| 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 |
|---|---|---|---|---|---|
| 102 | FP0102 : SLE (SYSTEMIC LUPUS ERYTHEMATOSIS) | 2,400 | 1,200 | Previous Discharge Summary | (Clinical Evaluation-Mandatory) and Relevant Investigations as per Initial Diagnosis |
| 103 | FP0103 : SCLERODERMA | 2.400 | 1,200 | Previous Discharge Summary | (Clinical Evaluation-Mandatory) and Relevant Investigations as per Initial Diagnosis |
| 105 | FP0105 : VACSULITIS | 2,400 | 1,200 | Previous Discharge Summary | (Clinical Evaluation-Mandatory) and Relevant Investigations as per Initial Diagnosis |
