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Philhealth Case Rates

Philhealth case rates

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0% found this document useful (0 votes)

38 views112 pages

Philhealth Case Rates

Philhealth case rates

Uploaded by

MarieGabrielleLaguna-Bedia

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as PDF, TXT or read online on Scribd

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

ABNORMAL SENSORIUM IN THE 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

10,000

3,000

7,000

ABSCESS OF RESPIRATORY TRACT

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

ABSCESS OF RESPIRATORY TRACT

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]

ABSCESS OF RESPIRATORY TRACT

10,000
10,000

3,000
3,000

7,000
7,000

ABSCESS OF RESPIRATORY TRACT

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
ACUTE GASTROENTERITIS
ACUTE GASTROENTERITIS

6,000
6,000
6,000

1,800
1,800
1,800

4,200
4,200
4,200

ACUTE GASTROENTERITIS

6,000

1,800

4,200

ACUTE GASTROENTERITIS

6,000

1,800

4,200

Shigellosis due to Shigella boydii; Group C shigellosis

ACUTE GASTROENTERITIS

6,000

1,800

4,200

A03.3

Shigellosis due to Shigella sonnei; Group D shigellosis

ACUTE GASTROENTERITIS

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

ACUTE GASTROENTERITIS
ACUTE GASTROENTERITIS
ACUTE GASTROENTERITIS
ACUTE GASTROENTERITIS
ACUTE GASTROENTERITIS
ACUTE GASTROENTERITIS
ACUTE GASTROENTERITIS
ACUTE GASTROENTERITIS
ACUTE GASTROENTERITIS

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

ACUTE GASTROENTERITIS

6,000

1,800

4,200

ACUTE GASTROENTERITIS

6,000

1,800

4,200

ACUTE GASTROENTERITIS

6,000

1,800

4,200

ACUTE GASTROENTERITIS

6,000

1,800

4,200

ACUTE GASTROENTERITIS

6,000

1,800

4,200

ACUTE GASTROENTERITIS
ACUTE GASTROENTERITIS
ACUTE GASTROENTERITIS
ACUTE GASTROENTERITIS
ACUTE GASTROENTERITIS
ACUTE GASTROENTERITIS
ACUTE GASTROENTERITIS

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

ACUTE GASTROENTERITIS

6,000

1,800

4,200

ACUTE GASTROENTERITIS

6,000

1,800

4,200

ACUTE GASTROENTERITIS

6,000

1,800

4,200

ACUTE GASTROENTERITIS

6,000

1,800

4,200

ACUTE GASTROENTERITIS

6,000

1,800

4,200

ACUTE GASTROENTERITIS
ACUTE GASTROENTERITIS

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

ACUTE GASTROENTERITIS

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

ACUTE GASTROENTERITIS
ACUTE GASTROENTERITIS
ACUTE GASTROENTERITIS
ACUTE GASTROENTERITIS
ACUTE GASTROENTERITIS

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

ACUTE GASTROENTERITIS

6,000

1,800

4,200

ACUTE GASTROENTERITIS

6,000

1,800

4,200

ACUTE GASTROENTERITIS

6,000

1,800

4,200

ACUTE GASTROENTERITIS

5,790

13,510

N17.8
N17.9

Other acute renal failure

Acute renal failure, unspecified;

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
AMOEBIASIS, NONHEPATIC
Amoebic nondysenteric colitis
AMOEBIASIS, NONHEPATIC
Amoeboma of intestine; Amoeboma NOS
AMOEBIASIS, NONHEPATIC
Cutaneous amoebiasis
AMOEBIASIS, NONHEPATIC
Amoebic Appendicitis
AMOEBIASIS, NONHEPATIC
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

ANNEX 1. LIST OF MEDICAL CASE RATES

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

ANNEX 1. LIST OF MEDICAL CASE RATES

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

ARTHRITIS INFECTIOUS

9,700

2,910

6,790

ARTHRITIS INFECTIOUS

9,700

2,910

6,790

ARTHRITIS INFECTIOUS

9,700

2,910

6,790

ARTHRITIS INFECTIOUS

9,700

2,910

6,790

ARTHRITIS INFECTIOUS

9,700

2,910

6,790

ARTHRITIS INFECTIOUS

9,700

2,910

6,790

ARTHRITIS INFECTIOUS

9,700

2,910

6,790

ARTHRITIS INFECTIOUS

9,700

2,910

6,790

ARTHRITIS INFECTIOUS

9,700

2,910

6,790

ARTHRITIS INFECTIOUS

9,700

2,910

6,790

ARTHRITIS INFECTIOUS

9,700

2,910

6,790

ARTHRITIS INFECTIOUS

9,700

2,910

6,790

ARTHRITIS INFECTIOUS
ARTHRITIS INFECTIOUS

9,700
9,700

2,910
2,910

6,790
6,790

ARTHRITIS INFECTIOUS

9,700

2,910

6,790

ARTHRITIS NONINFECTIOUS

7,000

2,100

4,900

ARTHRITIS NONINFECTIOUS

7,000

2,100

4,900

ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS

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
Pyogenic arthritis, unspecified; Infective arthritis NOS
shoulder region
Pyogenic arthritis, unspecified; Infective arthritis NOS
forearm
Pyogenic arthritis, unspecified; Infective arthritis NOS
hand
Pyogenic arthritis, unspecified; Infective arthritis NOS
pelvic region and thigh
Pyogenic arthritis, unspecified; Infective arthritis NOS
lower leg
Pyogenic arthritis, unspecified; Infective arthritis NOS
ankle and foot
Pyogenic arthritis, unspecified; Infective arthritis NOS
other sites
Pyogenic arthritis, unspecified; Infective arthritis NOS
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

ARTHRITIS NONINFECTIOUS

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

ARTHRITIS NONINFECTIOUS

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

ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS

7,000
7,000
7,000
7,000

2,100
2,100
2,100
2,100

4,900
4,900
4,900
4,900

Idiopathic gout; Gouty bursitis; Primary gout lower leg

ARTHRITIS NONINFECTIOUS

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

ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS

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

ANNEX 1. LIST OF MEDICAL CASE RATES

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

ARTHRITIS NONINFECTIOUS

7,000

2,100

4,900

M10.36

Gout due to impairment of renal function lower leg

ARTHRITIS NONINFECTIOUS

7,000

2,100

4,900

M10.39

Gout due to impairment of renal function site unspecified

ARTHRITIS NONINFECTIOUS

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

ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS

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

ARTHRITIS NONINFECTIOUS

7,000

2,100

4,900

ARTHRITIS NONINFECTIOUS

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

ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS

7,000
7,000
7,000
7,000
7,000
7,000
7,000

2,100
2,100
2,100
2,100
2,100
2,100
2,100

4,900
4,900
4,900
4,900
4,900
4,900
4,900

M13.17

Monoarthritis, not elsewhere classified ankle and foot

ARTHRITIS NONINFECTIOUS

7,000

2,100

4,900

M13.18

Monoarthritis, not elsewhere classified other sites

ARTHRITIS NONINFECTIOUS

7,000

2,100

4,900

M13.80

Other specified arthritis; Allergic arthritis multiple sites

ARTHRITIS NONINFECTIOUS

7,000

2,100

4,900

M13.81

Other specified arthritis; Allergic arthritis shoulder region

ARTHRITIS NONINFECTIOUS

7,000

2,100

4,900

7,000

2,100

4,900

7,000

2,100

4,900

ARTHRITIS NONINFECTIOUS

7,000

2,100

4,900

M13.92
M13.93
M13.94

ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS

7,000
7,000
7,000

2,100
2,100
2,100

4,900
4,900
4,900

ARTHRITIS NONINFECTIOUS

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

ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS
ARTHRITIS NONINFECTIOUS

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

ARTHRITIS NONINFECTIOUS

7,000

2,100

4,900

ARTHROPOD BORNE VIRAL FEVER

8,100

2,430

5,670

ARTHROPOD BORNE VIRAL FEVER

8,100

2,430

5,670

A92.2

Venezuelan equine fever; Venezuelan equine encephalitis;

ARTHROPOD BORNE VIRAL FEVER
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

ARTHROPOD BORNE VIRAL 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]

ARTHROPOD BORNE VIRAL 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

ANNEX 1. LIST OF MEDICAL CASE RATES

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 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
Primary arthrosis of other joints; Primary arthrosis
NOSupper arm
Primary arthrosis of other joints; Primary arthrosis
NOSpelvic region and thigh
Primary arthrosis of other joints; Primary arthrosis
NOSlower leg
Primary arthrosis of other joints; Primary arthrosis
NOSother sites
Primary arthrosis of other joints; Primary arthrosis NOSsite
unspecified
Post-traumatic arthrosis of other joints; Post-traumatic
arthrosis NOS multiple sites
Post-traumatic arthrosis of other joints; Post-traumatic
arthrosis NOS shoulder region
Post-traumatic arthrosis of other joints; Post-traumatic
arthrosis NOS upper arm
Post-traumatic arthrosis of other joints; Post-traumatic
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

ASTHMA IN ACUTE EXACERBATION

9,000

2,700

6,300

ASTHMA IN ACUTE EXACERBATION

ASTHMA IN ACUTE EXACERBATION
ASTHMA IN ACUTE EXACERBATION

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

BACK PAIN, RADICULOPATHY, SCIATICA

6,400

1,920

4,480

BACK PAIN, RADICULOPATHY, SCIATICA

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

ANNEX 1. LIST OF MEDICAL CASE RATES

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;

M54.14

M54.15

M54.16

BACK PAIN, RADICULOPATHY, SCIATICA

6,400

1,920

4,480

M54.98

Dorsalgia, unspecified; Backache NOS sacral and

sacrococcygeal region

BACK PAIN, RADICULOPATHY, SCIATICA

6,400

1,920

4,480

M54.99

Dorsalgia, unspecified; Backache NOS site unspecified

BACK PAIN, RADICULOPATHY, SCIATICA

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

ANNEX 1. LIST OF MEDICAL CASE RATES

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

ANNEX 1. LIST OF MEDICAL CASE RATES

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
Burns involving 20-29% of body surface
Burns involving 30-39% of body surface
Burns involving 40-49% of body surface
Burns involving 50-59% of body surface
Corrosions involving 20-29% of body surface
Corrosions involving 30-39% of body surface
Corrosions involving 40-49% of body surface

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 60-69% of body surface
Burns involving 70-79% of body surface
Burns involving 80-89% of body surface
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

ANNEX 1. LIST OF MEDICAL CASE RATES

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
CARDIOVASCULAR COMPLICATIONS IN THE
NEWBORN
CARDIOVASCULAR COMPLICATIONS IN THE
NEWBORN
CARDIOVASCULAR COMPLICATIONS IN THE
NEWBORN
CARDIOVASCULAR COMPLICATIONS IN THE
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

ANNEX 1. LIST OF MEDICAL CASE RATES

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
CHROMOSOMAL ABNORMALITIES
CHROMOSOMAL ABNORMALITIES
CHROMOSOMAL ABNORMALITIES
CHROMOSOMAL ABNORMALITIES
CHROMOSOMAL ABNORMALITIES
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

CHROMOSOMAL ABNORMALITIES

12,700

3,810

8,890

CHROMOSOMAL ABNORMALITIES

12,700

3,810

8,890

CHROMOSOMAL ABNORMALITIES

12,700

3,810

8,890

CHROMOSOMAL ABNORMALITIES

12,700

3,810

8,890

CHROMOSOMAL ABNORMALITIES

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

CHROMOSOMAL ABNORMALITIES
CHROMOSOMAL ABNORMALITIES

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

CHROMOSOMAL ABNORMALITIES

12,700

3,810

8,890

CHROMOSOMAL ABNORMALITIES

12,700

3,810

8,890

CHROMOSOMAL ABNORMALITIES
CHROMOSOMAL ABNORMALITIES
CHROMOSOMAL ABNORMALITIES
CHRONIC KIDNEY DISEASE
CHRONIC KIDNEY DISEASE
CHRONIC KIDNEY DISEASE
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

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

12,200

3,660

8,540

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

12,200

3,660

8,540

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

12,200

3,660

8,540

7,800

2,340

5,460

CLEFT LIP AND PALATE

CLEFT LIP AND PALATE
CLEFT LIP AND PALATE
CLEFT LIP AND PALATE
CLEFT LIP AND PALATE
CLEFT LIP AND PALATE
CLEFT LIP AND PALATE
CLEFT LIP AND PALATE
CLEFT LIP AND PALATE
CLEFT LIP AND PALATE

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

CLEFT LIP AND PALATE
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

ANNEX 1. LIST OF MEDICAL CASE RATES

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

COMPLICATIONS OF BENIGN NEOPLASMS OF THE

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

COGNITIVE DYSFUNCTION
Other amnesia; Amnesia NOS
COGNITIVE DYSFUNCTION
Senility; Old age without mention of psychosis; Senescence
COGNITIVE DYSFUNCTION
without mention of psychosis; Senile asthenia; Senile
debility
COMPLICATIONS OF BENIGN NEOPLASMS OF
Benign neoplasm of thyroid gland
ENDOCRINE GLANDS
COMPLICATIONS OF BENIGN NEOPLASMS OF
Benign neoplasm of Adrenal gland
ENDOCRINE GLANDS
COMPLICATIONS OF BENIGN NEOPLASMS OF
Benign neoplasm of Parathyroid gland
ENDOCRINE GLANDS
COMPLICATIONS OF BENIGN NEOPLASMS OF
Benign neoplasm of Pituitary gland
ENDOCRINE GLANDS
COMPLICATIONS OF BENIGN NEOPLASMS OF
Benign neoplasm of Craniopharyngeal duct
ENDOCRINE GLANDS
COMPLICATIONS OF BENIGN NEOPLASMS OF
Benign neoplasm of Pineal gland
ENDOCRINE GLANDS
COMPLICATIONS OF BENIGN NEOPLASMS OF
Benign neoplasm of Endocrine gland, unspecified
ENDOCRINE GLANDS
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
Benign neoplasm of Scapula and long bones of upper limb
BONES
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
Benign neoplasm of Short bones of upper limb
BONES
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
Benign neoplasm ofLong bones of lower limb
BONES
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
Benign neoplasm of Short bones of lower limb
BONES
Benign neoplasm of Bones of skull and face; Benign
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
neoplasm of Superior Maxilla; Benign neoplasm of Orbital
BONES
bone
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
Benign neoplasm of Lower jaw bone
BONES
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
Benign neoplasm of Vertebral column
BONES
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
Benign neoplasm of Ribs, sternum and clavicle
BONES
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
Benign neoplasm of Pelvic bones, sacrum and coccyx
BONES
Benign neoplasm of Bone and articular cartilage,
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
unspecified
BONES
Benign neoplasm of Caecum;Benign neoplasm of
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
Ileocaecal valve
DIGESTIVE SYSTEM
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
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

COMPLICATIONS OF BENIGN NEOPLASMS OF THE

DIGESTIVE SYSTEM
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
DIGESTIVE SYSTEM

COMPLICATIONS OF BENIGN NEOPLASMS OF THE

DIGESTIVE SYSTEM
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
Benign neoplasm of Anus and anal canal
DIGESTIVE SYSTEM
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
Benign neoplasm of Oesophagus
DIGESTIVE SYSTEM
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
Benign neoplasm of Stomach
DIGESTIVE SYSTEM
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
Benign neoplasm of Duodenum
DIGESTIVE SYSTEM
Benign neoplasm of Other and unspecified parts of small
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
intestine
DIGESTIVE SYSTEM
Benign neoplasm of Liver; Benign neoplasm of Intrahepatic COMPLICATIONS OF BENIGN NEOPLASMS OF THE
bile ducts
DIGESTIVE SYSTEM
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
Benign neoplasm of Extrahepatic bile ducts
DIGESTIVE SYSTEM
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
Benign neoplasm of Pancreas
DIGESTIVE SYSTEM
Benign neoplasm of Endocrine pancreas; Benign neoplasm
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
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

COMPLICATIONS OF BENIGN NEOPLASMS OF THE
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

COMPLICATIONS OF BENIGN NEOPLASMS OF THE

DIGESTIVE SYSTEM

8,700

2,610

6,090

Page 12 of 112

ANNEX 1. LIST OF MEDICAL CASE RATES

FIRST CASE RATE
ICD CODE

DESCRIPTION

GROUP

Case Rate

Professional
Fee

Health Care
Institution Fee

D17.6

Benign lipomatous neoplasm of spermatic cord

COMPLICATIONS OF BENIGN NEOPLASMS OF THE

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

COMPLICATIONS OF BENIGN NEOPLASMS OF THE

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

NERVOUS SYSTEM

14,800

4,440

10,360

COMPLICATIONS OF BENIGN NEOPLASMS OF THE

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

COMPLICATIONS OF BENIGN NEOPLASMS OF THE

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

Page 13 of 112

ANNEX 1. LIST OF MEDICAL CASE RATES

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
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
ORAL CAVITY, PHARYNX, LARYNX, SALIVARY
GLANDS
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
ORAL CAVITY, PHARYNX, LARYNX, SALIVARY
GLANDS
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
ORAL CAVITY, PHARYNX, LARYNX, SALIVARY
GLANDS
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
ORAL CAVITY, PHARYNX, LARYNX, SALIVARY
GLANDS
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
ORAL CAVITY, PHARYNX, LARYNX, SALIVARY
GLANDS
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
ORAL CAVITY, PHARYNX, LARYNX, SALIVARY
GLANDS
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
ORAL CAVITY, PHARYNX, LARYNX, SALIVARY
GLANDS
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
ORAL CAVITY, PHARYNX, LARYNX, SALIVARY
GLANDS
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
URINARY SYSTEM
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
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

COMPLICATIONS OF BENIGN NEOPLASMS OF THE

URINARY SYSTEM
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
URINARY SYSTEM
COMPLICATIONS OF BENIGN NEOPLASMS OF THE
URINARY SYSTEM

I51.1

Rupture of chordae tendineae, not elsewhere classified

COMPLICATIONS OF HEART DISEASES

14,400

4,320

10,080

I51.2

Rupture of papillary muscle, not elsewhere classified

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

COMPLICATIONS OF SEXUALLY TRANSMITTED

DISEASES

5,500

1,650

3,850

A52.7

Other symptomatic late syphilis

COMPLICATIONS OF SEXUALLY TRANSMITTED

DISEASES

5,500

1,650

3,850

COMPLICATIONS OF HEMANGIOMA AND

Trichomoniasis

T79.0
T79.1
T79.2

Air embolism (traumatic)

Fat embolism (traumatic)
Traumatic secondary and recurrent haemorrhage

COMPLICATIONS OF SEXUALLY TRANSMITTED

DISEASES
COMPLICATIONS OF SEXUALLY TRANSMITTED
DISEASES
COMPLICATIONS OF TRAUMA
COMPLICATIONS OF TRAUMA
COMPLICATIONS OF TRAUMA

T79.3

Post-traumatic wound infection, not elsewhere classified

COMPLICATIONS OF TRAUMA

9,300

2,790

6,510

COMPLICATIONS OF TRAUMA

9,300

2,790

6,510

COMPLICATIONS OF TRAUMA

9,300

2,790

6,510

COMPLICATIONS OF TRAUMA

9,300

2,790

6,510

COMPLICATIONS OF TRAUMA
COMPLICATIONS OF TRAUMA

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
CONGENITAL DERMATOLOGIC DISEASES
CONGENITAL DERMATOLOGIC DISEASES
CONGENITAL DERMATOLOGIC DISEASES
CONGENITAL DERMATOLOGIC DISEASES
CONGENITAL DERMATOLOGIC DISEASES
CONGENITAL DERMATOLOGIC DISEASES
CONGENITAL DERMATOLOGIC DISEASES
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

CONGENITAL DERMATOLOGIC DISEASES

11,800

3,540

8,260

CONGENITAL DERMATOLOGIC DISEASES

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

CONGENITAL DISORDERS OF THE FEMALE GENITAL

TRACT
CONGENITAL DISORDERS OF THE FEMALE GENITAL
TRACT
CONGENITAL DISORDERS OF THE FEMALE GENITAL
TRACT
CONGENITAL DISORDERS OF THE FEMALE GENITAL
TRACT
CONGENITAL DISORDERS OF THE FEMALE GENITAL
TRACT
CONGENITAL DISORDERS OF THE
MUSCULOSKELETAL SYSTEM
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

ANNEX 1. LIST OF MEDICAL CASE RATES

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
CONGENITAL DISORDERS OF THE
MUSCULOSKELETAL SYSTEM
CONGENITAL DISORDERS OF THE
MUSCULOSKELETAL SYSTEM

Case Rate

Professional
Fee

Health Care
Institution Fee

5,300

1,590

3,710

5,300

1,590

3,710

CONGENITAL DISORDERS OF THE

MUSCULOSKELETAL SYSTEM

5,300

1,590

3,710

CONGENITAL DISORDERS OF THE

MUSCULOSKELETAL SYSTEM

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

11,300

3,390

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

CONGENITAL GASTROINTESTINAL DISORDERS

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

CONGENITAL GASTROINTESTINAL DISORDERS

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

CONGENITAL GASTROINTESTINAL DISORDERS

CONGENITAL GASTROINTESTINAL DISORDERS
CONGENITAL GASTROINTESTINAL DISORDERS
CONGENITAL GASTROINTESTINAL DISORDERS

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

ANNEX 1. LIST OF MEDICAL CASE RATES

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

CONGENITAL GASTROINTESTINAL DISORDERS

11,300

3,390

7,910

Congenital malformation of intestine, unspecified

CONGENITAL GASTROINTESTINAL DISORDERS
Agenesis, aplasia and hypoplasia of gallbladder; Congenital
CONGENITAL GASTROINTESTINAL DISORDERS
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

CONGENITAL GASTROINTESTINAL DISORDERS

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

CONGENITAL GASTROINTESTINAL DISORDERS

CONGENITAL GASTROINTESTINAL DISORDERS
CONGENITAL GASTROINTESTINAL DISORDERS

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

CONGENITAL GASTROINTESTINAL DISORDERS

11,300

3,390

7,910

CONGENITAL GASTROINTESTINAL DISORDERS

11,300

3,390

7,910

CONGENITAL GASTROINTESTINAL DISORDERS

11,300

3,390

7,910

CONGENITAL GASTROINTESTINAL DISORDERS

11,300

3,390

7,910

CONGENITAL GASTROINTESTINAL DISORDERS

8,120
8,120
8,120
8,120

CONGENITAL HEART DISEASES

11,600

3,480

8,120

CONGENITAL HEART DISEASES

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

ANNEX 1. LIST OF MEDICAL CASE RATES

FIRST CASE RATE
ICD CODE

DESCRIPTION

GROUP

Congenital mitral stenosis; Congenital mitral atresia

CONGENITAL HEART DISEASES
Congenital mitral insufficiency
CONGENITAL HEART DISEASES
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

CONGENITAL HEART DISEASES

11,600

3,480

8,120

CONGENITAL HEART DISEASES

CONGENITAL HEART DISEASES
CONGENITAL HEART DISEASES
CONGENITAL HEART DISEASES

11,600
11,600
11,600
11,600

3,480
3,480
3,480
3,480

8,120
8,120
8,120
8,120

CONGENITAL HEART DISEASES

11,600

3,480

8,120

CONGENITAL HEART DISEASES

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

CONGENITAL HEART DISEASES

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

CONGENITAL HEART DISEASES

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

CONGENITAL HEART DISEASES

11,600

3,480

8,120

Q25.8

Other congenital malformations of great arteries

CONGENITAL HEART DISEASES

11,600

3,480

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

CONGENITAL HEART DISEASES

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
CONGENITAL HEART DISEASES
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

CONGENITAL HYPOTHYROIDISM

9,900

2,970

6,930

CONGENITAL HYPOTHYROIDISM

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 HEART DISEASES

CONGENITAL MALFORMATIONS OF THE

Page 18 of 112

ANNEX 1. LIST OF MEDICAL CASE RATES

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
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM

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

CONGENITAL MALFORMATIONS OF THE

BRAIN/NERVOUS SYSTEM

13,000

3,900

9,100

CONGENITAL MALFORMATIONS OF THE

BRAIN/NERVOUS SYSTEM

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

CONGENITAL MALFORMATIONS OF THE

BRAIN/NERVOUS SYSTEM
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM
CONGENITAL MALFORMATIONS OF THE
BRAIN/NERVOUS SYSTEM

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 MALFORMATIONS OF THE
Congenital deformity NOS of spinal cord or meninges;
BRAIN/NERVOUS SYSTEM
Congenital disease or lesion NOS of spinal cord or meninges

13,000

3,900

9,100

Q07.0

Arnold-Chiari syndrome

CONGENITAL MALFORMATIONS OF THE

BRAIN/NERVOUS SYSTEM

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

CONGENITAL MALFORMATIONS OF THE

BRAIN/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

CONGENITAL MALFORMATIONS OF THE

BRAIN/NERVOUS SYSTEM

13,000

3,900

9,100

CONGENITAL MALFORMATIONS OF THE

BRAIN/NERVOUS SYSTEM

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

CONGENITAL MALFORMATIONS OF THE

Q76.0

Spina bifida occulta

CONGENITAL MALFORMATIONS OF THE

BRAIN/NERVOUS SYSTEM

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

CONGENITAL MALFORMATIONS OF THE

BRAIN/NERVOUS SYSTEM

13,000

3,900

9,100

Page 19 of 112

ANNEX 1. LIST OF MEDICAL CASE RATES

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 MALFORMATIONS OF THE LOWER
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

CONGENITAL MALFORMATIONS OF THE LOWER

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

CONGENITAL OPHTHALMOLOGIC DISORDERS

4,300

1,290

3,010

CONGENITAL OPHTHALMOLOGIC DISORDERS

4,300

1,290

3,010

anomaly NOS of eye; Congenital deformity NOS of eye

CONGENITAL OPHTHALMOLOGIC DISORDERS

4,300

1,290

3,010

CONGENITAL RENAL DISORDERS

CONGENITAL RENAL DISORDERS
CONGENITAL RENAL DISORDERS
CONGENITAL RENAL DISORDERS
CONGENITAL RENAL DISORDERS
CONGENITAL RENAL DISORDERS
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

CONGENITAL RENAL DISORDERS

9,100

2,730

6,370

CONGENITAL RENAL DISORDERS

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

CONGENITAL MALFORMATIONS OF THE LOWER

RESPIRATORY TRACT
CONGENITAL MALFORMATIONS OF THE LOWER
RESPIRATORY TRACT
CONGENITAL MALFORMATIONS OF THE LOWER
RESPIRATORY TRACT
CONGENITAL MALFORMATIONS OF THE LOWER
RESPIRATORY TRACT
CONGENITAL MALFORMATIONS OF THE LOWER
RESPIRATORY TRACT
CONGENITAL MALFORMATIONS OF THE LOWER
RESPIRATORY TRACT
CONGENITAL MALFORMATIONS OF THE LOWER
RESPIRATORY TRACT

CONGENITAL MALFORMATIONS OF THE NOSE,

UPPER RESPIRATORY TRACT
CONGENITAL MALFORMATIONS OF THE NOSE,
UPPER RESPIRATORY TRACT
CONGENITAL MALFORMATIONS OF THE NOSE,
UPPER RESPIRATORY TRACT
CONGENITAL MALFORMATIONS OF THE NOSE,
UPPER RESPIRATORY TRACT
CONGENITAL MALFORMATIONS OF THE NOSE,
UPPER RESPIRATORY TRACT
CONGENITAL MALFORMATIONS OF THE NOSE,
UPPER RESPIRATORY TRACT
CONGENITAL MALFORMATIONS OF THE ORAL
CAVITY
CONGENITAL MALFORMATIONS OF THE ORAL
CAVITY
CONGENITAL MALFORMATIONS OF THE ORAL
CAVITY
CONGENITAL MALFORMATIONS OF THE ORAL
CAVITY
CONGENITAL OPHTHALMOLOGIC DISORDERS
CONGENITAL OPHTHALMOLOGIC DISORDERS

Page 20 of 112

ANNEX 1. LIST OF MEDICAL CASE RATES

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

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

CONGENITAL URINARY TRACT DISORDERS

9,100

2,730

6,370

Q62.3

Other obstructive defects of renal pelvis and ureter;

Congenital ureterocele

CONGENITAL URINARY TRACT DISORDERS

9,100

2,730

6,370

Q62.5

Duplication of ureter; Accessory of ureter, Double of ureter CONGENITAL URINARY TRACT DISORDERS

Other congenital malformations of bladder and urethra;

Accessory bladder; Accessory urethra; Congenital hernia of
bladder; Congenital malformation of bladder or urethra
CONGENITAL URINARY TRACT DISORDERS
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)

12,000

3,600

8,400

CONGENITAL URINARY TRACT DISORDERS

Page 21 of 112

ANNEX 1. LIST OF MEDICAL CASE RATES

FIRST CASE RATE
ICD CODE

Q28.2

DESCRIPTION

GROUP

Arteriovenous malformation of cerebral vessels;

Arteriovenous malformation of brain NOS;
CONGENITAL VASCULAR DISEASES
Congenital arteriovenous cerebral aneurysm (nonruptured)

Case Rate

Professional
Fee

Health Care
Institution Fee

CONNECTIVE TISSUE DISEASES
CONNECTIVE TISSUE DISEASES
CONNECTIVE TISSUE DISEASES
CONNECTIVE TISSUE DISEASES
CONNECTIVE TISSUE DISEASES

13,800
13,800
13,800
13,800
13,800
13,800

4,140
4,140
4,140
4,140
4,140
4,140

CONNECTIVE TISSUE DISEASES
CONNECTIVE TISSUE DISEASES

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

CONNECTIVE TISSUE DISEASES

13,800

4,140

9,660

CONNECTIVE TISSUE DISEASES

13,800

4,140

9,660

CRANIAL NERVE DISORDER

7,400

2,220

5,180

CRANIAL NERVE DISORDER

CRANIAL NERVE DISORDER
CRANIAL NERVE DISORDER
CRANIAL NERVE DISORDER
CRANIAL NERVE DISORDER
CRANIAL NERVE DISORDER
CRANIAL NERVE DISORDER

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

CRANIAL NERVE DISORDER

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 DISORDER
cranial nerve; Glossopharyngeal neuralgia
Disorders of vagus nerve; Disorder of pneumogastric [10th]
CRANIAL NERVE DISORDER
nerve

7,400

2,220

5,180

G52.7

Disorders of multiple cranial nerves; Polyneuritis cranialis

CRANIAL NERVE DISORDER

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

ANNEX 1. LIST OF MEDICAL CASE RATES

FIRST CASE RATE
ICD CODE

DESCRIPTION

GROUP
DEGENERATIVE DISEASES OF CENTRAL NERVOUS
SYSTEM
DEGENERATIVE DISEASES OF CENTRAL NERVOUS
SYSTEM
DEGENERATIVE DISEASES OF CENTRAL NERVOUS
SYSTEM
DEGENERATIVE DISEASES OF CENTRAL NERVOUS
SYSTEM
DEGENERATIVE DISEASES OF CENTRAL NERVOUS
SYSTEM
DEGENERATIVE DISEASES OF CENTRAL NERVOUS
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;
DEGENERATIVE DISEASES OF CENTRAL NERVOUS
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

DEGENERATIVE DISEASES OF CENTRAL NERVOUS

SYSTEM

10,000

3,000

7,000

DEGENERATIVE DISEASES OF CENTRAL NERVOUS

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

DIABETES MELLITUS WITH COMA OR KETOSIS

15,800

4,740

11,060

DIABETES MELLITUS WITH COMA OR KETOSIS

15,800

4,740

11,060

DEMYELINATING DISEASE OF CENTRAL NERVOUS

SYSTEM
DEMYELINATING DISEASE OF CENTRAL NERVOUS
SYSTEM
DEMYELINATING DISEASE OF CENTRAL NERVOUS
SYSTEM
DEMYELINATING DISEASE OF CENTRAL NERVOUS
SYSTEM
DEMYELINATING DISEASE OF CENTRAL NERVOUS
SYSTEM
DEMYELINATING DISEASE OF CENTRAL NERVOUS
SYSTEM
DEMYELINATING DISEASE OF CENTRAL NERVOUS
SYSTEM
DEMYELINATING DISEASE OF CENTRAL NERVOUS
SYSTEM
DEMYELINATING DISEASE OF CENTRAL NERVOUS
SYSTEM
DEMYELINATING DISEASE OF CENTRAL NERVOUS
SYSTEM
DEMYELINATING DISEASE OF CENTRAL NERVOUS
SYSTEM
DENGUE FEVER
DENGUE FEVER
DENGUE, SEVERE
DIABETES INSIPIDUS
DIABETES INSIPIDUS

DIABETES MELLITUS WITH COMA OR KETOSIS

Insulin-dependent diabetes mellitus with acididosis/

ketoacidosis without mention of coma; Diabetic acididosis
DIABETES MELLITUS WITH COMA OR KETOSIS
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
DIABETES MELLITUS WITH COMA OR KETOSIS
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 COMA OR KETOSIS
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

ANNEX 1. LIST OF MEDICAL CASE RATES

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

DIABETES MELLITUS WITH COMA OR KETOSIS

15,800

4,740

11,060

DIABETES MELLITUS WITH COMA OR KETOSIS

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

OTHER THAN COMA AND KETOSIS

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;

DIABETES MELLITUS WITH COMPLICATIONS

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

DISEASES OF BLOOD AND BLOOD FORMING

ORGANS

12,100

3,630

8,470

DISEASES OF BLOOD AND BLOOD FORMING

ORGANS

12,100

3,630

8,470

DISEASES OF BLOOD AND BLOOD FORMING

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

DISEASES OF BLOOD AND BLOOD FORMING

ORGANS
DISEASES OF BLOOD AND BLOOD FORMING
Abscess of spleen
ORGANS
DISEASES OF BLOOD AND BLOOD FORMING
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

ANNEX 1. LIST OF MEDICAL CASE RATES

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
DISEASES OF BLOOD AND BLOOD FORMING
ORGANS
DISEASES OF BLOOD AND BLOOD FORMING
ORGANS
DISEASES OF BLOOD AND BLOOD FORMING
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

DISEASES OF ESOPHAGUS

8,300

2,490

5,810

DISEASES OF ESOPHAGUS

DISEASES OF ORAL CAVITY, SALIVARY GLANDS,

AND JAW

8,300

2,490

5,810

Developmental (nonodontogenic) cysts of oral region; Cyst

DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
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
DISEASES OF BLOOD AND BLOOD FORMING
plasma volume; Acquired Polycythaemia due to high
ORGANS
altitude; Acquired Polycythaemia due to stress; Emotional
Polycythaemia; Hypoxaemic Polycytha
DISEASES OF BLOOD AND BLOOD FORMING
Essential thrombocytosis
ORGANS
DISEASES OF BLOOD AND BLOOD FORMING
Other specified diseases of blood and blood-forming organs
ORGANS
DISEASES OF BLOOD AND BLOOD FORMING
Langerhans' cell histiocytosis, not elsewhere classified
ORGANS
Haemophagocytic lymphohistiocytosis; Eosinophilic
DISEASES OF BLOOD AND BLOOD FORMING
granuloma; Hand-Schller-Christian disease; Chronic
ORGANS
Histiocytosis X
DISEASES OF BLOOD AND BLOOD FORMING
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;
DISEASES OF ESOPHAGUS
Chemical oesophagitis; Peptic oesophagitis
Achalasia of cardia; Achalasia NOS; Cardiospasm
DISEASES OF ESOPHAGUS
Ulcer of oesophagus; Erosion of oesophagus; Ulcer of
oesophagus NOS; Ulcer of oesophagus due to ingestion of
DISEASES OF ESOPHAGUS
chemicals; Ulcer of oesophagus due to ingestion of drugs
and medicaments; Fungal ulcer of oesophagus; Peptic ulcer
of oesophagus
Oesophageal obstruction; Compression of oesophagus;
DISEASES OF ESOPHAGUS
Constriction of oesophagus; Stenosis of oesophagus;
Stricture of oesophagus;
Perforation of oesophagus; Rupture of oesophagus
DISEASES OF ESOPHAGUS
Dyskinesia of oesophagus; Corksrew oesophagus; Diffuse
DISEASES OF ESOPHAGUS
oesophageal spasm; Spasm of oesophagus
Gastro-oesophageal laceration-haemorrhage syndrome;
DISEASES OF ESOPHAGUS
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

ANNEX 1. LIST OF MEDICAL CASE RATES

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

DISEASES OF ORAL CAVITY, SALIVARY GLANDS,

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

DISEASES OF ORAL CAVITY, SALIVARY GLANDS,

AND JAW

8,300

2,490

5,810

K09.9

Cyst of oral region, unspecified

DISEASES OF ORAL CAVITY, SALIVARY GLANDS,

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

DISEASES OF ORAL CAVITY, SALIVARY GLANDS,

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

DISEASES OF ORAL CAVITY, SALIVARY GLANDS,

AND JAW

8,300

2,490

5,810

DISEASES OF ORAL CAVITY, SALIVARY GLANDS,

AND JAW

8,300

2,490

5,810

8,300

2,490

5,810

8,300

2,490

5,810

DISEASES OF ORAL CAVITY, SALIVARY GLANDS,

AND JAW

8,300

2,490

5,810

DISEASES OF ORAL CAVITY, SALIVARY GLANDS,

AND JAW

8,300

2,490

5,810

K10.2

K10.3

DISEASES OF ORAL CAVITY, SALIVARY GLANDS,

AND JAW
Inflammatory conditions of jaws; Acute osteitis of jaw;
Chronic osteitis of jaw; Supparative osteitis of jaw; Acute
DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
neonatal osteomyelitis of jaw; Chronic neonatal
AND JAW
osteomyelitis of jaw; Supparative neonatal osteomyelitis of
jaw; Acute osteoradionecrosis o
DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
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

DISEASES OF ORAL CAVITY, SALIVARY GLANDS,

AND JAW
DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW
DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW
DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW
DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
AND JAW

DISEASES OF ORAL CAVITY, SALIVARY GLANDS,

AND JAW
DISEASES OF ORAL CAVITY, SALIVARY GLANDS,
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

DISEASES OF STOMACH AND DUODENUM

DISEASES OF STOMACH AND DUODENUM
DISEASES OF STOMACH AND DUODENUM

6,600
6,600
6,600

1,980
1,980
1,980

4,620
4,620
4,620

DISEASES OF STOMACH AND DUODENUM

6,600

1,980

4,620

DISEASES OF STOMACH AND DUODENUM

6,600

1,980

4,620

DISEASES OF STOMACH AND DUODENUM

6,600

1,980

4,620

DISEASES OF STOMACH AND DUODENUM

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
DISEASES OF THE GALLBLADDER AND BILIARY
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

DISEASES OF THE GALLBLADDER AND BILIARY

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

DISEASES OF THE GALLBLADDER AND BILIARY

TRACT

9,800

2,940

6,860

K80.8

Other cholelithiasis

DISEASES OF THE GALLBLADDER AND BILIARY

TRACT

9,800

2,940

6,860

Page 26 of 112

ANNEX 1. LIST OF MEDICAL CASE RATES

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

DISEASES OF THE GALLBLADDER AND BILIARY

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

DISEASES OF THE GALLBLADDER AND BILIARY

TRACT

9,800

2,940

6,860

DISEASES OF THE GALLBLADDER AND BILIARY

TRACT

9,800

2,940

6,860

DISEASES OF THE GALLBLADDER AND BILIARY

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

DISEASES OF THE GALLBLADDER AND BILIARY

TRACT
DISEASES OF THE GALLBLADDER AND BILIARY
TRACT
DISEASES OF THE GALLBLADDER AND BILIARY
TRACT
DISEASES OF THE GALLBLADDER AND BILIARY
TRACT

DISEASES OF THE GALLBLADDER AND BILIARY

TRACT
DISEASES OF THE GALLBLADDER AND BILIARY
TRACT
DISEASES OF THE GALLBLADDER AND BILIARY
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

DISEASES OF THE GALLBLADDER AND BILIARY

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

DISEASES OF THE PANCREAS

DISEASES OF THE PANCREAS
DISEASES OF THE PANCREAS
DISEASES OF THE PANCREAS

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

DISEASES OF THE PANCREAS

12,600

3,780

8,820

DISEASES OF THE PANCREAS

12,600

3,780

8,820

DISEASES OF THE PANCREAS

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
DISEASES OF THE PANCREAS
pancreas; Pancreatic infantilism; Pancreatic necrosis NOS;
Aseptic pancreatic necrosis; Fat necrosis of pancreas

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

DISEASES OF VASCULAR SYSTEM

13,100

3,930

DISEASES OF VASCULAR SYSTEM
DISEASES OF VASCULAR SYSTEM
DISEASES OF VASCULAR SYSTEM
DISEASES OF VASCULAR SYSTEM
DISEASES OF VASCULAR SYSTEM
DISEASES OF VASCULAR SYSTEM

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

DISEASES OF VASCULAR SYSTEM

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

ANNEX 1. LIST OF MEDICAL CASE RATES

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

DISODERS OF CHOROID AND RETINA

4,600

1,380

3,220

DISODERS OF CHOROID AND RETINA

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

DISORDER OF BONE DENSITY AND STRUCTURE

7,900

2,370

5,530

DISORDER OF BONE DENSITY AND STRUCTURE

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

DISORDER OF BONE DENSITY AND STRUCTURE

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

DISORDER OF BONE DENSITY AND STRUCTURE

DISORDER OF BONE DENSITY AND STRUCTURE
DISORDER OF BONE DENSITY AND STRUCTURE

7,900
7,900
7,900

2,370
2,370
2,370

5,530
5,530
5,530

DISORDER OF BONE DENSITY AND STRUCTURE

7,900

2,370

5,530

DISORDER OF BONE DENSITY AND STRUCTURE

DISORDER OF BONE DENSITY AND STRUCTURE
DISORDER OF BONE DENSITY AND STRUCTURE
DISORDER OF BONE DENSITY AND STRUCTURE
DISORDER OF BONE DENSITY AND STRUCTURE
DISORDER OF BONE DENSITY AND STRUCTURE
DISORDER OF BONE DENSITY AND STRUCTURE
DISORDER OF BONE DENSITY AND STRUCTURE
DISORDER OF BONE DENSITY AND STRUCTURE
DISORDER OF BONE DENSITY AND STRUCTURE
DISORDER OF BONE DENSITY AND STRUCTURE
DISORDER OF BONE DENSITY AND STRUCTURE
DISORDER OF BONE DENSITY AND STRUCTURE
DISORDER OF BONE DENSITY AND STRUCTURE

DISORDERS OF ADRENAL GLAND

9,900

2,970

6,930

DISORDERS OF ADRENAL GLAND

9,900
9,900

2,970
2,970

6,930
6,930

Drug-induced adrenocortical insufficiency

DISORDERS OF ADRENAL GLAND

Page 28 of 112

ANNEX 1. LIST OF MEDICAL CASE RATES

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

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
DISORDERS OF CARBOHYDRATE METABOLISM
deficiency; Galactosaemia

E74.3

Other disorders of intestinal carbohydrate absorption;

Glucose-galactose malabsorption; Sucrase deficiency

DISORDERS OF CARBOHYDRATE METABOLISM

E74.8

Other specified disorders of carbohydrate metabolism

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
DISORDERS OF GLYCOSAMINOGLYCAN
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,
DISORDERS OF GLYCOSAMINOGLYCAN
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
DISORDERS OF LIPOPROTEIN METABOLISM
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
DISORDERS OF LIPOPROTEIN METABOLISM
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

DISORDERS OF GLYCOSAMINOGLYCAN
METABOLISM
DISORDERS OF GLYCOSAMINOGLYCAN
METABOLISM

Page 29 of 112

ANNEX 1. LIST OF MEDICAL CASE RATES

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

DISORDERS OF LIPOPROTEIN METABOLISM

6,600

1,980

4,620

DISORDERS OF LIPOPROTEIN METABOLISM

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

DISORDERS OF MINERAL METABOLISM

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

DISORDERS OF MINERAL METABOLISM

7,300

2,190

5,110

Other disorders of mineral metabolism

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

DISORDERS OF THE PARATHYROID

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

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;
DISORDERS OF MINERAL METABOLISM
Hypophosphatasia; Vitamin-D-resistant osteomalacia;
Vitamin-D-resistant rickets
Disorders of magnesium metabolism; Hypermagnesaemia;
DISORDERS OF MINERAL METABOLISM
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

DISORDERS OF PORPHYRIN AND BILIRUBIN

METABOLISM
DISORDERS OF PORPHYRIN AND BILIRUBIN
METABOLISM
DISORDERS OF PORPHYRIN AND BILIRUBIN
METABOLISM
DISORDERS OF PORPHYRIN AND BILIRUBIN
METABOLISM
DISORDERS OF PURINE AND PYRIMIDINE
METABOLISM
DISORDERS OF THE PARATHYROID
DISORDERS OF THE PARATHYROID
DISORDERS OF THE PARATHYROID

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

ANNEX 1. LIST OF MEDICAL CASE RATES

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

7,600

2,280

5,320

M43.88

Other specified deforming dorsopathies sacral and

sacrococcygeal region

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
Deforming dorsopathy, unspecified; Curvature of spine
NOS thoracic region
Deforming dorsopathy, unspecified; Curvature of spine
NOS thoracolumbar region
Deforming dorsopathy, unspecified; Curvature of spine
NOS lumbar region
Deforming dorsopathy, unspecified; Curvature of spine
NOS lumbosacral region
Deforming dorsopathy, unspecified; Curvature of spine
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

ANNEX 1. LIST OF MEDICAL CASE RATES

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

EXTRAPYRAMIDAL AND MOVEMENT DISORDERS
EXTRAPYRAMIDAL AND MOVEMENT DISORDERS
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

EXTRAPYRAMIDAL AND MOVEMENT DISORDERS

8,300

2,490

5,810

EXTRAPYRAMIDAL AND MOVEMENT DISORDERS

8,300

2,490

5,810

EXTRAPYRAMIDAL AND MOVEMENT DISORDERS

8,300

2,490

5,810

EXTRAPYRAMIDAL AND MOVEMENT DISORDERS

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

EXTRAPYRAMIDAL AND MOVEMENT DISORDERS

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

EXTRAPYRAMIDAL AND MOVEMENT DISORDERS

EXTRAPYRAMIDAL AND MOVEMENT DISORDERS
EXTRAPYRAMIDAL AND MOVEMENT DISORDERS
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

G40.9
G21.0
G21.1
G21.8
G21.9
G23.0
G23.1
G23.8

Page 32 of 112

ANNEX 1. LIST OF MEDICAL CASE RATES

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

EXTRAPYRAMIDAL AND MOVEMENT DISORDERS

EXTRAPYRAMIDAL AND MOVEMENT DISORDERS
EXTRAPYRAMIDAL AND MOVEMENT DISORDERS

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

EXTRAPYRAMIDAL AND MOVEMENT DISORDERS

8,300

2,490

5,810

EXTRAPYRAMIDAL AND MOVEMENT DISORDERS

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

FEEDING PROBLEMS NEWBORN
FEEDING PROBLEMS NEWBORN
FEEDING PROBLEMS NEWBORN
FEEDING PROBLEMS NEWBORN
FEVER OF UNKNOWN ORIGIN
FLUID AND ELECTROLYTE DISTURBANCES

FRACTURES OF THE BONES OF THE THORAX
FRACTURES OF THE BONES OF THE THORAX
FRACTURES OF THE BONES OF THE THORAX
FRACTURES OF THE BONES OF THE THORAX
FRACTURES OF THE BONES OF THE THORAX
FRACTURES OF THE BONES OF THE THORAX
FRACTURES OF THE BONES OF THE THORAX
FRACTURES OF THE BONES OF THE THORAX
FRACTURES OF THE BONES OF THE THORAX
FRACTURES OF THE BONES OF THE THORAX
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
GASTROINTESTINAL DISORDERS OF THE
NEWBORN
GASTROINTESTINAL DISORDERS OF THE
NEWBORN
GASTROINTESTINAL DISORDERS OF THE
NEWBORN
GASTROINTESTINAL DISORDERS OF THE
NEWBORN
GASTROINTESTINAL DISORDERS OF THE
NEWBORN
GASTROINTESTINAL DISORDERS OF THE
NEWBORN
GASTROINTESTINAL DISORDERS OF THE
NEWBORN
GASTROINTESTINAL DISORDERS OF THE
NEWBORN
GASTROINTESTINAL DISORDERS OF THE
NEWBORN
GLAUCOMA

Page 33 of 112

Case Rate

Health Care
Institution Fee
5,810
5,810
5,810

ANNEX 1. LIST OF MEDICAL CASE RATES

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

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

Acute nephritic syndrome including Acute glomerular

DESCRIPTION

GROUP

Case Rate

Professional
Fee

Health Care
Institution Fee

N02.5

Recurrent and persistent haematuria including Benign

familial Haematuria; Benign familial Haematuria of
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES
childhood; Haematuria with morphological lesion specified
with Diffuse mesangiocapillary glomerulonephritis

10,000

3,000

7,000

N02.8

Recurrent and persistent haematuria including Benign

familial Haematuria; Benign familial Haematuria of
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES
childhood; Haematuria with morphological lesion specified
with other (Proliferative glomerulonephritis NOS)

10,000

3,000

7,000

N02.9

Recurrent and persistent haematuria including Benign

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 nephritic syndrome including Chronic glomerular
disease, Chronic glomerulonephritis, Chronic nephritis,
chronic renal disease NOS, with Focal and segmental
glomerular lesions
Chronic nephritic syndrome including Chronic glomerular
disease, Chronic glomerulonephritis, Chronic nephritis,
chronic renal disease NOS, withDiffuse membranous
glomerulonephritis
Chronic nephritic syndrome including Chronic glomerular
disease, Chronic glomerulonephritis, Chronic nephritis,
chronic renal disease NOS, with Diffuse mesangial
proliferative glomerulonephritis
Chronic nephritic syndrome including Chronic glomerular
disease, Chronic glomerulonephritis, Chronic nephritis,
chronic renal disease NOS, with Diffuse endocapillary
proliferative glomerulonephritis
Chronic nephritic syndrome including Chronic glomerular
disease, Chronic glomerulonephritis, Chronic nephritis,
chronic renal disease NOS, with Diffuse mesangiocapillary
glomerulonephritis
Chronic nephritic syndrome including Chronic glomerular
disease, Chronic glomerulonephritis, Chronic nephritis,
chronic renal disease NOS, with Diffuse crescentic
glomerulonephritis
Chronic nephritic syndrome including Chronic glomerular
disease, Chronic glomerulonephritis, Chronic nephritis,
chronic renal disease NOS, with Other (Proliferative
glomerulonephritis NOS)
Chronic nephritic syndrome including Chronic glomerular
disease, Chronic glomerulonephritis, Chronic nephritis,
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

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

GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES

10,000

3,000

7,000

N05.1

Unspecified nephritic syndrome including Glomerular

disease, Glomerulonephritis, Nephritis NOS with Focal and
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES
segmental glomerular lesions (with focal and segmental
hyalinosis; focal and segmental sclerosis) & Focal
glomerulonephritis

10,000

3,000

7,000

Page 35 of 112

ANNEX 1. LIST OF MEDICAL CASE RATES

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

3,000

7,000

Nephropathy induced by other drugs, medicaments and

GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES
biological substances
Nephropathy induced by unspecified drug, medicament or
GLOMERULAR AND INTERSTITIAL KIDNEY DISEASES
biological substance

bucket-handle tear multiple sites

HAND, FEET AND JOINT DEFORMITIES

9,200

2,760

6,440

Page 36 of 112

ANNEX 1. LIST OF MEDICAL CASE RATES

FIRST CASE RATE
ICD CODE

M23.21

M23.22

DESCRIPTION

GROUP

Derangement of meniscus due to old tear or injury; Old

bucket-handle tear Anterior cruciate ligament or Anterior HAND, FEET AND JOINT DEFORMITIES
horn of medial meniscus
Derangement of meniscus due to old tear or injury; Old
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

Derangement of meniscus due to old tear or injury; Old

bucket-handle tear Posterior horn of lateral meniscus

HAND, FEET AND JOINT DEFORMITIES

9,200

2,760

6,440

M23.46

Loose body in kneeOther and unspecified lateral meniscus

HAND, FEET AND JOINT DEFORMITIES

9,200

2,760

6,440

M23.5

Chronic instability of knee

HAND, FEET AND JOINT DEFORMITIES
Other internal derangements of knee; Laxity of ligament of
HAND, FEET AND JOINT DEFORMITIES
knee; Snapping knee multiple sites
Internal derangement of knee
HAND, FEET AND JOINT DEFORMITIES

9,200

2,760

6,440

9,200

2,760

6,440

HAND, FEET AND JOINT DEFORMITIES
HAND, FEET AND JOINT DEFORMITIES
HAND, FEET AND JOINT DEFORMITIES
HAND, FEET AND JOINT DEFORMITIES
HAND, FEET AND JOINT DEFORMITIES
HAND, FEET AND JOINT DEFORMITIES
HAND, FEET AND JOINT DEFORMITIES

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

HAND, FEET AND JOINT DEFORMITIES

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

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

HEART CONDUCTION DISORDERSS
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

ANNEX 1. LIST OF MEDICAL CASE RATES

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

HEART VALVE DISORDERS

HEART VALVE DISORDERS
HEART VALVE DISORDERS
HEART VALVE DISORDERS
HEART VALVE DISORDERS

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
HEART VALVE DISORDERS
regurgitation NOS or of specified cause, except rheumatic

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

HEMORRHAGE IN PREGNANCY AND POST

PARTUM PERIOD

7,000

2,100

4,900

HEMORRHAGE IN PREGNANCY AND POST

PARTUM PERIOD

7,000

2,100

4,900

HEMORRHAGE IN PREGNANCY AND POST

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
HEMARTHROSIS/JOINT EFFUSION
HEMARTHROSIS/JOINT EFFUSION
HEMARTHROSIS/JOINT EFFUSION
HEMARTHROSIS/JOINT EFFUSION
HEMARTHROSIS/JOINT EFFUSION
HEMARTHROSIS/JOINT EFFUSION
HEMARTHROSIS/JOINT EFFUSION
HEMARTHROSIS/JOINT EFFUSION
HEMARTHROSIS/JOINT EFFUSION
HEMARTHROSIS/JOINT EFFUSION
HEMARTHROSIS/JOINT EFFUSION
HEMOLYTIC UREMIC SYNDROME

HEMORRHAGE IN PREGNANCY AND POST

PARTUM PERIOD
HEMORRHAGE IN PREGNANCY AND POST
PARTUM PERIOD
HEMORRHAGE IN PREGNANCY AND POST
PARTUM PERIOD
HEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN
HEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN

Page 38 of 112

ANNEX 1. LIST OF MEDICAL CASE RATES

FIRST CASE RATE
ICD CODE

DESCRIPTION

GROUP
HEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN
HEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN
HEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN
HEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN
HEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN
HEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN
HEMORRHAGIC AND HEMATOLOGIC DISEASES OF
THE NEWBORN
HEMORRHAGIC AND HEMATOLOGIC DISEASES OF
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

HEMORRHAGIC CONDITIONS

12,800

3,840

8,960

HEMORRHAGIC CONDITIONS

12,800

3,840

8,960

HEMORRHAGIC CONDITIONS

12,800

3,840

8,960

HEMORRHAGIC CONDITIONS

12,800

3,840

8,960

HEMORRHAGIC CONDITIONS

12,800

3,840

8,960

HEMORRHAGIC CONDITIONS

12,800

3,840

8,960

HEMORRHAGIC CONDITIONS

12,800

3,840

8,960

HEMORRHAGIC CONDITIONS

12,800

3,840

8,960

Hereditary factor XI deficiency; Haemophilia C Plasma

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
HYPERTENSIVE EMERGENCY/URGENCY

9,000
9,000

2,700
2,700

6,300
6,300