| 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 |
|---|---|---|---|---|---|
| 74 | FP0074 : Term Baby with persistent pulmonary hypertension/meconia aspirition syndrom/mechanical ventilation/with or without clinical sepsis/with or without hyperbilirubinemia/with or without perinatal asphyxia | 3,000 | 1,000 | Previous Discharge Summary | (Clinical Evaluation-Mandatory), Relevant Investigations, LFT |
| 75 | FP0075 : Term baby with seiZures ventilated | 2,000 | 1,000 | Previous Discharge Summary | (Clinical Evaluation, TC, DC, Serum calcium, Blood Sugar-Mandatory) |
