcomas of liver
10,600
3,180
7,420
C22.7
Other specified carcinomas of liver
14,200
4,260
9,940
C22.9
Liver, unspecified
14,200
4,260
9,940
C23
Malignant neoplasm of gallbladder
14,200
4,260
9,940
C24.0
Malignant neoplasm of Extrahepatic bile duct; Malignant

neoplasm of Biliary duct or passage NOS; Malignant
neoplasm of Common bile duct; Malignant neoplasm of
Cystic duct; Malignant neoplasm of Hepatic duct
14,200
4,260
9,940
C24.1
Malignant neoplasm of Ampulla of Vater
14,200
4,260
9,940
Page 51 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
C24.8
Malignant neoplasm of Overlapping lesion of biliary tract
10,600
3,180
7,420
C24.9
Malignant neoplasm of Biliary tract, unspecified
14,200
4,260
9,940
C25.0
Malignant neoplasm of Head of pancreas
14,200
4,260
9,940
C25.1
Malignant neoplasm of Body of pancreas
14,200
4,260
9,940
C25.2
Malignant neoplasm of Tail of pancreas
14,200
4,260
9,940
C25.3
Malignant neoplasm of Pancreatic duct
14,200
4,260
9,940
14,200
4,260
9,940
14,200
4,260
9,940
C25.4
C25.7
Malignant neoplasm of Endocrine pancreas; Malignant

neoplasm of Islets of Langerhans
Malignant neoplasm of Other parts of pancreas; Malignant
neoplasm of Neck of pancreas
C25.8
Malignant neoplasm of Overlapping lesion of pancreas
14,200
4,260
9,940
C25.9
Malignant neoplasm of Pancreas, unspecified
14,200
4,260
9,940
C26.0
Malignant neoplasm of Intestinal tract, part unspecified;

Malignant neoplasm of Intestine NOS
14,200
4,260
9,940
C26.1
Malignant neoplasm of Spleen
14,200
4,260
9,940
C26.8
Malignant neoplasm of Overlapping lesion of digestive

system
14,200
4,260
9,940
C26.9
Malignant neoplasm of Ill-defined sites within the digestive

system; Malignant neoplasm of Alimentary canal or tract
NOS; Malignant neoplasm of Gastrointestinal tract NOS
14,200
4,260
9,940
10,600
3,180
7,420
10,600
3,180
7,420
10,600
3,180
7,420
4,260
9,940
C45.1
C48.1
C48.2
Mesothelioma of peritoneum; Mesothelioma of Mesentery;

Mesothelioma of Mesocolon; Mesothelioma of Omentum;
Mesothelioma of Parietal
Peritoneum; Mesothelioma of Pelvic Peritoneum
Malignant neoplasm of Specified parts of peritoneum;
Malignant neoplasm of Mesentery; Malignant neoplasm of
Mesocolon; Malignant neoplasm of Omentum; Malignant MALIGNANT NEOPLASMS OF DIGESTIVE ORGANS
neoplasm of Parietal Peritoneum; Malignant neoplasm of
Pelvic peritoneum
Malignant neoplasm of Peritoneum, unspecified
C76.2
Malignant neoplasm of Abdomen
14,200
C77.2
Secondary and unspecified malignant neoplasm of Intraabdominal lymph nodes
14,200
4,260
9,940
C78.4
Secondary malignant neoplasm of small intestine
14,200
4,260
9,940
14,200
4,260
9,940
14,200
4,260
9,940
14,200
4,260
9,940
14,200
4,260
9,940
MALIGNANT NEOPLASMS OF EARS AND NOSE
10,300
3,090
7,210
MALIGNANT NEOPLASMS OF EARS AND NOSE
10,300
3,090
7,210
MALIGNANT NEOPLASMS OF EYE

16,900
16,900
16,900
5,070
5,070
5,070
11,830
11,830
11,830
16,900
5,070
11,830
16,900
5,070
11,830
Malignant neoplasm of Orbit; Malignant neoplasm of

Connective tissue of orbit; Malignant neoplasm of
Extraocular muscle; Malignant neoplasm of Peripheral
nerves of orbit; Malignant neoplasm of Retrobulbar tissue;
Malignant neoplasm of Retro-ocular
16,900
5,070
11,830
16,900
5,070
11,830
11,400
3,420
7,980
11,400
3,420
7,980
C78.5
C78.6
C78.7
C78.8
C30.0
C30.1
C69.1
C69.2
C69.3
C69.4
C69.5
C69.6
C69.9
C51.0
C51.1
Secondary malignant neoplasm of large intestine and

rectum
Secondary malignant neoplasm of retroperitoneum and
peritoneum; Malignant ascites NOS
Secondary malignant neoplasm of liver
digestive organs
Malignant neoplasm of Nasal cavity; Malignant neoplasm of
Cartilage of nose; Malignant neoplasm of nasal Concha;
Malignant neoplasm of Internal nose; Malignant neoplasm
of Septum of nose; Malignant neoplasm of Vestibule of
nose
Malignant neoplasm of Middle ear; Malignant neoplasm of
Eustachian tube; Malignant neoplasm of Inner ear;
Malignant neoplasm of
Mastoid air cells
Malignant neoplasm of Cornea
Malignant neoplasm of Retina
Malignant neoplasm of Choroid
Malignant neoplasm of Ciliary body; Malignant neoplasm
of Eyeball
Malignant neoplasm of Lacrimal gland and duct; Malignant
neoplasm of Lacrimal sac; Malignant neoplasm of
Nasolacrimal duct
Malignant neoplasm of Eye, unspecified

Malignant neoplasm of Labium majus; Malignant neoplasm MALIGNANT NEOPLASMS OF FEMALE GENITAL
of Bartholin's [greater vestibular] gland
TRACT
MALIGNANT NEOPLASMS OF FEMALE GENITAL
Malignant neoplasm of Labium minus
TRACT
Page 52 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
C51.2
Malignant neoplasm of Clitoris

TRACT
11,400
3,420
7,980
C51.9
Malignant neoplasm of Vulva, unspecified; Malignant

neoplasm of External female genitalia NOS; Malignant
neoplasm of Pudendum

TRACT
11,400
3,420
7,980
C52
Malignant neoplasm of vagina
11,400
3,420
7,980
11,400
3,420
7,980
11,400
3,420
7,980
11,400
3,420
7,980
11,400
3,420
7,980
11,400
3,420
7,980
11,400
3,420
7,980
11,400
3,420
7,980
11,400
3,420
7,980
11,400
3,420
7,980
11,400
3,420
7,980
11,400
3,420
7,980
11,400
3,420
7,980
11,400
3,420
7,980
11,400
3,420
7,980
C53.0
C53.1
C53.8
C53.9
C54.0
C54.1
C54.2
C54.3
C54.8
C54.9
C55
C56
C57.0
C57.3
C57.4

TRACT
Malignant neoplasm of Endocervix
TRACT
Malignant neoplasm of Exocervix
TRACT
Malignant neoplasm of Overlapping lesion of cervix uteri
TRACT
Malignant neoplasm of Cervix uteri, unspecified
TRACT
Malignant neoplasm of Isthmus uteri; Malignant neoplasm MALIGNANT NEOPLASMS OF FEMALE GENITAL
of Lower uterine segment
TRACT
Malignant neoplasm of Endometrium
TRACT
Malignant neoplasm of Myometrium
TRACT
Malignant neoplasm of Fundus uteri
TRACT
Malignant neoplasm of Overlapping lesion of corpus uteri
TRACT
Corpus uteri, unspecified
TRACT
Malignant neoplasm of uterus, part unspecified
TRACT
Malignant neoplasm of ovary
TRACT
Malignant neoplasm of Fallopian tube; Malignant
neoplasm of Oviduct; Malignant neoplasm of Uterine tube TRACT
Malignant neoplasm of Parametrium; Malignant neoplasm MALIGNANT NEOPLASMS OF FEMALE GENITAL
of Uterine ligament NOS
TRACT
Malignant neoplasm of Uterine adnexa, unspecified
TRACT
11,400
3,420
7,980
C57.7
Malignant neoplasm of Other specified female genital

organs; Malignant neoplasm of Wolffian body or duct

TRACT
11,400
3,420
7,980
C57.8
Malignant neoplasm of Overlapping lesion of female genital

organs; Malignant neoplasm of Tubo-ovarian; Malignant
TRACT
neoplasm of Utero-ovarian
11,400
3,420
7,980
C57.9
Malignant neoplasm of Female genital organ, unspecified;

Malignant neoplasm of Female genitourinary tract NOS

TRACT
11,400
3,420
7,980
C58
Malignant neoplasm of placenta; Choriocarcinoma NOS;

Chorionepithelioma NOS
11,400
3,420
7,980
C79.6
Secondary malignant neoplasm of ovary

TRACT
TRACT
11,400
3,420
7,980
11,500
3,450
8,050
11,500
3,450
8,050
11,500
3,450
8,050
11,500
3,450
8,050
11,500
3,450
8,050
11,500
3,450
8,050
11,500
3,450
8,050
11,500
3,450
8,050
11,500
3,450
8,050
11,500
3,450
8,050
11,500
3,450
8,050
11,500
3,450
8,050
C00.0
C00.9
C01
C02.0
C02.1
C02.2
Malignant neoplasm of External upper lip; Malignant

neoplasm of Upper lip NOS; Malignant neoplasm of Upper MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
PHARYNX
lip; Malignant neoplasm of lipstick area; Malignant
neoplasm of Upper lip, vermilion border
MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
Malignant neoplasm of Lip, unspecified
PHARYNX
Malignant neoplasm of base of Dorsal surface of tongue ;
Malignant neoplasm of Fixed part of tongue NOS;
PHARYNX
Malignant neoplasm of Posterior third of tongue
Malignant neoplasm of Dorsal surface of base of tongue;
Malignant neoplasm of Anterior two-thirds of dorsal
PHARYNX
surface of tongue
Malignant neoplasm of Border of tongue; Malignant
neoplasm of Tip of tongue
PHARYNX
Malignant neoplasm of Ventral surface of tongue;
Malignant neoplasm of Anterior two-thirds of ventral
PHARYNX
surface of tongue; Malignant neoplasm of Frenulum
linguae
C02.3
Malignant neoplasm of Anterior two-thirds of tongue, part

unspecified; Malignant neoplasm of Middle third of tongue
PHARYNX
NOS; Malignant neoplasm of Mobile part of tongue NOS
C02.4
Malignant neoplasm of Lingual tonsil
C02.8
Malignant neoplasm of Overlapping lesion of tongue
C02.9
Malignant neoplasm of Tongue, unspecified
C03.0
Malignant neoplasm of Upper gum
C03.1
Malignant neoplasm of Lower gum

PHARYNX
PHARYNX
PHARYNX
PHARYNX
PHARYNX
Page 53 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
C03.9
Malignant neoplasm of Gum, unspecified
C04.9
Malignant neoplasm of Floor of mouth, unspecified
C05.0
Malignant neoplasm of Hard palate
C05.1
Malignant neoplasm of Soft palate
C05.9
Malignant neoplasm of Palate, unspecified
GROUP
PHARYNX
PHARYNX
PHARYNX
PHARYNX
PHARYNX
Case Rate
Professional
Fee
Health Care
Institution Fee
11,500
3,450
8,050
11,500
3,450
8,050
11,500
3,450
8,050
11,500
3,450
8,050
11,500
3,450
8,050
C06.0
Malignant neoplasm of Cheek mucosa; Malignant neoplasm

of Buccal mucosa NOS; Malignant neoplasm of Internal
PHARYNX
cheek
11,500
3,450
8,050
C06.1
Malignant neoplasm of Vestibule of mouth; Malignant

neoplasm of Upper buccal sulcus; Malignant neoplasm of
Lower buccal sulcus; Malignant neoplasm of Upper Labial
sulcus; Malignant neoplasm of Lower Labial sulcus

PHARYNX
11,500
3,450
8,050
C06.2
Malignant neoplasm of Retromolar area

PHARYNX
11,500
3,450
8,050
C06.9
Malignant neoplasm of Mouth, unspecified; Minor

Malignant neoplasm of minor salivary gland, unspecified
site; Malignant neoplasm of Oral cavity NOS

PHARYNX
11,500
3,450
8,050
C07
Malignant neoplasm of parotid gland
11,500
3,450
8,050
C08.0
Malignant neoplasm of Submandibular gland; Malignant

neoplasm of Submaxillary gland
11,500
3,450
8,050
C08.1
Malignant neoplasm of Sublingual gland
11,500
3,450
8,050
C08.9
Malignant neoplasm of Major salivary gland, unspecified;

Malignant neoplasm of Major Salivary gland NOS

PHARYNX
11,500
3,450
8,050
C09.0
Malignant neoplasm of Tonsillar fossa

PHARYNX
11,500
3,450
8,050
C09.9
Malignant neoplasm of Tonsil, unspecified; Malignant

neoplasm of Tonsil NOS; Malignant neoplasm of Faucial
Tonsil; Malignant neoplasm of Palatine Tonsil

PHARYNX
11,500
3,450
8,050
C10.0
Malignant neoplasm of Vallecula
11,500
3,450
8,050
11,500
3,450
8,050
11,500
3,450
8,050
11,500
3,450
8,050

PHARYNX
11,500
3,450
8,050

PHARYNX
11,500
3,450
8,050

PHARYNX
11,500
3,450
8,050

PHARYNX
11,500
3,450
8,050
C10.3
C10.4
C10.9
C11.0
C11.1
C11.2
C11.3

PHARYNX
PHARYNX
PHARYNX

PHARYNX
Malignant neoplasm of Posterior wall of oropharynx
PHARYNX
Malignant neoplasm of Branchial cleft; Malignant neoplasm MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
of Branchial cyst
PHARYNX
Malignant neoplasm of Oropharynx, unspecified
PHARYNX
Malignant neoplasm of Superior wall of nasopharynx;
Malignant neoplasm of Roof of nasopharynx
Malignant neoplasm of Posterior wall of nasopharynx;
Malignant neoplasm of Adenoid; Malignant neoplasm of
Pharyngeal tonsil
Malignant neoplasm of Lateral wall of nasopharynx;
Malignant neoplasm of Fossa of Rosenmller; Malignant
neoplasm of Opening of auditory tube; Malignant
neoplasm of Pharyngeal recess
Malignant neoplasm of Anterior wall of nasopharynx;
Malignant neoplasm of A nterior Nasopharyngeal surface
of soft palate; Malignant neoplasm of Posterior
Nasopharyngeal surface of soft palate; Malignant
neoplasm of Posterior margin of nasal choana; M
C11.9
Malignant neoplasm of Nasopharynx, unspecified

PHARYNX
11,500
3,450
8,050
C13.1
Malignant neoplasm of Aryepiglottic fold, hypopharyngeal

aspect hypopharynx ; Malignant neoplasm of Aryepiglottic
fold, hypopharynx NOS; Malignant neoplasm of
Aryepiglottic fold, marginal zone, hypopharynx

PHARYNX
11,500
3,450
8,050
C13.9
Malignant neoplasm of Hypopharynx, unspecified;

Malignant neoplasm of Hypopharyngeal wall NOS
11,500
3,450
8,050
11,500
3,450
8,050
11,500
3,450
8,050
11,500
3,450
8,050

PHARYNX
11,500
3,450
8,050
MALIGNANT NEOPLASMS OF LYMPHOID,

HEMATOPOIETIC AND RELATED TISSUE
13,900
4,170
9,730
C14.0
C14.8
C76.0
C77.0
B21.1

PHARYNX
Malignant neoplasm of Pharynx, unspecified
PHARYNX
Malignant neoplasm of Overlapping lesion of lip, oral cavity MALIGNANT NEOPLASMS OF LIP, ORAL CAVITY,
and pharynx
PHARYNX
Malignant neoplasm of Head, face and neck; Malignant
neoplasm of Cheek NOS; Malignant neoplasm of Nose NOS PHARYNX
Secondary and unspecified malignant neoplasm of Lymph
nodes of head, face and neck; Malignant neoplasm of
Supraclavicular lymph nodes
Burkitt's lymphoma
Page 54 of 112

FIRST CASE RATE
ICD CODE
B21.2
B21.3
C81.0
C81.1
C81.9
C82.0
C82.1
C82.2
C82.7
C82.9
C83.0
C83.2
C83.3
C83.4
C83.5
C83.7
C83.8
C83.9
C84.0
C84.1
C84.3
C84.4
C84.5
C85.0
C85.1
C85.7
C85.9
C90.0
C90.1
DESCRIPTION
other types of non-Hodgkin's lymphoma
other malignant neoplasms of lymphoid, haematopoietic
and related tissue
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee

13,900
4,170
9,730

13,900
4,170
9,730
Hodgkin's disease (Lymphocytic predominance); Hodgkin's MALIGNANT NEOPLASMS OF LYMPHOID,

disease (Lymphocytic-histiocytic predominance)
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730

Hodgkin's disease( Nodular sclerosis)
Hodgkin's disease, unspecified
Small cleaved cell, follicular non-Hodgkin's lymphoma
Mixed small cleaved non-Hodgkin's lymphoma and large
cell, follicular non-Hodgkin's lymphoma
Large cell, follicular non-Hodgkin's lymphoma
Other types of follicular non-Hodgkin's lymphoma
Follicular non-Hodgkin's lymphoma, unspecified; Nodular MALIGNANT NEOPLASMS OF LYMPHOID,
non-Hodgkin's lymphoma NOS
Small cell diffuse non-Hodgkin's lymphoma
Mixed small and large cell diffuse non-Hodgkin's lymphoma
Large cell diffuse non-Hodgkin's lymphoma
Immunoblastic diffuse non-Hodgkin's lymphoma
Lymphoblastic diffuse non-Hodgkin's lymphoma
Burkitt's tumour
Other types of diffuse non-Hodgkin's lymphoma
Diffuse non-Hodgkin's lymphoma, unspecified
Mycosis fungoides
Szary's disease
Lymphoepithelioid lymphoma; Lennert's lymphoma
Peripheral T-cell lymphoma
Other and unspecified T-cell lymphomas
Lymphosarcoma
B-cell lymphoma, unspecified
Other specified types of non-Hodgkin's lymphoma;
Malignant reticuloendotheliosis; Malignant reticulosis;
Microglioma
Non-Hodgkin's lymphoma, unspecified type; Lymphoma
NOS
Multiple myeloma; Kahler's disease; Myelomatosis
Plasma cell leukaemia
C90.2
Extramedullary Plasmacytoma; Malignant plasma cell

tumour NOS; Plasmacytoma NOS ; Solitary myeloma
C91.1
Chronic lymphocytic leukaemia
C91.2
Subacute lymphocytic leukaemia
C91.3
Prolymphocytic leukaemia
C91.4
Hairy-cell leukaemia; Leukaemic reticuloendotheliosis
C91.5
Adult T-cell leukaemia
C91.7
Other lymphoid leukaemia
C91.9
Lymphoid leukaemia, unspecified
C92.0
Acute myeloid leukaemia
C92.1
Chronic myeloid leukaemia
C92.2
Subacute myeloid leukaemia

Page 55 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
C92.3
Myeloid sarcoma; Chloroma; Granulocytic sarcoma
C92.4
Acute promyelocytic leukaemia
C92.5
Acute myelomonocytic leukaemia
C92.7
Other myeloid leukaemia
C92.9
Myeloid leukaemia, unspecified
C93.0
Acute monocytic leukaemia
C93.1
Chronic monocytic leukaemia
C93.9
Monocytic leukaemia, unspecified
C94.0
C94.2
Acute erythraemia and erythroleukaemia; Acute

erythraemic myelosis; Di Guglielmo's disease
Acute megakaryoblastic leukaemia; Acute megakaryocytic
Leukaemia
C94.4
Acute panmyelosis
C94.5
Acute myelofibrosis
C95.0
Acute leukaemia of unspecified cell type; Blast cell

leukaemia; Stem cell leukaemia
C95.1
Chronic leukaemia of unspecified cell type
C95.2
Subacute leukaemia of unspecified cell type
C95.7
Other leukaemia of unspecified cell type
C95.9
Leukaemia, unspecified
C96.0
Letterer-Siwe disease; Nonlipid reticuloendotheliosis;

Nonlipid reticulosis
C96.1
Malignant histiocytosis; Histiocytic medullary reticulosis
C96.2
C96.7
C96.9
C60.9
C61
C62.0
C62.1
Malignant mast cell tumour; Malignant mastocytoma;

Malignant mastocytosis; Mast cell sarcoma
Other specified malignant neoplasms of lymphoid,
haematopoietic and related tissue
Malignant neoplasm of lymphoid, haematopoietic and
related tissue, unspecified
Malignant neoplasm of Penis, unspecified; Malignant
neoplasm of Skin of penis NOS
Malignant neoplasm of prostate
Malignant neoplasm of Undescended testis; Ectopic
testis ; Malignant neoplasm of Retained testis
Malignant neoplasm of Descended testis; Malignant
neoplasm of Scrotal Testis
C62.9
Malignant neoplasm of Testis, unspecified
C63.0
Malignant neoplasm of Epididymis
C63.1
Malignant neoplasm of Spermatic cord
C63.2
C63.7
C63.9
C45.2
C45.7
C45.9
C48.0
C76.3
C76.4
C76.5
C76.7
C76.8
C77.3
C77.9
C79.7
Malignant neoplasm of Scrotum; Malignant neoplasm of

Skin of scrotum
Malignant neoplasm of Seminal vesicle; Malignant
neoplasm of Tunica vaginalis
Malignant neoplasm of Male genital organ, unspecified;
Male genitourinary tract NOS
Mesothelioma of pericardium
Mesothelioma of other sites
Mesothelioma, unspecified
Malignant neoplasm of Retroperitoneum
Malignant neoplasm of Pelvis; Malignant neoplasm of
Groin NOS; Malignant neoplasm of
Sites overlapping systems within the pelvis, such as
rectovaginal (septum) & rectovesical (septum)
Malignant neoplasm of Upper limb
Malignant neoplasm of Lower limb
Malignant neoplasm of Other ill-defined sites
Malignant neoplasm of Overlapping lesion of other and illdefined sites
Secondary and unspecified malignant neoplasm of Axillary
and upper limb lymph nodes; Secondary and unspecified
malignant neoplasm of Pectoral lymph nodes
Secondary and unspecified malignant neoplasm of Lymph
node, unspecified
Secondary malignant neoplasm of adrenal gland
GROUP
MALIGNANT NEOPLASMS OF MALE GENITAL
TRACT
TRACT
TRACT
TRACT
TRACT
TRACT
TRACT
TRACT
TRACT
TRACT
MALIGNANT NEOPLASMS OF MESOTHELIUM
Case Rate
Professional
Fee
Health Care
Institution Fee
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,900
4,170
9,730
13,400
4,020
9,380
13,400
4,020
9,380
13,400
4,020
9,380
13,400
4,020
9,380
13,400
4,020
9,380
13,400
4,020
9,380
13,400
4,020
9,380
13,400
4,020
9,380
13,400
4,020
9,380
13,400
4,020
9,380
10,600
10,600
10,600
10,600
3,180
3,180
3,180
3,180
7,420
7,420
7,420
7,420
MALIGNANT NEOPLASMS OF OTHER SITES
16,100
4,830
11,270

16,100
16,100
16,100
4,830
4,830
4,830
11,270
11,270
11,270
16,100
4,830
11,270
16,100
4,830
11,270
16,100
4,830
11,270
16,100
4,830
11,270
Page 56 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
C79.8
Secondary malignant neoplasm of other specified sites
16,100
4,830
11,270
C80
Malignant neoplasm without specification of site;

Unspecified site whether primary or secondary [Cancer,
Carcinoma, Carcinomatosis, Generalized cancer,
Generalized malignancy, Malignancy, Multiple cancer];
Malignant cachexia; Malignant neoplasm of Primary
16,100
4,830
11,270
13,300
3,990
9,310
13,300
3,990
9,310
C47.0
C47.1
C47.2
Malignant neoplasm of Peripheral nerves of head, face and

MALIGNANT NEOPLASMS OF PERIPHERAL NERVES
neck
Malignant neoplasm of Peripheral nerves of upper limb,
including shoulder
Malignant neoplasm of Peripheral nerves of lower limb,
including hip
13,300
3,990
9,310
C47.3
Malignant neoplasm of Peripheral nerves of thorax
13,300
3,990
9,310
C47.4
Malignant neoplasm of Peripheral nerves of abdomen
13,300
3,990
9,310
C47.5
Malignant neoplasm of Peripheral nerves of pelvis
13,300
3,990
9,310
13,300
3,990
9,310
13,300
3,990
9,310
C47.6
C47.9
Malignant neoplasm of Peripheral nerves of trunk,

unspecified
Malignant neoplasm of Peripheral nerves and autonomic
nervous system, unspecified
C32.0
Malignant neoplasm of Glottis; Malignant neoplasm of

MALIGNANT NEOPLASMS OF RESPIRATORY AND
Intrinsic larynx; Malignant neoplasm of true Vocal cord NOS INTRATHORACIC ORGANS
14,600
4,380
10,220
C32.1
Malignant neoplasm of Supraglottis: Malignant neoplasm

of Aryepiglottic fold, laryngeal aspect; Malignant neoplasm
of Epiglottis (suprahyoid portion) NOS; Malignant neoplasm
INTRATHORACIC ORGANS
of Extrinsic larynx; Malignant neoplasm of False vocal cord;
Malignant neoplasm
14,600
4,380
10,220
C32.2
Malignant neoplasm of Subglottis
14,600
4,380
10,220
C32.3
Malignant neoplasm of Laryngeal cartilage
14,600
4,380
10,220
C32.9
Malignant neoplasm of Larynx, unspecified
14,600
4,380
10,220
C33
Malignant neoplasm of trachea
14,600
4,380
10,220
C34.0
Malignant neoplasm of Main bronchus; Malignant

neoplasm of Carina; Malignant neoplasm of Hilus of lung
14,600
4,380
10,220
14,600
4,380
10,220
14,600
4,380
10,220
14,600
4,380
10,220
14,600
4,380
10,220
14,600
4,380
10,220
14,600
4,380
10,220
14,600
4,380
10,220
14,600
4,380
10,220
14,600
4,380
10,220
14,600
4,380
10,220
14,600
4,380
10,220
14,600
4,380
10,220
14,600
4,380
10,220
14,600
4,380
10,220
10,600
3,180
7,420
14,600
4,380
10,220
14,600
4,380
10,220
14,600
4,380
10,220
14,600
4,380
10,220
C34.1
C34.2
C34.3
C34.8
C34.9
C37
C38.0
C38.1
C38.3
C38.4
C38.8
C39.0
C39.8
C39.9
C45.0
C76.1
C77.1
C78.0
C78.1


Malignant neoplasm of Upper lobe, bronchus or lung
Malignant neoplasm of Middle lobe, bronchus or lung
Malignant neoplasm of Lower lobe, bronchus or lung
Malignant neoplasm of Overlapping lesion of bronchus and MALIGNANT NEOPLASMS OF RESPIRATORY AND
lung
Malignant neoplasm of Bronchus or lung, unspecified
Malignant neoplasm of thymus
Malignant neoplasm of Heart; Malignant neoplasm of
Pericardium
Malignant neoplasm of Anterior mediastinum
Malignant neoplasm of Mediastinum, part unspecified
Malignant neoplasm of Pleura
Malignant neoplasm of Overlapping lesion of heart,
mediastinum and pleura
Malignant neoplasm of Upper respiratory tract, part
unspecified
Malignant neoplasm of Overlapping lesion of respiratory
and intrathoracic organs
Malignant neoplasm of Ill-defined sites within the
respiratory system; Respiratory tract NOS
Mesothelioma of pleura
Malignant neoplasm of Thorax; Malignant neoplasm of
Axilla NOS; Malignant neoplasm of Intrathoracic NOS;
Malignant neoplasm of Thoracic NOS
Secondary and unspecified malignant neoplasm of
Intrathoracic lymph nodes
Secondary malignant neoplasm of lung
Secondary malignant neoplasm of mediastinum
Page 57 of 112

FIRST CASE RATE
ICD CODE
C78.2
C78.3
C31.0
C31.1
C31.2
C31.3
C31.8
C31.9
B21.0
C46.9
C49.0
C49.1
C49.2
C49.3
C49.4
C49.5
C49.6
C49.8
C49.9
DESCRIPTION
Secondary malignant neoplasm of pleura; Malignant pleural
effusion NOS
respiratory organs
Malignant neoplasm of Maxillary sinus; Malignant
neoplasm of Antrum (Highmore); Malignant neoplasm of
Antrum (maxillary)
Malignant neoplasm of Ethmoidal sinus
Malignant neoplasm of Frontal sinus
Malignant neoplasm of Sphenoidal sinus
Malignant neoplasm of Overlapping lesion of accessory
sinuses
Malignant neoplasm of Accessory sinus, unspecified
HUMAN IMMUNODEFICIENCY VIRUS [HIV] DISEASE
RESULTING IN KAPOSI'S SARCOMA
Kaposi's sarcoma, unspecified
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
14,600
4,380
10,220
14,600
4,380
10,220
MALIGNANT NEOPLASMS OF SINUSES
11,500
3,450
8,050

11,500
11,500
11,500
3,450
3,450
3,450
8,050
8,050
8,050
11,500
3,450
8,050
11,500
3,450
8,050
MALIGNANT NEOPLASMS OF SOFT TISSUES
12,000
3,600
8,400
12,000
3,600
8,400
Malignant neoplasm of Connective and soft tissue of head,

face and neck; Malignant neoplasm of Connective tissue of MALIGNANT NEOPLASMS OF SOFT TISSUES
ear; Malignant neoplasm of Connective tissue of eyelid
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
11,400
3,420
7,980
11,400
3,420
7,980
11,400
3,420
7,980
11,400
3,420
7,980
11,400
3,420
7,980
11,400
3,420
7,980
11,400
3,420
7,980
11,400
3,420
7,980
11,400
3,420
7,980
11,700
3,510
8,190
Malignant neoplasm of Connective and soft tissue of upper

limb, including shoulder
Malignant neoplasm of Connective and soft tissue of lower
limb, including hip
Malignant neoplasm of Connective and soft tissue of
thorax; Malignant neoplasm of Connective and soft tissue
of Axilla; Malignant neoplasm of Connective and soft tissue
of Diaphragm; Malignant neoplasm of Connective and soft
tissue of Great vessels
abdomen; Malignant neoplasm of Connective and soft
tissue of Abdominal wall; Malignant neoplasm of
Connective and soft tissue of Hypochondrium
Malignant neoplasm of Connective and soft tissue of pelvis;
Buttock; Malignant neoplasm of Connective and soft tissue
of Groin; Malignant neoplasm of Connective and soft
tissue of Perineum
Malignant neoplasm of Connective and soft tissue of trunk,
unspecified; Malignant neoplasm of Connective and soft
tissue of Back NOS
Malignant neoplasm of Overlapping lesion of connective
and soft tissue
Malignant neoplasm of Connective and soft tissue,
unspecified
MALIGNANT NEOPLASMS OF THYROID AND

OTHER ENDOCRINE GLANDS
MALNUTRITION
C73
Malignant neoplasm of thyroid gland
C74.0
Malignant neoplasm of Cortex of adrenal gland
C74.1
Malignant neoplasm of Medulla of adrenal gland
C74.9
Malignant neoplasm of Adrenal gland, unspecified
C75.0
Malignant neoplasm of Parathyroid gland
C75.1
Malignant neoplasm of Pituitary gland
C75.3
Malignant neoplasm of Pineal gland
C75.5
Malignant neoplasm of Aortic body and other paraganglia
C75.9
Malignant neoplasm of Endocrine gland, unspecified
E40
Kwashiorkor
E41
Nutritional marasmus; Severe malnutrition with marasmus MALNUTRITION
11,700
3,510
8,190
E42
Marasmic kwashiorkor; Severe protein-energy

malnutrition, intermediate form; Severe protein-energy
MALNUTRITION
malnutrition with signs of both kwashiorkor and marasmus
11,700
3,510
8,190
MALNUTRITION
MALNUTRITION
MALNUTRITION
11,700
11,700
11,700
3,510
3,510
3,510
8,190
8,190
8,190
MALNUTRITION
11,700
3,510
8,190
MALNUTRITION
E43
E44.0
E44.1
E45
E46
O10.0
O10.1
O10.2
Unspecified severe protein-energy malnutrition

Moderate protein-energy malnutrition
Mild protein-energy malnutrition
Retarded development following protein-energy
malnutrition; Nutritional short stature; Nutritional
stunting; Physical retardation due to malnutrition
Unspecified protein-energy malnutrition; Malnutrition
NOS; Protein-energy imbalance NOS
Pre-existing essential hypertension complicating pregnancy
child birth and the puerperium
Pre-existing hypertensive heart disease complicating
pregnancy, childbirth and the puerperium
Pre-existing hypertensive renal disease complicating
pregnancy childbirth and the puerperium
11,700
3,510
8,190
MATERNAL COMORBIDITIES CONDITIONS
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
Page 58 of 112

FIRST CASE RATE
ICD CODE
O10.3
DESCRIPTION
Pre-existing hypertensive heart and renal disease
complicating pregnancy, childbirth and the puerperium
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760

6,800
6,800
2,040
2,040
4,760
4,760
6,800
2,040
4,760

6,800
6,800
6,800
6,800
6,800
2,040
2,040
2,040
2,040
2,040
4,760
4,760
4,760
4,760
4,760
O14.0
O14.1
O14.9
O15.0
O15.1
Pre-existing secondary hypertension complicating

Unspecified pre-existing hypertension complicating
Pre-existing hypertensive disorder with superimposed
proteinuria
Gestational proteinuria
Gestational oedema with proteinuria
Gestational [pregnancy-induced] hypertension wihtout
significant proteinuria; Gestational hypertension NOS; Mild
pre-eclampsia
Moderate pre-eclampsia
Severe pre-eclampsia
Pre-eclampsia, unspecified
Eclampsia in pregnancy
Eclampsia in labour
O15.9
Eclampsia, unspecified as to time period; Eclampsia NOS
6,800
2,040
4,760
O16
Unspecified maternal hypertension

Threatened abortion; Haemorrhage specified as due to
threatened abortion
Other haemorrhage in early pregnancy
Haemorrhage in early pregnancy, unspecified
Mild hyperemesis gravidarum; Hyperemesis gravidarum,
mild or unspecified, starting before the end of the 22nd
week of gestation
6,800
2,040
4,760
6,800
2,040
4,760

6,800
6,800
2,040
2,040
4,760
4,760
6,800
2,040
4,760
O21.1
Hyperemesis gravidarum with metabolic disturbance;

Hyperemesis gravidarum, starting before the end of the
22nd week of gestation, with metabolic disturbance such as
carbohydrate depletion, dehydration, elctrolyte imbalance
6,800
2,040
4,760
O21.2
Late vomiting of pregnancy; Excessive vomiting starting

after 22 completed weeks of gestation
6,800
2,040
4,760
O21.8
Other vomiting complicating pregnancy; Vomiting due to

disease classified elsewhere, complicating pregnancy
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760

6,800
6,800
6,800
6,800
6,800
6,800
2,040
2,040
2,040
2,040
2,040
2,040
4,760
4,760
4,760
4,760
4,760
4,760
6,800
2,040
4,760
O24.9
O26.2
Vomiting of pregnancy, unspecified

Deep phlebothrombosis in pregnancy; Deep-vein
thrombosis, antepartum
Cerebral venous thrombosis in pregnancy; Cerebrovenous
sinus thrombosis in pregnancy
Venous complication in pregnancy, unspecified; Gestational
phlebitis NOS; Gestational phlebopathy NOS; Gestational
thrombosis NOS
Infections of kidney in pregnancy
Infections of other parts of urinary tract in pregnancy
Pre-existing diabetes mellitus, insulin-dependent
Pre-existing diabetes mellitus, non-insulin-dependent
Pre-existing malnutrition-related diabetes mellitus
Pre-existing diabetes mellitus, unspecified
Diabetes mellitus arising in pregnancy; Gestational diabetes
mellitus NOS
Diabetes mellitus in pregnancy, unspecified
Pregnancy care of habitual aborter

6,800
6,800
2,040
2,040
4,760
4,760
O26.3
Retained in trauterine contraceptive device in pregnancy
6,800
2,040
4,760
O26.4
Herpes gestationis
Maternal hypotension syndrome; Supine hypotensive
syndrome
6,800
2,040
4,760
6,800
2,040
4,760
O26.6
Liver disorders in pregnancy, childbirth and the puerperium MATERNAL COMORBIDITIES CONDITIONS
6,800
2,040
4,760
O26.7
Subluxation of symphysis (pubis) in pregnancy childbirth

and the puerperium
6,800
2,040
4,760
O26.8
Other specified pregnancy-related conditions; Exhaustion

and fatigue pregnancy-related; Peripheral neuritis
pregnancy-related; Renal disease pregnancy-related
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
Other abnormal findings on antenatal screening of mother MATERNAL COMORBIDITIES CONDITIONS
6,800
2,040
4,760
6,800
2,040
4,760

6,800
6,800
6,800
2,040
2,040
2,040
4,760
4,760
4,760
O10.4
O10.9
O11
O12.1
O12.2
O13
O20.0
O20.8
O20.9
O21.0
O21.9
O22.3
O22.5
O22.9
O23.0
O23.3
O24.0
O24.1
O24.2
O24.3
O24.4
O26.5
O26.9
O28.0
O28.3
O28.5
O28.8
O28.9
O29.8
O30.0
O30.1
Pregnancy-relatedcondition, unspecified
Abnormal haematological finding on antenatal screening of
mother
Abnormal ultrasonic finding on antenatal screening of
mother
Abnormal chromosomal and genetic finding on antenatal
screening of mother
Abnormal finding on antenatal screening of mother,

unspecified
Other complications of anaesthesia during pregnancy
Twin pregnancy
Triplet pregnancy
Page 59 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
O30.8
Other multiple gestation
6,800
Professional
Fee
2,040
O30.9
Multiple gestation, unspecified; Multiple pregnancy NOS
6,800
2,040
4,760
O31.0
Papyraceous fetus; Fetus compressus
6,800
2,040
4,760
O31.1
Continuing pregnancy after abortion of one fetus or more
6,800
2,040
4,760
6,800
2,040
4,760

6,800
6,800
6,800
2,040
2,040
2,040
4,760
4,760
4,760
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760

6,800
6,800
2,040
2,040
4,760
4,760
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
Maternal care for disproportion due to inlet contraction of

pelvis; Inlet contraction (pelvis) causing disproportion
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
O33.6
Maternal care for disproportion due to hydrocephalic fetus MATERNAL COMORBIDITIES CONDITIONS
6,800
2,040
4,760
O33.7
Maternal care for disproportion due to other fetal

deformities; Conjoined twins; Fetal ascites causing
disproportion; Fetal hydrops causing disproportion; Fetal
meaningomyelocele causing disproportion; Fetal tumour
causing disproportion
6,800
2,040
4,760
O33.9
Maternal care for disproportion, unspecified; Cephalopelvic

disproportion NOS; Fetopelvic disproportion NOS
6,800
2,040
4,760
O34.0
Maternal care for congenital malformation of uterus;

Maternal care for double uterus; Maternal care for Uterus
bicornis
6,800
2,040
4,760
O34.1
Maternal care for tumour of corpus uteri; Maternal for

polyp of corpus uteri; Maternal care for uterine fibroid
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
O32.6
O32.8
Continuing pregnancy after intrauterine death of one fetus

or more
Other complications specific to multiple gestation
Maternal care for unstable lie
Maternal care for breech presentation
Maternal care for transverse and oblique lie; Oblique
presentation; Transverse presentation
Maternal care for face, brow and chin presentation
Maternal care for high head at term; Failure of head to
enter pelvic brim
Maternal care for multiple gestation with malpresentation
of one fetus or more
Maternal care for compound presentation
Maternal care for other malpresentation of fetus
O32.9
Maternal care for malpresentation of fetus, unspecified
O31.2
O31.8
O32.0
O32.1
O32.2
O32.3
O32.4
O32.5
O33.0
O33.1
O33.2
O33.3
O33.4
O33.5
O34.2
O34.3
O34.4
O34.5
O34.6
O34.7
Maternal care for disproportion due to deformity of

maternal pelvic bones; Pelvic deformity causing
disproportion NOS
Maternal care for disproportion due to generally
contracted pelvis; Contracted pelvis NOS causing
disproportion
Maternal care for disproportion due to outlet contraction

of pelvis; Mid-cavity contraction pelvis causing
disproportion; Outlet contraction pelvis causing
disproportion
Maternal care for disproportion of mixed maternal and
fetal origin
Maternal care for disproportion due to unusually large
fetus; Disproportion of fetal origin with normally formed
fetus; Fetal disproportion NOS
Maternal care due to uterine scar from previous surgery;

Maternal care for scar from previous
Maternal care for cervical incompetence; Maternal care for
cerclage with or without mention of cervical incompetence;
Maternal care for Shirodkar suture with or without
mention of cervical incompetence
Maternal care for other abnormalities of cervix; Maternal
care for polyp of cervix; Maternal care for previous surgery
to cervix; Maternal care for stricture or stenosis of cervix;
Maternal care for tumour of cervix
Maternal care for other abnormalities of gravid uterus;
Maternal care for incarceratiion of gravid uterus; Maternal
care for prolapse of gravid uterus; Maternal care for
retroversion of gravid uterus
Maternal care for abnormality of vagina; Maternal care for
previous surgery to vagina; Maternal care for septate
vagina; Maternal care for acquired stenosis of vagina;
Maternal care for congenital stenosis of vagina; Maternal
care for tumour of vagina
Maternal care for abnormality of vulva and perineum;
Maternal care for fibrosis of perineum; Maternal care for
previous surgery to perineum or vulva; Maternal care for
rigid perineum; Maternal care for tumour of vulva
Page 60 of 112
Case Rate
Health Care
Institution Fee
4,760

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
O34.8
Maternal care for other abnormalities of pelvic organs;

Maternal care for cystocele; Maternal care for previous
pelvic floor repair; Maternal care for pendulous abdomen;
Maternal care for rectocele; Maternal care for rigid pelvic
floor
6,800
2,040
4,760
O34.9
Maternal care for abnormality of pelvic organ, unspecified
6,800
2,040
4,760
O35.0
Maternal care for (suspected) central nervous system

malformation in fetus; Maternal care for suspected fetal
anencephaly; Maternal care for suspected fetal spina bifida
6,800
2,040
4,760
O35.2
Maternal care for (suspected) hereditary disease in fetus
6,800
2,040
4,760
O35.3
Maternal care for (suspected) damage to fetus from viral

disease in mother; Maternal care for suspected damage to
fetus from maternal cytomegalovirus infection; Maternal
care for suspected damage to fetus from maternal rubella
6,800
2,040
4,760
O35.5
Maternal care for (suspected) damage to fetus by drugs;

Maternal care for suspected damage to fetus from drug
addiction
6,800
2,040
4,760
O35.8
Maternal care for other (suspected) fetal abnormality and

damage; Maternal care for suspected damage to fetus from
maternal listeriosis; Maternal care for suspected damage to
fetus from maternal toxoplasmosis
6,800
2,040
4,760
O35.9
Maternal care for (suspected) fetal abnormality and

damage, unspecified
6,800
2,040
4,760
O36.0
Maternal care for rhesus isoimmunization; Anti-D [Rh]

antibodies; Rh incompatibility (with hydrops fetalis)
6,800
2,040
4,760
O36.1
Maternal care for other isoimmunization; ABO

isoimmunization; Isoimmunization NOS (with hydrops
fetalis)
6,800
2,040
4,760
O36.2
Maternal care for hydrops fetalis; Hydrops fetalis NOS;

Hydrops fetalis not associated with isoimmunization
6,800
2,040
4,760
O36.3
O36.4
Maternal care for signs of fetal hypoxia

Maternal care for intrauterine death

6,800
6,800
2,040
2,040
4,760
4,760
O36.5
Maternal care for poor fetal growth; Maternal care for

known or suspected light-for-dates; Maternal care for
known or suspected placental insufficiency; Maternal care
for known or suspected small-for-dates
6,800
2,040
4,760
6,800
2,040
4,760

6,800
6,800
6,800
2,040
2,040
2,040
4,760
4,760
4,760
6,800
2,040
4,760
O36.6
O36.8
O36.9
O40
O41.0
Maternal care for excessive fetal growth; Maternal care for

known or suspected large-for-dates
Maternal care for other specified fetal problems
Maternal care for fetal problem, unspecified
POLYHYDRAMNIOS; HYDRAMNIOS
Oligohydramnios; Oligohydramnios without mention of
rupture of membrane
O41.1
Infection of amniotic sac and membranes; Amnionitis;

Chorioamnionitis; Membranitis; Placentitis
6,800
2,040
4,760
O41.8
Other specified disorders of amniotic fluid and membranes MATERNAL COMORBIDITIES CONDITIONS
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
Placental transfusion syndromes; Fetomaternal transfusion;

Maternofetal transfusion; Twin-to-twin transfusion
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
O44.0
Placenta praevia specified as without haemorrhage; Low

implantation of placenta, NOS or with haemorrhage
6,800
2,040
4,760
O44.1
Placenta praevia with haemorrhage; Low implantation of

placenta, NOS or with haemorrhage; Placenta praevia,
marginal NOS or with haemorrhage; Placenta praevia,
partial NOS or with haemorrhage; Placenta praevia, total
NOS or with haemorrhage
6,800
2,040
4,760
O41.9
O42.0
O42.1
O42.2
O42.9
O43.0
O43.1
O43.8
O43.9
Disorder of amniotic fluid and membranes, unspecified;

Premature rupture of membranes
Premature rupture of membranes on set of labour within
24 hours
Premature rupture of membranes on set of labour after 24
hours
Premature rupture of membranes, labour delayed by
therapy
Premature rupture of membranes, unspecified
Malformation of placenta; Abnormal placenta NOS;

Circumvallate placenta
Other placental disorders; Placental dysfunction; Placental
infarction
Placental disorder, unspecified
Page 61 of 112

FIRST CASE RATE
ICD CODE
O45.0
DESCRIPTION
GROUP
Premature separation of placenta with coagulation defect;

Abruptio placentae with (excessive) haemorrhage
associated with afibrinogenaemia; Abruptio placentae with MATERNAL COMORBIDITIES CONDITIONS
(excessive) haemorrhage associated with disseminated
intravascular coagulation; Abruptio
Case Rate
Professional
Fee
Health Care
Institution Fee
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
O46.0
Antepartum haemorrhage with coagulation defect;

Antepartum haemorrhage (excessive) associated with
afibrinogenaemia; Antepartum haemorrhage (excessive)
associated with disseminated intravascular coagulation;
Antepartum haemorrhage (excessive) associated w
6,800
2,040
4,760
O46.8
O46.9
O47.0
Other antepartum haemorrhage

Antepartum haemorrhage, unspecified
False labour before 37 completed weeks of gestation

6,800
6,800
6,800
2,040
2,040
2,040
4,760
4,760
4,760
O47.1
False labour at or after 37 completed weeks of gestation
6,800
2,040
4,760
O47.9
O48
False labour, unspecified

Prolonged pregnancy; Post-dates; Post-term
Tuberculosis complicating pregnancy, childbirth and the
puerperium
Syphilis complicating pregnancy, childbirth and the
puerperium
Gonorrhoeacomplicatingpregnancychildbirthandthepuerpe
rium
Other infections with apredominantly sexual mode of
transmission complicating pregnancy, childbirth and the
puerperium
Viral hepatitis complicating pregnancy, childbirth and the
puerperium
Other viral diseases complicating pregnancy, childbirth and
the puerperium
Protozoal diseases complicating pregnancy, childbirth and
the puerperium

6,800
6,800
2,040
2,040
4,760
4,760
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
O45.8
O45.9
O98.0
O98.1
O98.2
O98.3
O98.4
O98.5
O98.6
Other premature separation of placenta

Premature separation of placenta, unspecified; Abruptio
placenta NOS
6,800
2,040
4,760
O98.8
Other maternal infectious and parasitic diseases

6,800
2,040
4,760
O98.9
Unspecified maternal infectious or parasitic disease

6,800
2,040
4,760
O99.0
Anaemia complicating pregnancy, childbirth and the

puerperium
6,800
2,040
4,760
O99.1
Other diseases of the blood and blood-forming organs and

certain disorders involving the immune mechanism
6,800
2,040
4,760
O99.2
Endocrine, nutritional and metabolic diseases complicating

6,800
2,040
4,760
O99.3
Mental disorders and diseases of the nervous system

6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
6,800
2,040
4,760
O99.4
O99.5
O99.6
O99.7
Diseases of the circulatory system complicating pregnancy,

childbirth and the puerperium
Diseases of the respiratory system complicating pregnancy,
Diseases of the digestive system complicating pregnancy,
Diseases of the skin and subcutaneous tissue complicating
Other specified diseases and conditions complicating
Preterm labor, not resulting to delivery
Supervision of normal first pregnancy
Supervision of other normal pregnancy
Supervision of normal pregnancy, unspecified
Supervision of pregnancy with history of infertility
6,800
2,040
4,760
O60.0
Z34.0
Z34.8
Z34.9
Z35.0

6,800
6,800
6,800
6,800
6,800
2,040
2,040
2,040
2,040
2,040
4,760
4,760
4,760
4,760
4,760
Z35.1
Supervision of pregnancy with history of abortive outcome MATERNAL COMORBIDITIES CONDITIONS
6,800
2,040
4,760
6,800
2,040
4,760

6,800
6,800
6,800
2,040
2,040
2,040
4,760
4,760
4,760
O99.8
Z35.4
Z35.5
Z35.6
Supervision of pregnancy with other poor reproductive or

obstetric history
Supervision of pregnancy with grand multiparity
Supervision of elderly primigravida
Supervision of very young primigravida
Z35.7
Supervision of high-risk pregnancy due to social problems
6,800
2,040
4,760
Z35.8
Z35.9
A87.8
A87.9
Supervision of other high-risk pregnancies

Supervision of high-risk pregnancy, unspecified
Other viral meningitis
Viral meningitis, unspecified

MENINGITIS
MENINGITIS
6,800
6,800
25,700
25,700
2,040
2,040
7,710
7,710
4,760
4,760
17,990
17,990
Z35.2
Page 62 of 112

FIRST CASE RATE
ICD CODE
G00.0
G00.1
G00.2
G00.3
G00.8
G00.9
G03.0
G03.1
G03.8
G03.9
A39.2
A39.3
DESCRIPTION
Haemophilus meningitis; Meningitis due to Haemophilus
influenzae
Pneumococcal meningitis
Streptococcal meningitis
Staphylococcal meningitis
Other bacterial meningitis; Meningitis due to Escherichia
coli; Meningitis due to Friedlnder bacillus; Meningitis due
to Klebsiella
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
MENINGITIS
25,700
7,710
17,990
MENINGITIS
MENINGITIS
MENINGITIS
25,700
25,700
25,700
7,710
7,710
7,710
17,990
17,990
17,990
MENINGITIS
25,700
7,710
17,990
Bacterial meningitis, unspecified; Meningitis purulent NOS;

MENINGITIS
Meningitis pyogenic NOS; Meningitis suppurative NOS
25,700
7,710
17,990
Nonpyogenic meningitis; Nonbacterial meningitis

Chronic meningitis
Meningitis due to other specified causes
Meningitis, unspecified; Arachnoiditis (spinal) NOS
Acute meningococcaemia
Chronic meningococcaemia
Meningococcaemia, unspecified; Meningococcal
bacteraemia NOS
Meningococcal infection, unspecified; Meningococcal
disease NOS
Primary amenorrhoea; Failure to start menstruation at
puberty.
Secondary amenorrhoea; Absence of menstruation in a
woman who had previously menstruated.
MENINGITIS
MENINGITIS
MENINGITIS
MENINGITIS
MENINGOCOCCAL INFECTION
25,700
25,700
25,700
25,700
19,800
19,800
7,710
7,710
7,710
7,710
5,940
5,940
17,990
17,990
17,990
17,990
13,860
13,860
19,800
5,940
13,860
19,800
5,940
13,860
MENSTRUAL IRREGULARITIES
6,600
1,980
4,620
6,600
1,980
4,620
N91.2
Amenorrhoea, unspecified; Absence of menstruation NOS
6,600
1,980
4,620
N91.5
Oligomenorrhoea, unspecified; Hypomenorrhoea NOS
6,600
1,980
4,620
N92.0
Excessive and frequent menstruation with regular cycle;

Heavy periods NOS; Menorrhagia NOS; Polymenorrhoea
6,600
1,980
4,620
6,600
1,980
4,620
6,600
1,980
4,620
6,600
1,980
4,620
6,600
1,980
4,620
6,600
1,980
4,620
6,600
1,980
4,620
6,600
1,980
4,620
Other specified abnormal uterine and vaginal bleeding;

Dysfunctional or functional uterine or vaginal bleeding NOS
6,600
1,980
4,620
A39.4
A39.9
N91.0
N91.1
N92.1
N92.2
N92.3
N92.4
N92.5
N92.6
N93.0
N93.8
N93.9
Excessive and frequent menstruation with irregular cycle;

Irregular intermenstrual bleeding; Irregular, shortened
intervals between menstrual bleeding; Menometrorrhagia;
Metrorrhagia
Excessive menstruation at puberty; Excessive bleeding
associated with onset of menstrual periods; Pubertal
menorrhagia; Puberty bleeding
Ovulation bleeding; Regular intermenstrual bleeding
Excessive bleeding in the premenopausal period; Climateric
menorrhagia or metrorrhagia; Menopausal menorrhagia or
metrorrhagia; Preclimateric menorrhagia or metrorrhagia;
Premenopausal menorrhagia or metrorrhagia
Other specified irregular menstruation
Irregular menstruation, unspecified; Irregular bleeding
NOS; Irregular periods NOS
Postcoital and contact bleeding
Abnormal uterine and vaginal bleeding, unspecified

Other specified conditions associated with female genital
organs and menstrual cycle
Unspecified condition associated with female genital
organs and menstrual cycle
6,600
1,980
4,620
6,600
1,980
4,620
6,600
1,980
4,620
F01.1
Multi-infarct dementia; Predominantly cortical dementia
MENTAL AND BEHAVIORAL DISORDERS
7,800
2,340
5,460
F01.8
F01.9
Other vascular dementia

Vascular dementia, unspecified

7,800
7,800
2,340
2,340
5,460
5,460
F03
Unspecified dementia; Presenile dementia NOS; Presenile

psychosis NOS; Senile dementia NOS; Senile dementia
depressed or paranoid type; Senile psychosis NOS
7,800
2,340
5,460
F04
Organic amnesic syndrome, not induced by alcohol and

other psychoactive substances; Korsakov's psychosis or
syndrome, nonalcoholic
7,800
2,340
5,460
F05.0
Delirium not superimposed on dementia, so described
7,800
2,340
5,460
F05.8
F05.9
Other delirium
Other delirium
Organic hallucinosis; Organic hallucinatory state
(nonalcoholic)
Organic delusional [schizophrenia-like] disorder; Paranoid
and paranoid-hallucinatory organic states; Schizophrenialike psychosis in epilepsy
Organic mood [affective] disorders
Organic anxiety disorder
Mild cognitive disorder
Other specified mental disorders due to brain damage and
dysfunction and to physical disease; Epileptic psychosis
NOS

7,800
7,800
2,340
2,340
5,460
5,460
7,800
2,340
5,460
7,800
2,340
5,460

7,800
7,800
7,800
2,340
2,340
2,340
5,460
5,460
5,460
7,800
2,340
5,460
N94.8
N94.9
F06.0
F06.2
F06.3
F06.4
F06.7
F06.8
Page 63 of 112

FIRST CASE RATE
ICD CODE
F06.9
F07.0
F07.1
F07.2
F07.9
F09
F10.0
F10.1
F10.2
F10.3
F10.4
F10.5
F10.6
F10.7
F10.8
F10.9
F11.1
F11.2
F11.5
F11.9
F12.0
F12.5
F13.1
F13.2
F13.3
DESCRIPTION
Unspecified mental disorder due to brain damage and
dysfunction and to physical disease; Organic brain
syndrome NOS; Organic mental disorder NOS
Organic personality disorder; Organic pseudopsychopathic
personality;
Organic pseudoretarded personality; Frontal lobe
Syndrome; Limbic epilepsy personalitySyndrome ;
Lobotomy Syndrome; Postleucotomy Syndrome
Postencephalitic syndrome
Postconcussional syndrome; Postcontusional syndrome
(encephalopathy); Post-traumatic brain syndrome,
nonpsychotic
Unspecified organic personality and behavioural disorder
due to brain disease, damage and dysfunction; Organic
psychosyndrome
Unspecified organic or symptomatic mental disorder;
Organic Psychosis NOS; Symptomatic Psychosis NOS
Mental and behavioural disorders due to use of alcohol in
acute intoxication
Mental and behavioural disorders due to use of
alcohol:harmful use
Mental and behavioural disorders due to use of alcohol:
dependency syndrome
alcohol:withdrawal state
withdrawal state with delirium
psychotic disorder
amnesic syndrome
residual and late-onset psychotic disorder
other mental and behavioural disorders
unspecified mental and behavioural disorder
Mental and behavioural disorders due to use of opioids:
harmful use
dependence syndrome
psychotic disorder
cannabinoids: acute intoxication
cannabinoids: psychotic disorder
Mental and behavioural disorders due to use of sedatives
or hypnotics: harmful use
or hypnotics: dependence syndrome
or hypnotics: withdrawal state
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
F13.4

or hypnotics: withdrawal state with delirium
7,800
2,340
5,460
F13.5

or hypnotics: psychotic disorder
7,800
2,340
5,460
F13.7

or hypnotics: residual and late-onset psychotic disorder
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
F14.0
F14.2
F14.5
F14.6
F14.9
F15.0
F15.1
F15.2
F15.3
Mental and behavioural disorders due to use of cocaine:

acute intoxication
dependence syndrome
psychotic disorder
amnesic syndrome
Mental and behavioural disorders due to use of other
stimulants, including caffeine: acute intoxication
stimulants, including caffeine: harmful use
stimulants, including caffeine: dependence syndrome
stimulants, including caffeine: withdrawal state
Page 64 of 112

FIRST CASE RATE
ICD CODE
F15.5
DESCRIPTION
stimulants, including caffeine: psychotic disorder
stimulants, including caffeine: other mental and
behavioural disorders
stimulants, including caffeine: unspecified mental and
behavioural disorder
hallucinogens: acute intoxication
hallucinogens: harmful use
hallucinogens: dependence syndrome
hallucinogens: psychotic disorder
Mental and behavioural disorders due to use of tobacco:
dependence syndrome
Mental and behavioural disorders due to use of tobacco:
withdrawal state
Mental and behavioural disorders due to use of volatile
solvents: acute intoxication
solvents: withdrawal state with delirium
solvents: amnesic syndrome
Mental and behavioural disorders due to multiple drug use
and use of other psychoactive substances; misuse of drugs
NOS: harmful use
NOS: dependence syndrome
NOS: withdrawal state
NOS: psychotic disorder
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
F19.7

and use of other psychoactive substances; misuse of drugs MENTAL AND BEHAVIORAL DISORDERS
NOS: residual and late-onset psychotic disorder
7,800
2,340
5,460
F19.8

NOS: other mental and behavioural disorders
7,800
2,340
5,460
F19.9

NOS: unspecified mental and behavioural disorder
7,800
2,340
5,460
F15.8
F15.9
F16.0
F16.1
F16.2
F16.5
F17.2
F17.3
F18.0
F18.4
F18.6
F19.1
F19.2
F19.3
F19.5
F20.0
F20.1
F20.2
F20.3
F20.5
F20.6
F20.8
F20.9
F21
F22.0
Paranoid schizophrenia; Paraphrenic schizophrenia

Hebephrenic schizophrenia; Disorganized schizophrenia;
Hebephrenia
Catatonic schizophrenia; Catatonic stupor; Schizophrenic
catalepsy; Schizophrenic catatonia; Schizophrenic
flexibilitas cerea
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
Undifferentiated schizophrenia; Atypical schizophrenia
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
Residual schizophrenia; Chronic undifferentiated

schizophrenia; Restzustand (schizophrenic); Schizophrenic
residual state
Simple schizophrenia
Other schizophrenia; Cenesthopathic schizophrenia;
Schizophreniform disorder NOS; Schizophreniform
psychosis NOS
Schizophrenia, unspecified
Schizotypal disorder; Latent schizophrenic reaction;
Schizophrenia borderline; Schizophrenia latent;
Schizophrenia prepsychotic; Schizophrenia prodromal;
Schizophrenia pseudoneurotic;
Schizophrenia pseudopsychopathic; Schizotypal personality
disorder
Delusional disorder; Paranoia; Paranoid psychosis; Paranoid
state; Paraphrenia (late); Sensitiver Beziehungswahn
F22.8
Other persistent delusional disorders; Delusional

dysmorphophobia; Involutional paranoid state; Paranoia
querulans
7,800
2,340
5,460
F23.0
Acute polymorphic psychotic disorder without symptoms

of schizophrenia; Bouffe dlirante without symptoms of
schizophrenia or unspecified; Cycloid psychosis without
symptoms of schizophrenia or unspecified
7,800
2,340
5,460
Page 65 of 112

FIRST CASE RATE
ICD CODE
F23.1
F23.2
F23.3
F23.8
F23.9
F24
F25.0
F25.1
F25.2
DESCRIPTION
GROUP
Acute polymorphic psychotic disorder with symptoms of

schizophrenia; Bouffe dlirante with symptoms of
schizophrenia; Cycloid psychosis with symptoms of
schizophrenia
Acute schizophrenia-like psychotic disorder;Acute
(undifferentiated) schizophrenia;Brief schizophreniform
disorder; Brief schizophreniform psychosis; Oneirophrenia;
Schizophrenic reaction
Schizoaffective disorder, mixed type; Cyclic schizophrenia;

Mixed schizophrenic and affective psychosis
Professional
Fee
Health Care
Institution Fee
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
Other acute predominantly delusional psychotic disorders;

Paranoid reaction; Psychogenic paranoid psychosis
Other acute and transient psychotic disorders
Acute and transient psychotic disorder, unspecified; Brief
reactive psychosis NOS; Reactive psychosis
Induced delusional disorder; Folie deux; Induced
paranoid disorder; Induced psychotic disorder
Schizoaffective disorder, manic type; Schizoaffective
psychosis, manic type; Schizophreniform psychosis, manic
type
Schizoaffective disorder, depressive type; Schizoaffective
psychosis, depressive type; Schizophreniform psychosis,
depressive type
Case Rate
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460

7,800
7,800
7,800
2,340
2,340
2,340
5,460
5,460
5,460
7,800
2,340
5,460
F30.9
Other schizoaffective disorders

Schizoaffective disorder, unspecified; Schizoaffective
psychosis NOS
Other nonorganic psychotic disorders; Chronic
hallucinatory psychosis
Unspecified nonorganic psychosis; Psychosis NOS
Hypomania
Mania without psychotic symptoms
Mania with psychotic symptoms; Mania with moodcongruent psychotic symptoms; Mania with moodincongruent psychotic symptoms; Manic stupor
Manic episode, unspecified; Mania NOS
7,800
2,340
5,460
F31.0
Bipolar affective disorder, current episode hypomanic
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460

7,800
7,800
2,340
2,340
5,460
5,460
7,800
2,340
5,460

7,800
7,800
7,800
2,340
2,340
2,340
5,460
5,460
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
F33.2
Recurrent depressive disorder, current episode severe

without psychotic symptoms; Endogenous depression
without psychotic symptoms; Major depression, recurrent MENTAL AND BEHAVIORAL DISORDERS
without psychotic symptoms; Manic-depressive psychosis,
depressed type without psychotic sympto
7,800
2,340
5,460
F33.3
Recurrent depressive disorder, current episode severe with

psychotic symptoms including Endogenous depression with
psychotic symptoms; Manic-depressive psychosis,
depressed type with psychotic symptoms; Recurrent severe
episodes of major depression with
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
F25.8
F25.9
F28
F29
F30.0
F30.1
F30.2
F31.1
F31.2
F31.3
F31.5
F31.6
F31.7
F31.8
F31.9
F32.0
F32.1
F32.2
F32.3
F32.8
F32.9
F33.8
F33.9
F34.0
Bipolar affective disorder, current episode manic without

psychotic symptoms
Bipolar affective disorder, current episode manic with
psychotic symptoms
Bipolar affective disorder, current episode mild or
moderate depression
Bipolar affective disorder, current episode severe
depression with psychotic symptoms
Bipolar affective disorder, current episode mixed
Bipolar affective disorder, currently in remission
Other bipolar affective disorders; Bipolar II disorder;
Recurrent manic episodes NOS
Bipolar affective disorder, unspecified
Mild depressive episode
Moderate depressive episode
Severe depressive episode without psychotic symptoms;
[Agitated depression, Major depression, Vital depression]
single episode without psychotic symptoms
Severe depressive episode with psychotic symptoms; Single

episodes of major depression with psychotic symptoms;
Single episodes of psychogenic depressive psychosis; Single MENTAL AND BEHAVIORAL DISORDERS
episodes of psychotic depression; Single episodes of
reactive depressive psychosis
Other depressive episodes; Atypical depression; Single
episodes of "masked" depression NOS
Depressive episode, unspecified; Depression NOS;
Depressive disorder NOS
Other recurrent depressive disorders

Recurrent depressive disorder, unspecified; Monopolar
depression NOS
Cyclothymia; Affective personality disorder; Cycloid
personality; Cyclothymic personality
Page 66 of 112

FIRST CASE RATE
ICD CODE
F34.1
F42.1
F42.2
F42.8
F42.9
F43.0
F43.1
F43.2
F43.8
F44.0
F44.4
F44.8
F44.9
F45.0
F45.1
F45.2
F45.3
F45.4
F45.8
F45.9
F48.8
F48.9
F50.2
F53.0
F53.1
F53.9
F55
F59
F70.0
F72.9
F78.1
F78.8
F78.9
F79.8
F80.3
F82
DESCRIPTION
Dysthymia; Depressive neurosis; Depressive personality
disorder; Neurotic depression; Persistent anxiety
depression
Predominantly compulsive acts [obsessional rituals]
Mixed obsessional thoughts and acts
Other obsessive-compulsive disorders
Obsessive-compulsive disorder, unspecified
Acute stress reaction including Acute crisis reaction; Acute
reaction to stress; Combat fatigue; Crisis state; Psychic
shock
Post-traumatic stress disorder; Traumatic neurosis
Adjustment disorders; Culture shock; Grief reaction;
Hospitalism in children
Other reactions to severe stress
Dissociative amnesia
Dissociative motor disorders; Psychogenic aphonia;
Psychogenic dysphonia
Other dissociative [conversion] disorders; Ganser's
syndrome; Multiple personality; Psychogenic confusion;
Psychogenic twilight state
Dissociative [conversion] disorder, unspecified
Somatization disorder; Briquets disorder; Multiple
psychosomatic disorder
Undifferentiated somatoform disorder; Undifferentiated
psychosomatic disorder
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
7,800
2,340
5,460

7,800
7,800
7,800
7,800
2,340
2,340
2,340
2,340
5,460
5,460
5,460
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460

7,800
7,800
2,340
2,340
5,460
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460

7,800
7,800
2,340
2,340
5,460
5,460
Mild mental and behavioural disorders associated with the

puerperium, not elsewhere classified; Depression postnatal MENTAL AND BEHAVIORAL DISORDERS
NOS; Depression postpartum NOS
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
Abuse of non-dependence-producing substances; Abuse of

antacids; Abuse of herbal or folk remedies; Abuse of
steroids or hormones; Abuse of vitamins; Laxative habit
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
Hypochondriacal disorder; Body dysmorphic disorder;

Dysmorphophobia (nondelusional); Hypochondriacal
neurosis; Hypochondriasis; Nosophobia
Somatoform autonomic dysfunction; Cardiac neurosis; Da
Costa's syndrome; Gastric neurosis ; Neurocirculatory
asthenia
Psychogenic forms of aerophagy; Psychogenic forms of
cough, Psychogenic forms of diarrhea; Psychogenic forms
of dyspepsia; Psychogenic
Persistent somatoform pain disorder; Psychalgia;
Psychogenic backache; Psychogenic headache;
Somatoform pain disorder
Other somatoform disorders; Psychogenic dysmenorrhoea;
Psychogenic dysphagia, including "globus hystericus";
Psychogenic pruritus; Psychogenic torticollis; Teethgrinding
Somatoform disorder, unspecified; Psychosomatic disorder
NOS
Other specified neurotic disorders; Dhat syndrome;
Occupational neurosis, including writer's cramp;
Psychasthenia; Psychasthenic neurosis; Psychogenic
syncope
Neurotic disorder, unspecified; Neurosis NOS
Bulimia nervosa; Bulimia NOS; Hyperorexia nervosa
Severe mental and behavioural disorders associated with

the puerperium, not elsewhere classified; Puerperal
psychosis NOS
Puerperal mental disorder, unspecified
Unspecified behavioural syndromes associated with

physiological disturbances and physical factors;
Psychogenic physiological dysfunction NOS
Mild mental retardation; feeble-mindedness; mild mental
subnormality with the statement of no, or minimal,
impairment of behaviour
Severe mental retardation; severe mental subnormality
without mention of impairment of behaviour
Other mental retardation with significant impairment of
behaviour requiring attention or treatment
Other mental retardation with other impairments of
behaviour
Other mental retardation without mention of impairment
of behaviour
Unspecified mental retardation; mental deficiency NOS;
mental subnormality NOS with other impairments of
behaviour
Acquired aphasia with epilepsy [Landau-Kleffner]
Specific developmental disorder of motor function; Clumsy
child syndrome; Developmental coordination disorder;
Developmental dyspraxia
Page 67 of 112

FIRST CASE RATE
ICD CODE
F84.0
F84.2
F84.3
F84.5
F84.9
F89
F90.8
F92.0
F98.1
F99
E88.0
DESCRIPTION
Childhood autism; Autistic disorder; Infantile autism;
Infantile psychosis; Kanner's syndrome
Rett's syndrome
Other childhood disintegrative disorder; Dementia
infantilis; Disintegrative psychosis; Heller's syndrome;
Symbiotic psychosis
Asperger's syndrome; Autistic psychopathy; Schizoid
disorder of childhood
Pervasive developmental disorder, unspecified
Unspecified disorder of psychological development;
Developmental disorder NOS
Other hyperkinetic disorders
Depressive conduct disorder
Nonorganic encopresis; Functional encopresis;
Incontinence of faeces of nonorganic origin; Psychogenic
encopresis
Mental disorder, not otherwise specified; Mental illness
NOS
Disorders of plasma-protein metabolism, not elsewhere
classified; a-1-Antitrypsin deficiency; Bisalbuminaemia
E88.9
Lipodystrophy, not elsewhere classified; Lipodystrophy

NOS
Other specified metabolic disorders; Launois-Bensaude
adenolipomatosis; Trimethylaminuria
Metabolic disorder, unspecified
P70.0
Syndrome of infant of mother with gestational diabetes
E88.1
E88.8
P70.1
P70.2
P70.3
P70.4
P70.9
P71.0
P71.1
P71.3
P71.4
P71.9
P72.0
P72.1
Syndrome of infant of a diabetic mother; Maternal diabetes

mellitus (pre-existing) affecting fetus or newborn with
hypoglycaemia
Neonatal diabetes mellitus
Iatrogenic neonatal hypoglycaemia
Other neonatal hypoglycaemia; Transitory neonatal
hypoglycaemia
Transitory disorder of carbohydrate metabolism of fetus
and newborn, unspecified
Cow's milk hypocalcaemia in newborn
Other neonatal hypocalcaemia
Neonatal tetany without calcium or magnesium deficiency;
Neonatal tetany NOS
Transitory neonatal hypoparathyroidism
Transitory neonatal disorder of calcium and magnesium
metabolism, unspecified
Neonatal goitre, not elsewhere classified; Transitory
congenital goitre with normal function
Transitory neonatal hyperthyroidism; neonatal
thyrotoxicosis
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460

7,800
7,800
2,340
2,340
5,460
5,460
7,800
2,340
5,460
7,800
2,340
5,460
METABOLIC DISORDERS
10,700
3,210
7,490
METABOLIC DISORDERS
10,700
3,210
7,490
METABOLIC DISORDERS
10,700
3,210
7,490
METABOLIC DISORDERS
10,700
3,210
7,490
METABOLIC DISORDERS OF THE NEWBORN
9,300
2,790
6,510
9,300
2,790
6,510

9,300
9,300
2,790
2,790
6,510
6,510
9,300
2,790
6,510
9,300
2,790
6,510

9,300
9,300
2,790
2,790
6,510
6,510
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510
P72.2
Other transitory neonatal disorders of thyroid function, not

elsewhere classified; Transitory neonatal hypothyroidism
9,300
2,790
6,510
P72.8
Other specified transitory neonatal endocrine disorders
9,300
2,790
6,510
P72.9
P74.0
P74.1
P74.2
P74.4
P74.8
Transitory neonatal endocrine disorder, unspecified

Late metabolic acidosis of newborn
Dehydration of newborn
Disturbances of sodium balance of newborn
Other transitory electrolyte disturbances of newborn
Other transitory metabolic disturbances of newborn

9,300
9,300
9,300
9,300
9,300
9,300
2,790
2,790
2,790
2,790
2,790
2,790
6,510
6,510
6,510
6,510
6,510
6,510
P74.9
Transitory metabolic disturbance of newborn, unspecified
9,300
2,790
6,510
P80.9
P81.0
Hypothermia of newborn, unspecified

Environmental hyperthermia of newborn
Other specified disturbances of temperature regulation of
newborn
Disturbance of temperature regulation of newborn,
unspecified; Fever of newborn NOS
Neonatal erythema toxicum
Breast engorgement of newborn; Noninfective mastitis of
newborn
Other specified conditions of integument specific to fetus
and newborn; Bronze baby syndrome; Neonatal
scleroderma; Urticaria neonatorum

9,300
9,300
2,790
2,790
6,510
6,510
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510
5,000
1,500
3,500
MISCARRIAGE
5,000
1,500
3,500
MISCARRIAGE
MISCARRIAGE
5,000
5,000
1,500
1,500
3,500
3,500
P81.8
P81.9
P83.1
P83.4
P83.8
O02.0
Blighted ovum and nonhydatidiform mole; Carneous mole;

MISCARRIAGE
Fleshy mole; Intrauterine mole NOS; Pathological ovum
O02.8
O02.9
Missed abortion; Early fetal death with retention of dead

fetus
Other specified abnormal products of conception
Abnormal product of conception, unspecified
O03.4
Spontaneous abortion, incomplete, without complication
MISCARRIAGE
5,000
1,500
3,500
O03.9
Spontaneous abortion, complete or unspecified, without

complication
MISCARRIAGE
5,000
1,500
3,500
O02.1
Page 68 of 112

FIRST CASE RATE
ICD CODE
O05.4
O05.9
O06.4
O06.9
O07.0
O07.3
O07.4
O07.8
O07.9
O03.0
O03.1
O03.2
O03.3
O03.5
O03.6
O03.7
DESCRIPTION
GROUP
MISCARRIAGE
5,000
Professional
Fee
1,500
MISCARRIAGE
5,000
1,500
3,500
MISCARRIAGE
5,000
1,500
3,500
MISCARRIAGE
5,000
1,500
3,500
Failed medical abortion, complicated by genital tract and

pelvic infection with Endometritis; Oophoritis; Parametritis;
MISCARRIAGE
Parametritis; Pelvic peritonitis; Salpingitis; Salpingooophoritis; Sepsis; Septic shock; Septicaemia
5,000
1,500
3,500
MISCARRIAGE
5,000
1,500
3,500
MISCARRIAGE
5,000
1,500
3,500
MISCARRIAGE
5,000
1,500
3,500
MISCARRIAGE
5,000
1,500
3,500
MISCARRIAGE WITH COMPLICATIONS
6,900
2,070
4,830
6,900
2,070
4,830
6,900
2,070
4,830
6,900
2,070
4,830
6,900
2,070
4,830
6,900
2,070
4,830
6,900
2,070
4,830
Other abortion, incomplete, without complication

Other abortion, complete or unspecified, without
complication
Unspecified abortion or induced abortion NOS, incomplete,
without complication
Unspecified abortion or induced abortion NOS, complete or
unspecified, without complication
Failed medical abortion with other and unspecified

complications with Shock following abortion and ectopic
and molar pregnancy; Circulatory collapase; Postoperative
Shock; Renal failure following abortion and ectopic and
molar pregnancy; Oliguria Acute re
Failed medical abortion without complication; Failed
medical abortion NOS
Other and unspecified failed attempted abortion with other
and unspecified complications with with Shock following
abortion and ectopic and molar pregnancy; Circulatory
collapase; Postoperative Shock; Renal failure following
abortion and ectopic and mola
Other and unspecified failed attempted abortion without
complication; Failed attempted abortion NOS
Spontaneous abortion, incomplete, complicated by Genital
tract and pelvic infection with Genital tract and pelvic
infection following abortion and ectopic and molar
pregnancy; Endometritis; Oophoritis; Parametritis; Pelvic
peritonitis; Salpingitis; Salpin
Spontaneous abortion, incomplete, complicated Delayed or
excessive haemorrhage with Delayed or excessive
haemorrhage following abortion and ectopic and molar
pregnancy; Afibrinogenaemia; Defibrination syndrome;
Intravascular coagulation
Spontaneous abortion, incomplete, complicated by
Embolism with Embolism NOS or Air embolism or Amniotic
fluid embolism or Blood-clot embolism or Pulmonary
embolism or Pyaemic embolism or Septic or
septicopyaemic embolism or Soap embolism
Spontaneous abortion, incomplete, with other and
unspecified complications with Shock following abortion
and ectopic and molar pregnancy; Circulatory collapase;
Postoperative Shock; Renal failure following abortion and
ectopic and molar pregnancy; Oliguri
Spontaneous abortion, complete, complicated by Genital

tract and pelvic infection with Genital tract and pelvic
infection following abortion and ectopic and molar
pregnancy; Endometritis; Oophoritis; Parametritis; Pelvic
peritonitis; Salpingitis; Salpingo
Spontaneous abortion, complete or unspecified,
complicated Delayed or excessive haemorrhage with
Delayed or excessive haemorrhage following abortion and MISCARRIAGE WITH COMPLICATIONS
Spontaneous abortion, complete or unspecified, with other
complicated by Embolism with Embolism following
abortion and ectopic and molar pregnancy; Embolism NOS; MISCARRIAGE WITH COMPLICATIONS
Air embolism; Amniotic fluid embolism; Blood-clot
embolism; Pulmonary embolism; Pyaemic embo
Case Rate
Health Care
Institution Fee
3,500
O03.8
Spontaneous abortion, complete or unspecified, with

other and unspecified complications with Shock following
abortion and ectopic and molar pregnancy; Circulatory
collapase; Postoperative Shock; Renal failure following
abortion and ectopic and molar preg
6,900
2,070
4,830
O05.0
Other abortion, incomplete, complicated by Genital tract

and pelvic infection with Endometritis and/or Oophoritis
and/or Parametritis and/or Pelvic peritonitis and/or
Salpingitis and/or Salpingo-oophoritis and/or Sepsis and/or
Septic shock and/or Septicae
6,900
2,070
4,830
O05.1
Other abortion, incomplete, complicated Delayed or

excessive haemorrhage with Delayed or excessive
haemorrhage following abortion and ectopic and molar
pregnancy; Afibrinogenaemia; Defibrination syndrome;
6,900
2,070
4,830
Page 69 of 112

FIRST CASE RATE
ICD CODE
O05.8
DESCRIPTION
GROUP
Other abortion, complete, with other and unspecified

complications with Shock following abortion and ectopic
and molar pregnancy; Circulatory collapase; Postoperative MISCARRIAGE WITH COMPLICATIONS
Shock; Renal failure following abortion and ectopic and
molar pregnancy; Oliguria Acute
complicated by Genital tract and pelvic infection with
Endometritis and/or Oophoritis and/or Parametritis and/or MISCARRIAGE WITH COMPLICATIONS
Pelvic peritonitis and/or Salpingitis and/or Salpingooophoritis and/or Sepsis and/
Case Rate
Professional
Fee
Health Care
Institution Fee
6,900
2,070
4,830
6,900
2,070
4,830
6,900
2,070
4,830
6,900
2,070
4,830
O06.3

with other and unspecified complications with Shock
following abortion and ectopic and molar pregnancy;
Circulatory collapase; Postoperative Shock; Renal failure
following abortion and ectopic and
6,900
2,070
4,830
O06.5
Unspecified abortion or induced abortion NOS, complete,

or unspecified, complicated by Genital tract and pelvic
infection or Endometritis and/or Oophoritis and/or
Parametritis and/or Pelvic peritonitis and/or Salpingitis
and/or Salpingo-oophoritis and/or
6,900
2,070
4,830
6,900
2,070
4,830
6,900
2,070
4,830
6,900
2,070
4,830
6,900
2,070
4,830
6,900
2,070
4,830
6,900
2,070
4,830
O06.0
O06.1
O06.2
O06.6
O06.7
O06.8
O07.1
O07.5
O07.6

complicated Delayed or excessive haemorrhage with
Afibrinogenaemia or Defibrination syndrome or
complicated by Embolism or Embolism NOS with Air
embolism or Amniotic fluid embolism or Blood-clot
embolism or Pulmonary embolism or Pyaemic embolism or
Septic or septicopyaemic embolism or Soap e

complicated by Delayed or excessive haemorrhage or
Afibrinogenaemia or Defibrination syndrome or
complicated by Embolism or Embolism NOS or Air
embolism or Amniotic fluid embolism or Blood-clot
embolism or Pulmonary embolism or Pyaemic embolism or
Septic or septicopyaemic embolism or Soap emboli
with other and unspecified complications with Shock
following abortion and ectopic and molar pregnancy;
Circulatory collapase; Postoperative Shock; Renal failure
following abortion and ectopic and m
Failed medical abortion complicated by delayed or

excessive haemorrhage; Afibrinogenaemia with Delayed or
excessive haemorrhage following abortion and ectopic and MISCARRIAGE WITH COMPLICATIONS
molar pregnancy; Afibrinogenaemia; Defibrination
syndrome; Intravascular coagulation
Other and unspecified failed attempted abortion
complicated by genital tract and pelvic infection with
Endometritis; Oophoritis; Parametritis; Pelvic peritonitis;
Salpingitis; Salpingo-oophoritis; Sepsi; Septic shock;
Septicaemia
Other and unspecified failed attempted abortion
complicated by delayed or excessive haemorrhage with
Delayed or excessive haemorrhage following abortion and MISCARRIAGE WITH COMPLICATIONS
O08.3
Shock following abortion and ectopic and molar pregnancy;

Circulatory collapase; Postoperative Shock
6,900
2,070
4,830
O08.8
Other complications following abortion and ectopic and

molar pregnancy; Cardiac arrest; Urinary tract infection
6,900
2,070
4,830
M60.0
M60.00
Infective myositis; Tropical pyomyositis

Infective myositis; Tropical pyomyositis Multiple site
MUSCLE, TENDON, SOFT TISSUE DISORDERS

6,500
6,500
1,950
1,950
4,550
4,550
M60.01
Infective myositis; Tropical pyomyositis Shoulder region
6,500
1,950
4,550
M60.02
6,500
1,950
4,550
6,500
1,950
4,550
M60.06
Infective myositis; Tropical pyomyositis Upper arm

Infective myositis; Tropical pyomyositis Pelvic region and
thigh
Infective myositis; Tropical pyomyositis Lower leg
6,500
1,950
4,550
M60.07
Infective myositis; Tropical pyomyositis Ankle and foot
6,500
1,950
4,550
M60.08
Infective myositis; Tropical pyomyositis Other
6,500
1,950
4,550
M60.09
Infective myositis; Tropical pyomyositis Site unspecified
6,500
1,950
4,550
M60.05
Page 70 of 112

FIRST CASE RATE
ICD CODE
M60.1
M60.11
M60.2
M60.21
M60.23
M60.27
M60.8
M60.80
M60.81
M60.88
M60.89
M60.9
M60.90
M60.91
M60.92
M60.95
M60.96
M60.98
M60.99
DESCRIPTION
Interstitial myositis
Interstitial myositis Shoulder region
Foreign body granuloma of soft tissue, not elsewhere
classified
classified Shoulder region
classified Forearm
classified Ankle and foot
Other myositis
Other myositis Multiple site
Other myositis Shoulder region
Other myositis Other
Other myositis Site unspecified
Myositis, unspecified
Myositis, unspecified Multiple site
Myositis, unspecified Shoulder region
Myositis, unspecified Upper arm
Myositis, unspecified Pelvic region and thigh
Myositis, unspecified Lower leg
Myositis, unspecified Other
Myositis, unspecified Site unspecified
Calcification and ossification of muscles associated with
burns; Myositis ossificans associated with burns
GROUP
6,500
6,500
Professional
Fee
1,950
1,950
6,500
1,950
4,550
6,500
1,950
4,550
6,500
1,950
4,550
6,500
1,950
4,550

6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
Case Rate
Health Care
Institution Fee
4,550
4,550
6,500
1,950
4,550

6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
6,500
1,950
4,550
6,500
1,950
4,550
M62.60
M62.61
M62.62
M62.63
M62.65
M62.66
M62.67
M62.68
M62.69
M62.8
M62.80
M62.85
M62.86
M62.88
M62.89
M62.9
M62.90
M62.91
Other ossification of muscle Pelvic region and thigh

Other ossification of muscle Site unspecified
Calcification and ossification of muscle, unspecified
Diastasis of muscle
Diastasis of muscle Pelvic region and thigh
Diastasis of muscle Other
Other rupture of muscle (nontraumatic)
Contracture of muscle Other
Contracture of muscle Site unspecified
Muscle wasting and atrophy, not elsewhere classified;
Disuse atrophy NEC Lower leg
Muscle wasting and atrophy, not elsewhere classified;
Disuse atrophy NEC Site unspecified
Muscle strain Multiple site
Muscle strain Shoulder region
Muscle strain Upper arm
Muscle strain Forearm
Muscle strain Pelvic region and thigh
Muscle strain Lower leg
Muscle strain Ankle and foot
Muscle strain Other
Muscle strain Site unspecified
Muscle (sheath) hernia
Muscle (sheath) hernia Multiple site
Muscle (sheath) hernia Pelvic region and thigh
Muscle (sheath) hernia Lower leg
Muscle (sheath) hernia Other
Muscle (sheath) hernia Site unspecified
Disorder of muscle, unspecified
Disorder of muscle, unspecified Multiple site
Disorder of muscle, unspecified Shoulder region

6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
M62.95
Disorder of muscle, unspecified Pelvic region and thigh
6,500
1,950
4,550
M62.96
M62.97
M62.98
M62.99
M65.0
M65.1
M65.13
M65.2
M65.20
M65.22
M65.25
M65.29
M65.3
M65.3
M65.4
M65.4
M65.8
M65.80
M65.84
M65.86
M65.87
M65.89
M65.9
M65.90
Disorder of muscle, unspecified Lower leg

Disorder of muscle, unspecified Ankle and foot
Disorder of muscle, unspecified Other
Disorder of muscle, unspecified Site unspecified
Abscess of tendon sheath
Other infective tenosynovitis
Other infective (teno)synovitis Forearm
Calcific tendinitis
Calcific tendinitis Multiple site
Calcific tendinitis Upper arm
Calcific tendinitis Pelvic region and thigh
Calcific tendinitis Site unspecified
Trigger finger;Nodular tendinous disease
Trigger finger;Nodular tendinous disease
Radial styloid tenosynovitis [de Quervain]
Radial styloid tenosynovitis [de Quervain]
Other synovitis and tenosynovitis
Other synovitis and tenosynovitis Multiple site
Other synovitis and tenosynovitis Hand
Other synovitis and tenosynovitis Lower leg
Other synovitis and tenosynovitis Ankle and foot
Other synovitis and tenosynovitis Site unspecified
Synovitis and tenosynovitis, unspecified
Synovitis and tenosynovitis, unspecified Multiple site

6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
M61.3
M61.55
M61.59
M61.9
M62.0
M62.05
M62.08
M62.1
M62.48
M62.49
M62.56
M62.59
Page 71 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
M65.91
Synovitis and tenosynovitis, unspecified Shoulder region
6,500
1,950
4,550
M65.92
M65.93
M65.94

6,500
6,500
6,500
1,950
1,950
1,950
4,550
4,550
4,550
6,500
1,950
4,550
M65.96
Synovitis and tenosynovitis, unspecified Upper arm

Synovitis and tenosynovitis, unspecified Forearm
Synovitis and tenosynovitis, unspecified Hand
Synovitis and tenosynovitis, unspecified Pelvic region and
thigh
Synovitis and tenosynovitis, unspecified Lower leg
6,500
1,950
4,550
M65.97
Synovitis and tenosynovitis, unspecified Ankle and foot
6,500
1,950
4,550
M65.99
Synovitis and tenosynovitis, unspecified Site unspecified
6,500
1,950
4,550
M66.0
M66.4

6,500
6,500
1,950
1,950
4,550
4,550
6,500
1,950
4,550

6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
6,500
1,950
4,550

6,500
6,500
1,950
1,950
4,550
4,550
6,500
1,950
4,550
6,500
1,950
4,550
6,500
1,950
4,550
6,500
1,950
4,550
M71.1
M71.2
M71.2
M71.3
M71.31
M71.5
Rupture of popliteal cyst

Spontaneous rupture of other tendons
Spontaneous rupture of unspecified tendon; Rupture at
musculotendinous junction, nontraumatic
Short Achilles tendon (acquired)
Other contracture of tendon (sheath)
Synovial hypertrophy, not elsewhere classified
Transient synovitis; Toxic synovitis
Ganglion; Ganglion of joint or tendon (sheath)
Other specified disorders of synovium and tendon
Disorder of synovium and tendon, unspecified
Chronic crepitant synovitis of hand and wrist
Chronic crepitant synovitis of hand and wrist
Bursitis of hand
Olecranon bursitis
Olecranon bursitis
Other bursitis of elbow
Prepatellar bursitis
Prepatellar bursitis
Other bursitis of knee
Other bursitis of knee
Trochanteric bursitis; Trochanteric tendinitis
Trochanteric bursitis; Trochanteric tendinitis Shoulder
region
Other bursitis of hip; Ischial bursitis
Other bursitis of hip; Ischial bursitis
Other soft tissue disorders related to use, overuse and
pressure
Other soft tissue disorders related to use, overuse and
pressure
Unspecified soft tissue disorder related to use, overuse and
pressure
Unspecified soft tissue disorder related to use, overuse and
pressure
Other infective bursitis
Synovial cyst of popliteal space [Baker]
Synovial cyst of popliteal space [Baker]
Other bursal cyst; Synovial cyst NOS
Other bursal cyst; Synovial cyst NOS Shoulder region
Other bursitis, not elsewhere classified

6,500
6,500
6,500
6,500
6,500
6,500
1,950
1,950
1,950
1,950
1,950
1,950
4,550
4,550
4,550
4,550
4,550
4,550
M71.51
Other bursitis, not elsewhere classified Shoulder region
6,500
1,950
4,550
M71.8
M71.9
M71.91
M71.99
M72.0
M72.2
M72.2
M72.5
M72.88

6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
6,500
1,950
4,550
6,500
1,950
4,550
6,500
1,950
4,550
6,500
1,950
4,550
6,500
1,950
4,550
M75.2
Other specified bursopathies

Bursopathy, unspecified
Bursopathy, unspecified Shoulder region
Bursopathy, unspecified Site unspecified
Palmar fascial fibromatosis [Dupuytren]
Plantar fascial fibromatosis; Plantar fasciitis
Plantar fascial fibromatosis; Plantar fasciitis
FASCIITIS, NOT ELSEWHERE CLASSIFIED,
Other fibroblastic disorders; Abscess of fascia Other
Fibroblastic disorder, unspecified; Fasciitis NOS;
Fibromatosis NOS
Fibromatosis NOS Other
Fibromatosis NOS Site unspecified
Adhesive capsulitis of shoulder; Frozen shoulder;
Periarthritis of shoulder
Rotator cuff syndrome; Rotator cuff or supraspinatus tear
or rupture complete)(incomplete), not specified
as traumatic; Supraspinatus syndrome
Bicipital tendinitis
6,500
1,950
4,550
M75.3
Calcific tendinitis of shoulder; Calcified bursa of shoulder
6,500
1,950
4,550
M75.4
M75.5
M75.8
M75.9
M76
M76.0
M76.1
Impingement syndrome of shoulder

Bursitis of shoulder
Other shoulder lesions
Shoulder lesion, unspecified
Enthesopathies of lower limb, excluding foot
Gluteal tendinitis
Psoas tendinitis

6,500
6,500
6,500
6,500
6,500
6,500
6,500
1,950
1,950
1,950
1,950
1,950
1,950
1,950
4,550
4,550
4,550
4,550
4,550
4,550
4,550
M65.95
M66.5
M67.0
M67.1
M67.2
M67.3
M67.4
M67.8
M67.9
M70.0
M70.0
M70.1
M70.2
M70.2
M70.3
M70.4
M70.4
M70.5
M70.5
M70.6
M70.6
M70.7
M70.7
M70.8
M70.8
M70.9
M70.9
M72.9
M72.98
M72.99
M75.0
M75.1
Page 72 of 112

FIRST CASE RATE
ICD CODE
M76.3
M76.4
M76.5
M76.5
M76.6
M76.6
M76.7
DESCRIPTION
GROUP
6,500
6,500
6,500
6,500
6,500
6,500
6,500
Professional
Fee
1,950
1,950
1,950
1,950
1,950
1,950
1,950
6,500
1,950
4,550
6,500
1,950
4,550

6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
6,500
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
1,950
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
4,550
6,500
1,950
4,550
Case Rate
Health Care
Institution Fee
4,550
4,550
4,550
4,550
4,550
4,550
4,550
6,500
1,950
4,550
M79.80
M79.81
M79.82
M79.84
Iliotibial band syndrome

Tibial collateral bursitis [Pellegrini-Stieda]
Patellar tendinitis
Patellar tendinitis
Achilles tendinitis; Achilles bursitis
Achilles tendinitis; Achilles bursitis
Peroneal tendinitis
Other enthesopathies of lower limb, excluding foot;
Anterior tibial syndrome; Posterior tibial tendinitis
Other enthesopathies of lower limb, excluding foot;
Anterior tibial syndrome; Posterior tibial tendinitis
Enthesopathy of lower limb, unspecified
Medial epicondylitis
Medial epicondylitis
Lateral epicondylitis; Tennis elbow
Lateral epicondylitis; Tennis elbow
Calcaneal spur
Calcaneal spur
Other enthesopathy of foot
Other enthesopathy of foot
Other enthesopathies, not elsewhere classified
Other enthesopathies, not elsewhere classified
Enthesopathy, unspecified; Bone spur NOS; Capsulitis NOS;
Periarthritis NOS; Tendinitis NOS
Enthesopathy, unspecified; Bone spur NOS; Capsulitis NOS;
Periarthritis NOS; Tendinitis NOS Multiple site
Other specified soft tissue disorders Multiple site
Other specified soft tissue disorders Shoulder region
Other specified soft tissue disorders Upper arm
Other specified soft tissue disorders Hand

6,500
6,500
6,500
6,500
1,950
1,950
1,950
1,950
4,550
4,550
4,550
4,550
M79.85
Other specified soft tissue disorders Pelvic region and thigh MUSCLE, TENDON, SOFT TISSUE DISORDERS
6,500
1,950
4,550
M79.86
M79.87
M79.88
M79.89
M79.91
Other specified soft tissue disorders Lower leg

Other specified soft tissue disorders Ankle and foot
Other specified soft tissue disorders Other
Other specified soft tissue disorders Site unspecified
Soft tissue disorder, unspecified Shoulder region

6,500
6,500
6,500
6,500
6,500
1,950
1,950
1,950
1,950
1,950
4,550
4,550
4,550
4,550
4,550
M79.95
Soft tissue disorder, unspecified Pelvic region and thigh
6,500
1,950
4,550
M79.98
M79.99
M79.00
M79.01
M79.02
M79.05
M79.07
M79.08
M79.09
M79.10
M79.11
M79.12
M79.15
M79.16
M79.18
M79.19
M79.20
M79.21
M79.22
Soft tissue disorder, unspecified Other

Soft tissue disorder, unspecified Site unspecified
Rheumatism, unspecified Multiple site
Rheumatism, unspecified Shoulder region
Rheumatism, unspecified Upper arm
Rheumatism, unspecified Pelvic region and thigh
Rheumatism, unspecified Ankle and foot
Rheumatism, unspecified Other
Rheumatism, unspecified Site unspecified
Myalgia Multiple site
Myalgia Shoulder region
Myalgia Upper arm
Myalgia Pelvic region and thigh
Myalgia Lower leg
Myalgia Other
Myalgia Site unspecified
Neuralgia and neuritis, unspecified Multiple site
Neuralgia and neuritis, unspecified Shoulder region
Neuralgia and neuritis, unspecified Upper arm

MYALGIA, NEURALGIA, RHEUMATISM
6,500
6,500
5,900
5,900
5,900
5,900
5,900
5,900
5,900
5,900
5,900
5,900
5,900
5,900
5,900
5,900
5,900
5,900
5,900
1,950
1,950
1,770
1,770
1,770
1,770
1,770
1,770
1,770
1,770
1,770
1,770
1,770
1,770
1,770
1,770
1,770
1,770
1,770
4,550
4,550
4,130
4,130
4,130
4,130
4,130
4,130
4,130
4,130
4,130
4,130
4,130
4,130
4,130
4,130
4,130
4,130
4,130
M79.25
Neuralgia and neuritis, unspecified Pelvic region and thigh
5,900
1,770
4,130
M79.28
M79.29
M79.39
M96.8
P94.0
G70.0
G70.2
G70.8
G70.9
Neuralgia and neuritis, unspecified Other

Neuralgia and neuritis, unspecified Site unspecified
Panniculitis, unspecified Site unspecified
Other postprocedural musculoskeletal disorders
Transient neonatal myasthenia gravis
Myasthenia gravis
Congenital and developmental myasthenia
Other specified myoneural disorders
Myoneural disorder, unspecified

MYASTHENIA GRAVIS NEWBORN
MYOPATHIES
MYOPATHIES
MYOPATHIES
MYOPATHIES
5,900
5,900
5,900
5,900
11,600
7,900
7,900
7,900
7,900
1,770
1,770
1,770
1,770
3,480
2,370
2,370
2,370
2,370
4,130
4,130
4,130
4,130
8,120
5,530
5,530
5,530
5,530
G71.0
Muscular dystrophy; Muscular dystrophy autosomal

recessive, childhood type, resembling Duchenne or Becker;
Muscular dystrophy benign [Becker]; Muscular dystrophy MYOPATHIES
benign; capuloperoneal with early contractures [EmeryDreifuss]; Muscular dystrophy distal;
7,900
2,370
5,530
G71.1
Myotonic disorders; Dystrophia myotonica [Steinert];

Myotonia, chondrodystrophic; Myotonia, drug-induced;
Myotonia, symptomatic; Myotonia, congenita NOS;
Myotonia, congenita dominant [Thomsen]; Myotonia,
congenital recessive [Becker]; Neuromyotonia [Isaac
7,900
2,370
5,530
M76.8
M76.8
M76.9
M77.0
M77.0
M77.1
M77.1
M77.3
M77.3
M77.5
M77.5
M77.8
M77.8
M77.9
M77.9
MYOPATHIES
Page 73 of 112

FIRST CASE RATE
ICD CODE
G71.2
G71.9
G72.0
G72.1
G72.2
G72.3
G72.4
G72.8
G72.9
P91.0
DESCRIPTION
Congenital myopathies; Congenital muscular dystrophy
NOS; Congenital muscular dystrophy with specific
morphological abnormalities of the muscle fibre; Central
coreDisease ; Minicore Disease ; MulticoreDisease ; Fibretype disproportion; Myopathy myotubula
Primary disorder of muscle, unspecified; Hereditary
myopathy NOS
Drug-induced myopathy
Alcoholic myopathy
Myopathy due to other toxic agents
Periodic paralysis; Periodic paralysis (familial)
hyperkalaemic; Periodic paralysis (familial) hypokalaemic;
Periodic paralysis (familial) myotonic; Periodic paralysis
(familial) normokalaemic
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
MYOPATHIES
7,900
2,370
5,530
MYOPATHIES
7,900
2,370
5,530
MYOPATHIES
MYOPATHIES
MYOPATHIES
7,900
7,900
7,900
2,370
2,370
2,370
5,530
5,530
5,530
MYOPATHIES
7,900
2,370
5,530
7,900
7,900
7,900
25,800
2,370
2,370
2,370
7,740
5,530
5,530
5,530
18,060
NEONATE AFFECTED BY MATERNAL FACTORS
7,700
2,310
5,390
7,700
2,310
5,390
7,700
2,310
5,390
7,700
2,310
5,390
7,700
2,310
5,390
7,700
2,310
5,390
7,700
2,310
5,390
Inflammatory myopathy, not elsewhere classified

Other specified myopathies
Myopathy, unspecified
Neonatal cerebral ischaemia
Fetus and newborn affected by maternal hypertensive
disorders
Fetus and newborn affected by maternal renal and urinary
tract diseases
Fetus and newborn affected by maternal infectious and
parasitic diseases
Fetus and newborn affected by other maternal circulatory
and respiratory diseases
Fetus and newborn affected by maternal nutritional
disorders
Fetus and newborn affected by maternal injury
Fetus and newborn affected by surgical procedure on
mother
Fetus and newborn affected by other medical procedures
on mother, not elsewhere classified
MYOPATHIES
MYOPATHIES
MYOPATHIES
NEONATAL CEREBRAL ISCHEMIA
7,700
2,310
5,390
Fetus and newborn affected by other maternal conditions
7,700
2,310
5,390
7,700
2,310
5,390
7,700
2,310
5,390
7,700
2,310
5,390
7,700
2,310
5,390
7,700
2,310
5,390
7,700
2,310
5,390
7,700
2,310
5,390
7,700
2,310
5,390
P01.7
Fetus and newborn affected by malpresentation before

labour; Breech presentation before labor; External version
before labour; Face presentation before labour; Transverse
lie before labour; Unstable lie before labour
7,700
2,310
5,390
P01.8
Fetus and newborn affected by other maternal

complications of pregnancy; Spontaneous abortion, fetus
7,700
2,310
5,390
7,700
2,310
5,390
7,700
2,310
5,390
P02.1
Fetus and newborn affected by other forms of placental

separation and haemorrhage; Abruptio placentae;
Accidental haemorrhage; Antepartum haemorrhage;
Damage to placenta from amniocentesis, caesarian section
or surgical induction; Maternal blood loss; Pre
7,700
2,310
5,390
P02.2
Fetus and newborn affected by other and unspecified

morphological and functional abnormalities of placenta;
Placental dysfunction; Placental infarction; Placental
insufficiency
7,700
2,310
5,390
P02.3
Fetus and newborn affected by placental transfusion

syndromes; Placental and cord abnormalities resulting in
twin-to-twin or other transplacental transfusion
7,700
2,310
5,390
Fetus and newborn affected by prolapsed cord

Fetus and newborn affected by other compression of
umbilical cord; Cord (tightly) around neck; Entanglement of NEONATE AFFECTED BY MATERNAL FACTORS
cord; Knot in cord
7,700
2,310
5,390
P02.5
7,700
2,310
5,390
P02.6
Fetus and newborn affected by other and unspecified

conditions of umbilical cord; Short cord; Vasa praevia
7,700
2,310
5,390
P02.7
Fetus and newborn affected by chorioamnionitis;

Amnionitis; Membranitis; Placentitis
7,700
2,310
5,390
P00.0
P00.1
P00.2
P00.3
P00.4
P00.5
P00.6
P00.7
P00.8
P00.9
P01.0
P01.1
P01.2
P01.3
P01.4
P01.5
P01.6
P01.9
P02.0
P02.4
Fetus and newborn affected by unspecified maternal

condition
Fetus and newborn affected by incompetent cervix
Fetus and newborn affected by premature rupture of
membranes
Fetus and newborn affected by oligohydramnios
Fetus and newborn affected by polyhydramnios;
Hydramnios
Fetus and newborn affected by ectopic pregnancy;
Abdominal pregnancy
Fetus and newborn affected by multiple pregnancy; Triplet
pregnance; Twin pregnancy
Fetus and newborn affected by maternal death
Fetus and newborn affected by maternal complication of

pregnancy, unspecified
Fetus and newborn affected by placenta praevia
Page 74 of 112

FIRST CASE RATE
ICD CODE
P02.8
P02.9
P03.0
P03.1
P03.2
P03.3
P03.4
P03.5
P03.6
P03.8
P03.9
P04.0
P04.1
DESCRIPTION
Fetus and newborn affected by other abnormalities of
membranes
Fetus and newborn affected by abnormality of membranes,
unspecified
Fetus and newborn affected by breech delivery and
extraction
Fetus and newborn affected by other malpresentation,
malposition and disproportion during labour and delivery;
Contracted pelvis; Persistent occipitoposterior; Transverse
lie
Fetus and newborn affected by forceps delivery
Fetus and newborn affected by delivery by vacuum
extractor [ventouse]
Fetus and newborn affected by caesarean delivery
Fetus and newborn affected by precipitate delivery
Fetus and newborn affected by abnormal uterine
contractions
Fetus and newborn affected by other specified
complications of labour and delivery
Fetus and newborn affected by complication of labour and
delivery, unspecified
Fetus and newborn affected by maternal anaesthesia and
analgesia in pregnancy, labour and delivery
Fetus and newborn affected by other maternal medication;
Cancer chemotherapy; Cytotoxic drugs
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
7,700
2,310
5,390
7,700
2,310
5,390
7,700
2,310
5,390
7,700
2,310
5,390
7,700
2,310
5,390
7,700
2,310
5,390

7,700
7,700
2,310
2,310
5,390
5,390
7,700
2,310
5,390
7,700
2,310
5,390
7,700
2,310
5,390
7,700
2,310
5,390
7,700
2,310
5,390
P04.2
Fetus and newborn affected by maternal use of tobacco
7,700
2,310
5,390
P04.3
Fetus and newborn affected by maternal use of alcohol
7,700
2,310
5,390
7,700
2,310
5,390
7,700
2,310
5,390
D37.0
Neoplasm of uncertain or unknown behaviour of Lip, oral

cavity and pharynx; Neoplasm of uncertain or unknown
behaviour of Aryepiglottic fold NOS; Neoplasm of
NEOPLASMS OF UNKNOWN BEHAVIOR
uncertain or unknown behaviour of hypopharyngeal aspect
of Aryepiglottic fold ; Neoplasm of un
12,200
3,660
8,540
D37.1
Neoplasm of uncertain or unknown behaviour of Stomach
12,200
3,660
8,540
D37.2
Neoplasm of uncertain or unknown behaviour of Small

intestine
12,200
3,660
8,540
D37.3
Neoplasm of uncertain or unknown behaviour of Appendix NEOPLASMS OF UNKNOWN BEHAVIOR
12,200
3,660
8,540
D37.4
Neoplasm of uncertain or unknown behaviour of Colon
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
P04.5
P04.8
D37.5
D37.6
Fetus and newborn affected by maternal use of nutritional

chemical substances
Fetus and newborn affected by other maternal noxious
influences
Neoplasm of uncertain or unknown behaviour of Rectum;

Neoplasm of uncertain or unknown behaviour of
Rectosigmoid junction
Neoplasm of uncertain or unknown behaviour of Liver,
gallbladder and bile ducts; Neoplasm of uncertain or
unknown behaviour of Ampulla of Vater
D37.7
Neoplasm of uncertain or unknown behaviour of Other

digestive organs; Neoplasm of uncertain or unknown
behaviour of Anal canal; Neoplasm of uncertain or
unknown behaviour of Anal sphincter; Neoplasm of
uncertain or unknown behaviour of Anus NOS; Neoplasm
12,200
3,660
8,540
D37.9
Neoplasm of uncertain or unknown behaviour of Digestive

organ, unspecified
12,200
3,660
8,540
D38.0
Neoplasm of uncertain or unknown behaviour of Larynx;

Neoplasm of uncertain or unknown behaviour of laryngeal
aspect of Aryepiglottic fold; Neoplasm of uncertain or
unknown behaviour of Suprahyoid portion of Epiglottis
12,200
3,660
8,540
D38.1
Neoplasm of uncertain or unknown behaviour of Trachea,

bronchus and lung
12,200
3,660
8,540
D38.2
Neoplasm of uncertain or unknown behaviour of Pleura
12,200
3,660
8,540
D38.3

Mediastinum
12,200
3,660
8,540
D38.4
Neoplasm of uncertain or unknown behaviour of Thymus
12,200
3,660
8,540
D38.5

respiratory organs; Neoplasm of uncertain or unknown
behaviour of Accessory sinuses; Neoplasm of uncertain or NEOPLASMS OF UNKNOWN BEHAVIOR
unknown behaviour of Cartilage of nose; Neoplasm of
uncertain or unknown behaviour of Middle
12,200
3,660
8,540
D38.6

Respiratory organ, unspecified
12,200
3,660
8,540
D39.0
Neoplasm of uncertain or unknown behaviour of Uterus
12,200
3,660
8,540
Page 75 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
D39.1
Neoplasm of uncertain or unknown behaviour of Ovary
12,200
3,660
8,540
D39.2
Neoplasm of uncertain or unknown behaviour of Placenta;

Chorioadenoma destruens; Invasive Hydatidiform mole;
Malignant Hydatidiform mole
12,200
3,660
8,540
D39.7

female genital organs; Neoplasm of uncertain or unknown
behaviour of Skin of female genital organs
12,200
3,660
8,540
D39.9
Neoplasm of uncertain or unknown behaviour of Female

genital organ, unspecified
12,200
3,660
8,540
D40.0
Neoplasm of uncertain or unknown behaviour of Prostate
12,200
3,660
8,540
D40.1
Neoplasm of uncertain or unknown behaviour of Testis
12,200
3,660
8,540
12,200
3,660
8,540
D40.7
D40.9

male genital organs; Neoplasm of uncertain or unknown
behaviour of Skin of male genital organs
Neoplasm of uncertain or unknown behaviour of Male
genital organ, unspecified
12,200
3,660
8,540
D41.0
Neoplasm of uncertain or unknown behaviour of Kidney
12,200
3,660
8,540
D41.1
Neoplasm of uncertain or unknown behaviour of Renal

pelvis
12,200
3,660
8,540
D41.2
Neoplasm of uncertain or unknown behaviour of Ureter
12,200
3,660
8,540
D41.3
Neoplasm of uncertain or unknown behaviour of Urethra
12,200
3,660
8,540
D41.4
Neoplasm of uncertain or unknown behaviour of Bladder
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
D41.9
D42.0
D42.1
Neoplasm of uncertain or unknown behaviour of Urinary

organ, unspecified
Neoplasm of uncertain or unknown behaviour of Cerebral
meninges
Neoplasm of uncertain or unknown behaviour of Spinal
meninges
Meninges, unspecified
12,200
3,660
8,540
D43.0
Neoplasm of uncertain or unknown behaviour of Brain,

supratentorial; Neoplasm of uncertain or unknown
behaviour of Cerebral ventricle; Neoplasm of uncertain or
unknown behaviour of Cerebrum; Neoplasm of uncertain
or unknown behaviour of Frontal lobe; Neop
12,200
3,660
8,540
D43.1

infratentorial; Neoplasm of uncertain or unknown
behaviour of Brain stem; Neoplasm of uncertain or
unknown behaviour of Cerebellum; Neoplasm of
uncertain or unknown behaviour of Fourth ventricle
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
D42.9
D43.2
D43.3
D43.4
D43.7
D43.9
D44.0
D44.1
D44.2
D44.3
D44.4
D44.5
D44.6
D44.7
D44.8
D44.9
D45

unspecified
Neoplasm of uncertain or unknown behaviour of Cranial
nerves
Neoplasm of uncertain or unknown behaviour of Spinal
cord
parts of central nervous system
Neoplasm of uncertain or unknown behaviour of Central
nervous system, unspecified; Neoplasm of uncertain or
unknown behaviour of Central Nervous system NOS
Neoplasm of uncertain or unknown behaviour of Thyroid
gland
Neoplasm of uncertain or unknown behaviour of Adrenal
gland
Parathyroid gland
Neoplasm of uncertain or unknown behaviour of Pituitary
gland
Craniopharyngeal duct
Neoplasm of uncertain or unknown behaviour of Pineal
gland
Neoplasm of uncertain or unknown behaviour of Carotid
body
Neoplasm of uncertain or unknown behaviour of Aortic
body and other paraganglia
Pluriglandular involvement; Multiple endocrine
adenomatosis
Neoplasm of uncertain or unknown behaviour of Endocrine
gland, unspecified
Polycythaemia vera
Page 76 of 112

FIRST CASE RATE
ICD CODE
D46
D46.7
D46.9
D47.0
D47.1
D47.2
D47.3
D47.7
D47.9
D48.0
D48.1
D48.2
D48.3
D48.4
D48.6
D48.7
D48.9
G54.0
G54.1
G54.2
G54.3
G54.4
G54.5
G54.8
G54.9
G55.8*
DESCRIPTION
Myelodysplastic syndromes
Other myelodysplastic syndromes
Myelodysplastic syndrome, unspecified; Myelodysplastic
syndrome NOS; Myelodysplasia NOS; Preleukaemia
syndrome NOS
Histiocytic and mast cell tumours of uncertain and
unknown behaviour; Mast cell tumour NOS; Mastocytoma
NOS
Chronic myeloproliferative disease; Myelofibrosis with
myeloid metaplasia; Myeloproliferative disease,
unspecified; Megakaryocytic Myelosclerosis with myeloid
metaplasia
Monoclonal gammopathy
Essential thrombocythaemia; Haemorrhagic
thrombocythaemia; Idiopathic haemorrhagic
thrombocythaemia
Other specified neoplasms of uncertain or unknown
behaviour of lymphoid, haematopoietic and related tissue
GROUP
12,200
12,200
Professional
Fee
3,660
3,660
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
12,200
3,660
8,540
NERVE ROOT AND PLEXUS DISORDERS

7,900
7,900
7,900
7,900
7,900
2,370
2,370
2,370
2,370
2,370
5,530
5,530
5,530
5,530
5,530
7,900
2,370
5,530

7,900
7,900
2,370
2,370
5,530
5,530
7,900
2,370
5,530
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
16,900
5,070
11,830
NEWBORN COMPLICATED-LARGE BABY
7,000
2,100
4,900
NEWBORN COMPLICATED-LARGE BABY
7,000
2,100
4,900
Neoplasm of uncertain or unknown behaviour of lymphoid,

haematopoietic and related tissue, unspecified;
Lymphoproliferative disease NOS
Neoplasm of uncertain or unknown behaviour of Bone and
articular cartilage
Connective and other soft tissue; Neoplasm of uncertain or
unknown behaviour of Connective tissue of ear; Neoplasm
of uncertain or unknown behaviour of eyelid
Neoplasm of uncertain or unknown behaviour of Peripheral
nerves and autonomic nervous system
Retroperitoneum
Peritoneum
Neoplasm of uncertain or unknown behaviour of Breast;
Connective tissue of breast; Cystosarcoma phyllodes
specified sites; Neoplasm of uncertain or unknown
behaviour of Eye; Neoplasm of uncertain or unknown
behaviour of Heart; Neoplasm of uncertain or unknown
behaviour of Peripheral nerves of orbit
Neoplasm of uncertain or unknown behaviour, unspecified;
"Growth" NOS ; Neoplasm NOS;
New growth NOS; Tumour NOS
Brachial plexus disorders; Thoracic outlet syndrome
Lumbosacral plexus disorders
Cervical root disorders, not elsewhere classified
Thoracic root disorders, not elsewhere classified
Lumbosacral root disorders, not elsewhere classified
Neuralgic amyotrophy; Parsonage-Aldren-Turner
syndrome; Shoulder-girdle neuritis
Other nerve root and plexus disorders
Nerve root and plexus disorder, unspecified
Nerve root and plexus compressions in other diseases
classified elsewhere
NEWBORN COMPLICATED- LOW BIRTH

WEIGHT/PRETERM
WEIGHT/PRETERM
WEIGHT/PRETERM
WEIGHT/PRETERM
WEIGHT/PRETERM
WEIGHT/PRETERM
WEIGHT/PRETERM
P05.0
Light for gestational age
P05.1
Small for gestational age
P05.2
Fetal malnutrition without mention of light or small for

gestational age
P05.9
Slow fetal growth, unspecified
P07.0
Extremely low birth weight; Birth weight 999 g or less.
P07.1
Other low birth weight; Birth weight 1000-2499 g.
P07.2
Extreme immaturity; Less than 28 completed weeks (less

than 196 completed days) of gestation.
P07.3
Other preterm infants; 28 completed weeks or more but

less than 37 completed weeks (196 completed days but less
WEIGHT/PRETERM
than 259 completed days) of gestation; Prematurity NOS
P08.0
P08.1
Exceptionally large baby; Usually implies a birth weight of

4500 g or more.
Other heavy for gestational age infants; Other fetus or
infant heavy- or large-for-dates regardless of period of
gestation.
Page 77 of 112
Case Rate
Health Care
Institution Fee
8,540
8,540

FIRST CASE RATE
ICD CODE
P08.2
P36.0
DESCRIPTION
Post-term infant, not heavy for gestational age; Fetus or
infant with gestation period of 42 completed weeks or
more (294 days or
more), not heavy- or large-for-dates; Postmaturity NOS
GROUP
NEWBORN COMPLICATED-POSTTERM
Case Rate
Professional
Fee
Health Care
Institution Fee
7,500
2,250
5,250
NEWBORN SEPSIS
11,700
3,510
8,190
NEWBORN SEPSIS
11,700
3,510
8,190
NEWBORN SEPSIS
11,700
3,510
8,190
NEWBORN SEPSIS
11,700
3,510
8,190
NEWBORN SEPSIS
NEWBORN SEPSIS
NEWBORN SEPSIS
NEWBORN SEPSIS
11,700
11,700
11,700
11,700
3,510
3,510
3,510
3,510
8,190
8,190
8,190
8,190
8,500
2,550
5,950
8,500
2,550
5,950
8,500
2,550
5,950
8,500
2,550
5,950
9,200
2,760
6,440
NUTRITIONAL DISORDER
9,200
2,760
6,440
E50.8
Sepsis of newborn due to streptococcus, group B

Sepsis of newborn due to other and unspecified
streptococci
Sepsis of newborn due to Staphylococcus aureus
Sepsis of newborn due to other and unspecified
staphylococci
Sepsis of newborn due to Escherichia coli
Sepsis of newborn due to anaerobes
Other bacterial sepsis of newborn
Bacterial sepsis of newborn, unspecified
Other noninflammatory disorders of ovary, fallopian tube
and broad ligament; Broad ligament laceration syndrome
[Allen-Masters]
Noninflammatory disorder of ovary, fallopian tube and
broad ligament, unspecified
Other specified noninflammatory disorders of uterus;
Atrophy of uterus, acquired; Fibrosis of uterus NOS
Noninflammatory disorder of uterus, unspecified; Disorder
of uterus NOS
Vitamin A deficiency with conjunctival xerosis
Vitamin A deficiency with Bitot's spot and conjunctival
xerosis; Bitot's spot in the young child
OTHER MANIFESTATIONS OF VITAMIN A DEFICIENCY
9,200
2,760
6,440
E50.9
Vitamin A deficiency, unspecified; Hypovitaminosis A NOS
9,200
2,760
6,440
E51.1
E51.2
E51.8
E51.9
E53.1
9,200
9,200
9,200
9,200
9,200
2,760
2,760
2,760
2,760
2,760
6,440
6,440
6,440
6,440
6,440
9,200
2,760
6,440
E53.9
Dry Beriberi
Wernicke's encephalopathy
Other manifestations of thiamine deficiency
Thiamine deficiency, unspecified
Pyridoxine deficiency; Vitamin B6 deficiency
Deficiency of other specified B group vitamins; Biotin
Deficiency; Cyanocobalamin Deficiency; Folate Deficiency;
Folic acid Deficiency; Pantothenic acid Deficiency; Vitamin
B12 Deficiency
Vitamin B deficiency, unspecified
9,200
2,760
6,440
E54
Ascorbic acid deficiency; Deficiency of vitamin C; Scurvy
9,200
2,760
6,440
9,200
2,760
6,440
9,200
9,200
9,200
9,200
9,200
9,200
9,200
9,200
9,200
9,200
9,200
9,200
9,200
9,200
9,200
9,200
9,200
9,200
9,200
2,760
2,760
2,760
2,760
2,760
2,760
2,760
2,760
2,760
2,760
2,760
2,760
2,760
2,760
2,760
2,760
2,760
2,760
2,760
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
6,440
6,440
6,440
OBESITY HYPOVENTILATION
13,600
4,080
9,520
OBSTRUCTIVE UROPATHIES
9,700
2,910
6,790
9,700
2,910
6,790
9,700
2,910
6,790
9,700
9,700
2,910
2,910
6,790
6,790
P36.1
P36.2
P36.3
P36.4
P36.5
P36.8
P36.9
N83.8
N83.9
N85.8
N85.9
E50.0
E50.1
E53.8
E55.0
E55.9
E55.9
E56.0
E56.1
E56.8
E56.9
E58
E60
E61.1
E61.2
E61.6
E61.9
E63.1
E63.8
E63.9
E64.9
E67.0
E67.1
E67.3
E66.2
N13.0
Rickets, active; Infantile Osteomalacia; Juvenile

Osteomalacia
Vitamin D deficiency, unspecified; Avitaminosis D
Vitamin D deficiency
Deficiency of vitamin E
Deficiency of vitamin K
Deficiency of other vitamins
Vitamin deficiency, unspecified
Dietary calcium deficiency
Dietary zinc deficiency
Iron deficiency
Magnesium deficiency
Vanadium deficiency
Deficiency of nutrient element, unspecified
Imbalance of constituents of food intake
Other specified nutritional deficiencies
Nutritional deficiency, unspecified
Sequelae of unspecified nutritional deficiency
Hypervitaminosis A
Hypercarotenaemia
Hypervitaminosis D
Extreme obesity with alveolar hypoventilation; Pickwickian
syndrome
Hydronephrosis with ureteropelvic junction obstruction
NONINFLAMMATORY DISORDERS OF THE FEMALE

GENITAL TRACT
GENITAL TRACT
GENITAL TRACT
GENITAL TRACT
N13.3
N13.4
Hydronephrosis with ureteral stricture, not elsewhere

classified
Hydronephrosis with renal and ureteral calculous
obstruction
Other and unspecified hydronephrosis
Hydroureter
N13.5
Kinking and stricture of ureter without hydronephrosis
9,700
2,910
6,790
N13.6
Pyonephrosis; Conditions in N13.0-N13.5 with infection;

Obstructive uropathy with infection
9,700
2,910
6,790
N13.7
Vesicoureteral-reflux-associated uropathy; Vesicoureteral

reflux NOS; Vesicoureteral reflux with scarring
9,700
2,910
6,790
Other obstructive and reflux uropathy

Obstructive and reflux uropathy, unspecified; Urinary tract
obstruction NOS
9,700
2,910
6,790
9,700
2,910
6,790
N13.1
N13.2
N13.8
N13.9
Page 78 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
M86.0
M86.1
M86.15
M86.17
M86.19
M86.2
M86.29
M86.4
M86.5
Orchitis, epididymitis and epididymo-orchitis with abscess;

Abscess of epididymis or testis
Orchitis, epididymitis and epididymo-orchitis without
abscess; Epididymitis NOS; Orchitis NOS
Acute haematogenous osteomyelitis
Other acute osteomyelitis
Other acute osteomyelitis Pelvic region and thigh
Other acute osteomyelitis Ankle and foot
Other acute osteomyelitis Site unspecified
Subacute osteomyelitis
Subacute osteomyelitis Site unspecified
Chronic osteomyelitis with draining sinus
Other chronic haematogenous osteomyelitis
M86.50
Other chronic haematogenous osteomyelitis Multiple site
OSTEOMYELITIS AND OSTEONECROSIS
13,000
3,900
9,100
M86.6
M86.60
M86.61
M86.62
M86.63
M86.65
M86.66
M86.67
M86.68
M86.69
M86.8
M86.80
Other chronic osteomyelitis

Other chronic osteomyelitis Multiple site
Other chronic osteomyelitis Shoulder region
Other chronic osteomyelitis Upper arm
Other chronic osteomyelitis Forearm
Other chronic osteomyelitis Pelvic region and thigh
Other chronic osteomyelitis Lower leg
Other chronic osteomyelitis Ankle and foot
Other chronic osteomyelitis Other
Other chronic osteomyelitis Site unspecified
Other osteomyelitis; Brodie's abscess
Other osteomyelitis; Brodie's abscess Multiple site

13,000
13,000
13,000
13,000
13,000
13,000
13,000
13,000
13,000
13,000
13,000
13,000
3,900
3,900
3,900
3,900
3,900
3,900
3,900
3,900
3,900
3,900
3,900
3,900
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
M86.81
Other osteomyelitis; Brodie's abscess Shoulder region
13,000
3,900
9,100
M86.88
Other osteomyelitis; Brodie's abscess Other

Osteomyelitis, unspecified; Infection of bone NOS;
Periostitis without mention of osteomyelitis
13,000
3,900
9,100
13,000
3,900
9,100
M86.90

Periostitis without mention of osteomyelitis Multiple site
13,000
3,900
9,100
M86.91

Periostitis without mention of osteomyelitis Shoulder
region
13,000
3,900
9,100
M86.92

Periostitis without mention of osteomyelitis Upper arm
13,000
3,900
9,100
13,000
3,900
9,100
13,000
3,900
9,100
N45.0
N45.9
M86.9
M86.94
M86.95

Periostitis without mention of osteomyelitis Hand
Periostitis without mention of osteomyelitis Pelvic region
and thigh
ORCHITIS
7,900
2,370
5,530
ORCHITIS
7,900
2,370
5,530

13,000
13,000
13,000
13,000
13,000
13,000
13,000
13,000
13,000
3,900
3,900
3,900
3,900
3,900
3,900
3,900
3,900
3,900
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
M86.96

Periostitis without mention of osteomyelitis Lower leg
13,000
3,900
9,100
M86.97

Periostitis without mention of osteomyelitis Ankle and foot
13,000
3,900
9,100
13,000
3,900
9,100
13,000
3,900
9,100
M86.98
M86.99

Periostitis without mention of osteomyelitis Other
Periostitis without mention of osteomyelitis Site
unspecified
M87.05
Idiopathic aseptic necrosis of bone Pelvic region and thigh
13,000
3,900
9,100
M87.2
M87.8
M87.85
M87.86
M87.9
M87.90
M87.91
M87.95
M87.99
M88.0
M88.9
A31.8
Osteonecrosis due to previous trauma

Other osteonecrosis
Other osteonecrosis Pelvic region and thigh
Other osteonecrosis Lower leg
Osteonecrosis, unspecified
Osteonecrosis, unspecified Multiple site
Osteonecrosis, unspecified Shoulder region
Osteonecrosis, unspecified Pelvic region and thigh
Osteonecrosis, unspecified Site unspecified
Paget's disease of skull
Paget's disease of bone, unspecified
Other mycobacterial infections
Mycobacterial infection, unspecified ; Atypical
mycobacterium infection Not Otherwise Specified;
Mycobacteriosis NOS; Listeriosis (listerial foodborne
infection)
Pulmonary actinomycosis
Abdominal actinomycosis
Cervicofacial actinomycosis
Actinomycotic septicaemia
Other forms of actinomycosis
Actinomycosis, unspecified
Cutaneous nocardiosis
Nocardiosis, unspecified

OTHER BACTERIAL DISEASES
13,000
13,000
13,000
13,000
13,000
13,000
13,000
13,000
13,000
13,000
13,000
8,900
3,900
3,900
3,900
3,900
3,900
3,900
3,900
3,900
3,900
3,900
3,900
2,670
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
9,100
6,230
8,900
2,670
6,230

8,900
8,900
8,900
8,900
8,900
8,900
8,900
8,900
2,670
2,670
2,670
2,670
2,670
2,670
2,670
2,670
6,230
6,230
6,230
6,230
6,230
6,230
6,230
6,230
A31.9
A42.0
A42.1
A42.2
A42.7
A42.8
A42.9
A43.1
A43.9
Page 79 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
A44.9
A48.8
A49.0
A49.2
A49.3
A49.8
A49.9
Cutaneous and mucocutaneous bartonellosis; Verruga

peruana
Bartonellosis, unspecified
Other specified bacterial diseases
Staphylococcal infection, unspecified
Haemophilus influenzae infection, unspecified
Mycoplasma infection, unspecified
Other bacterial infections of unspecified site
Bacterial infection, unspecified; Bacteraemia NOS
A44.1
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
8,900
2,670
6,230

8,900
8,900
8,900
8,900
8,900
8,900
8,900
2,670
2,670
2,670
2,670
2,670
2,670
2,670
6,230
6,230
6,230
6,230
6,230
6,230
6,230
B20.1
HIV DISEASE RESULTING IN OTHER BACTERIAL INFECTIONS OTHER BACTERIAL DISEASES
8,900
2,670
6,230
M89.0
Algoneurodystrophy; Shoulder-hand syndrome; Sudeck's

atrophy; Sympathetic reflex dystrophy
OTHER BONE DISORDERS
8,800
2,640
6,160
M89.01
Algoneurodystrophy; Shoulder-hand syndrome; Sudeck's

atrophy; Sympathetic reflex dystrophy Shoulder region
8,800
2,640
6,160
8,800
2,640
6,160
8,800
2,640
6,160
8,800
2,640
6,160

8,800
8,800
8,800
2,640
2,640
2,640
6,160
6,160
6,160
8,800
2,640
6,160
8,800
2,640
6,160
8,800
2,640
6,160
8,800
2,640
6,160
8,800
2,640
6,160
8,800
2,640
6,160

8,800
8,800
8,800
2,640
2,640
2,640
6,160
6,160
6,160
8,800
2,640
6,160
8,800
2,640
6,160

OTHER CEREBROVASCULAR DISEASES
8,800
8,800
8,800
8,800
15,200
15,200
2,640
2,640
2,640
2,640
4,560
4,560
6,160
6,160
6,160
6,160
10,640
10,640
15,200
4,560
10,640
15,200
4,560
10,640
15,200
4,560
10,640
15,200
4,560
10,640
15,200
4,560
10,640
15,200
4,560
10,640
15,200
4,560
10,640
15,200
4,560
10,640
M89.2
M89.4
M89.48
M89.5
M89.54
M89.6
M89.8
M89.85
M89.86
M89.87
M89.88
M89.89
M89.95
M89.98
M89.99
M91.1
M91.8
M94.0
M94.8
M99.8
M99.9
I65.2
I67.0
I67.1
I67.2
I67.3
I67.5
I67.6
I67.7
I67.8
I67.9+G46.7*
I67.9+G46.8*
A56.4
A71.1
A71.9
A74.9
Q85.1
Other disorders of bone development and growth

Other hypertrophic osteoarthropathy; Marie-Bamberger
disease; Pachydermoperiostosis
Other hypertrophic osteoarthropathy; Marie-Bamberger
disease; Pachydermoperiostosis Other
Osteolysis
Osteolysis Hand
Osteopathy after poliomyelitis
Other specified disorders of bone; Infantile cortical
hyperostoses; Post-traumatic subperiosteal ossification
Pelvic region and thigh
Lower leg
Ankle and foot
Other
Site unspecified
Disorder of bone, unspecified Pelvic region and thigh
Disorder of bone, unspecified Other
Disorder of bone, unspecified Site unspecified
JUVENILE OSTEOCHONDROSIS OF HEAD OF FEMUR [LEGGCALV-PERTHES]
OTHER JUVENILE OSTEOCHONDROSIS OF HIP AND PELVIS;
JUVENILE OSTEOCHONDROSIS AFTER REDUCTION OF
CONGENITAL DISLOCATION OF HIP
Chondrocostal junction syndrome [Tietze]
Other specified disorders of cartilage
Other biomechanical lesions
Biomechanical lesion, unspecified
Occlusion and stenosis of carotid artery
Dissection of cerebral arteries, nonruptured
Cerebral aneurysm, nonruptured; Cerebral aneurysm NOS;
Cerebral arteriovenous fistula, acquired
Cerebral atherosclerosis; Atheroma of cerebral arteries
Progressive vascular leukoencephalopathy; Binswanger's
disease
Moyamoya disease
Nonpyogenic thrombosis of intracranial venous system;
Nonpyogenic thrombosis of cerebral vein; Nonpyogenic
thrombosis of intracrannial venous sinus
Cerebral arteritis, not elsewhere classified
Other specified cerebrovascular diseases; Acute
cerebrovascular insufficiency NOS; Chronic Cerebral
ischaemia
Other lacunar syndrome in unspecified cerebrovascular
disease
Other vascular syndrome in unspecified cerebrovascular
disease
Chlamydial infection of pharynx
Active stage of trachoma; Active stage of trachoma;
Trachomatous Granular conjunctivitis; Trachomatous
follicular conjunctivitis; Trachomatous pannus
Trachoma, unspecified
Chlamydial infection, unspecified; Chlamydiosis NOS
Tuberous sclerosis; Bourneville's disease; Epiloia
15,200
4,560
10,640
OTHER CHLAMYDIAL DISEASES
8,500
2,550
5,950
8,500
2,550
5,950
8,500
8,500
11,600
2,550
2,550
3,480
5,950
5,950
8,120

OTHER CONGENITAL MALFORMATIONS
Page 80 of 112

FIRST CASE RATE
ICD CODE
Q87.0
Q87.1
Q87.2
Q87.3
Q87.4
Q87.8
Q89.0
Q89.1
Q89.2
Q89.4
Q89.7
Q89.8
Q89.9
I80.0
I80.1
I80.2
I80.3
I80.8
I80.9
I81
I82.0
I82.1
I82.2
I82.3
I82.8
I82.9
E15
E16.0
DESCRIPTION
Congenital malformation syndromes predominantly
affecting facial appearance; Acrocephalopolysyndactyly;
Acrocephalosyndactyly [Apert]; Cryptophthalmos
syndrome; Cyclopia; Syndrome Goldenhar; Moebius
Syndrome; oro-facial-digital Syndrome; Robin Syndrom
associated with short stature; Aarskog Syndrome;
Cockayne Syndrome; De Lange Syndrome ; Dubowitz
Syndrome; Noonan; Syndrome Prader-Willi Syndrome;
Robinow-Silverman-Smith Syndrome ;
Russell-Silver; Syn
involving limbs; Holt-Oram Syndrome; Klippel-TrnaunayWeber Syndrome; nail patella Syndrome;
Rubinstein-Taybi Syndrome; sirenomelia Syndrome;
thrombocytopenia Syndrome with absent radius [TAR];
VAT
Congenital malformation syndromes involving early
overgrowth; Beckwith-Wiedemann Syndrome; Sotos;
Syndrome Weaver Syndrome
Marfan's syndrome
Other specified congenital malformation syndromes, not
elsewhere classified; Alpor Syndrome; Laurence-Moon(Bardet)-Biedl Syndrome; Zellweger Syndrome
Congenital malformations of spleen; Asplenia (congenital);
Congenital splenomegaly
Congenital malformations of adrenal gland
Congenital malformations of other endocrine glands;
Congenital malformation of parathyroid or thyroid gland;
Persistent thyroglossal duct; Thyroglossal cyst
Conjoined twins; Craniopagus; Dicephaly; Double monster;
Pygopagus; Thoracopagus
Multiple congenital malformations, not elsewhere
classified; Monster NOS; Multiple congenital anomalies
NOS; Multiple congenital deformities NOS
Other specified congenital malformations
Congenital malformation, unspecified; Congenital anomaly
NOS; Congenital deformity NOS
Phlebitis and thrombophlebitis of superficial vessels of
lower extremities
Phlebitis and thrombophlebitis of femoral vein
Phlebitis and thrombophlebitis of other deep vessels of
lower extremities; Deep vein thrombosis NOS
Phlebitis and thrombophlebitis of lower extremities,
unspecified; Embolism or thrombosis of lower extermity
NOS
Phlebitis and thrombophlebitis of other sites
Phlebitis and thrombophlebitis of unspecified site
Portal vein thrombosis; Portal (vein) obstruction
Budd-Chiari syndrome
Thrombophlebitis migrans
Embolism and thrombosis of vena cava
Embolism and thrombosis of renal vein
Embolism and thrombosis of other specified veins
Embolism and thrombosis of unspecified vein
Nondiabetic hypoglycaemic coma; Nondiabetic
hypoglycaemic coma; Drug-induced insulin coma in
nondiabetic; Hyperinsulinism with hypoglycaemic coma;
Hypoglycaemic coma NOS
Drug-induced hypoglycaemia without coma
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
11,600
3,480
8,120
OTHER DISORDERS OF CIRCULATORY SYSTEM
12,400
3,720
8,680
12,400
3,720
8,680
12,400
3,720
8,680
12,400
3,720
8,680

12,400
12,400
12,400
12,400
12,400
12,400
12,400
12,400
12,400
3,720
3,720
3,720
3,720
3,720
3,720
3,720
3,720
3,720
8,680
8,680
8,680
8,680
8,680
8,680
8,680
8,680
8,680
OTHER DISORDERS OF GLUCOSE REGULATION
8,100
2,430
5,670
8,100
2,430
5,670
E16.1
Other hypoglycaemia; Functional nonhyperinsulinaemic

hypoglycaemia; Hyperinsulinism NOS; Functional
Hyperinsulinism; Hyperplasia of pancreatic islet beta cells
NOS; Posthypoglycaemic coma encephalopathy
8,100
2,430
5,670
E16.3
Increased secretion of glucagon; Hyperplasia of pancreatic

endocrine cells with glucagon excess; Hyperplasia of
pancreatic endocrine cells with glucagon excess
8,100
2,430
5,670
E16.4
Abnormal secretion of gastrin; Hypergastrinaemia
8,100
2,430
5,670
E16.8
Other specified disorders of pancreatic internal secretion;

Increased secretion from endocrine pancreas of growth
hormone-releasing hormone; Increased secretion from
endocrine pancreas of pancreatic polypeptide; Increased
secretion from endocrine pancrea
8,100
2,430
5,670
8,100
2,430
5,670
7,800
2,340
5,460
7,800
2,340
5,460
E16.9
N82.0
N83.0
Disorder of pancreatic internal secretion, unspecified; Isletcell hyperplasia NOS; Pancreatic endocrine cell hyperplasia OTHER DISORDERS OF GLUCOSE REGULATION
NOS
OTHER DISORDERS OF THE FEMALE GENITAL
Vesicovaginal fistula
TRACT
Follicular cyst of ovary; Cyst of graafian follicle;
Haemorrhagic follicular cyst of ovary
TRACT
Page 81 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
N83.3
Acquired atrophy of ovary and fallopian tube
N83.6
Haematosalpinx
N83.7
Haematoma of broad ligament
N85.7
Haematometra; Haematosalpinx with haematometra
N89.7
Haematocolpos; Haematocolpos with haematometra or

haematosalpinx
Q51.2
Other doubling of uterus' Doubling of uterus NOS
Q51.3
Bicornate uterus
Q51.8
Other congenital malformations of uterus and cervix;

Hypoplasia of uterus and cervix
Q52.1
Doubling of vagina; Septate vagina
Q52.2
Congenital rectovaginal fistula
Q52.3
Imperforate hymen
Q52.8
N47
GROUP
TRACT
TRACT
TRACT
TRACT
TRACT
TRACT
TRACT
TRACT
TRACT
TRACT
TRACT
TRACT
Other specified congenital malformations of female

genitalia
Redundant prepuce, phimosis and paraphimosis; Adherent
OTHER DISORDERS OF THE MALE GENITAL TRACT
prepuce; Tight foreskin
Case Rate
Professional
Fee
Health Care
Institution Fee
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
7,800
2,340
5,460
6,400
1,920
4,480
N48.8
Other specified disorders of penis; Atrophyof corpus

cavernosum and penis ; Hypertrophy of corpus cavernosum OTHER DISORDERS OF THE MALE GENITAL TRACT
and penis ; Thrombosis of corpus cavernosum and penis
6,400
1,920
4,480
N50.0
Atrophy of testis
6,400
1,920
4,480
N50.1
Vascular disorders of male genital organs; Haematocele of

male genital organs NOS; Haemorrhage of male genital
organs;, Thrombosis of male genital organs
6,400
1,920
4,480
N50.8
Other specified disorders of male genital organs; Atrophy of

scrotum, seminal vesicle, spermatic cord, testis [except
atrophy], tunica vaginalis and vas deferens; Hypertrophy of OTHER DISORDERS OF THE MALE GENITAL TRACT
scrotum, seminal vesicle, spermatic cord, testis [except
atrophy], tunica vag
6,400
1,920
4,480
Q55.0
Absence and aplasia of testis; Monorchism
6,400
1,920
4,480
Q55.1
Hypoplasia of testis and scrotum; Fusion of testes
6,400
1,920
4,480
Q55.2
Other congenital malformations of testis and scrotum;

Congenital malformation of testis or scrotum NOS;
Polyorchism; Retractile testis; Testis migrans
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
Q55.9
Congenital malformation of male genital organ,

unspecified; Congenital anomalyNOS of male genital organ OTHER DISORDERS OF THE MALE GENITAL TRACT
; Congenital deformity NOS of male genital organ
6,400
1,920
4,480
Q56.1
Male pseudohermaphroditism, not elsewhere classified;

Male pseudohermaphroditism NOS
6,400
1,920
4,480
Q56.3
Pseudohermaphroditism, unspecified
Q55.4
Q55.6
Other congenital malformations of vas deferens,

epididymis, seminal vesicles and prostate; Absence or
aplasia of prostate; Absence or aplasia of spermatic cord;
Congenital malformation of vas deferens, epididymis,
seminal vesicles or prostate
NOS
Other congenital malformations of penis; Congenital
malformation of penis NOS; Curvature of penis (lateral);
Hypoplasia of penis
6,400
1,920
4,480
OTHER DISORDERS OF THE NERVOUS SYSTEM
15,800
4,740
11,060

15,800
15,800
4,740
4,740
11,060
11,060
15,800
4,740
11,060
15,800
4,740
11,060
15,800
4,740
11,060
G93.0
Cerebral cysts; Arachnoid cyst; Porencephalic cyst, acquired OTHER DISORDERS OF THE NERVOUS SYSTEM
15,800
4,740
11,060
G93.2
Benign intracranial hypertension

Postviral fatigue syndrome; Benign myalgic
encephalomyelitis
Encephalopathy, unspecified
Reye's syndrome
Other specified disorders of brain
Disorder of brain, unspecified
15,800
4,740
11,060
15,800
4,740
11,060

15,800
15,800
15,800
15,800
4,740
4,740
4,740
4,740
11,060
11,060
11,060
11,060
G90.0
G90.1
G90.2
G90.3
G90.4
G90.9
G93.3
G93.4
G93.7
G93.8
G93.9
Idiopathic peripheral autonomic neuropathy; Carotid sinus

syncope
Familial dysautonomia [Riley-Day]
Horner's syndrome; Bernard(-Horner) syndrome
Multi-system degeneration; Neurogenic orthostatic
hypotension [Shy-Drager]
Autonomic dysreflexia
Disorder of autonomic nervous system, unspecified;
acquired hydrocephalus
Page 82 of 112

FIRST CASE RATE
ICD CODE
G94.8*
G95.0
G95.1
G95.2
DESCRIPTION
OTHER SPECIFIED DISORDERS OF BRAIN IN DISEASES
CLASSIFIED ELSEWHERE
Syringomyelia and syringobulbia
Vascular myelopathies; Acute infarction of spinal cord
(embolic)(nonembolic); Arterial thrombosis of spinal cord;
Haematomyelia; Nonpyogenic intraspinal phlebitis and
thrombophlebitis; Oedema of spinal cord; Subacute
necrotic myelopathy
Cord compression, unspecified
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
15,800
4,740
11,060
15,800
4,740
11,060
15,800
4,740
11,060
15,800
4,740
11,060
G95.8
Other specified diseases of spinal cord; Cord bladder NOS;

elopathy drug-induced; Myelopathy radiation-induced
15,800
4,740
11,060
G95.9
G96.0
Disease of spinal cord, unspecified; Myelopathy NOS

Cerebrospinal fluid leak

15,800
15,800
4,740
4,740
11,060
11,060
G96.1
Disorders of meninges, not elsewhere classified; Cerebral

Meningeal adhesions; Spinal Meningeal adhesions
15,800
4,740
11,060
G96.8
G96.9
Other specified disorders of central nervous system

Disorder of central nervous system, unspecified

15,800
15,800
4,740
4,740
11,060
11,060
G98
OTHER DISORDERS OF NERVOUS SYSTEM, NOT ELSEWHERE

CLASSIFIED; NERVOUS SYSTEM DISORDER NOS
15,800
4,740
11,060
P90
P91.1
P91.2
P94.1
Convulsions of newborn
Acquired periventricular cysts of newborn
Neonatal cerebral leukomalacia
Congenital hypertonia
OTHER DISORDERS OF THE NEWBORN

12,000
12,000
12,000
12,000
3,600
3,600
3,600
3,600
8,400
8,400
8,400
8,400
P94.2
Congenital hypotonia; Nonspecific floppy baby syndrome
12,000
3,600
8,400
P94.9
Disorder of muscle tone of newborn, unspecified

Complications of intrauterine procedures, not elsewhere
classified
Other specified conditions originating in the perinatal
period
Condition originating in the perinatal period, unspecified;
Congenital debility NOS
Acute thyroiditis; Abscess of thyroid; Pyogenic Thyroiditis;
Suppurative Thyroiditis
Subacute thyroiditis; de Quervain Thyroiditis; Giant-Cell
Thyroiditis; Granulomatous Thyroiditis; Nonsuppurative
Thyroiditis
Chronic thyroiditis with transient thyrotoxicosis
Autoimmune thyroiditis; Hashimoto's thyroiditis ; Transient
hashitoxicosis; Lymphadenoid goitre; lymphocytic
thyroiditis; Struma lymphomatosa
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
12,000
3,600
8,400
OTHER DISORDERS OF THE THYROID
8,500
2,550
5,950
8,500
2,550
5,950
8,500
2,550
5,950
8,500
2,550
5,950
Other chronic thyroiditis; Chronic Thyroiditis NOS; Chronic

Fibrous Thyroiditis; Ligneous Thyroiditis; Riedel Thyroiditis
8,500
2,550
5,950
8,500
2,550
5,950
8,500
2,550
5,950
8,500
2,550
5,950
8,500
2,550
5,950
10,900
3,270
7,630
10,900
3,270
7,630
E29.1
Testicular hypofunction; Defective biosynthesis of testicular

androgen NOS; 5-a-Reductase deficiency (with male
OTHER ENDOCRINE DISORDERS
pseudohermaphroditism); Testicular hypogonadism NOS
10,900
3,270
7,630
E29.9
E31.0
E31.1
E31.9
Testicular dysfunction, unspecified

Autoimmune polyglandular failure
Polyglandular hyperfunction
Polyglandular dysfunction, unspecified

10,900
10,900
10,900
10,900
3,270
3,270
3,270
3,270
7,630
7,630
7,630
7,630
E32.0
Persistent hyperplasia of thymus; Hypertrophy of thymus
10,900
3,270
7,630
E32.8
E32.9
E34.0
Other diseases of thymus

Disease of thymus, unspecified
Carcinoid syndrome
Other specified endocrine disorders; Pineal gland
dysfunction; Progeria
Endocrine disorder, unspecified; Endocrine Disturbance
NOS; Hormone Disturbance NOS
Renal osteodystrophy; Azotaemic osteodystrophy;
Phosphate-losing tubular disorders; Renal rickets; Renal
short stature
Other disorders resulting from impaired renal tubular
function; Lightwood-Albright syndrome; Renal tubular
acidosis NOS; Secondary hyperparathyroidism of renal
origin
Disorder resulting from impaired renal tubular function,
unspecified

10,900
10,900
10,900
3,270
3,270
3,270
7,630
7,630
7,630
10,900
3,270
7,630
10,900
3,270
7,630
OTHER NEPHROPATHY
9,500
2,850
6,650
OTHER NEPHROPATHY
9,500
2,850
6,650
OTHER NEPHROPATHY
9,500
2,850
6,650
P96.5
P96.8
P96.9
E06.0
E06.1
E06.2
E06.3
E06.5
E06.9
E07.0
E07.1
E07.8
E25.9
E28.8
E34.8
E34.9
N25.0
N25.8
N25.9
Thyroiditis, unspecified
Hypersecretion of calcitonin; C-cell hyperplasia of thyroid;
Hypersecretion of thyrocalcitonin
Dyshormogenetic goitre; Familial dyshormogenetic goitre;
Pendred's syndrome
Other specified disorders of thyroid; Abnormality of thyroidOTHER DISORDERS OF THE THYROID
binding globulin; Haemorrhage of thyroid; Infarction of
thyroid; Sick-euthyroid syndrome
Adrenogenital disorder, unspecified; Adrenogenital
syndrome NOS
Other ovarian dysfunction
Page 83 of 112

FIRST CASE RATE
ICD CODE
N28.1
J92.9
J94.0
J94.1
J94.8
J94.9
J98.0
DESCRIPTION
Cyst of kidney, acquired; Multiple cyst of kidney, acquired;
Solitary cyst of kidney, acquired
Pleural plaque without asbestos; Pleural plaque NOS;
Pleural thickening
Chylous effusion; Chyliform effusion
Fibrothorax
Other specified pleural conditions; Hydrothorax
Pleural condition, unspecified
Diseases of bronchus, not elsewhere classified;
Broncholithiasis; Calcification of bronchus; Stenosis of
bronchus; Ulcer of bronchus; Tracheobronchial collapse;
Tracheobronchial dyskinesia
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
9,500
2,850
6,650
OTHER PLEURAL CONDITIONS
13,500
4,050
9,450

13,500
13,500
13,500
13,500
4,050
4,050
4,050
4,050
9,450
9,450
9,450
9,450
OTHER RESPIRATORY DISORDERS
10,200
3,060
7,140
OTHER NEPHROPATHY
J98.4
Other disorders of lung; Calcification of lung; Acquired

cystic lung disease; Lung disease NOS; Pulmolithiasis
10,200
3,060
7,140
J98.5
Diseases of mediastinum, not elsewhere classified; Fibrosis

of mediastinum; Hernia of mediastinum; Retraction of
mediastinum; Mediastinitis of mediastinum
10,200
3,060
7,140
10,200
3,060
7,140
10,200
3,060
7,140
10,200
3,060
7,140
OTHER SPIROCHAETAL DISEASES
8,800
2,640
6,160
8,800
2,640
6,160
J98.6
J98.8
J98.9
A66.9
A67.1
A68.9
Disorders of diaphragm; Diaphragmatitis; Paralysis of

diaphragm; Relaxation of diaphragm
Other specified respiratory disorders
Respiratory disorder, unspecified; Chronic respiratory
disease NOS
Yaws, unspecified
Intermediate lesions of pinta; Erythematous plaques of
carate pinta; Hyperchromic lesions of carate pinta;
Hyperkeratosis of carate pinta; Pintids of carate pinta
Relapsing fever, unspecified
8,800
2,640
6,160
A69.0
Necrotizing ulcerative stomatitis; Cancrum oris;

Fusospirochaetal gangrene; Noma; Stomatitis gangrenosa
8,800
2,640
6,160
A69.1
Other Vincent's infections; Fusospirochaetal pharyngitis ;

Acute Necrotizing Ulcerative gingivitis; Acute Necrotizing
Ulcerative Gingivostomatitis; Spirochaetal stomatitis,
Trench mouth; Vincent's angina; Vincents gingivitis
8,800
2,640
6,160
8,800
2,640
6,160
8,800
2,640
6,160
OTITIS MEDIA
7,800
2,340
5,460
OTITIS MEDIA
7,800
2,340
5,460
Chronic serous otitis media; Chronic tubotympanal catarrh OTITIS MEDIA
7,800
2,340
5,460
OTITIS MEDIA
7,800
2,340
5,460
OTITIS MEDIA
7,800
2,340
5,460
OTITIS MEDIA
7,800
2,340
5,460
OTITIS MEDIA
7,800
2,340
5,460
OTITIS MEDIA
7,800
2,340
5,460
OTITIS MEDIA
7,800
2,340
5,460
OTITIS MEDIA
7,800
2,340
5,460
OTITIS MEDIA
7,800
2,340
5,460
OTITIS MEDIA
7,800
2,340
5,460
OVARIAN CYSTS
7,800
2,340
5,460
OVARIAN CYSTS
7,900
2,370
5,530
PELVIC INFLAMMATORY DISEASES

9,000
9,000
9,000
9,000
9,000
9,000
2,700
2,700
2,700
2,700
2,700
2,700
6,300
6,300
6,300
6,300
6,300
6,300
A69.2
A69.9
H65.0
H65.1
H65.2
H65.3
H65.4
H65.9
H66.0
H66.1
H66.2
H66.3
H66.4
H66.9
N83.1
N83.2
N70.0
N70.1
N70.9
N71.0
N71.1
N71.9
Lyme disease; Erythema chronicum migrans due to Borrelia

burgdorferi
Spirochaetal infection, unspecified
Acute serous otitis media; Acute and subacute secretory
otitis media
Other acute nonsuppurative otitis media; Acute otitis
media; S ubacute otitis media; Acute Mucoid allergic otitis
media; Subacute mucoid allergic otitis media; Acute
allergic Sanguinous otitis media; Subacute Sanguinous
allergic otitis media; Acute a
Chronic mucoid otitis media; Glue ear; Otitis media, chronic
mucinous; Otitis media, chronic secretory; Otitis media,
chronic transudative
Other chronic nonsuppurative otitis media; Otitis media,
chronic allergic; Otitis media, chronic exudative; Otitis
media, chronic nonsuppurative NOS; Otitis media, chronic
seromucinous; Otitis media, chronic with effusion
(nonpurulent)
Nonsuppurative otitis media, unspecified; Allergic Otitis
media ; Catarrhal Otitis media; Exudative Otitis media ;
Mucoid Otitis media ; Secretory Otitis media ;
Seromucinous otitis media; Serous Otitis media;
Transudative Otitis media; Otitis media with
Acute suppurative otitis media
Chronic tubotympanic suppurative otitis media; Benign
chronic suppurative otitis media; Chronic tubotympanic
disease
Chronic atticoantral suppurative otitis media; Chronic
atticoantral disease
Other chronic suppurative otitis media; Chronic
suppurative otitis media NOS
Suppurative otitis media, unspecified; Purulent otitis media
NOS
Otitis media, unspecified; Otitis media NOS; Acute Otitis
media NOS; Chronic Otitis media NOS
Corpus luteum cyst; Haemorrhagic corpus luteum cyst
Other and unspecified ovarian cysts; Retention of ovary;
Simple cyst of ovary
Acute salpingitis and oophoritis
Chronic salpingitis and oophoritis; Hydrosalpinx
Salpingitis and oophoritis, unspecified
Acute inflammatory disease of uterus
Chronic inflammatory disease of uterus
Inflammatory disease of uterus, unspecified
Page 84 of 112

FIRST CASE RATE
ICD CODE
N72
N73.0
N73.1
N73.2
N73.3
N73.4
N73.5
N73.6
N73.8
N73.9
DESCRIPTION
Inflammatory disease of cervix uteri; Cervicitis with or
without erosion or ectropion; Endocervicitis with or
without erosion or ectropion; Exocervicitis with or without
erosion or ectropion
Acute parametritis and pelvic cellulitis; Acute abcess of
broad ligament; Acute abscess of parametrium; Acute
pelvic cellulitis, female
Chronic parametritis and pelvic cellulitis
Unspecified parametritis and pelvic cellulitis
Female acute pelvic peritonitis
Female chronic pelvic peritonitis
Female pelvic peritonitis, unspecified
Female pelvic peritoneal adhesions
Other specified female pelvic inflammatory diseases
Female pelvic inflammatory disease, unspecified; Female
pelvic infection or inflammation NOS
Female pelvic inflammatory disorders in other diseases
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
9,000
2,700
6,300
9,000
2,700
6,300

9,000
9,000
9,000
9,000
9,000
9,000
9,000
2,700
2,700
2,700
2,700
2,700
2,700
2,700
6,300
6,300
6,300
6,300
6,300
6,300
6,300
9,000
2,700
6,300
9,000
2,700
6,300
O08.0
Genital tract and pelvic infection following abortion and

ectopic and molar pregnancy; Endometritis; Oophoritis;
Parametritis; Pelvic peritonitis; Salpingitis; Salpingooophoritis; Sepsis; Septic shock; Septicaemia
9,000
2,700
6,300
N94.0
N94.1
N94.2
N94.3
N94.4
N94.5
N94.6
Mittelschmerz
Dyspareunia
Vaginismus
Premenstrual tension syndrome
Primary dysmenorrhoea
Secondary dysmenorrhoea
Dysmenorrhoea, unspecified
PELVIC PAIN
PELVIC PAIN
PELVIC PAIN
PELVIC PAIN
PELVIC PAIN
PELVIC PAIN
PELVIC PAIN
4,800
4,800
4,800
4,800
4,800
4,800
4,800
1,440
1,440
1,440
1,440
1,440
1,440
1,440
3,360
3,360
3,360
3,360
3,360
3,360
3,360
K25.0
Gastric ulcer, acute / Acute erosion of stomach/ Pylorus

peptic ulcer / Stomach peptic ulcer with hemorrhage
PEPTIC ULCER DISEASE WITH HEMORRHAGE
12,800
3,840
8,960
K25.1
Gastric ulcer, acute/ Acute erosion of stomach/ Pylorus

peptic ulcer / Stomach peptic ulcer with perforation
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
N74.8*
K25.2
K25.4
K25.5
K25.6
K26.0
K26.1
K26.4
K26.5
K26.6
K27.0
K27.1
K27.2
K27.4
K27.5

peptic ulcer / Stomach peptic ulcer with both haemorrhage
and perforation
Gastric/ Peptic/ Pyloric ulcer/ erosion, chronic or
unspecified with haemorrhage
unspecified with perforation
unspecified with both haemorrhage and perforation
Duodenal ulcer, acute / Acute erosion of duodenum/
Duodenal peptic ulcer/ Postpyloric peptic ulcer with
haemorrhage
Duodenal peptic ulcer/ Postpyloric peptic ulcer with
perforation
Chronic Duodenal/ Postpyloric ulcer/ erosion, or
unspecified with haemorrhage
unspecified with both haemorrhage and perforation
Acute Peptic ulcer/ Gastroduodenal ulcer NOS, site
unspecified, with haemorrhage
Acute Peptic ulcer / Gastroduodenal ulcer, site unspecified,
with perforation
Acute Peptic/ Gastroduodenal ulcer, site unspecified, with
both haemorrhage and perforation
Chronic or unspecified Peptic/ Gastroduodenal ulcer, site
unspecified, with haemorrhage
K27.6

unspecified, with both haemorrhage and perforation
12,800
3,840
8,960
K28.0
Acute Gastrojejunal ulcer/ Anastomotic peptic ulcer or

erosion/ Gastrocolic peptic ulcer or erosion/
Gastrointestinal peptic ulcer or erosion/ Gastrojejunal
peptic ulcer or erosion/ Jejunal peptic ulcer or erosion/
Marginal peptic ulcer or erosion/ Stomal
12,800
3,840
8,960
K28.1

12,800
3,840
8,960
Page 85 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
K28.2

12,800
3,840
8,960
K28.3

12,800
3,840
8,960
K28.4
Chronic or unspecified Gastrojejunal ulcer/ Anastomotic

peptic ulcer or erosion/ Gastrocolic peptic ulcer or erosion/
Marginal peptic ulcer o
12,800
3,840
8,960
K28.5

12,800
3,840
8,960
K28.6

12,800
3,840
8,960
12,800
3,840
8,960
PEPTIC ULCER DISEASE WITHOUT HEMORRHAGE
6,100
1,830
4,270
6,100
1,830
4,270
6,100
1,830
4,270
6,100
1,830
4,270
6,100
1,830
4,270
6,100
1,830
4,270
6,100
1,830
4,270
6,100
1,830
4,270
K29.0
K25.3
K25.7
K25.9
K26.3
K26.7
K26.9
K27.3
K27.7
K27.9
Acute haemorrhagic gastritis; Acute erosive gastritis with

haemorrhage
peptic ulcer / Stomach peptic ulcer without haemorrhage
or perforation
Gastric/ Peptic/ Pyloric ulcer/ erosion, chronic without
haemorrhage or perforation
Gastric/ Peptic/ Pyloric ulcer/ erosion, unspecified as acute
or chronic, without haemorrhage or perforation
Duodenal peptic ulcer/ Postpyloric peptic ulcer without
Chronic Duodenal/ Postpyloric ulcer/ erosion, without
Duodenal/ Postpyloric ulcer/ erosion, unspecified as acute
or chronic, without haemorrhage or perforation
Acute Peptic/ Gastroduodenal ulcer, site unspecified,
without haemorrhage or perforation
Chronic Peptic/ Gastroduodenal ulcer, site unspecified,
without haemorrhage or perforation
Peptic/ Gastroduodenal ulcer, unspecified as acute or
chronic, without haemorrhage or perforation
6,100
1,830
4,270
K28.7
Chronic Gastrojejunal ulcer/ Anastomotic peptic ulcer or

Marginal peptic ulcer or erosion/ Stom
6,100
1,830
4,270
K28.9
Unspecified as acute or chronic Gastrojejunal ulcer/

Anastomotic peptic ulcer or erosion/ Gastrocolic peptic
ulcer or erosion/ Gastrointestinal peptic ulcer or erosion/
Gastrojejunal peptic ulcer or erosion/ Jejunal peptic ulcer
or erosion/ Marginal pepti
6,100
1,830
4,270
K29.1
Other acute gastritis
6,100
1,830
4,270
K29.2
Alcoholic gastritis
6,100
1,830
4,270
K29.3
Chronic superficial gastritis
6,100
1,830
4,270
K29.4
Chronic atrophic gastritis; Gastric atrophy
6,100
1,830
4,270
6,100
1,830
4,270
6,100
1,830
4,270
K29.5
K29.6
Chronic gastritis, unspecified; Chronic Antral gastritis;

Chronic Fundal gastritis
Other gastritis; Giant hypertrophic gastritis; Granulomatous
gastritis; Menetrier's disease
K29.7
Gastritis, unspecified
6,100
1,830
4,270
K29.8
Duodenitis
6,100
1,830
4,270
K29.9
Gastroduodenitis, unspecified
6,100
1,830
4,270
P23.0
P23.1
P23.2
Congenital pneumonia due to viral agent

Congenital pneumonia due to Chlamydia
Congenital pneumonia due to staphylococcus
PERINATAL INFECTIONS
12,700
12,700
12,700
3,810
3,810
3,810
8,890
8,890
8,890
Page 86 of 112

FIRST CASE RATE
ICD CODE
P23.3
P23.4
P23.5
DESCRIPTION
GROUP
12,700
12,700
12,700
Professional
Fee
3,810
3,810
3,810
12,700
3,810
8,890
12,700
3,810
8,890
12,700
3,810
8,890
12,700
12,700
12,700
3,810
3,810
3,810
8,890
8,890
8,890
12,700
3,810
8,890
12,700
12,700
3,810
3,810
8,890
8,890
Case Rate
Health Care
Institution Fee
8,890
8,890
8,890
12,700
3,810
8,890
P37.3
P37.5
Congenital pneumonia due to streptococcus, group B

Congenital pneumonia due to Escherichia coli
Congenital pneumonia due to Pseudomonas
Congenital pneumonia due to other bacterial agents;
Haemophilus influenzae; Klebsiella pneumonia;
Mycoplasma; Streptococcus, except group B
Congenital pneumonia
Congenital rubella syndrome; Congenital rubella
pneumonitis
Congenital cytomegalovirus infection
Congenital herpesviral [herpes simplex] infection
Congenital viral hepatitis
Other congenital viral diseases; Congenital varicella
[chickenpox]
Congenital viral disease, unspecified
Congenital tuberculosis
Congenital toxoplasmosis; Hydrocephalus due to congenital
toxoplasmosis
Congenital falciparum malaria
Neonatal candidiasis
12,700
12,700
3,810
3,810
8,890
8,890
P37.8
Other specified congenital infectious and parasitic diseases PERINATAL INFECTIONS
12,700
3,810
8,890
P37.9
Congenital infectious and parasitic disease, unspecified
12,700
3,810
8,890
P38
Omphalitis of newborn with or without mild haemorrhage
12,700
3,810
8,890
P39.0
Neonatal infective mastitis
12,700
3,810
8,890
P39.1
Neonatal conjunctivitis and dacryocystitis; Neonatal

chlaydial conjunctivitis; Ophthalmia neonatorum NOS
12,700
3,810
8,890
P39.2
Intra-amniotic infection of fetus, not elsewhere classified
12,700
3,810
8,890
P39.3
P39.4
Neonatal urinary tract infection

Neonatal skin infection; Neonatal pyoderma
12,700
12,700
3,810
3,810
8,890
8,890
P39.8
Other specified infections specific to the perinatal period
12,700
3,810
8,890
P39.9
Infection specific to the perinatal period, unspecified
12,700
3,810
8,890
K66.0
Peritoneal adhesions; Adhesions of abdominal wall;

Adhesions of diaphragm; Adhesions of intestine; Adhesions
PERITONEAL DISORDERS
of male pelvis; MesentericAdhesions; Adhesions of
omentum; Adhesions of stomach; Adhesive bands
10,800
3,240
7,560
K66.8
K66.9
Other specified disorders of peritoneum

Disorder of peritoneum, unspecified
10,800
10,800
3,240
3,240
7,560
7,560
K65.0
Acute peritonitis; Abdominopelvic abscess; Mesenteric

abscess; Abscess of omentum; Abscess of peritoneum;
Retrocaecal abscess; Retroperitoneal abscess;
PERITONITIS
Subdiaphragmatic abscess; Subhepatic abscess; Subphrenic
abscess; Acute Generalized peritonitis; Acute
14,700
4,410
10,290
PERITONITIS
14,700
4,410
10,290
PERITONITIS
14,700
4,410
10,290
PHAKOMATOSES
10,800
3,240
7,560
PHAKOMATOSES
10,800
3,240
7,560
PLEURAL EFFUSION
14,200
4,260
9,940
PLEURAL EFFUSION
14,200
4,260
9,940
PNEUMONIA HIGH RISK
32,000
9,600
22,400
PNEUMONIA HIGH RISK

PNEUMONIA HIGH RISK
PNEUMONIA HIGH RISK
PNEUMONIA HIGH RISK
PNEUMONIA HIGH RISK
32,000
32,000
32,000
32,000
32,000
9,600
9,600
9,600
9,600
9,600
22,400
22,400
22,400
22,400
22,400
PNEUMONIA HIGH RISK
32,000
9,600
22,400
PNEUMONIA HIGH RISK
32,000
9,600
22,400
PNEUMONIA HIGH RISK

PNEUMONIA HIGH RISK
PNEUMONIA HIGH RISK
PNEUMONIA HIGH RISK
PNEUMONIA HIGH RISK
PNEUMONIA HIGH RISK
32,000
32,000
32,000
32,000
32,000
32,000
9,600
9,600
9,600
9,600
9,600
9,600
22,400
22,400
22,400
22,400
22,400
22,400
P23.6
P23.9
P35.0
P35.1
P35.2
P35.3
P35.8
P35.9
P37.0
P37.1
K65.8
K65.9
Q85.8
Q85.9
J90
J91*
B20.6
J12.03
J12.13
J12.23
J12.33
J12.93
J13.3
J14.3
J15.03
J15.13
J15.23
J15.33
J15.43
J15.53
Other peritonitis; Chronic proliferative peritonitis;

Mesentric fat necrosis; Mesentric saponification; Peritonitis
due to bile; Peritonitis due to urine
Peritonitis, unspecified
Other phakomatoses, not elsewhere classified; PeutzJeghers Syndrome; Sturge-Weber(-Dimitri)Syndrome; von
Hippel-Lindau Syndrome
Phakomatosis, unspecified; Hamartosis NOS
Pleural effusion, not elsewhere classified; Pleurisy with
effusion
Pleural effusion in conditions classified elsewhere
HIV DISEASE RESULTING IN PNEUMOCYSTIS CARINII
PNEUMONIA
Adenoviral pneumonia, high risk
Respiratory syncytial virus pneumonia, high risk
Parainfluenza virus pneumonia, high risk
Human metapneumovirus pneumonia, high risk
Viral pneumonia, high risk
Pneumonia [bronchopneumonia]due to Streptococcus
pneumoniae, high risk
Pneumonia [bronchopneumonia] due to Haemophilus
influenzae, high risk
Pneumonia due to Klebsiella pneumoniae, high risk
Pneumonia due to Pseudomonas, high risk
Pneumonia due to staphylococcus, high risk
Pneumonia due to streptococcus, group B, high risk
Pneumonia due to other streptococci, high risk
Pneumonia due to Escherichia coli, high risk
J15.63
Pneumonia due to other aerobic Gram-negative bacteria;

Pneumonia due to Serratia marcescens, high risk
PNEUMONIA HIGH RISK
32,000
9,600
22,400
J15.73
Pneumonia due to Mycoplasma pneumoniae, high risk
PNEUMONIA HIGH RISK
32,000
9,600
22,400
J15.93
Bacterial pneumonia [bronchopneumonia], high risk
PNEUMONIA HIGH RISK
32,000
9,600
22,400
Page 87 of 112

FIRST CASE RATE
ICD CODE
J16.03
J18.03
J18.13
J18.23
J18.93
J18.99, Y95
A01.0+ J17.0*
A02.2+ J17.0*
A21.2+ J17.0*
A22.1+ J17.0*
A31.0
A37.0+ J17.0*
DESCRIPTION
GROUP
Chlamydial pneumonia, high risk

Bronchopneumonia, high risk
Lobar pneumonia, high risk
Hypostatic pneumonia, high risk
Community-acquired pneumonia IV
(This classification utilized the American Thoracic Society
recommendation. This is equivalent to CAP, high risk in the
Philippine Clinical Practice Guidelines on the Diagnosis,
Empiric Management, and Prevention of Communityacquired Pneumonia in Immunocompetent Adults, 2010
update)
Nosocomial pneumonia
Pneumonia in typhoid fever
Pneumonia in salmonella infection
Pneumonia in tularemia
Pneumonia in anthrax
Pulmonary mycobacterial infection; Infection due to
Mycobacterium avium, Mycobacterium intracellulare
[Battey bacillus]; Mycobacterium kansasii
PNEUMONIA HIGH RISK

PNEUMONIA HIGH RISK
PNEUMONIA HIGH RISK
PNEUMONIA HIGH RISK
32,000
32,000
32,000
32,000
Professional
Fee
9,600
9,600
9,600
9,600
PNEUMONIA HIGH RISK
32,000
9,600
22,400
RISK
RISK
RISK
RISK
32,000
15,000
15,000
15,000
15,000
9,600
4,500
4,500
4,500
4,500
22,400
10,500
10,500
10,500
10,500
PNEUMONIA MODERATE RISK
15,000
4,500
10,500
Pneumonia in whooping cough due to Bordatella pertusis
15,000
4,500
10,500
15,000
4,500
10,500
15,000
4,500
10,500
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
RISK
RISK
RISK
RISK
RISK
RISK
RISK
RISK
RISK
RISK
RISK
RISK
RISK
RISK
RISK
RISK
RISK
RISK
15,000
15,000
15,000
15,000
15,000
15,000
15,000
15,000
15,000
15,000
15,000
15,000
15,000
15,000
15,000
15,000
15,000
15,000
4,500
4,500
4,500
4,500
4,500
4,500
4,500
4,500
4,500
4,500
4,500
4,500
4,500
4,500
4,500
4,500
4,500
4,500
10,500
10,500
10,500
10,500
10,500
10,500
10,500
10,500
10,500
10,500
10,500
10,500
10,500
10,500
10,500
10,500
10,500
10,500
PNEUMONIA HIGH RISK

PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
Case Rate
Health Care
Institution Fee
22,400
22,400
22,400
22,400
A37.9+ J17.0*
A42.0+ J17.0*
A48.1
A53.0+ J17.0*
A54.8+ J17.0*
A69.8+ J17.8*
A70+ J17.8*
A78+ J17.8*
B01.2+ J17.1*
B01.2+ J17.1*
B05.2+ J17.1*
B05.2+ J17.1*
B06.8+ J17.1*
B25.0+ J17.1*
B37.1+ J17.2*
B38.0+ J17.2*
B38.1+ J17.2*
B38.2+ J17.2*
Pneumonia in whooping cough due to Bordatella

parapertusis
Pneumonia in whooping cough due to Bordatella species
other than pertusis or parapertusis
Pneumonia in whooping cough
Pneumonia in actinomycoses
Legionnaires' disease
Pneumonia in nocardiosis
Pneumonia in gonorrhea
Pneumonia in spirochaetal
Pneumonia in ornithosis
Pneumonia in Q fever
Varicella pneumonia
Pneumonia in varicella
Measles complicated by pnuemonia
Pneumonia in measles
Pneumonia in rubella
Pneumonia in cytomegalovirus disease
Pneumonia in candidiasis
Pneumonia in acute pulmonary coccidiomycosis
Pneumonia in chronic pulmonary coccidiomycosis
Pneumonia in pulmonary coccidioidomycosis
B39.0+ J17.2*
Pneumonia in acute pulmonary histoplasmosis capsulati
15,000
4,500
10,500
B39.1+ J17.2*
Pneumonia in chronic pulmonary histoplasmosis capsulati
15,000
4,500
10,500
B39.2+ J17.2*
B39.9+ J17.2*
B44.0+ J17.2*
B44.1+ J17.2*
B58.3+ J17.3*
Pneumonia in pulmonary histoplasmosis capsulati

Pneumonia in histoplasmosis
Pneumonia in invasive pulmonary aspergillosis
Pneumonia in other pulmonary aspergillosis
Pneumonia in taxoplasmosis
Pneumonia in schistosomiasis due to Schistosoma
hematobium
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
RISK
RISK
RISK
RISK
RISK
15,000
15,000
15,000
15,000
15,000
4,500
4,500
4,500
4,500
4,500
10,500
10,500
10,500
10,500
10,500
15,000
4,500
10,500
Pneumonia in schistosomiasis due to Schistosoma mansoni PNEUMONIA MODERATE RISK
A37.1+ J17.0*
A37.8+ J17.0*
B65.0+ J17.3*
B65.1+ J17.3*
B65.2+ J17.3*
B65.8+ J17.3*
B65.9+ J17.3*
B77.8+ J17.3*
I00+ J17.8*
J12.02
J12.12
J12.22
J12.32
J12.92
J13.2
J14.2

japonicum
intercalatum; mattheei; mekongi
Pneumonia in schistosomiasis
Pneumonia in ascariasis
Pneumonia in rheumatic fever
Adenoviral pneumonia, moderate risk
Respiratory syncytial virus pneumonia, moderate risk
Parainfluenza virus pneumonia, moderate risk
Human metapneumovirus pneumonia, moderate risk
Viral pneumonia, moderate risk
Pneumonia [bronchopneumonia] due to Streptococcus
pneumoniae, moderate risk
Pneumonia [bronchopneumonia]due to Haemophilus
influenzae, moderate risk
15,000
4,500
10,500
15,000
4,500
10,500
15,000
4,500
10,500
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
RISK
RISK
RISK
RISK
RISK
RISK
RISK
RISK
15,000
15,000
15,000
15,000
15,000
15,000
15,000
15,000
4,500
4,500
4,500
4,500
4,500
4,500
4,500
4,500
10,500
10,500
10,500
10,500
10,500
10,500
10,500
10,500
15,000
4,500
10,500
15,000
4,500
10,500
J15.02
Pneumonia due to Klebsiella pneumoniae, moderate risk
15,000
4,500
10,500
J15.12
J15.22
Pneumonia due to Pseudomonas, moderate risk

Pneumonia due to staphylococcus, moderate risk

15,000
15,000
4,500
4,500
10,500
10,500
J15.32
Pneumonia due to streptococcus, group B, moderate risk
15,000
4,500
10,500
J15.42
J15.52
Pneumonia due to other streptococci, moderate risk

Pneumonia due to Escherichia coli, moderate risk

15,000
15,000
4,500
4,500
10,500
10,500
J15.62
Pneumonia due to other aerobic Gram-negative bacteria;

Pneumonia due to Serratia marcescens, moderate risk
15,000
4,500
10,500
Page 88 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
J15.72
Pneumonia due to Mycoplasma pneumoniae, moderate

risk
15,000
4,500
10,500
J15.92
Bacterial pneumonia [bronchopneumonia], moderate risk
15,000
4,500
10,500
J16.02
J18.02
J18.12
J18.22
Chlamydial pneumonia, moderate risk

Bronchopneumonia, moderate risk
Lobar pneumonia, moderate risk
Hypostatic pneumonia, moderate risk
Community-acquired pneumonia III
(This classification utilized the American Thoracic Society
recommendation. This is equivalent to CAP, moderate risk
in the Philippine Clinical Practice Guidelines on the
Diagnosis, Empiric Management, and Prevention of
Community- acquired Pneumonia in Immunocompetent
Adults, 2010 update)
Aspiration pneumonia
Lipid pneumonia
Neonatal pneumonia
Spontaneous tension pneumothorax
Other spontaneous pneumothorax
Other pneumothorax
Pneumothorax, unspecified
Poisoning by Otheropioids; Poisoning by Codeine;
Poisoning by Morphine
Poisoning by Other synthetic narcotics; Poisoning by
Pethidine
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
PNEUMONIA MODERATE
RISK
RISK
RISK
RISK
15,000
15,000
15,000
15,000
4,500
4,500
4,500
4,500
10,500
10,500
10,500
10,500
15,000
4,500
10,500

PNEUMOTHORAX
PNEUMOTHORAX
PNEUMOTHORAX
PNEUMOTHORAX
POISONING CAUSED BY ANESTHETICS AND DRUGS
AFFECTING THE NERVOUS SYSTEM
15,000
15,000
15,000
15,300
15,300
15,300
15,300
4,500
4,500
4,500
4,590
4,590
4,590
4,590
10,500
10,500
10,500
10,710
10,710
10,710
10,710
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
J18.92
J69.0
J69.1
P24.9
J93.0
J93.1
J93.8
J93.9
T40.2
T40.4
T40.6
Poisoning by Other and unspecified narcotics
T40.7
Poisoning by Cannabis (derivatives)
T40.9
Poisoning by Other and unspecified psychodysleptics

[hallucinogens]; Poisoning by Mescaline; Poisoning by
Psilocin; Poisoning by Psilocybine
T41.0
Poisoning by Inhaled anaesthetics
T41.1
Poisoning by Intravenous anaesthetics; Thiobarbiturates
T41.3
Poisoning by Local anaesthetics
T41.5
Poisoning by Therapeutic gases; Carbon dioxide; Oxygen
T42.0
Poisoning by Hydantoin derivatives
T42.1
Poisoning by Iminostilbenes; Carbamazepine
T42.2
Poisoning by Succinimides and oxazolidinediones
T42.3
Poisoning by Barbiturates
T42.4
Poisoning by Benzodiazepines

6,700
2,010
4,690
T42.6
Poisoning by Other antiepileptic and sedativehypnoticdrugs; Poisoning by Methaqualone;Poisoning by

Valproic acid

6,700
2,010
4,690
T42.7
Poisoning by Antiepileptic and sedative-hypnotic drugs,

unspecified; Poisoning by Draught sleeping NOS; Poisoning
by Sleeping drug NOS;Poisoning by Sleeping tablet NOS
6,700
2,010
4,690
T42.8
Poisoning by Antiparkinsonism drugs and other central

muscle-tone depressants; Poisoning by Amantadine
6,700
2,010
4,690
T43.2
Poisoning by Other and unspecified antidepressants
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
T43.3
T43.4
T43.5
T43.6
T43.9
T44.1
T44.2


Poisoning by Phenothiazine antipsychotics and neuroleptics
Poisoning by Butyrophenone and thioxanthene
neuroleptics
Poisoning by Other and unspecified antipsychotics and
neuroleptics
Poisoning by Psychostimulants with abuse potential
Poisoning by Psychotropic drug, unspecified
Poisoning by Other parasympathomimetics [cholinergics]
Poisoning by Ganglionic blocking drugs, not elsewhere
classified
T44.3
Poisoning by Other parasympatholytics [anticholinergics

and antimuscarinics] and spasmolytics, not elsewhere
classified; Poisoning byPapaverine

6,700
2,010
4,690
T44.4
Poisoning by Predominantly -adrenoreceptor agonists,

not elsewhere classified; Poisoning by Metaraminol

6,700
2,010
4,690
Page 89 of 112

FIRST CASE RATE
ICD CODE
T44.5
T44.6
T44.7
T44.9
T45.0
DESCRIPTION
GROUP
Poisoning by Predominantly -adrenoreceptor agonists, not

Poisoning by -Adrenoreceptor antagonists, not elsewhere
classified
Poisoning by -Adrenoreceptor antagonists, not elsewhere
classified
Poisoning by Other and unspecified drugs primarily
affecting the autonomic nervous system; Drug stimulating
both -and -adrenoreceptors

Poisoning by Antiallergic and antiemetic drugs
Case Rate
Professional
Fee
Health Care
Institution Fee
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690

6,700
2,010
4,690

6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
6,700
2,010
4,690
T36.0
Poisoning by Antineoplastic and immunosuppressive drugs;

Poisoning by Antineoplastic antibiotics; Poisoning by
Cytarabine
Poisoning by Vitamins, not elsewhere classified
Poisoning by Enzymes, not elsewhere classified
Poisoning by Analeptics and opioid receptor antagonists
Drugs, medicaments and biological substances causing
adverse effects in therapeutic
use: Hydantoin derivatives
use: Other and unspecified antiepileptics
use: Barbiturates, not elsewhere classified
use: Benzodiazepines
use: Sedative, hypnotic and antianxiety drug,
unspecified;sleeping draught NOS;sleeping drug
NOS;sleeping tablet NOS
use: Other antipsychotics and neuroleptics
use: Psychodysleptics [hallucinogens]
use: Other parasympatholytics [anticholinergics and
antimuscarinics] and spasmolytics, not elsewhere
classified;papaverine
use: Beta-adrenoreceptor antagonists, not elsewhere
classified
Poisoning by Penicillins
POISONING CAUSED BY ANTIBIOTICS
7,300
2,190
5,110
T36.1
Poisoning by Cefalosporins and other -lactam antibiotics
7,300
2,190
5,110
T36.2
T36.3
T36.4
T36.5
T36.6
T36.8
T36.9
T37.0
T37.1
Poisoning by Chloramphenicol group

Poisoning by Macrolides
Poisoning by Tetracyclines
Poisoning by Aminoglycosides; Streptomycin
Poisoning by Rifamycins
Poisoning by Other systemic antibiotics
Poisoning by Systemic antibiotic, unspecified
Poisoning by Sulfonamides
Poisoning by Antimycobacterial drugs
Poisoning by Antimalarials and drugs acting on other blood
protozoa
Poisoning by Anthelminthics
Poisoning by Antiviral drugs

7,300
7,300
7,300
7,300
7,300
7,300
7,300
7,300
7,300
2,190
2,190
2,190
2,190
2,190
2,190
2,190
2,190
2,190
5,110
5,110
5,110
5,110
5,110
5,110
5,110
5,110
5,110
7,300
2,190
5,110

7,300
7,300
2,190
2,190
5,110
5,110
7,300
2,190
5,110
7,300
2,190
5,110
7,300
2,190
5,110
7,300
2,190
5,110
7,300
2,190
5,110
T45.1
T45.2
T45.3
T50.7
Y46.2
Y46.6
Y47.0
Y47.1
Y47.9
Y49.5
Y49.6
Y51.3
Y51.7
T37.2
T37.4
T37.5
T37.8
T37.9
Y40.0
Y40.1
Y40.2
Poisoning by Other specified systemic anti-infectives and

antiparasitics; Poisoning by Hydroxyquinoline derivatives
Poisoning by Systemic anti-infective and antiparasitic,
unspecified
use: Systemic antibiotics: Penicillins
use: Systemic antibiotics: Cefalosporins and other betalactam antibiotics
use: Systemic antibiotics: Chloramphenicol group
Page 90 of 112

FIRST CASE RATE
ICD CODE
Y40.4
Y40.6
Y40.8
Y40.9
Y41.0
Y41.1
Y41.5
Y41.8
DESCRIPTION
use: Systemic antibiotics: Tetracyclines
use: Systemic antibiotics: Rifamycins
use: Systemic antibiotics: Other systemic antibiotics
use: Systemic antibiotics: Systemic antibiotic, unspecified
Sulfonamides
use: Systemic antibiotics: Antimycobacterial drugs
use: Systemic antibiotics: Antiviral drugs
adverse effects in therapeutic use: Systemic antibiotics:
Other specified systemic anti-infectives and antiparasitics;
hydroxyquinoline derivatives
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
7,300
2,190
5,110
7,300
2,190
5,110
7,300
2,190
5,110
7,300
2,190
5,110
7,300
2,190
5,110
7,300
2,190
5,110
7,300
2,190
5,110
7,300
2,190
5,110
Y41.9

use: Systemic anti-infective and antiparasitic, unspecified
7,300
2,190
5,110
Y56.0

use: Local antifungal, anti-infective and anti-inflammatory
drugs, not elsewhere classified
7,300
2,190
5,110
T39.0
Poisoning by Salicylates
7,400
2,220
5,180
T39.1
Poisoning by 4-Aminophenol derivatives
7,400
2,220
5,180
7,400
2,220
5,180
7,400
2,220
5,180
7,400
2,220
5,180
7,400
2,220
5,180
7,400
2,220
5,180
POISONING CAUSED BY CARDIOVASCULAR DRUGS
12,500
3,750
8,750
12,500
3,750
8,750
12,500
3,750
8,750
12,500
3,750
8,750
12,500
3,750
8,750
12,500
3,750
8,750
12,500
3,750
8,750
12,500
3,750
8,750
12,500
3,750
8,750
Y52.2

use: Other antidysrhythmic drugs, not elsewhere classified
12,500
3,750
8,750
T48.3
Poisoning by Antitussives
6,200
1,860
4,340
T48.4
Poisoning by Expectorants
6,200
1,860
4,340
T48.5
Poisoning by Anti-common-cold drugs
6,200
1,860
4,340
T48.6
Poisoning by Antiasthmatics, not elsewhere classified; -

adrenoreceptor agonists used in asthma theraphy;
Poisoning by Salbutamol
6,200
1,860
4,340
T39.3
T39.8
T39.9
Y45.8
Y45.9
T46.0
T46.1
T46.2
T46.3
T46.5
T46.6
T46.7
T46.9
Y52.0
Poisoning by Other nonsteroidal anti-inflammatory drugs

[NSAID]
Poisoning by Other nonopioid analgesics and antipyretics,
not elsewhere classified
Poisoning by Nonopioid analgesic, antipyretic and
antirheumatic, unspecified
Other analgesics and antipyretics
use: Analgesic, antipyretic and anti-inflammatory drug,
unspecified
Poisoning by Cardiac-stimulant glycosides and drugs of
similar action
Poisoning by Calcium-channel blockers
Poisoning by Other antidysrhythmic drugs, not elsewhere
classified
Poisoning by Coronary vasodilators, not elsewhere
classified; Poisoning by Dipyridamole
Poisoning by Other antihypertensive drugs, not elsewhere
classified; Poisoning by Clonidine;Poisoning by
Guanethidine; Poisoning by Rauwolfia
Poisoning by Antihyperlipidaemic and antiarteriosclerotic
drugs
Poisoning by Peripheral vasodilators;Poisoning by Nicotimic
acid (derivatives)
Poisoning by Other and unspecified agents primarily
affecting the cardiovascular system
use: Cardiac-stimulant glycosides and drugs of similar
action
POISONING CAUSED BY ANTI-INFLAMMATORY

AGENTS
AGENTS
AGENTS
AGENTS
AGENTS
AGENTS
AGENTS
POISONING CAUSED BY DRUGS AFFECTING THE

PULMONARY SYSTEM
PULMONARY SYSTEM
PULMONARY SYSTEM
PULMONARY SYSTEM
Page 91 of 112

FIRST CASE RATE
ICD CODE
Y55.3
Y55.4
DESCRIPTION
use: Antitussives
use: Expectorants
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee

PULMONARY SYSTEM
6,200
1,860
4,340

PULMONARY SYSTEM
6,200
1,860
4,340

PULMONARY SYSTEM
6,200
1,860
4,340
6,300
1,890
4,410
6,300
1,890
4,410
Y55.6

use: Antiasthmatics, not elsewhere classified:
aminophylline, salbutamol, theobromine;theophylline
T50.0
Poisoning by Mineralocorticoids and their antagonists
T50.1
Poisoning by Loop [high-ceiling] diuretics
T50.2
Poisoning by Carbonic-anhydrase inhibitors,

benzothiadiazides and other diuretics;Poisoning by
Acetazolamide

RENAL SYSTEM
6,300
1,890
4,410
T50.4
Poisoning by Drugs affecting uric acid metabolism

RENAL SYSTEM
6,300
1,890
4,410
T50.9
Poisoning by Other and unspecified drugs, medicaments

and biological substances; Poisoning by Acidifying agents;
Poisoning by Alkalizing agents; Poisoning by
Immunoglobulin; Poisoning by Immunologicals; Poisoning
by Lipotropic drugs; Poisoning by Parathy

RENAL SYSTEM
6,300
1,890
4,410
T47.0
Poisoning by HistamineH2-receptor antagonists
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
8,300
2,490
5,810
7,300
7,300
7,300
2,190
2,190
2,190
5,110
5,110
5,110
7,300
2,190
5,110
T47.1
T47.2
T47.3
T47.4
T47.5
T47.6
T47.8
T47.9
T48.1
Y53.8
T45.4
T45.5
T45.6
T45.7

RENAL SYSTEM
RENAL SYSTEM
POISONING CAUSED BY GASTROINTESTINAL

DRUGS
Poisoning by Other antacids and anti-gastric-secretion
drugs
DRUGS
Poisoning by Stimulant laxatives
DRUGS
Poisoning by Saline and osmotic laxatives
DRUGS
Poisoning by Other laxatives; Poisoning by Intestinal atonia POISONING CAUSED BY GASTROINTESTINAL
drugs
DRUGS
Poisoning by Digestants
DRUGS
Poisoning by Antidiarrhoeal drugs
DRUGS
Poisoning by Other agents primarily affecting the
gastrointestinal system
DRUGS
Poisoning by Agent primarily affecting the gastrointestinal POISONING CAUSED BY GASTROINTESTINAL
system, unspecified
DRUGS
Poisoning by Skeletal muscle relaxants [neuromuscular
blocking agents]
DRUGS
DRUGS
use: Other agents primarily affecting the gastrointestinal
system
Poisoning by Iron and its compounds
POISONING CAUSED BY HEMATOLOGIC AGENTS
Poisoning by Anticoagulants
Poisoning by Fibrinolysis-affecting drugs
Poisoning by Anticoagulant antagonists, vitamin K and
other coagulants
T45.8
Poisoning by Other primarily systemic and haematological

agents; Poisoning by Liver preparations and other
antianaemic agents; Poisoning by Natural blood and blood
products; Poisoning by Plasma substitute
7,300
2,190
5,110
T45.9
Primarily systemic and haematological agent, unspecified
7,300
2,190
5,110
7,300
2,190
5,110
7,300
2,190
5,110
Y44.2
Y44.3

use: Anticoagulants
use: Anticoagulant antagonists, vitamin K and other
coagulants
T38.0
Poisoning by Glucocorticoids and synthetic analogues
POISONING CAUSED BY HORMONES
8,500
2,550
5,950
T38.1
T38.2
Poisoning by Thyroid hormones and substitutes

Poisoning by Antithyroid drugs
Poisoning by Insulin and oral hypoglycaemic [antidiabetic]
drugs
Poisoning by Oral contraceptives; Poisoning by Multipleand-single-ingredient preparations
Poisoning by Other estrogens and progestogens; Mixtures
and substitutes
Poisoning by Antigonadotrophins, antiestrogens,
antiandrogens, not elsewhere classified; Poisoning by
Tamoxifen
Poisoning by Androgens and anabolic congeners

8,500
8,500
2,550
2,550
5,950
5,950
8,500
2,550
5,950
8,500
2,550
5,950
8,500
2,550
5,950
8,500
2,550
5,950
8,500
2,550
5,950
T38.3
T38.4
T38.5
T38.6
T38.7
Page 92 of 112

FIRST CASE RATE
ICD CODE
Y42.0
Y42.2
Y42.3
Y42.4
Y42.5
Y45.1
DESCRIPTION
use: Glucocorticoids and synthetic analogues
use: Antithyroid drugs
use: Insulin and oral hypoglycaemic [antidiabetic] drugs
use: Oral contraceptives;multiple-and single-ingredient
preparations
use: Other estrogens and progestogens;mixtures and
substitutes
use: Salicylates
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
8,500
2,550
5,950
8,500
2,550
5,950
8,500
2,550
5,950
8,500
2,550
5,950
8,500
2,550
5,950
8,500
2,550
5,950
Y45.2

use: Propionic acid derivatives;propanoic acid derivatives
8,500
2,550
5,950
Y45.3

use: Other nonsteroidal anti-inflammatory drugs [NSAID]
8,500
2,550
5,950
Y45.5

use: 4-Aminophenol derivatives
8,500
2,550
5,950
T51.0
Toxic effect of Ethanol;Toxic effect of Ethyl alcohol
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
T51.2
T51.3
T51.8
T51.9
T52.0
T52.2
T52.4
T52.8
T52.9
T53.0
T53.1
T53.4
T53.6
T53.9
T54.1
T54.2
T54.3
T54.9
T55
T56.0
T56.1
POISONING CAUSED BY ORGANIC SUBSTANCES

AND HEAVY METALS
AND HEAVY METALS
Toxic effect of 2-Propanol; Toxic effect of Isoprophyl

aclohol
Toxic effect of Fusel oil; Toxic effect of Amyl alcohol; Toxic
effect of Butyl alcohol [1-butanol]; Toxic effect of Propyl
AND HEAVY METALS
alcohol [1-proponol]
Toxic effect of Other alcohols
AND HEAVY METALS
Toxic effect of Alcohol, unspecified
AND HEAVY METALS
Toxic effect of Petroleum products; Toxic effect of
Gasoline [petrol]; Toxic effect of Kerosine [paraffin oil];
Toxic effect of Paraffin wax; Toxic effect of Petroleum
AND HEAVY METALS
ether; Toxic effect of Petroleum naphtha; Toxic effect of
Petroleum spirits
Toxic effect of Homologues of benzene; Toxic effect of
Toluene [methylbenzene]; Toxic effect of Xylene
AND HEAVY METALS
[dimethylbenzene]
Toxic effect of Ketones
AND HEAVY METALS
Toxic effect of Other organic solvents
AND HEAVY METALS
Toxic effect of Organic solvent, unspecified
AND HEAVY METALS
Toxic effect of Carbon tetrachloride;Toxic effect of
Tetrachloromethane
AND HEAVY METALS
Toxic effect of Chloroform; Toxic effect of
Trichloromethane
AND HEAVY METALS
Toxic effect of Dichloromethane;Toxic effect of Methylene POISONING CAUSED BY ORGANIC SUBSTANCES
chloride
AND HEAVY METALS
Toxic effect of Other halogen derivatives of aliphatic
hydrocarbons
AND HEAVY METALS
Toxic effect of Halogen derivative of aliphatic and aromatic POISONING CAUSED BY ORGANIC SUBSTANCES
hydrocarbons, unspecified
AND HEAVY METALS
Toxic effect of Other corrosive organic compounds
AND HEAVY METALS
Toxic effect of Corrosive acids and acid-like substances;
Toxic effect of Acid hydrochlorie;Toxic effect of Acid
AND HEAVY METALS
sulfurie
Toxic effect of Corrosive alkalis and alkali-like substances;
Toxic effect of Potassium hydroxide;Toxic effect of Sodium
AND HEAVY METALS
hydroxide
Toxic effect of Corrosive substance, unspecified
AND HEAVY METALS
Toxic effect of soaps and detergents
AND HEAVY METALS
Toxic effect of Lead and its compounds
AND HEAVY METALS
Toxic effect of Mercury and its compounds
AND HEAVY METALS
Page 93 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
T56.5
Toxic effect of Zinc and its compounds
T56.8
Toxic effect of Other metals
T57.0
Toxic effect of Arsenic and its compounds
T57.1
Toxic effect of Phosphorus and its compounds
T57.3
Toxic effect of Hydrogen cyanide
T57.8
Toxic effect of Other specified in organic substances
T57.9
Toxic effect of Inorganic substance, unspecified
T58
Toxic effect of carbon monoxide from all sources
T59.0
Toxic effect of Nitrogen oxides
T59.2
Toxic effect of Formal dehyde
T59.3
Toxic effect of Lacrimogenic gas; Toxic effect of Tear gas
T59.4
Toxic effect of Chlorine gas
T59.7
Toxic effect of Carbon dioxide
T59.8
Toxic effect of Other specified gases, fumes and vapours
T59.9
Toxic effect of Gases, fumes and vapours, unspecified
T60.0
Toxic effect of Organophosphate and carbamate

insecticides
T60.1
Toxic effect of Halogenated insecticides
T60.2
Toxic effect of Other insecticides
T60.3
Toxic effect of Herbicides and fungicides
T60.4
Toxic effect of Rodenticides; Toxic effect of Thallium
T60.8
Toxic effect of Other pesticides
T60.9
Toxic effect of Pesticide, unspecified
T65.0
Toxic effect of Cyanides
T65.3
Toxic effect of Nitro derivatives and aminoderivatives of

benzene and its homologues; Toxic effect of Aniline
[benzenamine]; Toxic effect of Nitrobenzene; Toxic effect
of Trinitrotoluene
T65.4
Toxic effect of Carbondisulfide
T65.6
Toxic effect of Paints and dyes, not elsewhere classified
T65.8
Toxic effect of other specified substances
T49.2
T49.3
Poisoning by Local astringents and local detergents

Poisoning by Emollients, demulcents and protectants
Poisoning by Keratolytics, keratoplastics and other hair
treatment drugs and preparations
T49.4
T49.5
T49.7
T49.8
T49.9
Y56.2
Y56.3
T61.0
T61.1
T61.2
T61.8
T61.9
T62.0
T62.1
T62.2
T62.8
Poisoning by Ophthalmological drugs and preparations;

Poisoning by Eye, nose and throat anti-infectives
Poisoning by Dental drugs, topically applied
Othertopical agents; Spermicides
Poisoning by Topical agent, unspecified
use: Local astringents and local detergents
use: Emollients, demulcents and protectants
Toxic effect of Ciguatera fish poisoning
Toxic effect of Scombroid fish poisoning;Toxic effect of
Histamine-like syndrome
Toxic effect of Other fish and shellfish poisoning
Toxic effect of other seafoods
Toxic effect of unspecified seafood
Toxic effect of Ingested mushrooms
Toxic effect of Ingested berries
Toxic effect of Other ingested (parts of) plant(s)
Toxic effect of Other specified noxious substances eaten as
food
GROUP
AND HEAVY METALS
AND HEAVY METALS
AND HEAVY METALS
AND HEAVY METALS
AND HEAVY METALS
AND HEAVY METALS
AND HEAVY METALS
AND HEAVY METALS
AND HEAVY METALS
AND HEAVY METALS
AND HEAVY METALS
AND HEAVY METALS
AND HEAVY METALS
AND HEAVY METALS
AND HEAVY METALS
AND HEAVY METALS
AND HEAVY METALS
AND HEAVY METALS
AND HEAVY METALS
AND HEAVY METALS
AND HEAVY METALS
AND HEAVY METALS
AND HEAVY METALS
Case Rate
Professional
Fee
Health Care
Institution Fee
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
6,400
1,920
4,480
5,300
5,300
1,590
1,590
3,710
3,710
POISONING CAUSED BY TOPICAL AGENTS
5,300
1,590
3,710
5,300
1,590
3,710

5,300
5,300
5,300
1,590
1,590
1,590
3,710
3,710
3,710
5,300
1,590
3,710
5,300
1,590
3,710
POISONING FROM ANIMALS, INSECTS, PLANTS
5,700
1,710
3,990
5,700
1,710
3,990

5,700
5,700
5,700
5,700
5,700
5,700
1,710
1,710
1,710
1,710
1,710
1,710
3,990
3,990
3,990
3,990
3,990
3,990
5,700
1,710
3,990

AND HEAVY METALS
AND HEAVY METALS
AND HEAVY METALS
AND HEAVY METALS
Page 94 of 112

FIRST CASE RATE
ICD CODE
T62.9
T63.0
T63.1
T63.2
T63.3
T63.4
T63.5
T63.6
T63.8
T63.9
T64
T65.2
Y43.0
Y54.3
Y54.8
Y55.0
Y56.6
Y58.0
Y58.4
Y59.9
G60.0
DESCRIPTION
Toxic effect of Noxious substance eaten as food,
unspecified
Toxic effect of Snake venom;Toxic effect of Sea-snake
venom
Toxic effect of Venom of other reptiles; Toxic effect of
Lizard venom
Toxic effect of Venom of scorpion
Toxic effect of Venom of spider
Toxic effect of Venom of other arthropods;Toxic effect of
Insect bite or sting, venomous
Toxic effect of contact with fish
Toxic effect of contact with other marine animals; Jellyfish;
Sea anemone; Shellfish; Starfish
Toxic effect of contact with other venomous animals;
Venom of amphibian
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
5,700
1,710
3,990
5,700
1,710
3,990
5,700
1,710
3,990

5,700
5,700
1,710
1,710
3,990
3,990
5,700
1,710
3,990
5,700
1,710
3,990
5,700
1,710
3,990
5,700
1,710
3,990
5,700
1,710
3,990
5,700
1,710
3,990
5,700
1,710
3,990
POISONING OTHERS
8,300
2,490
5,810
POISONING OTHERS
8,300
2,490
5,810
POISONING OTHERS
8,300
2,490
5,810
POISONING OTHERS
8,300
2,490
5,810
POISONING OTHERS
8,300
2,490
5,810
POISONING OTHERS
8,300
2,490
5,810
POISONING OTHERS
8,300
2,490
5,810
POISONING OTHERS
8,300
2,490
5,810
Hereditary motor and sensory neuropathy; Disease CharcotMarie-Tooth; Disease Djerine-Sottas; Hereditary motor
and sensory neuropathy, types I-IV; Hypertrophic
POLYNEUROPATHIES
neuropathy of infancy; Peroneal muscular atrophy axonal
type; Peroneal muscular atrophy hypert
10,600
3,180
7,420
Toxic effect of contact with unspecified venomous animal

Toxic effect of aflation and other mycotoxin food
contaminants
Toxic effect of Tobacco and nicotine
use: Antiallergic and antiemetic drugs
use: Benzothiadiazine derivatives
use: Agents affecting uric acid metabolism
use: Oxytocic drugs;ergot alkaloids
use: Otorhinolaryngological drugs and preparations
use: BCG vaccine
use: Tetanus vaccine
use: Vaccine or biological substance, unspecified
POLYNEUROPATHIES
POLYNEUROPATHIES
POLYNEUROPATHIES
10,600
10,600
10,600
3,180
3,180
3,180
7,420
7,420
7,420
POLYNEUROPATHIES
10,600
3,180
7,420
POLYNEUROPATHIES
10,600
3,180
7,420
POLYNEUROPATHIES
10,600
3,180
7,420
POLYNEUROPATHIES
POLYNEUROPATHIES
POLYNEUROPATHIES
POLYNEUROPATHIES
POLYNEUROPATHIES
10,600
10,600
10,600
10,600
10,600
3,180
3,180
3,180
3,180
3,180
7,420
7,420
7,420
7,420
7,420
POLYNEUROPATHIES
10,600
3,180
7,420
G62.9
Refsum's disease
Neuropathy in association with hereditary ataxia
Idiopathic progressive neuropathy
Other hereditary and idiopathic neuropathies; Morvan's
disease; Nelaton's syndrome; Sensory neuropathy
dominantly inherited; Sensory neuropathy recessively
inherited
Hereditary and idiopathic neuropathy, unspecified
Guillain-Barr syndrome; Acute post- infective polyneuritis;
Acute infective polyneuritis
Other inflammatory polyneuropathies
Inflammatory polyneuropathy, unspecified
Drug-induced polyneuropathy
Alcoholic polyneuropathy
Polyneuropathy due to other toxic agents
Other specified polyneuropathies; Radiation-induced
polyneuropathy
Polyneuropathy, unspecified; Neuropathy NOS
POLYNEUROPATHIES
10,600
3,180
7,420
G63.8*
Polyneuropathy in other diseases classified elsewhere
POLYNEUROPATHIES
10,600
3,180
7,420
POLYNEUROPATHIES
G60.1
G60.2
G60.3
G60.8
G60.9
G61.0
G61.8
G61.9
G62.0
G62.1
G62.2
G62.8
G64
N84.0
N84.1
N84.2
N84.3
N84.8
N84.9
O08.2
Other disorders of peripheral nervous system; Disorder of

peripheral nervous system NOS
Polyp of corpus uteri; Polyp of endometrium; Polyp of
uterus NOS
Polyp of cervix uteri; Mucous polyp of cervix
Polyp of vagina
Polyp of vulva; Polyp of labia
Polyp of other parts of female genital tract
Polyp of female genital tract, unspecified
Embolism following abortion and ectopic and molar
pregnancy; Embolism NOS; Air embolism; Amniotic fluid
embolism; Blood-clot embolism; Pulmonary embolism;
Pyaemic embolism; Septic or septicopyaemic embolism;
Soap embolism
10,600
3,180
7,420
POLYPS, FEMALE GENITAL TRACT
5,200
1,560
3,640

5,200
5,200
5,200
5,200
5,200
1,560
1,560
1,560
1,560
1,560
3,640
3,640
3,640
3,640
3,640
POST PARTUM COMPLICATIONS
9,300
2,790
6,510
Page 95 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
O71.2
Metabolic disorders following abortion and ectopic and

molar pregnancy
Complication following abortion and ectopic and molar
pregnancy, unspecified
Other intrapartum haemorrhage; Excessive intrapartum
haemorrhage
Rupture of uterus before on set of labour
Rupture of uterus during labour; Rupture of uterus not
stated as occuring before onset of labour
Post partum inversion of uterus
9,300
2,790
6,510
O71.3
Obstetric laceration of cervix; Annular detachment of cervix POST PARTUM COMPLICATIONS
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510

9,300
9,300
2,790
2,790
6,510
6,510
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510

9,300
9,300
2,790
2,790
6,510
6,510
9,300
2,790
6,510
POSTPARTUM CARE FOR DELIVERIES IN TRANSIT
2,000
600
1,400
POSTPROCEDURAL DISORDERS
10,300
3,090
7,210
Postprocedural hypoparathyroidism; Parathyroprival tetany POSTPROCEDURAL DISORDERS
O08.5
O08.9
O67.8
O71.0
O71.1
O71.5
O71.7
O71.8
O71.9
O74.0
O74.2
O74.8
O75.1
O75.8
O75.9
O87.9
Z39.0
E89.0
E89.2
E89.3
E89.4
E89.5
E89.6
Other obstetric injury to pelvic organs; Obstetric injury to

bladder; Obstetric injury to urethra
Obstetric haematoma of pelvis; Obstetric haematoma of
perineum; Obstetric haematoma of vagina; Obstetric
haematoma of vulva
Other specified obstetric trauma
Obstetric trauma, unspecified
Aspiration pneumonitis due to anaesthesia during labour
and delivery; Inhalation of stomach contents or secretions
NOS due to anaesthesia during labour and delivery;
Mendelson's syndrome due to anaesthesia during labour
and delivery
Cardiac complications of anaesthesia during labour and
delivery; Cardiac arrest due to anaesthesia during labour
and delivery; Cardiac failure due to anaesthesia during
labour and delivery
Other complications of anaesthesia during labour and
delivery
Shock during or following labour and delivery; Obstetic
shock
Other specified complications of labour and delivery
Complication of labour and delivery, unspecified
Venous complication in the puerperium, unspecified;
Puerperal phlebitis NOS; Puerperal phlebopathy NOS;
Puerperal thrombosis NOS
Care and examination immediately after delivery
Postprocedural hypothyroidism; Postirradiation
hypothyroidism; Postsurgical hypothyroidism
Postprocedural hypopituitarism; Postirradiation

hypopituitarism
Postprocedural ovarian failure
Postprocedural testicular hypofunction
Postprocedural adrenocortical hypofunction;
Postprocedural adreno-medullary hypofunction
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510
9,300
2,790
6,510
10,300
3,090
7,210
10,300
3,090
7,210
10,300
10,300
3,090
3,090
7,210
7,210
10,300
3,090
7,210
E89.8
Other postprocedural endocrine and metabolic disorders
10,300
3,090
7,210
G97.1
G97.8
H59.0
Other reaction to spinal and lumbar puncture

Other postprocedural disorders of nervous system
Vitreous syndrome following cataract surgery
Other postprocedural disorders of eye and adnexa;
Chorioretinal scars after surgery for detachment
10,300
10,300
10,300
3,090
3,090
3,090
7,210
7,210
7,210
10,300
3,090
7,210
H59.9
Postprocedural disorder of eye and adnexa, unspecified
10,300
3,090
7,210
H95.8
Other postprocedural disorders of ear and mastoid process POSTPROCEDURAL DISORDERS
10,300
3,090
7,210
I97.0
Postcardiotomy syndrome
Postmastectomy lymphoedema syndrome; Elephantiasis
due to mastectomy; Obliteration of lymphatic vessels due POSTPROCEDURAL DISORDERS
to mastectomy
Tracheostomy malfunction; Haemorrhage from
tracheostomy stoma; Obstruction of tracheostomy airway;
Sepsis of tracheostomy stoma; Tracheo-oesophageal fistula
following tracheostomy
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
Acute pulmonary insufficiency following thoracic surgery
10,300
3,090
7,210
10,300
3,090
7,210
10,300
10,300
10,300
10,300
10,300
3,090
3,090
3,090
3,090
3,090
7,210
7,210
7,210
7,210
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
10,300
10,300
3,090
3,090
3,090
7,210
7,210
7,210
H59.8
I97.2
J95.0
J95.1
J95.2
J95.4
J95.5
J95.8
J95.9
K91.0
K91.1
K91.2
K91.3
K91.4
K91.5
Acute pulmonary insufficiency following nonthoracic

surgery
Mendelson's syndrome
Postprocedural subglottic stenosis
Other postprocedural respiratory disorders
Postprocedural respiratory disorder, unspecified
Vomiting following gastrointestinal surgery
Postgastric surgery syndromes; Dumping syndrome;
Postgastrectomy syndrome; Postvagotomy syndrome
Postsurgical malabsorption, not elsewhere classified;
Postsurgical blind loop syndrome
Postoperative intestinal obstruction
Colostomy and enterostomy malfunction
Postcholecystectomy syndrome
Page 96 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
K91.8
Other postprocedural disorders of digestive system, not

10,300
3,090
7,210
K91.9
Postprocedural disorder of digestive system, unspecified
10,300
3,090
7,210
N99.0
Postprocedural renal failure

Postprocedural urethral stricture; Postcatheterization
urethral stricture
Postprocedural pelvic peritoneal adhesions
Other postprocedural disorders of genitourinary system;
Residual ovary syndrome
Postprocedural disorder of genitourinary system,
unspecified
Haemorrhage and haematoma complicating a procedure,
not elsewhere classified; Haemorrhage at any site resulting
from a procedure
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
N99.1
N99.4
N99.8
N99.9
T81.0
T81.1
Shock during or resulting from a procedure not elsewhere

classified; Collapse NOS during or following a procedure;
Endotoxic shock during or following a procedure;
Hypovolaemic during or following a procedure; Septic
shock during or following a procedure;
10,300
3,090
7,210
T81.2
Accidental puncture and laceration during a procedure not

elsewhere classified; Accidental perforation of blood vessel
by catheter, endoscope, instrument, probe during a
procedure; Accidental perforation of nerve by catheter,
endoscope, instrument, probe
10,300
3,090
7,210
T81.3
Disruption of operation wound, not elsewhere classified;

Dehiscene of operation wound; Rupture of operation
wound
10,300
3,090
7,210
T81.4
Infection following a procedure, not elsewhere classified;

Intra-abdominal abscess postprocedural abcess; Intraabdominal stitch postprocedural abscess; Intra-abdominal POSTPROCEDURAL DISORDERS
subphrenic postprocedural abcess; Intra-abdominal wound
postprocedural abcess; Septica
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
T81.8
T82.0
T82.1
T82.2
T82.3
T82.4
T82.5
T82.7
T82.8
T83.1
T83.2
T83.3
T83.5
T83.8
T83.9
T84.0
Other complications of procedures, not elsewhere

classified; Complication of inhalation therapy; Emphysema
(subcutaneous) resulting from a procedure; Persistent
postoperative fistula
Mechanical complication of heart valve prosthesis;
Mechanical breakdown due to heart valve prosthesis;
Displacement due to heart valve prosthesis; Failure due to POSTPROCEDURAL DISORDERS
heart valve prosthesis; Leakage due to heart valve
prosthesis; Malposition due to heart valve
Mechanical complication of cardiac electronic device;
Conditions listed in T82.0 due to electrodes; Conditions
listed in T82.0 due to pulse generator (battery)
Mechanical complication of coronary artery bypass and
valve grafts
Mechanical complication of other vascular grafts; Condition
listed in T82.0 due to aortic (bifurcation) graft
(replacement); Condition listed in T82.0 due to arterial
(carotid) (femoral) graft (bypass)
Mechanical complication of vascular dialysis catheter
Mechanical complication of other cardiac and vascular
devices and implants; Conditions listed in T82.0 due to
arteriovenous fistula surgically created; arterivenous
Shunt surgically created; Artificial heart; Ballon
counterpulsation device; Infusion cat
Infection and inflammatory reaction due to other cardiac
and vascular devices, implants and grafts
Other complications of cardiac and vascular prosthetic
devices, implants and grafts; Complication due to cardiac
and vascular prosthetic devices, implants and grafts;
Embolism due to cardiac and vascular prosthetic devices,
implants and grafts; Fibrosis d
Mechanical complication of other urinary devices and
implants; Concditions listed in T82.0 due to Urinary
electronic stimultor device; Urinary sphincter implant;
Urinary stent
Mechanical complication of graft of urinary organ
Mechanical complication of intrauterine contraceptive
device
Infection and inflammatory reaction due to prosthetic
device, implant and graft in urinary system
Other complications of genitourinary prosthetic devices,
implants and grafts
Unspecified complication of genitourinary prosthetic
device, implants and grafts
Mechanical complication of internal joint prosthesis
Page 97 of 112

FIRST CASE RATE
ICD CODE
T84.1
T84.2
T84.4
T84.5
T84.6
T84.7
T84.8
T84.9
T85.0
T85.3
T85.5
T85.6
T85.7
T85.8
T85.9
N40
N41.0
N41.1
N41.2
N41.3
N41.8
N41.9
N42.0
N42.1
N42.2
N42.8
N42.9
O15.2
O85
O86.0
O86.1
O86.2
O86.3
O86.4
O86.8
O87.0
O87.1
O87.2
O87.8
O88.1
O88.2
DESCRIPTION
Mechanical complication of internal fixation device of
bones of limb
Mechanical complication of internal fixation device of other
bones
Mechanical complication of other internal orthopaedic
devices, implants and grafts
Infection and inflammatory reaction due to internal joint
prosthesis
Infection and inflammatory reaction due to internal fixation
device [any site]
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
10,300
3,090
7,210
9,200
2,760
6,440
PROSTATE DISORDERS
PROSTATE DISORDERS
PROSTATE DISORDERS
PROSTATE DISORDERS
PROSTATE DISORDERS
9,200
9,200
9,200
9,200
9,200
2,760
2,760
2,760
2,760
2,760
6,440
6,440
6,440
6,440
6,440
PROSTATE DISORDERS
9,200
2,760
6,440
PROSTATE DISORDERS
PROSTATE DISORDERS
PROSTATE DISORDERS
PROSTATE DISORDERS
PROSTATE DISORDERS
PUERPERAL COMPLICATIONS
9,200
9,200
9,200
9,200
9,200
6,800
2,760
2,760
2,760
2,760
2,760
2,040
6,440
6,440
6,440
6,440
6,440
4,760
10,600
3,180
7,420
10,600
3,180
7,420
Other infection of genital tract following delivery; Cervicitis

following delivery; Vaginitis following delivery
Infection and inflammatory reaction due to other internal

orthopaedic prosthetic devices, implants and grafts
Other complications of internal orthopaedic prosthetic
devices, implants and grafts
Unspecified complication of internal orthopaedic prosthetic
device, implant and graft
Mechanical complication of ventricular intracranial
(communicating) shunt
Mechanical complication of other ocular prosthetic devices,
implants and grafts Conditions listed in T82.0 due to
corneal graft; Conditions listed in T82.0 due to prosthetic
orbit of eye
Mechanicalcomplicationofgastrointestinalprostheticdevices
implantsand; Conditions listed in T82.0 due to Bile-duct
prosthesis; Conditions listed in T82.0 oesophageal antireflux device
Mechanical complication of other specified internal
prosthetic devices, Implants and grafts; Conditions listed in
T82.0 due to epidural and subdural infusion catheter;
Conditions listed in T82.0 due to intraperitonael dialysis
catheter; Conditions listed
Infection and inflammatory reaction due to other internal
prosthetic devices, implants and grafts
Other complications of internal prosthetic devices, implants
and grafts, not elsewhere classified
Unspecified complication of internal prosthetic device,
implant and graft; Complication of internal prosthetic
device, implants and graft NOS
Hyperplasia of prostate; Adenofibromatous hypertrophy of

prostate; Adenoma (benign)of prostate ; Enlargement of
prostate (benign); Fibroadenoma of prostate; Fibroma of PROSTATE DISORDERS
prostate; Hypertrophy of prostate (benign); Myoma of
prostate; Median bar (prostate),
Acute prostatitis
Chronic prostatitis
Abscess of prostate
Prostatocystitis
Other inflammatory diseases of prostate
Inflammatory disease of prostate, unspecified; Prostatitis
NOS
Calculus of prostate; Prostatic stone
Congestion and haemorrhage of prostate
Atrophy of prostate
Other specified disorders of prostate
Disorder of prostate, unspecified
Eclampsia in the puerperium
Puerperal sepsis; Puerperal endometritis; Puerperal fever;
Puerperal peritonitis; Puerperal septicaemia
Infection of obstetric surgical wound; Infected caesarean
section wound following delivery; Infected perineal repair
following delivery
Urinary tract infection following delivery

Other genitourinary tract infections following delivery;
Puerperal genitourinary tract infection NOS
Pyrexia of unknown origin following delivery; Puerperal
infection NOS; Puerperal pyrexia NOS
Other specified puerpera linfections
Superficial thrombophlebitis in the puerperium
Deep phlebothrombosis in the puerperium; Deep-vein
thrombosis, postpartum; Pelvic thrombophlebitis,
postpartum
Haemorrhoids in the puerperium
Other venous complications in the puerperium; Genital
varices in the puerperium
Amniotic fluid embolism
Obstetric blood-clot embolism; Obstetric pulmonary
embolism NOS; Puerperal pulmonary embolism NOS
10,600
3,180
7,420
10,600
3,180
7,420
10,600
3,180
7,420
10,600
3,180
7,420
10,600
10,600
3,180
3,180
7,420
7,420
10,600
3,180
7,420
10,600
3,180
7,420
10,600
3,180
7,420
10,600
3,180
7,420
10,600
3,180
7,420
Page 98 of 112

FIRST CASE RATE
ICD CODE
O89.0
O89.1
O89.2
O89.4
O89.8
DESCRIPTION
Pulmonary complications of anaesthesia during the
puerperium; Aspiration pneumonitis due to anaesthesia
during the puerperium; Inhalation of stomach
contents or secretions NOS due to anaesthesia during the
puerperium
Mendelson's syndrome due to anaest
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
10,600
3,180
7,420
10,600
3,180
7,420
10,600
3,180
7,420
10,600
3,180
7,420
10,600
3,180
7,420
10,600
3,180
7,420
10,600
3,180
7,420
10,600
3,180
7,420
10,600
10,600
3,180
3,180
7,420
7,420
10,600
3,180
7,420
10,600
3,180
7,420
10,600
3,180
7,420
10,600
3,180
7,420
Cardiac complications of anaesthesia during the

puerperium; Cardiac arrest due to anaesthesia during the
puerperium; Cardiac failure due to anaesthesia during the
puerperium
Central nervous system complications of anaesthesia
during the puerperium; Cerebral anoxia due to anaesthesia PUERPERAL COMPLICATIONS
during the puerperium
Spinal and epidural anaesthesia-induced headache during
the puerperium
Other complications of anaesthesia during the puerperium PUERPERAL COMPLICATIONS
O90.9
Complication of anaesthesia during the puerperium,

unspecified
Disruption of caesarean section wound
Disruption of perineal obstetric wound; Disruption of
wound of episiotomy; Disruption of wound of perineal
laceration; Secondary perineal tear
Haematoma of obstetric wound
Cardiomyopathy in the puerperium
Postpartum acute renal failure; Hepatorenal syndrome
following labour and delivery
Postpartum thyroiditis
Other complications of the puerperium, not elsewhere
classified
Complication of the puerperium, unspecified
P20.0
Intrauterine hypoxia first noted before onset of labour
PULMONARY COMPLICATIONS IN THE NEWBORN
10,900
3,270
7,630
P20.1
Intrauterine hypoxia first noted during labour and delivery
10,900
3,270
7,630
P20.9
Intrauterine hypoxia, unspecified
10,900
3,270
7,630
P21.0
Severe birth asphyxia; Pulse less than 100 per minute at

birth and falling or steady, respiration absent or gasping,
colour poor, tone absent; Asphyxia with 1-minute apgar
score 0-3; White asphyxia
10,900
3,270
7,630
P21.1
Mild and moderate birth asphyxia; Normal respiration not

established within one minute, but heart rate 100 or above,
some muscle tone present, some response to stimulation;
Asphyxia with 1-minute Apgar score 4-7; Blue asphyxia
10,900
3,270
7,630
10,900
3,270
7,630
10,900
3,270
7,630
O89.9
O90.0
O90.1
O90.2
O90.3
O90.4
O90.5
O90.8
P21.9
P22.0
Birth asphyxia, unspecified; Anoxia, NOS; Asphyxia, NOS;

Hypoxia, NOS
Respiratory distress syndrome of newborn; Hyaline
membrane disease
P22.1
Transient tachypnoea of newborn
10,900
3,270
7,630
P22.8
Other respiratory distress of newborn
10,900
3,270
7,630
P22.9
Respiratory distress of newborn, unspecified
10,900
3,270
7,630
P24.0
Neonatal aspiration of meconium
10,900
3,270
7,630
P24.1
Neonatal aspiration of amniotic fluid and mucus;Aspiration

of liquor (amnii)
10,900
3,270
7,630
P24.2
Neonatal aspiration of blood
10,900
3,270
7,630
P24.3
Neonatal aspiration of milk and regurgitated food
10,900
3,270
7,630
P24.8
Other neonatal aspiration syndromes
10,900
3,270
7,630
P24.9
Neonatal aspiration syndrome, unspecified; Neonatal

aspiration pneumonia NOS
10,900
3,270
7,630
P25.0
Interstitial emphysema originating in the perinatal period
10,900
3,270
7,630
P25.1
Pneumothorax originating in the perinatal period
10,900
3,270
7,630
P25.2
Pneumomediastinum originating in the perinatal period
10,900
3,270
7,630
10,900
3,270
7,630
10,900
3,270
7,630
10,900
3,270
7,630
10,900
3,270
7,630
P25.8
P26.0
P26.1
P26.8
Other conditions related to interstitial emphysema

originating in the perinatal period
Tracheobronchial haemorrhage originating in the perinatal
period
Massive pulmonary haemorrhage originating in the
perinatal period
Other pulmonary haemorrhages originating in the perinatal
period
Page 99 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
P26.9
Unspecified pulmonary haemorrhage originating in the

perinatal period
10,900
3,270
7,630
P27.0
Wilson-Mikity syndrome; Pulmonary dysmaturity
10,900
3,270
7,630
10,900
3,270
7,630
10,900
3,270
7,630
10,900
3,270
7,630
P27.1
P27.8
P27.9
Bronchopulmonary dysplasia originating in the perinatal

period
Other chronic respiratory diseases originating in the
perinatal period; Congenital pulmonary fibrosis; Ventilator PULMONARY COMPLICATIONS IN THE NEWBORN
lung in newborn
Unspecified chronic respiratory disease originating in the
perinatal period
P28.0
Primary atelectasis of newborn; Primary failure to expand

terminal respiratory units; Pulmonary hypoplasia
associated with short gestation; Pulmonary immaturity NOS
10,900
3,270
7,630
P28.1
Other and unspecified atelectasis of newborn; Atelectasis,

NOS; Atelectasis, partial; Atelectasis, secondary; Resorption PULMONARY COMPLICATIONS IN THE NEWBORN
atelectasis without respiratory distress syndrome
10,900
3,270
7,630
P28.2
Cyanotic attacks of newborn
10,900
3,270
7,630
P28.3
Primary sleep apnoea of newborn; leep apnoea of newborn

NOS
10,900
3,270
7,630
P28.4
Other apnoea of newborn
10,900
3,270
7,630
P28.5
Respiratory failure of newborn
10,900
3,270
7,630
P28.8
Other specified respiratory conditions of newborn;

congenital laryngeal stridor NOS; Snuffles in newborn
10,900
3,270
7,630
P29.3
Persistent fetal circulation; Delayed closure of ductus

arteriosus; Persistent pulmonary hypertension of newborn
10,900
3,270
7,630
10,900
3,270
7,630
PULMONARY EMBOLISM
24,300
7,290
17,010
PULMONARY EMBOLISM
24,300
7,290
17,010
PULMONARY HEART DISEASE

14,100
14,100
4,230
4,230
9,870
9,870
14,100
4,230
9,870
14,100
4,230
9,870
14,100
4,230
9,870
P29.9
I26.0
I26.9
I27.0
I27.1
I27.2
I27.8
Cardiovascular disorder originating in the perinatal period,

unspecified
Pulmonary embolism with mention of acute cor pulmonale;
Acute cor pulmonale NOS
Pulmonary embolism without mention of acute cor
pulmonale; Pulmonary embolism NOS
Primary pulmonary hypertension
Kyphoscoliotic heart disease
Other secondary pulmonary hypertension; Pulmonary
artery hypertension
Other specified pulmonary heart diseases
I27.9
Pulmonary heart disease, unspecified; Chronic

cardiopulmonary disease; Chronic Cor pulmonale NOS
N11.0
Nonobstructive reflux-associated chronic pyelonephritis;

PYELONEPHRITIS
Chronic Pyelonephritis associated with vesicoureteral reflux
10,900
3,270
7,630
N11.1
Chronic obstructive pyelonephritis; Chronic pyelonephritis

associated with anomaly of [pelviureteric junction,
pyeloureteric junction, ureter]; Chronic pyelonephritis
associated with kinking of [pelviureteric junction,
pyeloureteric junction, ureter]; Chr
PYELONEPHRITIS
10,900
3,270
7,630
PYELONEPHRITIS
10,900
3,270
7,630
RED CELL APLASIA

RED CELL APLASIA
RED CELL APLASIA
7,300
7,300
7,300
2,190
2,190
2,190
5,110
5,110
5,110
RENAL INFARCT
9,600
2,880
6,720
RENAL/BLADDER ABSCESS
13,900
13,900
4,170
4,170
9,730
9,730
13,900
4,170
9,730
14,700
4,410
10,290
14,700
4,410
10,290
14,700
4,410
10,290
14,700
4,410
10,290
14,700
4,410
10,290
14,700
4,410
10,290
14,700
4,410
10,290
14,700
4,410
10,290
N11.8
D60.0
D60.8
D60.9
N28.0
N15.1
N30.8
N34.0
J60
J61
J62.0
J62.8
J63.0
J63.3
J63.4
J63.8
Other chronic tubulo-interstitial nephritis; Nonobstructive

chronic pyelonephritis NOS
Chronic acquired pure red cell aplasia
Other acquired pure red cell aplasias
Acquired pure red cell aplasia, unspecified
Ischaemia and infarction of kidney; Embolism of renal
artery; Obstruction of renal artery; Occlusion of renal
artery; Thrombosis of renal artery; Renal infarct
Renal and perinephric abscess
Other cystitis; Abscess of bladder
Urethral abscess; Abscess of Cowper's gland; Abscess of
Littr's gland; Periurethral Abscess ; Abscess of urethral
gland
Coalworker's pneumoconiosis; Anthracosilicosis;
Anthracosis; Coalworker's lung
Pneumoconiosis due to asbestos and other mineral fibres;
Asbestosis
RESPIRATORY CONDITIONS DUE TO EXTERNAL

AGENTS
AGENTS
Pneumoconiosis due to talc dust
AGENTS
Pneumoconiosis due to other dust containing silica; Silicosis RESPIRATORY CONDITIONS DUE TO EXTERNAL
NOS
AGENTS
Aluminosis (of lung)
AGENTS
Graphite fibrosis (of lung)
AGENTS
Siderosis
AGENTS
Pneumoconiosis due to other specified inorganic dusts
AGENTS
Page 100 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
AGENTS
AGENTS
AGENTS
AGENTS
AGENTS
AGENTS
AGENTS
J64
Unspecified pneumoconiosis
J65
Pneumoconiosis associated with tuberculosis
J66.2
Cannabinosis
J66.8
Airway disease due to other specific organic dusts
J67.0
Farmer's lung; Harvester's lung; Haymaker's lung; Mouldy

hay disease
J67.1
Bagassosis; Bagasse disease; Bagasse pneumonitis
J67.5
Mushroom-worker's lung
J67.7
Air-conditioner and humidifier lung; Allergic alveolitis due

to fungi, thermophilic actinomycetees and other organisms
AGENTS
growing in ventilation (air-conditioning) systems
Case Rate
Professional
Fee
Health Care
Institution Fee
14,700
4,410
10,290
14,700
4,410
10,290
14,700
4,410
10,290
14,700
4,410
10,290
14,700
4,410
10,290
14,700
4,410
10,290
14,700
4,410
10,290
14,700
4,410
10,290

AGENTS
14,700
4,410
10,290

AGENTS
14,700
4,410
10,290

AGENTS
14,700
4,410
10,290
J68.1
Acute pulmonary oedema due to chemicals, gases, fumes

and vapours; Acute Chemical pulmonary oedema

AGENTS
14,700
4,410
10,290
J68.2
Upper respiratory inflammation due to chemicals, gases,

fumes and vapours, not elsewhere classified

AGENTS
14,700
4,410
10,290
J68.3
Other acute and subacute respiratory conditions due to

chemicals, gases, fumes and vapours; Reactive airways
dysfunction syndrome; Hyperactive airway disease

AGENTS
14,700
4,410
10,290
J68.4
Chronic respiratory conditions due to chemicals, gases,

fumes and vapours; Diffuse emphysema due to inhalation
of chemicals, gases, fumes and vapours; Chronic
emphysema due to inhalation of chemicals, gases, fumes
and vapours; Chronic obliterative bronchi

AGENTS
14,700
4,410
10,290
14,700
4,410
10,290
14,700
4,410
10,290
14,700
4,410
10,290
14,700
4,410
10,290
14,700
4,410
10,290
14,700
4,410
10,290
14,700
4,410
10,290
14,700
4,410
10,290
14,700
4,410
10,290
14,700
4,410
10,290
32,000
32,000
32,000
7,700
9,600
9,600
9,600
2,310
22,400
22,400
22,400
5,390
J67.8
J67.9
J68.0
J68.8
J68.9
J69.0
J69.1
J69.8
J70.0
Hypersensitivity pneumonitis due to other organic dusts;

Cheese-washer's lung; Coffee-worker's lung; Fishmealworker's lung; Furrier's lung; Sequoiosis
Hypersensitivity pneumonitis due to unspecified organic
dust; Extrinsic allergic alveolitis NOS; Hypersensitivity
pneumonitis NOS
Bronchitis and pneumonitis due to chemicals, gases, fumes
and vapours; Acute chemical bronchitis
Other respiratory conditions due to chemicals, gases, fumes

and vapours
Unspecified respiratory condition due to chemicals, gases,
fumes and vapours
Pneumonitis due to food and vomit; Aspiration pneumonia
due to NOS; Aspiration pneumonia due to regurgitated
food; Aspiration pneumonia due to gastric secretions;
Aspiration pneumonia due to milk; Aspiration pneumonia
due to vomit
Pneumonitis due to oils and essences; Lipid pneumonia
Pneumonitis due to other solids and liquids; Pneumonitis
due to aspiration of blood
Acute pulmonary manifestations due to radiation;
Radiation pneumonitis

AGENTS
AGENTS
AGENTS
AGENTS
AGENTS
AGENTS
AGENTS
AGENTS
AGENTS
AGENTS
RESPIRATORY FAILURE
RESPIRATORY FAILURE
RESPIRATORY FAILURE
RETINAL VASCULAR OCCLUSION
J70.2
Acute drug-induced interstitial lung disorders
J70.4
Drug-induced interstitial lung disorders, unspecified
J70.8
Respiratory conditions due to other specified external

agents
J70.9
Respiratory conditions due to unspecified external agent
J96.0
J96.1
J96.9
H34.1
Acute respiratory failure

Chronic respiratory failure
Respiratory failure, unspecified
Central retinal artery occlusion
H34.2
Other retinal artery occlusions; Hollenhorst's plaque;

Retinal artery occlusion; Retinal artery branch occlusion ;
Retinal artery partial occlusion; Retinal microembolism
7,700
2,310
5,390
H34.8
Other retinal vascular occlusions; Retinal central vein

occlusion ; Retinal vein occlusion incipient; Retinal vein
occlusion partial; Retinal vein occlusion tributary
7,700
2,310
5,390
H34.9
Retinal vascular occlusion, unspecified
7,700
2,310
5,390
I00
Rheumatic fever without mention of heart involvement;

Arthritis, rheumatic, acute or subacute involvement
RHEUMATIC FEVER
10,100
3,030
7,070
I01.0
Acute rheumatic pericarditis; Acute rheumatic pericarditis RHEUMATIC FEVER
10,100
3,030
7,070
Acute rheumatic endocarditis; Acute rheumatic valvulitis
10,100
3,030
7,070
I01.1
RHEUMATIC FEVER
Page 101 of 112

FIRST CASE RATE
ICD CODE
I01.2
I01.8
I01.9
I02.0
I02.9
I05.0
I05.1
I05.2
I05.8
I05.9
I06.0
I06.1
I06.2
I06.8
I06.9
I07.0
DESCRIPTION
GROUP
RHEUMATIC FEVER
10,100
Professional
Fee
3,030
RHEUMATIC FEVER
10,100
3,030
7,070
RHEUMATIC FEVER
10,100
3,030
7,070
RHEUMATIC FEVER
10,100
3,030
7,070
RHEUMATIC FEVER
10,100
3,030
7,070
RHEUMATIC HEART DISEASE
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
Other rheumatic aortic valve diseases

Rheumatic aortic valve disease unspecified; Rheumatic
aortic valve disease NOS
12,800
3,840
8,960
12,800
3,840
8,960
Tricuspid stenosis; Rheumatic tricuspid valve stenosis
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960

12,800
12,800
3,840
3,840
8,960
8,960
Acute rheumatic myocarditis;

Other acute rheumatic heart disease; Acute rheumatic
pancarditis
Acute rheumatic heart disease unspecified; Acute
rheumatic carditis; Active rheumatic heart disease; Acute
rheumatic heart disease
Rheumatic chorea with heart involvement; Chorea NOS
with heart involvement
Rheumatic chorea without heart involvement; Rheumatic
chorea NOS
Mitral stenosis; Rheumatic mitral valve obstruction
Rheumatic mitral insufficiency; Rheumatic mitral
incompetence; Rheumatic mitral regurgitation
Mitral stenosis with insufficiency; Mitral stenosis with
incompetence or regurgitation
Other mitral valve diseases; Mitral valve failure
Mitral valve disease unspecified; Chronic mitral valve
disorder NOS
Rheumatic aortic stenosis; Rheumatic aortic valve
obstruction
Rheumatic aortic insufficiency; Rheumatic aortic
incompetence; Rheumatic aortic regurgitation
Rheumatic aortic stenosis with insufficiency; Rheumatic
aortic stenosis with incompetence or regurgitation
Case Rate
Health Care
Institution Fee
7,070
I08.1
I08.2
Tricuspid insufficiency; Rheumatic tricuspid valve

insufficiency
Tricuspid valve disease unspecified; Tricuspid valve disorder
NOS
Disorders of both mitral and aortic valves; Involvement of
both mitral and aortic valves whether specified as
rheumatic or of unspecified origin
Disorders of both mitral and tricuspid valves
Disorders of both aortic and tricuspid valves
I08.3
Combined disorders of mitral aortic and tricuspid valves
12,800
3,840
8,960
I08.8
I08.9
I09.0
Other multiple valve diseases

Multiple valve disease, unspecified
Rheumatic myocarditis
Rheumatic diseases of endocardium, valve unspecified;
Chronic rheumatic endocarditis; Chronic rheumatic
valvulitis

12,800
12,800
12,800
3,840
3,840
3,840
8,960
8,960
8,960
12,800
3,840
8,960
12,800
3,840
8,960
12,800
3,840
8,960
RICKETTSIOSES
7,000
2,100
4,900
RICKETTSIOSES
7,000
2,100
4,900
RICKETTSIOSES
7,000
2,100
4,900
RICKETTSIOSES
RICKETTSIOSES
SARS
SCARLET FEVER
SEPSIS
SEPSIS
7,000
7,000
2,100
2,100
4,900
4,900
8,300
32,000
32,000
2,490
9,600
9,600
5,810
22,400
22,400
SEPSIS
32,000
9,600
22,400
SEPSIS
SEPSIS
SEPSIS
32,000
32,000
32,000
9,600
9,600
9,600
22,400
22,400
22,400
SEPSIS
32,000
9,600
22,400
SEPSIS
SEPSIS
SEPSIS
32,000
32,000
32,000
9,600
9,600
9,600
22,400
22,400
22,400
SEPSIS
32,000
9,600
22,400
SEPSIS
SEPSIS
SEPSIS
SEQUELAE OF CEREBROVASCULAR DISEASES
32,000
32,000
32,000
10,300
10,300
9,600
9,600
9,600
3,090
3,090
22,400
22,400
22,400
7,210
7,210
I07.1
I07.9
I08.0
I09.1
I09.2
I09.8
A75.0
A75.9
A77.0
A79.0
A79.9
U04.9
A38
A40.0
A40.1
A40.3
A40.8
A40.9
A41.0
A41.1
A41.2
A41.3
A41.4
A41.5
A41.8
A41.9
A48.3
I69.0
I69.1
Chronic rheumatic pericarditis; Rheumatic adherent

pericardium; Chronic rheumatic mediastinopericarditis;
Chronic rheumatic myopericarditis
Other specified rheumatic heart diseases; Rheumatic
disease of pulmonary valve
Epidemic louse-borne typhus fever due to Rickettsia
prowazekii; Cl assical typhus fever;
Epidemic louse-borne typhus
Typhus fever, unspecified
Spotted fever due to Rickettsia rickettsii; Rocky Mountain
spotted fever; Sao Paulo fever
Trench fever ; Quintan fever; Wolhynian fever
Rickettsiosis, unspecified; Rickettsial infection NOS
Severe Acute Respiratory Syndrome (SARS)
Scarlet fever; Scarlatina
Septicaemia due to streptococcus, group A
Septicaemia due to streptococcus, group B
Septicaemia due to Streptococcus pneumoniae;
Pneumococcal septicaemia
Other streptococcal septicaemia
Streptococcal septicaemia, unspecified
Septicaemia due to Staphylococcus aureus
Septicaemia due to other specified staphylococcus;
Septicaemia due to coagulase-negative staphylococcus
Septicaemia due to unspecified staphylococcus
Septicaemia due to Haemophilus influenzae
Septicaemia due to anaerobes
Septicaemia due to other Gram-negative organisms; Gramnegative septicaemia NOS
Other specified septicaemia
Septicaemia, unspecified; Septic shock
Toxic shock syndrome
Sequelae of subarachnoid haemorrhage
Sequelae of intracerebral haemorrhage
Page 102 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
I69.2
Sequelae of other nontraumatic intracranial haemorrhage
10,300
3,090
7,210
I69.3
Sequelae of cerebral infarction

Sequelae of stroke, not specified as haemorrhage or
infarction
10,300
3,090
7,210
10,300
3,090
7,210
Sequelae of other and unspecified cerebrovascular diseases SEQUELAE OF CEREBROVASCULAR DISEASES
10,300
3,090
7,210
10,700
3,210
7,490
10,700
3,210
7,490
10,700
3,210
7,490
10,700
3,210
7,490
10,700
3,210
7,490
10,700
3,210
7,490
10,700
3,210
7,490
8,000
2,400
5,600
8,800
8,500
8,500
8,500
8,500
8,500
8,500
2,640
2,550
2,550
2,550
2,550
2,550
2,550
6,160
5,950
5,950
5,950
5,950
5,950
5,950
SEQUELAE OF TRAUMA INJURIES
8,500
2,550
5,950

8,500
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
2,550
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
5,950
I69.4
I69.8
B90.0
SEQUELAE OF CENTRAL NERVOUS SYSTEM TUBERCULOSIS
B90.8
SEQUELAE OF TUBERCULOSIS OF OTHER ORGANS
B90.9
SEQUELAE OF RESPIRATORY AND UNSPECIFIED

TUBERCULOSIS; SEQUELAE OF TUBERCULOSIS NOS
B94.1
Sequelae of viral encephalitis
B94.2
Sequelae of viral hepatitis
B94.8
Sequelae of other specified infectious and parasitic

diseases
B94.9
Sequelae of unspecified infectious or parasitic disease
SEQUELAE OF INFECTIOUS AND PARASITIC

DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
DISEASES
SEQUELAE OF INFLAMMATORY DISEASE OF THE
CENTRAL NERVOUS SYSTEM
SEQUELAE OF NUTRITIONAL DEFICIENCIES
T91.1
T91.2
T91.3
T92.0
T92.1
T92.8
T93.0
T93.1
T93.2
Sequelae of inflammatory diseases of central nervous

system
Sequelae of other nutritional deficiencies
Sequelae of superficial injury of head
Sequelae of open wound of head
Sequelae of fracture of skull and facial bones
Sequelae of intra cranial injury
Sequelae of other specified injuries of head
Sequelae of unspecified injury of head
Sequelae of superficial injury and open wound of neck and
trunk
Sequelae of fracture of spine
Sequelae of other fracture of thorax and pelvis
Sequelae of injury of spinal cord
Sequelae of open wound of upper limb
Sequelae of fracture of arm
Sequelae of other specified injuries of upper limb
Sequelae of open wound of lower limb
Sequelae of fracture of femur
Sequelae of other fractures of lower limb
T93.3
Sequelae of dislocation sprain and strain of lower limb
8,500
2,550
5,950
T93.8
T94.0
T94.1
Sequelae of other specified injuries of lower limb

Sequelae of injuries involving multiple body regions
Sequelae of injuries, not specified by body regions

8,500
8,500
8,500
2,550
2,550
2,550
5,950
5,950
5,950
T95.0
Sequelae of burn, corrosion and frostbite of head and neck SEQUELAE OF TRAUMA INJURIES
8,500
2,550
5,950
T95.2
Sequelae of burn, corrosion and frostbite of upper limb
8,500
2,550
5,950
T95.3
Sequelae of burn, corrosion and frostbite of lower limb
8,500
2,550
5,950
T95.8
Sequelae of other specified burn corrosion and frostbite
8,500
2,550
5,950
T95.9
T98.2
R57.0
R57.1
R57.8
Sequelae of unspecified burn, corrosion and frostbite

Sequelae of certain early complications of trauma
Cardiogenic shock
Hypovolaemic shock
Other shock; Endotoxic shock

SHOCK
SHOCK
SHOCK
8,500
8,500
32,000
32,000
32,000
2,550
2,550
9,600
9,600
9,600
5,950
5,950
22,400
22,400
22,400
R57.9
Shock, unspecified; Failure of peripheral circulation NOS
SHOCK
32,000
9,600
22,400
T88.2
Shock due to anaesthesia; Shock due to anaesthesia in

which the correct sustance was properly administered
SHOCK
32,000
9,600
22,400
6,700
2,010
4,690
SKULL FRACTURES
10,700
3,210
7,490
SKULL FRACTURES
10,700
3,210
7,490
SKULL FRACTURES
10,700
3,210
7,490
S02.1
Fracture of base of skull: Fracture of anterior fossa, middle

fossa, posterior fossa; Fracture of Occiput; Fracture of
SKULL FRACTURES
orbital roof; Fracture of ethmoid sinus & frontal sinus;
Fracture of Sphenoid; Fracture of temporal bone
10,700
3,210
7,490
S02.10
CLOSED FRACTURE OF BASE OF SKULL/ ANTERIOR FOSSA/

MIDDLE FOSSA/ POSTERIOR FOSSA/ OCCIPUT/ ORBITAL
ROOF/ ETHMOID SINUS/ FRONTAL SINUS/ SPHENOID/
TEMPORAL BONE
10,700
3,210
7,490
G09
E64.8
T90.0
T90.1
T90.2
T90.5
T90.8
T90.9
T91.0
Q89.3
S02.0
S02.00
S02.01
Situs inversus; Dextrocardia with situs inversus; Mirrorimage atrial arrangement with situs inversus; Situs inversus
or transverses abdominalis; Situs inversus or transversus
thoracis; Transposition of abdominal viscera; Transposition
of thoracic visce
Fracture o f vault of skull; Fracture of Frontal bone;
Fracture of Parietal bone
CLOSED FRACTURE OF VAULT OF SKULL/ FRONTAL BONE/
PARIETAL BONE
OPEN FRACTURE OF VAULT OF SKULL/ FRONTAL BONE/
PARIETAL BONE
SITUS INVERSUS
SKULL FRACTURES
Page 103 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
S02.20
S02.21
S02.30
S02.31
S02.40
S02.41
S02.50
S02.60
S02.61
OPEN FRACTURE OF BASE OF SKULL/ ANTERIOR FOSSA/

MIDDLE FOSSA/ POSTERIOR FOSSA/ OCCIPUT/ ORBITAL
ROOF/ ETHMOID SINUS/ FRONTAL SINUS/ SPHENOID/
TEMPORAL BONE
closed fracture of nasal bones
open fracture of nasal bones
Closed fracture of orbital floor
Open fracture of orbital floor
Closed Fracture of malar and maxillary bones
Open Fracture of malar and maxillary bones
Closed Fracture of tooth
Closed Fracture of mandible
Open Fracture of mandible
S02.70
Closed Multiple fractures involving skull and facial bones
SKULL FRACTURES
10,700
3,210
7,490
S02.71
Open Multiple fractures involving skull and facial bones
SKULL FRACTURES
10,700
3,210
7,490
SKULL FRACTURES
10,700
3,210
7,490
SKULL FRACTURES
10,700
3,210
7,490
S02.11
S02.80
S02.81
closed Fractures of other skull and facial bones including

Alveolus, Orbit NOS, Palate
open Fractures of other skull and facial bones including
Alveolus, Orbit NOS, Palate
SKULL FRACTURES
10,700
3,210
7,490
SKULL FRACTURES
SKULL FRACTURES
SKULL FRACTURES
SKULL FRACTURES
SKULL FRACTURES
SKULL FRACTURES
SKULL FRACTURES
SKULL FRACTURES
SKULL FRACTURES
10,700
10,700
10,700
10,700
10,700
10,700
10,700
10,700
10,700
3,210
3,210
3,210
3,210
3,210
3,210
3,210
3,210
3,210
7,490
7,490
7,490
7,490
7,490
7,490
7,490
7,490
7,490
S02.90
Closed Fracture of skull and facial bones, part unspecified
SKULL FRACTURES
10,700
3,210
7,490
S02.91
Open Fracture of skull and facial bones, part unspecified
SKULL FRACTURES
10,700
3,210
7,490
SLEEP APNEA
10,800
3,240
7,560
SPONDYLOPATHIES
SPONDYLOPATHIES
SPONDYLOPATHIES
SPONDYLOPATHIES
SPONDYLOPATHIES
SPONDYLOPATHIES
8,300
8,300
8,300
8,300
8,300
8,300
2,490
2,490
2,490
2,490
2,490
2,490
5,810
5,810
5,810
5,810
5,810
5,810
SPONDYLOPATHIES
8,300
2,490
5,810
M46.1
M46.16
M46.19
M46.2
Sleep apnoea; Sleep apnoea, central; Sleep apnoea,

obstructive
Spondylolysis
Spondylolisthesis
Other fusion of spine; Ankylosis of spinal joint
Other recurrent vertebral subluxation
Torticollis
Ankylosing spondylitis; Rheumatoid arthritis of spine
Spinal enthesopathy; Disorder of ligamentous or muscular
attachments of spine
Sacroiliitis, not elsewhere classified
Sacroiliitis, not elsewhere classified lumbar region
Sacroiliitis, not elsewhere classified site unspecified
Osteomyelitis of vertebra
SPONDYLOPATHIES
SPONDYLOPATHIES
SPONDYLOPATHIES
SPONDYLOPATHIES
8,300
8,300
8,300
8,300
2,490
2,490
2,490
2,490
5,810
5,810
5,810
5,810
M46.28
Osteomyelitis of vertebra sacral and sacrococcygeal region SPONDYLOPATHIES
8,300
2,490
5,810
M46.29
M46.3
Osteomyelitis of vertebra site unspecified

Infection of intervertebral disc (pyogenic)
SPONDYLOPATHIES
SPONDYLOPATHIES
8,300
8,300
2,490
2,490
5,810
5,810
M46.36
Infection of intervertebral disc (pyogenic) lumbar region
SPONDYLOPATHIES
8,300
2,490
5,810
M46.4
M46.46
M46.47
M46.49
M46.5
M46.8
8,300
8,300
8,300
8,300
8,300
8,300
2,490
2,490
2,490
2,490
2,490
2,490
5,810
5,810
5,810
5,810
5,810
5,810
8,300
2,490
5,810
M46.9
Discitis, unspecified
SPONDYLOPATHIES
Discitis, unspecified lumbar region
SPONDYLOPATHIES
Discitis, unspecified lumbosacral region
SPONDYLOPATHIES
Discitis, unspecified site unspecified
SPONDYLOPATHIES
Other infective spondylopathies
SPONDYLOPATHIES
Other specified inflammatory spondylopathies
SPONDYLOPATHIES
Other specified inflammatory spondylopathies lumbosacral
SPONDYLOPATHIES
region
Inflammatory spondylopathy, unspecified
SPONDYLOPATHIES
8,300
2,490
5,810
M46.92
Inflammatory spondylopathy, unspecified cervical region
SPONDYLOPATHIES
8,300
2,490
5,810
SPONDYLOPATHIES
8,300
2,490
5,810
G47.3
M43.0
M43.1
M43.2
M43.5
M43.6
M45
M46.0
M46.87
M46.97
M46.98
Inflammatory spondylopathy, unspecified lumbosacral

region
Inflammatory spondylopathy, unspecified sacral and
SPONDYLOPATHIES
8,300
2,490
5,810
M46.99
Inflammatory spondylopathy, unspecified site unspecified SPONDYLOPATHIES
8,300
2,490
5,810
M47.1
M47.1+G99.2*
M47.2
Other spondylosis with myelopathy

Myelopathy in Other spondylosis with myelopathy
Other spondylosis with radiculopathy
Other spondylosis with radiculopathy Multiple sites in
spine
SPONDYLOPATHIES
SPONDYLOPATHIES
SPONDYLOPATHIES
8,300
8,300
8,300
2,490
2,490
2,490
5,810
5,810
5,810
SPONDYLOPATHIES
8,300
2,490
5,810
M47.22
Other spondylosis with radiculopathy cervical region
SPONDYLOPATHIES
8,300
2,490
5,810
M47.26
Other spondylosis with radiculopathy lumbar region
SPONDYLOPATHIES
8,300
2,490
5,810
M47.27
Other spondylosis with radiculopathy lumbosacral region
SPONDYLOPATHIES
8,300
2,490
5,810
M47.29
Other spondylosis with radiculopathy site unspecified
SPONDYLOPATHIES
8,300
2,490
5,810
M47.8
Cervical spondylosis without myelopathy or radiculopathy;

Lumbosacral spondylosis without myelopathy or
SPONDYLOPATHIES
radiculopathy; Thoracic spondylosis without myelopathy or
radiculopathy
8,300
2,490
5,810
M47.80

SPONDYLOPATHIES
radiculopathy Multiple sites in spine
8,300
2,490
5,810
M47.20
Page 104 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
M47.81

SPONDYLOPATHIES
radiculopathy occipito-atlanto-axial region
8,300
2,490
5,810
M47.82

SPONDYLOPATHIES
radiculopathy cervical region
8,300
2,490
5,810
M47.83

SPONDYLOPATHIES
radiculopathy cervicothoracic region
8,300
2,490
5,810
M47.84

SPONDYLOPATHIES
radiculopathy thoracic region
8,300
2,490
5,810
M47.85

SPONDYLOPATHIES
radiculopathy thoracolumbar region
8,300
2,490
5,810
M47.86

SPONDYLOPATHIES
radiculopathy lumbar region
8,300
2,490
5,810
M47.87

SPONDYLOPATHIES
radiculopathy lumbosacral region
8,300
2,490
5,810
M47.88

SPONDYLOPATHIES
radiculopathy sacral and sacrococcygeal region
8,300
2,490
5,810
M47.89

SPONDYLOPATHIES
radiculopathy site unspecified
8,300
2,490
5,810
M47.9
M47.90
M47.92
M47.94
M47.95
M47.96
M47.97
M47.99
M48.0
Spondylosis, unspecified
Spondylosis, unspecified Multiple sites in spine
Spondylosis, unspecified cervical region
Spondylosis, unspecified thoracic region
Spondylosis, unspecified thoracolumbar region
Spondylosis, unspecified lumbar region
Spondylosis, unspecified lumbosacral region
Spondylosis, unspecified site unspecified
Spinal stenosis; Caudal stenosis
SPONDYLOPATHIES
SPONDYLOPATHIES
SPONDYLOPATHIES
SPONDYLOPATHIES
SPONDYLOPATHIES
SPONDYLOPATHIES
SPONDYLOPATHIES
SPONDYLOPATHIES
SPONDYLOPATHIES
8,300
8,300
8,300
8,300
8,300
8,300
8,300
8,300
8,300
2,490
2,490
2,490
2,490
2,490
2,490
2,490
2,490
2,490
5,810
5,810
5,810
5,810
5,810
5,810
5,810
5,810
5,810
M48.00
Spinal stenosis; Caudal stenosis Multiple sites in spine
SPONDYLOPATHIES
8,300
2,490
5,810
M48.02
Spinal stenosis; Caudal stenosis cervical region
SPONDYLOPATHIES
8,300
2,490
5,810
M48.03
Spinal stenosis; Caudal stenosis cervicothoracic region
SPONDYLOPATHIES
8,300
2,490
5,810
M48.04
Spinal stenosis; Caudal stenosis thoracic region
SPONDYLOPATHIES
8,300
2,490
5,810
M48.05
Spinal stenosis; Caudal stenosis thoracolumbar region
SPONDYLOPATHIES
8,300
2,490
5,810
M48.06
M48.07
SPONDYLOPATHIES
SPONDYLOPATHIES
8,300
8,300
2,490
2,490
5,810
5,810
SPONDYLOPATHIES
8,300
2,490
5,810
SPONDYLOPATHIES
8,300
2,490
5,810
SPONDYLOPATHIES
8,300
2,490
5,810
SPONDYLOPATHIES
8,300
2,490
5,810
M48.2
M48.3
M48.32
Spinal stenosis; Caudal stenosis lumbar region

Spinal stenosis; Caudal stenosis lumbosacral region
Spinal stenosis; Caudal stenosis sacral and sacrococcygeal
region
Spinal stenosis; Caudal stenosis site unspecified
Ankylosing hyperostosis [Forestier]; Diffuse idiopathic
skeletal hyperostosis [DISH]
Ankylosing hyperostosis [Forestier]; Diffuse idiopathic
skeletal hyperostosis [DISH] lumbar region
Kissing spine
Traumatic spondylopathy
Traumatic spondylopathy cervical region
SPONDYLOPATHIES
SPONDYLOPATHIES
SPONDYLOPATHIES
8,300
8,300
8,300
2,490
2,490
2,490
5,810
5,810
5,810
M48.4
Fatigue fracture of vertebra; Stress fracture of vertebra
SPONDYLOPATHIES
8,300
2,490
5,810
M48.5
Collapsed vertebra NOS; Wedging of vertebra NOS

Collapsed vertebra NOS; Wedging of vertebra NOS thoracic
region
Collapsed vertebra NOS; Wedging of vertebra NOS lumbar
region
Collapsed vertebra NOS; Wedging of vertebra NOS
lumbosacral region
Ossification of posterior longitudinal ligament
Ossification of posterior longitudinal ligament Multiple sites
in spine
SPONDYLOPATHIES
8,300
2,490
5,810
SPONDYLOPATHIES
8,300
2,490
5,810
SPONDYLOPATHIES
8,300
2,490
5,810
SPONDYLOPATHIES
8,300
2,490
5,810
SPONDYLOPATHIES
8,300
2,490
5,810
SPONDYLOPATHIES
8,300
2,490
5,810
M48.08
M48.09
M48.1
M48.16
M48.54
M48.56
M48.57
M48.8
M48.80
Page 105 of 112

FIRST CASE RATE
ICD CODE
M48.85
M48.86
M48.89
M48.9
M48.92
M48.95
M48.96
M48.98
M48.99
M49.0*
M49.8*
L00
DESCRIPTION
Ossification of posterior longitudinal ligament
thoracolumbar region
Ossification of posterior longitudinal ligament lumbar
region
Ossification of posterior longitudinal ligament site
unspecified
Spondylopathy, unspecified
Spondylopathy, unspecified cervical region
Spondylopathy, unspecified thoracolumbar region
Spondylopathy, unspecified lumbar region
Spondylopathy, unspecified sacral and sacrococcygeal
region
Spondylopathy, unspecified site unspecified
Pott's curvature
Spondylopathy in other diseases classified elsewhere
Staphylococcal scalded skin syndrome; Pemphigus
neonatorum; Ritter's disease
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
SPONDYLOPATHIES
8,300
2,490
5,810
SPONDYLOPATHIES
8,300
2,490
5,810
SPONDYLOPATHIES
8,300
2,490
5,810
SPONDYLOPATHIES
SPONDYLOPATHIES
SPONDYLOPATHIES
SPONDYLOPATHIES
8,300
8,300
8,300
8,300
2,490
2,490
2,490
2,490
5,810
5,810
5,810
5,810
SPONDYLOPATHIES
8,300
2,490
5,810
SPONDYLOPATHIES
SPONDYLOPATHIES
SPONDYLOPATHIES
8,300
8,300
8,300
2,490
2,490
2,490
5,810
5,810
5,810
10,200
3,060
7,140
STAPHYLOCCOCAL SCALDED SKIN SYNDROME
G41.0
Grand mal status epilepticus; Tonic-clonic status epilepticus STATUS EPILEPTICUS
15,600
4,680
10,920
G41.1
G41.2
G41.8
G41.9
Petit mal status epilepticus; Epileptic absence status

Complex partial status epilepticus
Other status epilepticus
Status epilepticus, unspecified
STATUS EPILEPTICUS
STATUS EPILEPTICUS
STATUS EPILEPTICUS
STATUS EPILEPTICUS
15,600
15,600
15,600
15,600
4,680
4,680
4,680
4,680
10,920
10,920
10,920
10,920
L51.1
Bullous erythema multiforme; Stevens-Johnson syndrome
STEVEN JOHNSONS SYNDROME
12,300
3,690
8,610
I60.0
Subarachnoid haemorrhage from carotid siphon and

bifurcation
STROKE - HEMORRHAGIC
38,000
11,400
26,600
I60.1
Subarachnoid haemorrhage from middle cerebral artery
38,000
11,400
26,600
38,000
11,400
26,600
38,000
11,400
26,600
38,000
38,000
11,400
11,400
26,600
26,600
38,000
11,400
26,600
38,000
11,400
26,600
38,000
11,400
26,600
38,000
11,400
26,600
38,000
11,400
26,600
38,000
11,400
26,600
I60.2
I60.3
I60.4
I60.5
I60.6
I60.7
I60.8
I60.9
I61.0
I61.1
Subarachnoid haemorrhage from anterior communicating

artery
Subarachnoid haemorrhage from posterior communicating
artery
Subarachnoid haemorrhage from basilar artery
Subarachnoid haemorrhage from vertebral artery
Subarachnoid haemorrhage from other intracranial
arteries; Multiple involvement of intracranial arteries
Subarachnoid haemorrhage from intracranial artery,
unspecified; Congenital ruptured berry aneurysm NOS;
Subarachnoid haemorrhage from cerebral artery NOS;
Subarachnoid haemorrhage from communicating artery
NOS
Other subarachnoid haemorrhage; Meningeal
haemorrhage; Rupture of cerebral arteriovenous
malformation
Subarachnoid haemorrhage, unspecified
Intracerebral haemorrhage in hemisphere, subcortical;
Deep intracerebral haemorrhage
Intracerebral haemorrhage in hemisphere, cortical;
Cerebral lobe haemorrhage; Superficial intracerebral
haemorrhage
I61.2
Intracerebral haemorrhage in hemisphere, unspecified
38,000
11,400
26,600
I61.3
I61.4
I61.5
I61.6
I61.8
I61.9
Intracerebral haemorrhage in brain stem

Intracerebral haemorrhage in cerebellum
Intracerebral haemorrhage, intraventricular
Intracerebral haemorrhage, multiple localized
Other intracerebral haemorrhage
Intracerebral haemorrhage, unspecified
Acute Subdural haemorrhage; Nontraumatic Subdural
haemorrhage
Nontraumatic extradural haemorrhage; Nontraumatic
epidural haemorrhage
38,000
38,000
38,000
38,000
38,000
38,000
11,400
11,400
11,400
11,400
11,400
11,400
26,600
26,600
26,600
26,600
26,600
26,600
38,000
11,400
26,600
38,000
11,400
26,600
I62.9
Intracranial haemorrhage (nontraumatic), unspecified
38,000
11,400
26,600
I63.0
Cerebral infarction due to thrombosis of precerebral

arteries
STROKE - INFARCTION
28,000
8,400
19,600
I63.1
Cerebral infarction due to embolism of precerebral arteries STROKE - INFARCTION
28,000
8,400
19,600
I63.2
Cerebral infarction due to unspecified occlusion or stenosis

STROKE - INFARCTION
of precerebral arteries
28,000
8,400
19,600
I63.3
Cerebral infarction due to thrombosis of cerebral arteries
STROKE - INFARCTION
28,000
8,400
19,600
I63.4
Cerebral infarction due to embolism of cerebral arteries
STROKE - INFARCTION
28,000
8,400
19,600
STROKE - INFARCTION
28,000
8,400
19,600
STROKE - INFARCTION
28,000
8,400
19,600
STROKE - INFARCTION
STROKE - INFARCTION
28,000
28,000
8,400
8,400
19,600
19,600
I62.0
I62.1
I63.8
I63.9
Cerebral infarction due to unspecified occlusion or stenosis

of cerebral arteries
Cerebral infarction due to cerebral venous thrombosis,
nonpyogenic
Other cerebral infarction
Cerebral infarction, unspecified
I63.9+G46.7*
Other lacunar syndrome in unspecified cerebral infarction
STROKE - INFARCTION
28,000
8,400
19,600
I64
Stroke, not specified as hemorrhage or infarction
STROKE - INFARCTION
28,000
8,400
19,600
I63.5
I63.6
Page 106 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
G10
Huntington's disease; Huntington's chorea
G11.0
Congenital nonprogressive ataxia
G11.1
G11.3
G11.9
G12.0
G12.1
G12.2
GROUP
SYSTEMIC ATROPHIES INVOLVING CENTRAL
NERVOUS SYSTEM
NERVOUS SYSTEM
Case Rate
Professional
Fee
Health Care
Institution Fee
10,400
3,120
7,280
10,400
3,120
7,280

NERVOUS SYSTEM
10,400
3,120
7,280

NERVOUS SYSTEM
10,400
3,120
7,280
Hereditary ataxia, unspecified; Hereditary cerebellar ataxia

NOS; Hereditary cerebellar degeneration; Hereditary
NERVOUS SYSTEM
cerebellar disease; Hereditary cerebellar syndrome
10,400
3,120
7,280

NERVOUS SYSTEM
10,400
3,120
7,280

NERVOUS SYSTEM
10,400
3,120
7,280

NERVOUS SYSTEM
10,400
3,120
7,280
Early-onset cerebellar ataxia including Early-onset

cerebellar ataxia with essential tremor; Early-onset
cerebellar ataxia with myoclonus [Hunt's ataxia]; Earlyonset cerebellar ataxia with retained tendon reflexes;
Friedreich's ataxia (autosomal recessiv
Cerebellar ataxia with defective DNA repair; Ataxia
telangiectasia [Louis-Bar]
Infantile spinal muscular atrophy, type I [WerdnigHoffman]

Other inherited spinal muscular atrophy; Progressive bulbar
palsy of childhood [Fazio-Londe]; Spinal muscular atrophy
adult form
Spinal muscular atrophy childhood form, type II; Spinal
muscular atrophy distal; Spinal muscular atrophy juvenile
form, type
Motor neuron disease; Familial motor neuron disease;
AmyotrophicLateral sclerosis; Primary Lateral sclerosis ;
Progressive bulbar palsy; Progressive spinal muscular
atrophy
G12.9
Spinal muscular atrophy, unspecified

NERVOUS SYSTEM
10,400
3,120
7,280
G20
PARKINSON'S DISEASE; HEMIPARKINSONISM; PARALYSIS

AGITANS; PARKINSONISM OR PARKINSON'S DISEASE NOS;
IDIOPATHIC PARKINSONISM OR PARKINSON'S DISEASE;
PRIMARY PARKINSONISM OR PARKINSON'S DISEASE

NERVOUS SYSTEM
10,400
3,120
7,280
SYSTEMIC LUPUS ERYTHEMATOSUS

TETANUS
TETANUS
TETANUS
TETANUS
THALASSEMIA
11,900
11,900
11,900
11,900
11,900
11,900
16,500
16,500
16,500
16,500
5,600
3,570
3,570
3,570
3,570
3,570
3,570
4,950
4,950
4,950
4,950
1,680
8,330
8,330
8,330
8,330
8,330
8,330
11,550
11,550
11,550
11,550
3,920
5,600
1,680
3,920
THALASSEMIA
THALASSEMIA
THALASSEMIA
THALASSEMIA
TOXIC EPIDERMAL NECROLYSIS
TRANSIENT CEREBRAL ISCHEMIC ATTACKS
5,600
5,600
5,600
5,600
15,900
7,300
7,300
7,300
7,300
7,300
1,680
1,680
1,680
1,680
4,770
2,190
2,190
2,190
2,190
2,190
3,920
3,920
3,920
3,920
11,130
5,110
5,110
5,110
5,110
5,110
7,300
2,190
5,110
7,300
2,190
5,110
TRAUMA RELATED TO BIRTH PROCESS
13,800
4,140
9,660

13,800
13,800
13,800
13,800
4,140
4,140
4,140
4,140
9,660
9,660
9,660
9,660
13,800
4,140
9,660

13,800
13,800
13,800
13,800
13,800
13,800
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
4,140
4,140
4,140
4,140
4,140
4,140
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
L93.0
L93.1
L93.2
M32.0
M32.8
M32.9
A33
A34
A35
R29.0
D56.0
D56.1
D56.2
D56.3
D56.4
D56.8
L51.2
G45.0
G45.1
G45.2
G45.3
G45.4
G45.8
G45.9
P10.0
P10.1
P10.2
P10.3
P10.4
P10.9
P11.1
P11.2
P11.9
P12.0
P12.3
P12.8
P12.9
P13.2
P13.4
P13.8
P13.9
P14.0
P14.3
Discoid lupus erythematosus; Lupus erythematosus

Subacute cutaneous lupus erythematosus
Lupus erymatosus profundus; Lupus panniculitis
Drug-induced systemic lupus erythematosus
Other forms of systemic lupus erythematosus
Systemic lupus erythematosus, unspecified
Tetanus neonatorum
Obstetrical tetanus
Other tetanus; Tetanus NOS
Tetany; Carpopedal spasm
Alpha thalassaemia
Beta thalassaemia; Cooley's anaemia; Severe beta
thalassaemia; Thalassaemia intermedia; Thalassaemia
major;
Delta-beta thalassaemia
Thalassaemia trait
Hereditary persistence of fetal haemoglobin [HPFH]
Other thalassaemias
Toxic epidermal necrolysis [Lyell]
Vertebro-basilar artery syndrome
Hemispheric carotid artery syndrome
Multiple and bilateral precerebral artery syndromes
Amaurosis fugax
Transient global amnesia
Other transient cerebral ischaemic attacks and related
syndromes
Transient cerebral ischaemic attack, unspecified; Spasm of
cerebral artery; Transient cerebral ischaemia NOS
Subdural haemorrhage due to birth injury; Subdural
haematoma (localized) due to birth injury
Cerebral haemorrhage due to birth injury
Intraventricular haemorrhage due to birth injury
Subarachnoid haemorrhage due to birth injury
Tentorial tear due to birth injury
Unspecified intracranial laceration and haemorrhage due to
birth injury
Other specified brain damage due to birth injury
Unspecified brain damage due to birth injury
Birth injury to central nervous system, unspecified
Cephalhaematoma due to birth injury
Bruising of scalp due to birth injury
Other birth injuries to scalp
Birth injury to scalp, unspecified
Birth injury to femur
Fracture of clavicle due to birth injury
Birth injuries to other parts of skeleton
Birth injury to skeleton, unspecified
Erb's paralysis due to birth injury
Other brachial plexus birth injuries
THALASSEMIA
Page 107 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
P15.4
Birth injury to face; Facial congestion due to birth injury
13,800
4,140
9,660
P15.5
P15.8
P15.9
Birth injury to external genitalia

Other specified birth injuries
Birth injury, unspecified
Tuberculosis of intrathoracic lymph nodes, confirmed
bacteriologically & histologicaly; Tuberculosis of hilar
lymph nodes, confirmed bacteriologically & histologicaly;
Tuberculosis of mediastinal, lymph nodes, confirmed
bacteriologically & histologicaly;
Tuberculosis of larynx, trachea and bronchus, confirmed
bacteriologically
and histologically ; Tuberculosis of bronchus,confirmed
bacteriologically and histologically; Tuberculosis of glottis,
confirmed bacteriologically and histologically; Tuberculo

13,800
13,800
13,800
4,140
4,140
4,140
9,660
9,660
9,660
TUBERCULOSIS, EXTRAPULMONARY
11,900
3,570
8,330
11,900
3,570
8,330
11,900
3,570
8,330
11,900
3,570
8,330
A16.3
Tuberculosis of intrathoracic lymph nodes, without

mention of bacteriological or histological confirmation;
Tuberculosis of hilar lymph nodes NOS without mention of TUBERCULOSIS, EXTRAPULMONARY
bacteriological or histological confirmation; Tuberculosis of
intrathoracic lymph nodes,
11,900
3,570
8,330
A16.4
Tuberculosis of bronchus, NOS, without mention of

bacteriological or histological onfirmation; Tuberculosis of
glottis, NOS, without mention of bacteriological or
histological onfirmation; Tuberculosis of larynx, NOS,
without mention of bacteriologic
11,900
3,570
8,330
11,900
3,570
8,330
11,900
3,570
8,330
A15.4
A15.5
A15.6
A15.8
A16.5
A16.8
Tuberculous pleurisy, confirmed bacteriologically and

histologically
[Tuberculosis of pleura, confirmed bacteriologically and
histologically; Tuberculous empyema, confirmed
bacteriologically & histologically
Other respiratory tuberculosis, confirmed bacteriologically
and histologically; Mediastinal tuberculosis, confirmed
bacteriologically and histologically; Nasopharyngeal
tuberculosis, confirmed bacteriologically and histologically;
Tuberculosis of nose,
Tuberculous pleurisy, without mention of bacteriological or

histological
confirmation; Tuberculosis of pleura, NOS, without
mention of bacteriological or histological confirmation;
Tuberculous empyema, NOS, without mention of
bacteriological or his
Other respiratory tuberculosis, without mention of
bacteriological or histological confirmation; Mediastinal
tuberculosis, NOS without mention of bacteriological or
histological confirmation; Nasopharyngeal tuberculosis,
NOS without mention of bacteriolog
A18.2
Tuberculous peripheral lymphadenopathy; Tuberculous

adenitis
11,900
3,570
8,330
A18.3
Tuberculosis of intestines, peritoneum and mesenteric

glands; Tuberculosis of retroperitoneal lymph nodes
11,900
3,570
8,330
11,900
3,570
8,330
TUBERCULOSIS, MILIARY
15,100
15,100
15,100
15,100
15,100
4,530
4,530
4,530
4,530
4,530
10,570
10,570
10,570
10,570
10,570
A18.4
A19.0
A19.1
A19.2
A19.8
A19.9
Erythema tuberculous induratum, ; Lupus exedens; Lupus

vulgaris; Lupus exedens, NOS; Lupus vulgaris, NOS;
Scrofuloderma
Acute miliary tuberculosis of a single specified site
Acute miliary tuberculosis of multiple sites
Acute miliary tuberculosis, unspecified
Other miliary tuberculosis
Miliary tuberculosis
A15.0
Tuberculosis of lung, confirmed by sputum microscopy

with or without culture; Tuberculous Bronchiectasis,
confirmed by sputum microscopy with or without culture;
Tuberculous fibrosis of lung, confirmed by sputum
microscopy with or without culture; Tubercu
TUBERCULOSIS, PULMONARY
9,800
2,940
6,860
A15.1
Tuberculosis of lung, confirmed by culture only;

Tuberculous Bronchiectasis, confirmed by culture only;
Tuberculous fibrosis of lung, confirmed by culture only;
Tuberculous pneumonia, confirmed by culture only;
Tuberculous pneumothorax, confirmed by cul
9,800
2,940
6,860
A15.2
Tuberculosis of lung, confirmed histologically only;

Tuberculous Bronchiectasis, confirmed histologically only;
Tuberculous fibrosis of lung, confirmed histologically only; TUBERCULOSIS, PULMONARY
Tuberculous pneumonia, confirmed histologically only;
Tuberculous pneumothorax
9,800
2,940
6,860
Page 108 of 112

FIRST CASE RATE
ICD CODE
A15.3
A15.7
A15.9
A16.0
A16.1
A16.2
DESCRIPTION
Tuberculosis of lung, confirmed by unspecified means;
Tuberculous Bronchiectasis, confirmed but unspecified
whether bacteriologically or histologically; Tuberculous
fibrosis of lung, confirmed but unspecified whether
bacteriologically or histologically
Primary respiratory tuberculosis, confirmed
bacteriologically and histologically
Respiratory tuberculosis unspecified, confirmed
bacteriologically and histologically
Tuberculosis of lung, bacteriologically and histologically
negative;
Tuberculous Bronchiectasis , bacteriologically and
histologically negative; Tuberculous fibrosis of lung,
bacteriologically and histologically negative; Tuberculous
pneumonia, bac
Tuberculosis of lung, bacteriological and histological
examination not done; Tuberculous Bronchiectasis,
bacteriological and histological examination not done;
Tuberculous fibrosis of lung, bacteriological and histological
examination not done; Tuberculo
Tuberculosis of lung, NOS, without mention of
bacteriological or histological confirmation; Tuberculous
bronchiectasis, NOS, without mention of bacteriological or
histological confirmation; Tuberculous fibrosis of lung,
NOS, without mention of bact
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
9,800
2,940
6,860
9,800
2,940
6,860
9,800
2,940
6,860
9,800
2,940
6,860
9,800
2,940
6,860
9,800
2,940
6,860
Page 109 of 112

FIRST CASE RATE
ICD CODE
DESCRIPTION
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
A16.7
Primary respiratory tuberculosis without mention of

bacteriological or histological confirmation; Primary
respiratory tuberculosis NOS; Primary tuberculous
complex
9,800
2,940
6,860
A16.9
Respiratory tuberculosis unspecified, without mention of

bacteriological or histological confirmation; Respiratory
tuberculosis NOS; Tuberculosis NOS
9,800
2,940
6,860
TYPHOID FEVER
TYPHOID FEVER
TYPHOID FEVER
TYPHOID FEVER
10,000
10,000
10,000
10,000
3,000
3,000
3,000
3,000
7,000
7,000
7,000
7,000
TYPHOID FEVER
10,000
3,000
7,000
TYPHOID FEVER
TYPHOID FEVER
TYPHOID FEVER
TYPHOID FEVER
TYPHOID FEVER
10,000
10,000
10,000
10,000
10,000
3,000
3,000
3,000
3,000
3,000
7,000
7,000
7,000
7,000
7,000
URINARY TRACT ATROPHY/HYPERTROPHY
11,300
3,390
7,910

11,300
11,300
11,300
3,390
3,390
3,390
7,910
7,910
7,910
11,300
3,390
7,910
11,300
3,390
7,910
11,300
3,390
7,910
URINARY TRACT INFECTION [ADMISSIBLE]

VERTEBRAL DISC DISORDERS
7,500
7,500
7,500
7,500
7,500
7,500
7,800
7,800
7,800
7,800
2,250
2,250
2,250
2,250
2,250
2,250
2,340
2,340
2,340
2,340
5,250
5,250
5,250
5,250
5,250
5,250
5,460
5,460
5,460
5,460
7,800
2,340
5,460
A01.0
A01.1
A01.2
A01.3
7,800
2,340
5,460
M51.3
M51.4
Typhoid fever
Paratyphoid fever A
Paratyphoid fever B
Paratyphoid fever C
Paratyphoid fever, unspecified; Infection due to Salmonella
paratyphi NOS
Salmonella enteritis; Salmonellosis
Salmonella septicaemia
Localized salmonella infections
Other specified salmonella infections
Salmonella infection, unspecified
Unspecified contracted kidney; Atrophy of kidney
(terminal); Renal sclerosis NOS
Small kidney, unilateral
Small kidney, bilateral
Small kidney, unspecified
Other specified disorders of kidney and ureter;
Hypertrophy of kidney, Megaloureter, Nephroptosis,
Pyelitis cystica, Pyeloureteritis cystica, Ureteritis cystica,
Ureterocele
Disorder of kidney and ureter, unspecified; Nephropathy
NOS; Renal disease NOS
Other disorders of kidney and ureter in other diseases
Acute cystitis
Chronic Interstitial cystitis
Other chronic cystitis
Trigonitis; Urethrotrigonitis
Cystitis, unspecified
Urinary tract infection, site not specified
Cervical disc disorder with radiculopathy
Other cervical disc displacement
Other cervical disc degeneration
Other cervical VERTEBRAL DISC DISORDERS
LUMBAR AND OTHER INTERVERTEBRAL DISC DISORDERS
WITH RADICULOPATHY; SCIATICA DUE TO
INTERVERTEBRAL DISC DISORDER
Other specified intervertebral disc displacement
Lumbago due to displacement of intervertebral disc
Other specified intervertebral disc degenerations
Schmorl's node

7,800
7,800
2,340
2,340
5,460
5,460
M51.8
Other specified intervertebral VERTEBRAL DISC DISORDERS VERTEBRAL DISC DISORDERS
7,800
2,340
5,460
M99.0
M99.1
M99.3
M99.5
SEGMENTAL AND SOMATIC DYSFUNCTION, RIB CAGE

Subluxation complex (vertebral)
Osseous stenosis of neural canal
Intervertebral disc stenosis of neural canal
7,800
7,800
7,800
7,800
2,340
2,340
2,340
2,340
5,460
5,460
5,460
5,460
A01.4
A02.0
A02.1
A02.2
A02.8
A02.9
N26
N27.0
N27.1
N27.9
N28.8
N28.9
N29.8*
N30.0
N30.1
N30.2
N30.3
N30.9
N39.0
M50.1
M50.2
M50.3
M50.8
M51.1
M51.2

Page 110 of 112

FIRST CASE RATE
ICD CODE
M99.7
H81.0
H81.1
H81.2
H81.3
DESCRIPTION
Connective tissue and disc stenosis of intervertebral
foramina
Mnire's disease; Labyrinthine hydrops; Mnire's
syndrome or vertigo
Benign paroxysmal vertigo
Vestibular neuronitis
Other peripheral vertigo; Lermoyez' syndrome; Aural
Vertigo ; Otogenic Vertigo; Peripheral NOS Vertigo
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
7,800
2,340
5,460
VERTIGINOUS DISORDERS
5,700
1,710
3,990
5,700
5,700
1,710
1,710
3,990
3,990
5,700
1,710
3,990
H81.4
Vertigo of central origin; Central positional nystagmus
5,700
1,710
3,990
H81.8
Other disorders of vestibular function

Disorder of vestibular function, unspecified; Vertiginous
syndrome NOS
Labyrinthine fistula
5,700
1,710
3,990
5,700
1,710
3,990
5,700
1,710
3,990
H81.9
H83.1
H83.2
Labyrinthine dysfunction; Hypersensitivity of labyrinth;

Hypofunction of labyrinth; Loss of function Of labyrinth
5,700
1,710
3,990
R42
Dizziness and giddiness; Light-headedness; Vertigo NOS
5,700
1,710
3,990
A96.0
Junin haemorrhagic fever; Argentinian haemorrhagic fever VIRAL HEMORRHAGIC FEVER
7,900
2,370
5,530
A96.1
Machupo haemorrhagic fever; Bolivian haemorrhagic fever VIRAL HEMORRHAGIC FEVER
A98.4
A98.8
A99
B15.0
Ebola virus disease

Other specified viral haemorrhagic fevers
Unspecified viral haemorrhagic fever
ACUTE HEPATITIS A WITH HEPATIC COMA
ACUTE HEPATITIS A WITHOUT HEPATIC COMA; HEPATITIS A
(ACUTE)(VIRAL) NOS
ACUTE HEPATITIS B WITH DELTA-AGENT (COINFECTION)
WITH HEPATIC COMA
ACUTE HEPATITIS B WITH DELTA-AGENT (COINFECTION)
WITHOUT HEPATIC COMA
ACUTE HEPATITIS B WITHOUT DELTA-AGENT WITH
HEPATIC COMA
ACUTE HEPATITIS B WITHOUT DELTA-AGENT AND
WITHOUT HEPATIC COMA; HEPATITIS B (ACUTE)(VIRAL)
NOS
7,900
2,370
5,530
VIRAL HEMORRHAGIC FEVER

VIRAL HEPATITIS
7,900
7,900
7,900
11,800
2,370
2,370
2,370
3,540
5,530
5,530
5,530
8,260
VIRAL HEPATITIS
11,800
3,540
8,260
VIRAL HEPATITIS
11,800
3,540
8,260
VIRAL HEPATITIS
11,800
3,540
8,260
VIRAL HEPATITIS
11,800
3,540
8,260
VIRAL HEPATITIS
11,800
3,540
8,260
B17.0
ACUTE DELTA-(SUPER)INFECTION OF HEPATITIS B CARRIER VIRAL HEPATITIS
11,800
3,540
8,260
B17.1
B17.2
ACUTE HEPATITIS C
ACUTE HEPATITIS E
OTHER SPECIFIED ACUTE VIRAL HEPATITIS; HEPATITIS NONA NON-B (ACUTE)(VIRAL) NEC
CHRONIC VIRAL HEPATITIS B WITH DELTA-AGENT
CHRONIC VIRAL HEPATITIS B WITHOUT DELTA-AGENT;
CHRONIC (VIRAL) HEPATITIS B
CHRONIC VIRAL HEPATITIS C
OTHER CHRONIC VIRAL HEPATITIS
CHRONIC VIRAL HEPATITIS, UNSPECIFIED
UNSPECIFIED VIRAL HEPATITIS HEPATIC WITH COMA
UNSPECIFIED VIRAL HEPATITIS WITHOUT HEPATIC COMA;
VIRAL HEPATITIS NOS
VIRAL HEPATITIS
VIRAL HEPATITIS
11,800
11,800
3,540
3,540
8,260
8,260
VIRAL HEPATITIS
11,800
3,540
8,260
VIRAL HEPATITIS
11,800
3,540
8,260
VIRAL HEPATITIS
11,800
3,540
8,260
VIRAL HEPATITIS
VIRAL HEPATITIS
VIRAL HEPATITIS
VIRAL HEPATITIS
11,800
11,800
11,800
11,800
3,540
3,540
3,540
3,540
8,260
8,260
8,260
8,260
VIRAL HEPATITIS
11,800
3,540
8,260
A80.1
Acute paralytic poliomyelitis, wild virus, imported
VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM
21,100
6,330
14,770
A80.2
Acute paralytic poliomyelitis, wild virus, indigenous
21,100
6,330
14,770
B15.9
B16.0
B16.1
B16.2
B16.9
B17.8
B18.0
B18.1
B18.2
B18.8
B18.9
B19.0
B19.9
Page 111 of 112

FIRST CASE RATE
ICD CODE
A80.9
A81.0
A81.1
A81.2
DESCRIPTION
Acute poliomyelitis, unspecified
Creutzfeldt-Jakob disease; Subacute spongiform
encephalopathy
Subacute sclerosing panencephalitis; Dawson's inclusion
body encephalitis ; Van Bogaert's sclerosing
leukoencephalopathy
Progressive multifocal leukoencephalopathy; Multifocal
leukoencephalopathy NOS
GROUP
Case Rate
Professional
Fee
Health Care
Institution Fee
21,100
6,330
14,770
21,100
6,330
14,770
21,100
6,330
14,770
21,100
6,330
14,770
A81.9
Atypical virus infection of central nervous system,

unspecified; Prion disease of central nervous system NOS
21,100
6,330
14,770
A82.0
Sylvatic rabies
21,100
6,330
14,770
A82.1
Urban rabies
21,100
6,330
14,770
A82.9
Rabies, unspecified
21,100
6,330
14,770
A83.0
Japanese encephalitis
21,100
6,330
14,770
A83.2
Eastern equine encephalitis
21,100
6,330
14,770
A83.5
California encephalitis; California meningoencephalitis

La Crosse encephalitis
21,100
6,330
14,770
A83.8
Other mosquito-borne viral encephalitis
21,100
6,330
14,770
A83.9
Mosquito-borne viral encephalitis, unspecified
21,100
6,330
14,770
A85.2
Arthropod-borne viral encephalitis, unspecified;
21,100
6,330
14,770
A85.8
Other specified viral encephalitis; Encephalitis lethargic;

Von Economo-Cruchet disease
21,100
6,330
14,770
A86
Unspecified viral encephalitis; Viral encephalomyelitis NOS;

Viral meningoencephalitis NOS
21,100
6,330
14,770
A88.8
Other specified viral infections of central nervous system
21,100
6,330
14,770
A89
Unspecified viral infection of central nervous system
21,100
6,330
14,770
A37.0
A37.1
A37.8
A37.9
A20.0
A20.9
A21.0
A21.1
A21.2
A21.3
A21.9
WHOOPING COUGH
WHOOPING COUGH
WHOOPING COUGH
WHOOPING COUGH
ZOONOTIC BACTERIAL DISEASES
10,600
10,600
10,600
10,600
11,700
11,700
11,700
11,700
11,700
11,700
11,700
3,180
3,180
3,180
3,180
3,510
3,510
3,510
3,510
3,510
3,510
3,510
7,420
7,420
7,420
7,420
8,190
8,190
8,190
8,190
8,190
8,190
8,190
11,700
3,510
8,190
A22.2
A22.7
A22.9
A23.1
A23.9
Whooping cough due to Bordetella pertussis

Whooping cough due to Bordetella parapertussis
Whooping cough due to other Bordetella species
Whooping cough, unspecified
Bubonic plague
Plague, unspecified
Ulceroglandular tularaemia; Ophthalmic tularaemia
Oculoglandular tularaemia; Ophthalmic tularaemia
Pulmonary tularaemia
Gastrointestinal tularaemia; Abdominal tularaemia
Tularaemia, unspecified
Cutaneous anthrax; Malignant carbuncle; Malignant
pustule
Gastrointestinal anthrax
Anthrax septicaemia
Anthrax, unspecified
Brucellosis due to Brucella abortus
Brucellosis, unspecified

11,700
11,700
11,700
11,700
11,700
3,510
3,510
3,510
3,510
3,510
8,190
8,190
8,190
8,190
8,190
A24.0
Glanders; Infection due to Pseudomonas mallei; Malleus
11,700
3,510
8,190
11,700
3,510
8,190

11,700
11,700
11,700
11,700
11,700
3,510
3,510
3,510
3,510
3,510
8,190
8,190
8,190
8,190
8,190
11,700
3,510
8,190
11,700
3,510
8,190
A22.0
A24.1
A25.9
A26.8
A26.9
A28.0
A28.1
A28.8
A28.9
Acute and fulminating melioidosis; Melioidosis pneumonia

; Melioidosis septicaemia
Rat-bite fever, unspecified
Other forms of erysipeloid
Erysipeloid, unspecified
Pasteurellosis
Cat-scratch disease; Cat-scratch fever
Other specified zoonotic bacterial diseases, not elsewhere
classified
Zoonotic bacterial disease, unspecified
Page 112 of 112

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Philhealth Case Rates

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ANNEX 1.

LIST OF MEDICAL CASE RATES

Neonatal cerebral irritability

ABNORMAL SENSORIUM IN THE NEWBORN

Disturbance of cerebral status of newborn, unspecified

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

Peritonsillar abscess; Abscess of tonsil; Peritonsillar

Abscess of lung without pneumonia; Abscess of lung NOS

ABSCESS OF RESPIRATORY TRACT

ABSCESS OF RESPIRATORY TRACT

ABSCESS OF RESPIRATORY TRACT

Shigellosis due to Shigella flexneri;Group B shigellosis

Shigellosis due to Shigella boydii; Group C shigellosis

Shigellosis due to Shigella sonnei; Group D shigellosis

Other specified protozoal intestinal diseases; Intestinal

Viral intestinal infection, unspecified; Viral enteritis NOS;

Other specified intestinal infections

ANNEX 1. LIST OF MEDICAL CASE RATES

Acute renal failure with tubular necrosis; Tubular necrosis

ACUTE RENAL FAILURE

Acute renal failure with acute cortical necrosis; Cortical

ACUTE RENAL FAILURE

Acute renal failure with medullary necrosis; Medullary

Other acute renal failure

ACUTE RENAL FAILURE

Renal failure following abortion and ectopic and molar

Adult respiratory distress syndrome; Adult hyaline

ADULT RESPIRATORY DISTRESS SYNDROME

Other adverse food reactions, not elsewhere classified

Angioneurotic oedema; Giant urticaria; Quinke's oedema

Allergy, unspecified; Allergic reaction NOS; Hypersensitivity

Nutritional anaemia, unspecified; Simple chronic anaemia

Anaemia due to glucose-6-phosphate dehydrogenase

ANNEX 1. LIST OF MEDICAL CASE RATES

Sickle-cell anaemia with crisis; Hb-SS disease with crisis

Sickle-cell anaemia without crisis; Sickle-cell anaemia NOS;

Sickle-cell trait; Hb-S trait ; Heterozygous Haemoglobin S

Other sickle-cell disorders

Other haemoglobinopathies; Abnormal haemoglobin NOS;

Other specified hereditary haemolytic anaemias;

Drug-induced nonautoimmune haemolytic anaemia; DrugANEMIA

Other acquired haemolytic anaemias

Anaemia in other chronic diseases classified elsewhere

Hereditary sideroblastic anaemia; Sex-linked hypochromic

Secondary sideroblastic anaemia due to drugs and toxins

Other sideroblastic anaemias; Sideroblastic anaemia NOS;

ANNEX 1. LIST OF MEDICAL CASE RATES

Other specified anaemias; Infantile pseudoleukaemia;

Pneumococcal arthritis and polyarthritis, Site unspecified

Other streptococcal arthritis and polyarthritis, Site

Inflammatory polyarthropathy, pelvic region and thigh

Inflammatory polyarthropathy, site unspecified

Rheumatoid arthritis, unspecified, pelvic region and thigh

Rheumatoid arthritis, unspecified, lower leg

Juvenile rheumatoid arthritis; Juvenile rheumatoid arthritis

Juvenile rheumatoid arthritis; Juvenile rheumatoid arthritis

Juvenile ankylosing spondylitis site unspecified

Urate tophus of heart shoulder region