| SERIAL NUMBER | Procedure | 1st Qtr | Per Qtr (for next 3 Qtrs) | Requirements while submitting for follow-up Preauth | Requirements while submitting for follow-up Claims |
|---|---|---|---|---|---|
| 9 | FP0009 : Coronary Balloon Angioplasty | 4,000 | 2,000 | Previous Discharge Summary | (INR Levels, ECG, Clinical Evaluation, ECHO-M-Mandatory) |
| 10 | FP0010 : Renal Angioplasty | 4,000 | 2,000 | Previous Discharge Summary | (BP, Clinical Evaluation, Doppler, PT/INR, USG-KUB-Mandatory) |
| 11 | FP0011 : Peripheral Angioplasty | 4,000 | 2,000 | Previous Discharge Summary | (Color Doppler, Capillary Filling Period, Claudications, Clinical Evaluation,PT/INR-Mandatory) |
| 12 | FP0012 : Vertebral Angioplasty | 4,000 | 2,000 | Previous Discharge Summary | (Color Doppler, Clinical Evaluation, PT/INR-Mandatory) |
