AnnexA MedicalCaseRates

Annex A - List of Medical Case Rates
First Case Rate

ICD Code Description
Case Rate Health Facility Fee Professional Fee
A00.0 CHOLERA DUE TO VIBRIO CHOLERAE 01, BIOVAR CHOLERAE 7,800.00 5,460.00 2,340.00
A00.1 CHOLERA DUE TO VIBRIO CHOLERAE 01, BIOVAR ELTOR 7,800.00 5,460.00 2,340.00
A00.9 CHOLERA, UNSPECIFIED 7,800.00 5,460.00 2,340.00
A01.0 TYPHOID FEVER 13,000.00 9,100.00 3,900.00
A01.0+ J17.0* PNEUMONIA IN TYPHOID FEVER 19,500.00 13,650.00 5,850.00
A01.1 PARATYPHOID FEVER A 13,000.00 9,100.00 3,900.00
A01.2 PARATYPHOID FEVER B 13,000.00 9,100.00 3,900.00
A01.3 PARATYPHOID FEVER C 13,000.00 9,100.00 3,900.00
PARATYPHOID FEVER, UNSPECIFIED; INFECTION DUE TO
A01.4 13,000.00 9,100.00 3,900.00
SALMONELLA PARATYPHI NOS
A02.0 SALMONELLA ENTERITIS; SALMONELLOSIS 13,000.00 9,100.00 3,900.00
A02.1 SALMONELLA SEPTICAEMIA 13,000.00 9,100.00 3,900.00
A02.2 LOCALIZED SALMONELLA INFECTIONS 13,000.00 9,100.00 3,900.00
A02.2+ J17.0* PNEUMONIA IN SALMONELLA INFECTION 19,500.00 13,650.00 5,850.00
A02.8 OTHER SPECIFIED SALMONELLA INFECTIONS 13,000.00 9,100.00 3,900.00
A02.9 SALMONELLA INFECTION, UNSPECIFIED 13,000.00 9,100.00 3,900.00
SHIGELLOSIS DUE TO SHIGELLA DYSENTERIAE; GROUP A
A03.0 7,800.00 5,460.00 2,340.00
SHIGELLOSIS [SHIGA-KRUSE DYSENTERY]
SHIGELLOSIS DUE TO SHIGELLA FLEXNERI;GROUP B
A03.1 7,800.00 5,460.00 2,340.00
SHIGELLOSIS
SHIGELLOSIS DUE TO SHIGELLA BOYDII; GROUP C
A03.2 7,800.00 5,460.00 2,340.00
SHIGELLOSIS
SHIGELLOSIS DUE TO SHIGELLA SONNEI; GROUP D
A03.3 7,800.00 5,460.00 2,340.00
SHIGELLOSIS
A03.8 OTHER SHIGELLOSIS 7,800.00 5,460.00 2,340.00
A03.9 SHIGELLOSIS, UNSPECIFIED; ; BACILLARY DYSENTERY NOS 7,800.00 5,460.00 2,340.00
A04.0 ENTEROPATHOGENIC ESCHERICHIA COLI INFECTION 7,800.00 5,460.00 2,340.00
A04.1 ENTEROTOXIGENIC ESCHERICHIA COLI INFECTION 7,800.00 5,460.00 2,340.00
A04.2 ENTEROINVASIVE ESCHERICHIA COLI INFECTION 7,800.00 5,460.00 2,340.00
A04.3 ENTEROHAEMORRHAGIC ESCHERICHIA COLI INFECTION 7,800.00 5,460.00 2,340.00
A04.4 OTHER INTESTINAL ESCHERICHIA COLI INFECTIONS 7,800.00 5,460.00 2,340.00
A04.5 CAMPYLOBACTER ENTERITIS 7,800.00 5,460.00 2,340.00
A04.6 ENTERITIS DUE TO YERSINIA ENTEROCOLITICA 7,800.00 5,460.00 2,340.00
ENTEROCOLITIS DUE TO CLOSTRIDIUM DIFFICILE;
A04.7 FOODBORNE INTOXICATION BY CLOSTRIDIUM DIFFICILE; 7,800.00 5,460.00 2,340.00
PSEUDOMEMBRANOUS COLITIS
A04.8 OTHER SPECIFIED BACTERIAL INTESTINAL INFECTIONS 7,800.00 5,460.00 2,340.00
BACTERIAL INTESTINAL INFECTION, UNSPECIFIED.
A04.9 7,800.00 5,460.00 2,340.00
BACTERIAL ENTERITIS NOS
A05.0 FOODBORNE STAPHYLOCOCCAL INTOXICATION 7,800.00 5,460.00 2,340.00
BOTULISM; CLASSICAL FOODBORNE INTOXICATION DUE TO
A05.1 6,240.00 4,368.00 1,872.00
CLOSTRIDIUM BOTULINUM
FOODBORNE CLOSTRIDIUM PERFRINGENS [CLOSTRIDIUM
A05.2 WELCHII] INTOXICATION. ENTERITIS NECROTICANS. 7,800.00 5,460.00 2,340.00
PIG-BEL
A05.3 FOODBORNE VIBRIO PARAHAEMOLYTICUS INTOXICATION 7,800.00 5,460.00 2,340.00

A05.4 FOODBORNE BACILLUS CEREUS INTOXICATION 7,800.00 5,460.00 2,340.00
A05.8 OTHER SPECIFIED BACTERIAL FOODBORNE INTOXICATIONS 7,800.00 5,460.00 2,340.00
A05.9 BACTERIAL FOODBORNE INTOXICATION, UNSPECIFIED 7,800.00 5,460.00 2,340.00

ACUTE AMOEBIC DYSENTERY; ACUTE AMOEBIASIS;
A06.0 7,800.00 5,460.00 2,340.00
INTESTINAL AMOEBIASIS NOS
A06.1 CHRONIC INTESTINAL AMOEBIASIS 7,800.00 5,460.00 2,340.00
A06.2 AMOEBIC NONDYSENTERIC COLITIS 7,800.00 5,460.00 2,340.00
A06.3 AMOEBOMA OF INTESTINE; AMOEBOMA NOS 7,800.00 5,460.00 2,340.00
A06.4+ K77.0* AMOEBIC LIVER ABSCESS; HEPATIC AMOEBIASIS 13,000.00 9,100.00 3,900.00
A06.7 CUTANEOUS AMOEBIASIS 7,800.00 5,460.00 2,340.00
A06.8 AMOEBIC APPENDICITIS 7,800.00 5,460.00 2,340.00
A07.0 BALANTIDIASIS; BALANTIDIAL DYSENTERY 7,800.00 5,460.00 2,340.00
A07.1 GIARDIASIS [LAMBLIASIS] 7,800.00 5,460.00 2,340.00
A07.2 CRYPTOSPORIDIOSIS 7,800.00 5,460.00 2,340.00
ISOSPORIASIS; INFECTION DUE TO ISOSPORA BELLI AND
A07.3 ISOSPORA HOMINIS; INTESTINAL COCCIDIOSIS; 7,800.00 5,460.00 2,340.00
ISOSPOROSIS
OTHER SPECIFIED PROTOZOAL INTESTINAL DISEASES;
A07.8 INTESTINAL TRICHOMONIASIS; SARCOCYSTOSIS; 7,800.00 5,460.00 2,340.00
SARCOSPORIDIOSIS
PROTOZOAL INTESTINAL DISEASE,
UNSPECIFIED;FLAGELLATE DIARRHOEA; PROTOZOAL
A07.9 7,800.00 5,460.00 2,340.00
COLITIS; PROTOZOAL DIARRHOEA; PROTOZOAL
DYSENTERY
A08.0 ROTAVIRAL ENTERITIS 7,800.00 5,460.00 2,340.00
ACUTE GASTROENTEROPATHY DUE TO NORWALK AGENT;
A08.1 7,800.00 5,460.00 2,340.00
SMALL ROUND STRUCTURED VIRUS ENTERITIS
Page 1 of 126
First Case Rate

A08.2 ADENOVIRAL ENTERITIS 7,800.00 5,460.00 2,340.00
A08.3 OTHER VIRAL ENTERITIS 7,800.00 5,460.00 2,340.00
VIRAL INTESTINAL INFECTION, UNSPECIFIED; VIRAL
A08.4 ENTERITIS NOS; VIRAL GASTROENTERITIS NOS; VIRAL 7,800.00 5,460.00 2,340.00
GASTROENTEROPATHY NOS
A08.5 OTHER SPECIFIED INTESTINAL INFECTIONS 7,800.00 5,460.00 2,340.00
A09.0 INFECTIOUS DIARRHEA 7,800.00 5,460.00 2,340.00
A09.9 ACUTE GASTROENTERITIS 7,800.00 5,460.00 2,340.00
TUBERCULOSIS OF LUNG, CONFIRMED BY SPUTUM
MICROSCOPY WITH OR WITHOUT CULTURE; TUBERCULOUS
BRONCHIECTASIS, CONFIRMED BY SPUTUM MICROSCOPY
A15.0 12,740.00 8,918.00 3,822.00
WITH OR WITHOUT CULTURE; TUBERCULOUS FIBROSIS OF
LUNG, CONFIRMED BY SPUTUM MICROSCOPY WITH OR
WITHOUT CULTURE; TUBERCU
TUBERCULOSIS OF LUNG, CONFIRMED BY CULTURE ONLY;

TUBERCULOUS BRONCHIECTASIS, CONFIRMED BY CULTURE
ONLY; TUBERCULOUS FIBROSIS OF LUNG, CONFIRMED BY
A15.1 12,740.00 8,918.00 3,822.00
CULTURE ONLY; TUBERCULOUS PNEUMONIA, CONFIRMED
BY CULTURE ONLY; TUBERCULOUS PNEUMOTHORAX,
CONFIRMED BY CUL
TUBERCULOSIS OF LUNG, CONFIRMED HISTOLOGICALLY

ONLY; TUBERCULOUS BRONCHIECTASIS, CONFIRMED
HISTOLOGICALLY ONLY; TUBERCULOUS FIBROSIS OF LUNG,
A15.2 12,740.00 8,918.00 3,822.00
CONFIRMED HISTOLOGICALLY ONLY; TUBERCULOUS
PNEUMONIA, CONFIRMED HISTOLOGICALLY ONLY;
TUBERCULOUS PNEUMOTHORAX
TUBERCULOSIS OF LUNG, CONFIRMED BY UNSPECIFIED

MEANS; TUBERCULOUS BRONCHIECTASIS, CONFIRMED
BUT UNSPECIFIED WHETHER BACTERIOLOGICALLY OR
A15.3 12,740.00 8,918.00 3,822.00
HISTOLOGICALLY; TUBERCULOUS FIBROSIS OF LUNG,
CONFIRMED BUT UNSPECIFIED WHETHER
BACTERIOLOGICALLY OR HISTOLOGICALLY
TUBERCULOSIS OF INTRATHORACIC LYMPH NODES,

CONFIRMED BACTERIOLOGICALLY & HISTOLOGICALY;
TUBERCULOSIS OF HILAR LYMPH NODES, CONFIRMED
A15.4 15,470.00 10,829.00 4,641.00
BACTERIOLOGICALLY & HISTOLOGICALY; TUBERCULOSIS
OF MEDIASTINAL, LYMPH NODES, CONFIRMED
BACTERIOLOGICALLY & HISTOLOGICALY;
TUBERCULOSIS OF LARYNX, TRACHEA AND BRONCHUS,
CONFIRMED BACTERIOLOGICALLY
AND HISTOLOGICALLY ; TUBERCULOSIS OF
A15.5 BRONCHUS,CONFIRMED BACTERIOLOGICALLY AND 15,470.00 10,829.00 4,641.00
HISTOLOGICALLY; TUBERCULOSIS OF GLOTTIS,
CONFIRMED BACTERIOLOGICALLY AND HISTOLOGICALLY;
TUBERCULO
TUBERCULOUS PLEURISY, CONFIRMED
BACTERIOLOGICALLY AND HISTOLOGICALLY
[TUBERCULOSIS OF PLEURA, CONFIRMED
A15.6 15,470.00 10,829.00 4,641.00
BACTERIOLOGICALLY AND HISTOLOGICALLY;
TUBERCULOUS EMPYEMA, CONFIRMED
BACTERIOLOGICALLY & HISTOLOGICALLY
PRIMARY RESPIRATORY TUBERCULOSIS, CONFIRMED
A15.7 12,740.00 8,918.00 3,822.00
OTHER RESPIRATORY TUBERCULOSIS, CONFIRMED
BACTERIOLOGICALLY AND HISTOLOGICALLY; MEDIASTINAL
TUBERCULOSIS, CONFIRMED BACTERIOLOGICALLY AND
A15.8 15,470.00 10,829.00 4,641.00
HISTOLOGICALLY; NASOPHARYNGEAL TUBERCULOSIS,
CONFIRMED BACTERIOLOGICALLY AND HISTOLOGICALLY;
TUBERCULOSIS OF NOSE,
RESPIRATORY TUBERCULOSIS UNSPECIFIED, CONFIRMED

A15.9 12,740.00 8,918.00 3,822.00
TUBERCULOSIS OF LUNG, BACTERIOLOGICALLY AND

HISTOLOGICALLY NEGATIVE;
TUBERCULOUS BRONCHIECTASIS , BACTERIOLOGICALLY
A16.0 12,740.00 8,918.00 3,822.00
AND HISTOLOGICALLY NEGATIVE; TUBERCULOUS FIBROSIS
OF LUNG, BACTERIOLOGICALLY AND HISTOLOGICALLY
NEGATIVE; TUBERCULOUS PNEUMONIA, BAC
TUBERCULOSIS OF LUNG, BACTERIOLOGICAL AND

HISTOLOGICAL EXAMINATION NOT DONE; TUBERCULOUS
BRONCHIECTASIS, BACTERIOLOGICAL AND HISTOLOGICAL
A16.1 12,740.00 8,918.00 3,822.00
EXAMINATION NOT DONE; TUBERCULOUS FIBROSIS OF
LUNG, BACTERIOLOGICAL AND HISTOLOGICAL
EXAMINATION NOT DONE; TUBERCULO
Page 2 of 126
First Case Rate

TUBERCULOSIS OF LUNG, NOS, WITHOUT MENTION OF
BACTERIOLOGICAL OR HISTOLOGICAL CONFIRMATION;
TUBERCULOUS BRONCHIECTASIS, NOS, WITHOUT
A16.2 12,740.00 8,918.00 3,822.00
MENTION OF BACTERIOLOGICAL OR HISTOLOGICAL
CONFIRMATION; TUBERCULOUS FIBROSIS OF LUNG, NOS,
WITHOUT MENTION OF BACT

WITHOUT MENTION OF BACTERIOLOGICAL OR
HISTOLOGICAL CONFIRMATION; TUBERCULOSIS OF HILAR
A16.3 15,470.00 10,829.00 4,641.00
LYMPH NODES NOS WITHOUT MENTION OF
TUBERCULOSIS OF BRONCHUS, NOS, WITHOUT MENTION

OF BACTERIOLOGICAL OR HISTOLOGICAL ONFIRMATION;
TUBERCULOSIS OF GLOTTIS, NOS, WITHOUT MENTION OF
A16.4 15,470.00 10,829.00 4,641.00
BACTERIOLOGICAL OR HISTOLOGICAL ONFIRMATION;
TUBERCULOSIS OF LARYNX, NOS, WITHOUT MENTION OF
BACTERIOLOGIC
TUBERCULOUS PLEURISY, WITHOUT MENTION OF

BACTERIOLOGICAL OR HISTOLOGICAL
CONFIRMATION; TUBERCULOSIS OF PLEURA, NOS,
A16.5 15,470.00 10,829.00 4,641.00
WITHOUT MENTION OF BACTERIOLOGICAL OR
HISTOLOGICAL CONFIRMATION; TUBERCULOUS EMPYEMA,
NOS, WITHOUT MENTION OF BACTERIOLOGICAL OR HIS
PRIMARY RESPIRATORY TUBERCULOSIS WITHOUT

A16.7 12,740.00 8,918.00 3,822.00
CONFIRMATION; PRIMARY RESPIRATORY TUBERCULOSIS
NOS; PRIMARY TUBERCULOUS COMPLEX
OTHER RESPIRATORY TUBERCULOSIS, WITHOUT MENTION

OF BACTERIOLOGICAL OR HISTOLOGICAL CONFIRMATION;
MEDIASTINAL TUBERCULOSIS, NOS WITHOUT MENTION OF
A16.8 15,470.00 10,829.00 4,641.00
NASOPHARYNGEAL TUBERCULOSIS, NOS WITHOUT
MENTION OF BACTERIOLOG
RESPIRATORY TUBERCULOSIS UNSPECIFIED, WITHOUT
A16.9 12,740.00 8,918.00 3,822.00
CONFIRMATION; RESPIRATORY TUBERCULOSIS NOS;
TUBERCULOSIS NOS
TUBERCULOUS PERIPHERAL LYMPHADENOPATHY;
A18.2 15,470.00 10,829.00 4,641.00
TUBERCULOUS ADENITIS
TUBERCULOSIS OF INTESTINES, PERITONEUM AND
A18.3 MESENTERIC GLANDS; TUBERCULOSIS OF 15,470.00 10,829.00 4,641.00
RETROPERITONEAL LYMPH NODES
ERYTHEMA TUBERCULOUS INDURATUM, ; LUPUS
A18.4 EXEDENS; LUPUS VULGARIS; LUPUS EXEDENS, NOS; LUPUS 15,470.00 10,829.00 4,641.00
VULGARIS, NOS; SCROFULODERMA
ACUTE MILIARY TUBERCULOSIS OF A SINGLE SPECIFIED
A19.0 19,630.00 13,741.00 5,889.00
SITE
A19.1 ACUTE MILIARY TUBERCULOSIS OF MULTIPLE SITES 19,630.00 13,741.00 5,889.00
A19.2 ACUTE MILIARY TUBERCULOSIS, UNSPECIFIED 19,630.00 13,741.00 5,889.00
A19.8 OTHER MILIARY TUBERCULOSIS 19,630.00 13,741.00 5,889.00
A19.9 MILIARY TUBERCULOSIS 19,630.00 13,741.00 5,889.00
A20.0 BUBONIC PLAGUE 15,210.00 10,647.00 4,563.00
A20.9 PLAGUE, UNSPECIFIED 15,210.00 10,647.00 4,563.00
ULCEROGLANDULAR TULARAEMIA; OPHTHALMIC
A21.0 15,210.00 10,647.00 4,563.00
TULARAEMIA
OCULOGLANDULAR TULARAEMIA; OPHTHALMIC
A21.1 15,210.00 10,647.00 4,563.00
TULARAEMIA
A21.2 PULMONARY TULARAEMIA 15,210.00 10,647.00 4,563.00
A21.2+ J17.0* PNEUMONIA IN TULAREMIA 19,500.00 13,650.00 5,850.00
GASTROINTESTINAL TULARAEMIA; ABDOMINAL
A21.3 15,210.00 10,647.00 4,563.00
TULARAEMIA
A21.9 TULARAEMIA, UNSPECIFIED 15,210.00 10,647.00 4,563.00
CUTANEOUS ANTHRAX; MALIGNANT CARBUNCLE;
A22.0 15,210.00 10,647.00 4,563.00
MALIGNANT PUSTULE
A22.1+ J17.0* PNEUMONIA IN ANTHRAX 19,500.00 13,650.00 5,850.00
A22.2 GASTROINTESTINAL ANTHRAX 15,210.00 10,647.00 4,563.00
A22.7 ANTHRAX SEPTICAEMIA 15,210.00 10,647.00 4,563.00
A22.9 ANTHRAX, UNSPECIFIED 15,210.00 10,647.00 4,563.00
A23.1 BRUCELLOSIS DUE TO BRUCELLA ABORTUS 15,210.00 10,647.00 4,563.00
A23.9 BRUCELLOSIS, UNSPECIFIED 15,210.00 10,647.00 4,563.00
GLANDERS; INFECTION DUE TO PSEUDOMONAS MALLEI;
A24.0 15,210.00 10,647.00 4,563.00
MALLEUS
ACUTE AND FULMINATING MELIOIDOSIS; MELIOIDOSIS
A24.1 15,210.00 10,647.00 4,563.00
PNEUMONIA ; MELIOIDOSIS SEPTICAEMIA
A25.9 RAT-BITE FEVER, UNSPECIFIED 15,210.00 10,647.00 4,563.00
Page 3 of 126
First Case Rate

A26.8 OTHER FORMS OF ERYSIPELOID 15,210.00 10,647.00 4,563.00
A26.9 ERYSIPELOID, UNSPECIFIED 15,210.00 10,647.00 4,563.00
LEPTOSPIROSIS ICTEROHAEMORRHAGICA; LEPTOSPIROSIS
A27.0 DUE TO LEPTOSPIRA INTERROGANS SEROVAR 14,300.00 10,010.00 4,290.00
ICTEROHAEMORRHAGIAE
A27.8 OTHER FORMS OF LEPTOSPIROSIS 14,300.00 10,010.00 4,290.00
A27.9 LEPTOSPIROSIS, UNSPECIFIED 14,300.00 10,010.00 4,290.00
A28.0 PASTEURELLOSIS 15,210.00 10,647.00 4,563.00
A28.1 CAT-SCRATCH DISEASE; CAT-SCRATCH FEVER 15,210.00 10,647.00 4,563.00
OTHER SPECIFIED ZOONOTIC BACTERIAL DISEASES, NOT
A28.8 15,210.00 10,647.00 4,563.00
ELSEWHERE CLASSIFIED
A28.9 ZOONOTIC BACTERIAL DISEASE, UNSPECIFIED 15,210.00 10,647.00 4,563.00
A30.0 HANSEN'S DISEASE: INDETERMINATE LEPROSY; I LEPROSY 11,440.00 8,008.00 3,432.00
A30.1 HANSEN'S DISEASE : TUBERCULOID LEPROSY; TT LEPROSY 11,440.00 8,008.00 3,432.00

HANSEN'S DISEASE: BORDERLINE TUBERCULOID LEPROSY;
A30.2 11,440.00 8,008.00 3,432.00
BT LEPROSY
HANSEN'S DISEASE: BORDERLINE LEPROMATOUS LEPROSY;
A30.4 11,440.00 8,008.00 3,432.00
BL LEPROSY
A30.5 HANSEN'S DISEASE: LEPROMATOUS LEPROSY; LL LEPROSY 11,440.00 8,008.00 3,432.00
A30.8 OTHER FORMS OF LEPROSY 11,440.00 8,008.00 3,432.00
A30.9 LEPROSY, UNSPECIFIED 11,440.00 8,008.00 3,432.00
PULMONARY MYCOBACTERIAL INFECTION; INFECTION DUE
TO MYCOBACTERIUM AVIUM, MYCOBACTERIUM
A31.0 19,500.00 13,650.00 5,850.00
INTRACELLULARE [BATTEY BACILLUS]; MYCOBACTERIUM
KANSASII
A31.8 OTHER MYCOBACTERIAL INFECTIONS 11,570.00 8,099.00 3,471.00
MYCOBACTERIAL INFECTION, UNSPECIFIED ; ATYPICAL
MYCOBACTERIUM INFECTION NOT OTHERWISE SPECIFIED;
A31.9 11,570.00 8,099.00 3,471.00
MYCOBACTERIOSIS NOS; LISTERIOSIS (LISTERIAL
FOODBORNE INFECTION)
A33 TETANUS NEONATORUM 21,450.00 15,015.00 6,435.00
A34 OBSTETRICAL TETANUS 21,450.00 15,015.00 6,435.00
A35 OTHER TETANUS; TETANUS NOS 21,450.00 15,015.00 6,435.00
PHARYNGEAL DIPHTHERIA; DIPHTHERITIC MEMBRANOUS
A36.0 11,310.00 7,917.00 3,393.00
ANGINA; TONSILLAR DIPHTHERIA
A36.3 CUTANEOUS DIPHTHERIA 11,310.00 7,917.00 3,393.00
A36.9 DIPHTHERIA, UNSPECIFIED 11,310.00 7,917.00 3,393.00
A37.0 WHOOPING COUGH DUE TO BORDETELLA PERTUSSIS 13,780.00 9,646.00 4,134.00
PNEUMONIA IN WHOOPING COUGH DUE TO BORDATELLA
A37.0+ J17.0* 19,500.00 13,650.00 5,850.00
PERTUSIS
A37.1 WHOOPING COUGH DUE TO BORDETELLA PARAPERTUSSIS 13,780.00 9,646.00 4,134.00
A37.1+ J17.0* 19,500.00 13,650.00 5,850.00
PARAPERTUSIS
A37.8 WHOOPING COUGH DUE TO OTHER BORDETELLA SPECIES 13,780.00 9,646.00 4,134.00

A37.8+ J17.0* 19,500.00 13,650.00 5,850.00
SPECIES OTHER THAN PERTUSIS OR PARAPERTUSIS
A37.9 WHOOPING COUGH, UNSPECIFIED 13,780.00 9,646.00 4,134.00
A37.9+ J17.0* PNEUMONIA IN WHOOPING COUGH 19,500.00 13,650.00 5,850.00
A38 SCARLET FEVER; SCARLATINA 10,790.00 7,553.00 3,237.00
A39.2 ACUTE MENINGOCOCCAEMIA 25,740.00 18,018.00 7,722.00
A39.3 CHRONIC MENINGOCOCCAEMIA 25,740.00 18,018.00 7,722.00
MENINGOCOCCAEMIA, UNSPECIFIED; MENINGOCOCCAL
A39.4 25,740.00 18,018.00 7,722.00
BACTERAEMIA NOS
MENINGOCOCCAL INFECTION, UNSPECIFIED;
A39.9 25,740.00 18,018.00 7,722.00
MENINGOCOCCAL DISEASE NOS
A40.0 SEPTICAEMIA DUE TO STREPTOCOCCUS, GROUP A 41,600.00 29,120.00 12,480.00
A40.1 SEPTICAEMIA DUE TO STREPTOCOCCUS, GROUP B 41,600.00 29,120.00 12,480.00
SEPTICAEMIA DUE TO STREPTOCOCCUS PNEUMONIAE;
A40.3 41,600.00 29,120.00 12,480.00
PNEUMOCOCCAL SEPTICAEMIA
A40.8 OTHER STREPTOCOCCAL SEPTICAEMIA 41,600.00 29,120.00 12,480.00
A40.9 STREPTOCOCCAL SEPTICAEMIA, UNSPECIFIED 41,600.00 29,120.00 12,480.00
A41.0 SEPTICAEMIA DUE TO STAPHYLOCOCCUS AUREUS 41,600.00 29,120.00 12,480.00
SEPTICAEMIA DUE TO OTHER SPECIFIED
A41.1 STAPHYLOCOCCUS; SEPTICAEMIA DUE TO COAGULASE- 41,600.00 29,120.00 12,480.00
NEGATIVE STAPHYLOCOCCUS
A41.2 SEPTICAEMIA DUE TO UNSPECIFIED STAPHYLOCOCCUS 41,600.00 29,120.00 12,480.00
A41.3 SEPTICAEMIA DUE TO HAEMOPHILUS INFLUENZAE 41,600.00 29,120.00 12,480.00
A41.4 SEPTICAEMIA DUE TO ANAEROBES 41,600.00 29,120.00 12,480.00
SEPTICAEMIA DUE TO OTHER GRAM-NEGATIVE
A41.5 41,600.00 29,120.00 12,480.00
ORGANISMS; GRAM-NEGATIVE SEPTICAEMIA NOS
A41.8 OTHER SPECIFIED SEPTICAEMIA 41,600.00 29,120.00 12,480.00
A41.9 SEPTICAEMIA, UNSPECIFIED; SEPTIC SHOCK 41,600.00 29,120.00 12,480.00
A42.0 PULMONARY ACTINOMYCOSIS 11,570.00 8,099.00 3,471.00
A42.0+ J17.0* PNEUMONIA IN ACTINOMYCOSES 19,500.00 13,650.00 5,850.00
A42.1 ABDOMINAL ACTINOMYCOSIS 11,570.00 8,099.00 3,471.00
Page 4 of 126
First Case Rate

A42.2 CERVICOFACIAL ACTINOMYCOSIS 11,570.00 8,099.00 3,471.00
A42.7 ACTINOMYCOTIC SEPTICAEMIA 11,570.00 8,099.00 3,471.00
A42.8 OTHER FORMS OF ACTINOMYCOSIS 11,570.00 8,099.00 3,471.00
A42.9 ACTINOMYCOSIS, UNSPECIFIED 11,570.00 8,099.00 3,471.00
A43.1 CUTANEOUS NOCARDIOSIS 11,570.00 8,099.00 3,471.00
A43.9 NOCARDIOSIS, UNSPECIFIED 11,570.00 8,099.00 3,471.00
CUTANEOUS AND MUCOCUTANEOUS BARTONELLOSIS;
A44.1 11,570.00 8,099.00 3,471.00
VERRUGA PERUANA
A44.9 BARTONELLOSIS, UNSPECIFIED 11,570.00 8,099.00 3,471.00
A46 ERYSIPELAS 12,480.00 8,736.00 3,744.00
GAS GANGRENE; CLOSTRIDIAL CELLULITIS; CLOSTRIDIAL
A48.0 12,480.00 8,736.00 3,744.00
MYONECROSIS
A48.1 LEGIONNAIRES' DISEASE 19,500.00 13,650.00 5,850.00
A48.3 TOXIC SHOCK SYNDROME 41,600.00 29,120.00 12,480.00
A48.8 OTHER SPECIFIED BACTERIAL DISEASES 11,570.00 8,099.00 3,471.00
A49.0 STAPHYLOCOCCAL INFECTION, UNSPECIFIED 11,570.00 8,099.00 3,471.00
A49.2 HAEMOPHILUS INFLUENZAE INFECTION, UNSPECIFIED 11,570.00 8,099.00 3,471.00
A49.3 MYCOPLASMA INFECTION, UNSPECIFIED 11,570.00 8,099.00 3,471.00
A49.8 OTHER BACTERIAL INFECTIONS OF UNSPECIFIED SITE 11,570.00 8,099.00 3,471.00
A49.9 BACTERIAL INFECTION, UNSPECIFIED; BACTERAEMIA NOS 11,570.00 8,099.00 3,471.00
EARLY CUTANEOUS CONGENITAL SYPHILIS: , EARLY

MUCOCUTANEOUS CONGENITAL SYPHILIS, EARLY VISCERAL
CONGENITAL SYPHILIS; EARLY CONGENITAL SYPHILITIC
A50.0 16,640.00 11,648.00 4,992.00
LARYNGITIS; EARLY CONGENITAL SYPHILITIC
OCULOPATHY; EARLY CONGENITAL SYPHILITIC
OSTEOCHONDROPATHY; EAR
EARLY CONGENITAL SYPHILIS, UNSPECIFIED; CONGENITAL

A50.2 16,640.00 11,648.00 4,992.00
SYPHILIS NOS LESS THAN TWO YEARS AFTER BIRTH.
LATE CONGENITAL NEUROSYPHILIS [JUVENILE

NEUROSYPHILIS]; DEMENTIA PARALYTICA JUVENILIS;
A50.4 16,640.00 11,648.00 4,992.00
JUVENILE GENERAL PARESIS ; JUVENILE TABES DORSALIS;
JUVENILE TABOPARETIC NEUROSYPHILIS
OTHER LATE CONGENITAL SYPHILIS, SYMPTOMATIC;
A50.5 16,640.00 11,648.00 4,992.00
SYPHILITIC SADDLE NOSE
A50.9 CONGENITAL SYPHILIS, UNSPECIFIED 16,640.00 11,648.00 4,992.00
A52.1 LATE SYMPTOMATIC NEUROSYPHILIS; TABES DORSALIS 7,150.00 5,005.00 2,145.00
NEUROSYPHILIS, UNSPECIFIED; SYPHILITIC GUMMA OF
CENTRAL NERVOUS SYSTEM NOS; LATE SYPHILIS OF
A52.3 7,150.00 5,005.00 2,145.00
CENTRAL NERVOUS SYSTEM NOS; SYPHILOMA OF CENTRAL
NERVOUS SYSTEM NOS
A52.7 OTHER SYMPTOMATIC LATE SYPHILIS 7,150.00 5,005.00 2,145.00
LATENT SYPHILIS, UNSPECIFIED AS EARLY OR LATE;
A53.0 LATENT SYPHILIS NOS; POSITIVE SEROLOGICAL REACTION 7,150.00 5,005.00 2,145.00
FOR SYPHILIS
A53.0+ J17.0* PNEUMONIA IN NOCARDIOSIS 19,500.00 13,650.00 5,850.00
GONOCOCCAL INFECTION OF LOWER GENITOURINARY
A54.1 TRACT WITH PERIURETHRAL AND ACCESSORY GLAND 7,150.00 5,005.00 2,145.00
ABSCESS; GONOCOCCAL BARTHOLIN'S GLAND ABSCESS
GONOCOCCAL PELVIPERITONITIS AND OTHER
A54.2 7,150.00 5,005.00 2,145.00
GONOCOCCAL GENITOURINARY INFECTIONS
A54.8 GONOCOCCAL SEPTICAEMIA; GONOCOCCAL SKIN LESIONS 7,150.00 5,005.00 2,145.00
A54.8+ J17.0* PNEUMONIA IN GONORRHEA 19,500.00 13,650.00 5,850.00
CHLAMYDIAL LYMPHOGRANULOMA (VENEREUM);
A55 CLIMATIC OR TROPICAL BUBO ; DURAND-NICOLAS-FAVRE 7,150.00 5,005.00 2,145.00
DISEASE; ESTHIOMENE; LYMPHOGRANULOMA INGUINALE
CHLAMYDIAL INFECTION OF PELVIPERITONEUM AND
A56.1 7,150.00 5,005.00 2,145.00
OTHER GENITOURINARY ORGANS;
A56.4 CHLAMYDIAL INFECTION OF PHARYNX 11,050.00 7,735.00 3,315.00
A59 TRICHOMONIASIS 7,150.00 5,005.00 2,145.00
A66.9 YAWS, UNSPECIFIED 11,440.00 8,008.00 3,432.00
INTERMEDIATE LESIONS OF PINTA; ERYTHEMATOUS
PLAQUES OF CARATE PINTA; HYPERCHROMIC LESIONS OF
A67.1 11,440.00 8,008.00 3,432.00
CARATE PINTA; HYPERKERATOSIS OF CARATE PINTA;
PINTIDS OF CARATE PINTA
A68.9 RELAPSING FEVER, UNSPECIFIED 11,440.00 8,008.00 3,432.00
NECROTIZING ULCERATIVE STOMATITIS; CANCRUM ORIS;
A69.0 FUSOSPIROCHAETAL GANGRENE; NOMA; STOMATITIS 11,440.00 8,008.00 3,432.00
GANGRENOSA
Page 5 of 126
First Case Rate

OTHER VINCENT'S INFECTIONS; FUSOSPIROCHAETAL
PHARYNGITIS ; ACUTE NECROTIZING ULCERATIVE
GINGIVITIS; ACUTE NECROTIZING ULCERATIVE
A69.1 11,440.00 8,008.00 3,432.00
GINGIVOSTOMATITIS; SPIROCHAETAL STOMATITIS,
TRENCH MOUTH; VINCENT'S ANGINA; VINCENT’S
GINGIVITIS
LYME DISEASE; ERYTHEMA CHRONICUM MIGRANS DUE TO
A69.2 11,440.00 8,008.00 3,432.00
BORRELIA BURGDORFERI
A69.8+ J17.8* PNEUMONIA IN SPIROCHAETAL 19,500.00 13,650.00 5,850.00
A69.9 SPIROCHAETAL INFECTION, UNSPECIFIED 11,440.00 8,008.00 3,432.00
A70+ J17.8* PNEUMONIA IN ORNITHOSIS 19,500.00 13,650.00 5,850.00
ACTIVE STAGE OF TRACHOMA; ACTIVE STAGE OF
TRACHOMA; TRACHOMATOUS GRANULAR CONJUNCTIVITIS;
A71.1 11,050.00 7,735.00 3,315.00
TRACHOMATOUS FOLLICULAR CONJUNCTIVITIS;
TRACHOMATOUS PANNUS
A71.9 TRACHOMA, UNSPECIFIED 11,050.00 7,735.00 3,315.00
CHLAMYDIAL INFECTION, UNSPECIFIED; CHLAMYDIOSIS
A74.9 11,050.00 7,735.00 3,315.00
NOS
EPIDEMIC LOUSE-BORNE TYPHUS FEVER DUE TO
A75.0 RICKETTSIA PROWAZEKII; CL ASSICAL TYPHUS FEVER; 9,100.00 6,370.00 2,730.00
EPIDEMIC LOUSE-BORNE TYPHUS
A75.9 TYPHUS FEVER, UNSPECIFIED 9,100.00 6,370.00 2,730.00
SPOTTED FEVER DUE TO RICKETTSIA RICKETTSII; ROCKY
A77.0 9,100.00 6,370.00 2,730.00
MOUNTAIN SPOTTED FEVER; SAO PAULO FEVER
A78+ J17.8* PNEUMONIA IN Q FEVER 19,500.00 13,650.00 5,850.00
A79.0 TRENCH FEVER ; QUINTAN FEVER; WOLHYNIAN FEVER 9,100.00 6,370.00 2,730.00
RICKETTSIOSIS, UNSPECIFIED; RICKETTSIAL INFECTION
A79.9 9,100.00 6,370.00 2,730.00
NOS
CREUTZFELDT-JAKOB DISEASE; SUBACUTE SPONGIFORM
A81.0 27,430.00 19,201.00 8,229.00
ENCEPHALOPATHY
SUBACUTE SCLEROSING PANENCEPHALITIS; DAWSON'S
A81.1 INCLUSION BODY ENCEPHALITIS ; VAN BOGAERT'S 27,430.00 19,201.00 8,229.00
SCLEROSING LEUKOENCEPHALOPATHY
PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY;
A81.2 27,430.00 19,201.00 8,229.00
MULTIFOCAL LEUKOENCEPHALOPATHY NOS
ATYPICAL VIRUS INFECTION OF CENTRAL NERVOUS
A81.9 SYSTEM, UNSPECIFIED; PRION DISEASE OF CENTRAL 27,430.00 19,201.00 8,229.00
NERVOUS SYSTEM NOS
A82.0 SYLVATIC RABIES 27,430.00 19,201.00 8,229.00
A82.1 URBAN RABIES 27,430.00 19,201.00 8,229.00
A82.9 RABIES, UNSPECIFIED 27,430.00 19,201.00 8,229.00
A83.0 JAPANESE ENCEPHALITIS 27,430.00 19,201.00 8,229.00
A83.2 EASTERN EQUINE ENCEPHALITIS 27,430.00 19,201.00 8,229.00
CALIFORNIA ENCEPHALITIS; CALIFORNIA
A83.5 MENINGOENCEPHALITIS 27,430.00 19,201.00 8,229.00
LA CROSSE ENCEPHALITIS
A83.8 OTHER MOSQUITO-BORNE VIRAL ENCEPHALITIS 27,430.00 19,201.00 8,229.00
A83.9 MOSQUITO-BORNE VIRAL ENCEPHALITIS, UNSPECIFIED 27,430.00 19,201.00 8,229.00
A85.2 ARTHROPOD-BORNE VIRAL ENCEPHALITIS, UNSPECIFIED; 27,430.00 19,201.00 8,229.00
OTHER SPECIFIED VIRAL ENCEPHALITIS; ENCEPHALITIS

A85.8 27,430.00 19,201.00 8,229.00
LETHARGIC; VON ECONOMO-CRUCHET DISEASE
UNSPECIFIED VIRAL ENCEPHALITIS; VIRAL
A86 ENCEPHALOMYELITIS NOS; VIRAL MENINGOENCEPHALITIS 27,430.00 19,201.00 8,229.00
NOS
A87.8 OTHER VIRAL MENINGITIS 33,410.00 23,387.00 10,023.00
A87.9 VIRAL MENINGITIS, UNSPECIFIED 33,410.00 23,387.00 10,023.00
OTHER SPECIFIED VIRAL INFECTIONS OF CENTRAL
A88.8 27,430.00 19,201.00 8,229.00
NERVOUS SYSTEM
UNSPECIFIED VIRAL INFECTION OF CENTRAL NERVOUS
A89 27,430.00 19,201.00 8,229.00
SYSTEM
CHIKUNGUNYA VIRUS DISEASE; CHIKUNGUNYA
A92.0 10,530.00 7,371.00 3,159.00
(HAEMORRHAGIC) FEVER
A92.1 O'NYONG-NYONG FEVER 10,530.00 7,371.00 3,159.00
VENEZUELAN EQUINE FEVER; VENEZUELAN EQUINE
A92.2 ENCEPHALITIS; VENEZUELAN ENCEPHALOMYELITIS VIRUS 10,530.00 7,371.00 3,159.00
DISEASE
A92.8 OTHER SPECIFIED MOSQUITO-BORNE VIRAL FEVERS 10,530.00 7,371.00 3,159.00
A93.1 SANDFLY FEVER; PAPPATACI FEVER; PHLEBOTOMUS FEVER 10,530.00 7,371.00 3,159.00
OTHER SPECIFIED ARTHROPOD-BORNE VIRAL FEVERS; PIRY
A93.8 VIRUS DISEASE; VESICULAR STOMATITIS VIRUS DISEASE 10,530.00 7,371.00 3,159.00
[INDIANA FEVER]
UNSPECIFIED ARTHROPOD-BORNE VIRAL FEVER;
A94 UNSPECIFIED ARTHROPOD-BORNE VIRAL FEVER; 10,530.00 7,371.00 3,159.00
ARBOVIRAL FEVER NOS; ARBOVIRUS INFECTION NOS
Page 6 of 126
First Case Rate

JUNIN HAEMORRHAGIC FEVER; ARGENTINIAN
A96.0 10,270.00 7,189.00 3,081.00
HAEMORRHAGIC FEVER
MACHUPO HAEMORRHAGIC FEVER; BOLIVIAN
A96.1 10,270.00 7,189.00 3,081.00
HAEMORRHAGIC FEVER
DENGUE WITHOUT WARNING SIGNS; DENGUE FEVER (DF)
A97.0 DENGUE HAEMORRHAGIC FEVER GRADES 1 AND 2; DENGUE 13,000.00 9,100.00 3,900.00
HAEMORRHAGIC FEVER WITHOUT WARNING SIGNS
DENGUE WITH WARNING SIGNS; DENGUE HAEMORRHAGIC
A97.1 13,000.00 9,100.00 3,900.00
FEVER WITH WARNING SIGNS
A98.8 OTHER SPECIFIED VIRAL HAEMORRHAGIC FEVERS 10,270.00 7,189.00 3,081.00
A99 UNSPECIFIED VIRAL HAEMORRHAGIC FEVER 10,270.00 7,189.00 3,081.00
B01.2+ J17.1* PNEUMONIA IN VARICELLA 19,500.00 13,650.00 5,850.00
B01.9 VARICELLA [CHICKENPOX] WITHOUT COMPLICATION 5,200.00 3,640.00 1,560.00
MEASLES COMPLICATED BY ENCEPHALITIS; ENCEPHALITIS,
B05.0+ G05.1* MYELITIS AND ENCEPHALOMYELITIS IN VIRAL DISEASES 28,080.00 19,656.00 8,424.00
CLASSIFIED ELSEWHERE
MEASLES COMPLICATED BY MENINGITIS; MENINGITIS IN
B05.1+ G02.0* 33,410.00 23,387.00 10,023.00
VIRAL DISEASES CLASSIFIED ELSEWHERE
B05.2+ J17.1* PNEUMONIA IN MEASLES 19,500.00 13,650.00 5,850.00
MEASLES COMPLICATED BY OTITIS MEDIA; OTITIS MEDIA
B05.3+ H67.1* 10,140.00 7,098.00 3,042.00
IN VIRAL DISEASES CLASSIFIED ELSEWHERE
B05.4 MEASLES WITH INTESTINAL COMPLICATIONS 12,350.00 8,645.00 3,705.00
B05.8 MEASLES WITH OTHER COMPLICATIONS 10,010.00 7,007.00 3,003.00
B05.9 MEASLES WITHOUT COMPLICATIONS 10,010.00 7,007.00 3,003.00
B06.8 RUBELLA WITH OTHER COMPLICATIONS 5,200.00 3,640.00 1,560.00
B06.8+ J17.1* PNEUMONIA IN RUBELLA 19,500.00 13,650.00 5,850.00
B06.9 RUBELLA WITHOUT COMPLICATION 5,200.00 3,640.00 1,560.00
B09 VIRAL EXANTHEM 5,200.00 3,640.00 1,560.00
B15.0 ACUTE HEPATITIS A WITH HEPATIC COMA 15,340.00 10,738.00 4,602.00
ACUTE HEPATITIS A WITHOUT HEPATIC COMA; HEPATITIS A
B15.9 15,340.00 10,738.00 4,602.00
(ACUTE)(VIRAL) NOS
ACUTE HEPATITIS B WITH DELTA-AGENT (COINFECTION)
B16.0 15,340.00 10,738.00 4,602.00
WITH HEPATIC COMA
ACUTE HEPATITIS B WITH DELTA-AGENT (COINFECTION)
B16.1 15,340.00 10,738.00 4,602.00
WITHOUT HEPATIC COMA
ACUTE HEPATITIS B WITHOUT DELTA-AGENT WITH
B16.2 15,340.00 10,738.00 4,602.00
HEPATIC COMA
ACUTE HEPATITIS B WITHOUT DELTA-AGENT AND
B16.9 WITHOUT HEPATIC COMA; HEPATITIS B (ACUTE)(VIRAL) 15,340.00 10,738.00 4,602.00
NOS
B17.0 ACUTE DELTA-(SUPER)INFECTION OF HEPATITIS B CARRIER 15,340.00 10,738.00 4,602.00
B17.1 ACUTE HEPATITIS C 15,340.00 10,738.00 4,602.00
B17.2 ACUTE HEPATITIS E 15,340.00 10,738.00 4,602.00
OTHER SPECIFIED ACUTE VIRAL HEPATITIS; HEPATITIS
B17.8 15,340.00 10,738.00 4,602.00
NON-A NON-B (ACUTE)(VIRAL) NEC
B18.0 CHRONIC VIRAL HEPATITIS B WITH DELTA-AGENT 15,340.00 10,738.00 4,602.00
CHRONIC VIRAL HEPATITIS B WITHOUT DELTA-AGENT;
B18.1 15,340.00 10,738.00 4,602.00
CHRONIC (VIRAL) HEPATITIS B
B18.2 CHRONIC VIRAL HEPATITIS C 15,340.00 10,738.00 4,602.00
B18.8 OTHER CHRONIC VIRAL HEPATITIS 15,340.00 10,738.00 4,602.00
B18.9 CHRONIC VIRAL HEPATITIS, UNSPECIFIED 15,340.00 10,738.00 4,602.00
B19.0 UNSPECIFIED VIRAL HEPATITIS HEPATIC WITH COMA 15,340.00 10,738.00 4,602.00
UNSPECIFIED VIRAL HEPATITIS WITHOUT HEPATIC COMA;
B19.9 15,340.00 10,738.00 4,602.00
VIRAL HEPATITIS NOS
HIV DISEASE RESULTING IN OTHER BACTERIAL
B20.1 11,570.00 8,099.00 3,471.00
INFECTIONS
HUMAN IMMUNODEFICIENCY VIRUS [HIV] DISEASE
B21.0 15,600.00 10,920.00 4,680.00
RESULTING IN KAPOSI'S SARCOMA
B21.1 18,070.00 12,649.00 5,421.00
RESULTING IN BURKITT'S LYMPHOMA
B21.2 RESULTING IN OTHER TYPES OF NON-HODGKIN'S 18,070.00 12,649.00 5,421.00
LYMPHOMA
B21.3 RESULTING IN OTHER MALIGNANT NEOPLASMS OF 18,070.00 12,649.00 5,421.00
LYMPHOID, HAEMATOPOIETIC AND RELATED TISSUE
B22.0 RESULTING IN ENCEPHALOPATHY; HUMAN 28,860.00 20,202.00 8,658.00
IMMUNODEFICIENCY VIRUS [HIV] DEMENTIA
B25.0+ J17.1* PNEUMONIA IN CYTOMEGALOVIRUS DISEASE 19,500.00 13,650.00 5,850.00
B34.1 ECHOVIRUS INFECTION NOS 5,200.00 3,640.00 1,560.00
B34.2 CORONAVIRUS INFECTION, UNSPECIFIED 5,200.00 3,640.00 1,560.00
B34.3 PARVOVIRUS INFECTION, UNSPECIFIED 5,200.00 3,640.00 1,560.00
B34.4 PAPOVAVIRUS INFECTION, UNSPECIFIED 5,200.00 3,640.00 1,560.00
B34.8 OTHER VIRAL INFECTIONS OF UNSPECIFIED SITE 5,200.00 3,640.00 1,560.00
B34.9 VIRAL INFECTION, UNSPECIFIED; 5,200.00 3,640.00 1,560.00
B37.1+ J17.2* PNEUMONIA IN CANDIDIASIS 19,500.00 13,650.00 5,850.00
B38.0+ J17.2* PNEUMONIA IN ACUTE PULMONARY COCCIDIOMYCOSIS 19,500.00 13,650.00 5,850.00
Page 7 of 126
First Case Rate

B38.1+ J17.2* PNEUMONIA IN CHRONIC PULMONARY COCCIDIOMYCOSIS 19,500.00 13,650.00 5,850.00
B38.2+ J17.2* PNEUMONIA IN PULMONARY COCCIDIOIDOMYCOSIS 19,500.00 13,650.00 5,850.00
PNEUMONIA IN ACUTE PULMONARY HISTOPLASMOSIS
B39.0+ J17.2* 19,500.00 13,650.00 5,850.00
CAPSULATI
PNEUMONIA IN CHRONIC PULMONARY HISTOPLASMOSIS
B39.1+ J17.2* 19,500.00 13,650.00 5,850.00
CAPSULATI
B39.2+ J17.2* PNEUMONIA IN PULMONARY HISTOPLASMOSIS CAPSULATI 19,500.00 13,650.00 5,850.00
B39.9+ J17.2* PNEUMONIA IN HISTOPLASMOSIS 19,500.00 13,650.00 5,850.00
B44.0+ J17.2* PNEUMONIA IN INVASIVE PULMONARY ASPERGILLOSIS 19,500.00 13,650.00 5,850.00
B44.1+ J17.2* PNEUMONIA IN OTHER PULMONARY ASPERGILLOSIS 19,500.00 13,650.00 5,850.00
B50.9 PLASMODIUM FALCIPARUM MALARIA 5,200.00 3,640.00 1,560.00
B51.9 PLASMODIUM VIVAX MALARIA WITHOUT COMPLICATIONS 5,200.00 3,640.00 1,560.00
PLASMODIUM MALARIAE MALARIA WITHOUT
B52.9 5,200.00 3,640.00 1,560.00
COMPLICATIONS
B58.3+ J17.3* PNEUMONIA IN TAXOPLASMOSIS 19,500.00 13,650.00 5,850.00
PNEUMONIA IN SCHISTOSOMIASIS DUE TO SCHISTOSOMA
B65.0+ J17.3* 19,500.00 13,650.00 5,850.00
HEMATOBIUM
SCHISTOSOMIASIS DUE TO SCHISTOSOMA MANSONI
B65.1 5,200.00 3,640.00 1,560.00
[INTESTINAL SCHISTOSOMIASIS]
B65.1+ J17.3* 19,500.00 13,650.00 5,850.00
MANSONI
B65.2 SCHISTOSOMIASIS DUE TO SCHISTOSOMA JAPONICUM 5,200.00 3,640.00 1,560.00
B65.2+ J17.3* 19,500.00 13,650.00 5,850.00
JAPONICUM
B65.3 CERCARIAL DERMATITIS; SWIMMER'S ITCH 5,200.00 3,640.00 1,560.00
INFECTION DUE TO SCHISTOSOMA INTERCALATUM,
B65.8 5,200.00 3,640.00 1,560.00
SCHISTOSOMA MATTHEEI , SCHISTOSOMA MEKONGI
B65.8+ J17.3* 19,500.00 13,650.00 5,850.00
INTERCALATUM; MATTHEEI; MEKONGI
B65.9 SCHISTOSOMIASIS, UNSPECIFIED 5,200.00 3,640.00 1,560.00
B65.9+ J17.3* PNEUMONIA IN SCHISTOSOMIASIS 19,500.00 13,650.00 5,850.00
B77.8+ J17.3* PNEUMONIA IN ASCARIASIS 19,500.00 13,650.00 5,850.00
B77.9 ASCARIASIS 5,200.00 3,640.00 1,560.00
B82.0 INTESTINAL HELMINTHIASIS, UNSPECIFIED 5,200.00 3,640.00 1,560.00
B82.9 INTESTINAL PARASITISM, UNSPECIFIED 5,200.00 3,640.00 1,560.00
B90.0 SEQUELAE OF CENTRAL NERVOUS SYSTEM TUBERCULOSIS 13,910.00 9,737.00 4,173.00
B90.8 SEQUELAE OF TUBERCULOSIS OF OTHER ORGANS 13,910.00 9,737.00 4,173.00
SEQUELAE OF RESPIRATORY AND UNSPECIFIED
B90.9 13,910.00 9,737.00 4,173.00
TUBERCULOSIS; SEQUELAE OF TUBERCULOSIS NOS
B94.1 SEQUELAE OF VIRAL ENCEPHALITIS 13,910.00 9,737.00 4,173.00
B94.2 SEQUELAE OF VIRAL HEPATITIS 13,910.00 9,737.00 4,173.00
SEQUELAE OF OTHER SPECIFIED INFECTIOUS AND
B94.8 13,910.00 9,737.00 4,173.00
PARASITIC DISEASES
SEQUELAE OF UNSPECIFIED INFECTIOUS OR PARASITIC
B94.9 13,910.00 9,737.00 4,173.00
DISEASE
MALIGNANT NEOPLASM OF EXTERNAL UPPER LIP;
MALIGNANT NEOPLASM OF UPPER LIP NOS; MALIGNANT
C00.0 NEOPLASM OF UPPER LIP; MALIGNANT NEOPLASM OF 14,950.00 10,465.00 4,485.00
LIPSTICK AREA; MALIGNANT NEOPLASM OF UPPER LIP,
VERMILION BORDER
C00.9 MALIGNANT NEOPLASM OF LIP, UNSPECIFIED 14,950.00 10,465.00 4,485.00
MALIGNANT NEOPLASM OF BASE OF DORSAL SURFACE OF
TONGUE ; MALIGNANT NEOPLASM OF FIXED PART OF
C01 14,950.00 10,465.00 4,485.00
TONGUE NOS; MALIGNANT NEOPLASM OF POSTERIOR
THIRD OF TONGUE
MALIGNANT NEOPLASM OF DORSAL SURFACE OF BASE OF
C02.0 TONGUE; MALIGNANT NEOPLASM OF ANTERIOR TWO- 14,950.00 10,465.00 4,485.00
THIRDS OF DORSAL SURFACE OF TONGUE
MALIGNANT NEOPLASM OF BORDER OF TONGUE;
C02.1 14,950.00 10,465.00 4,485.00
MALIGNANT NEOPLASM OF TIP OF TONGUE
MALIGNANT NEOPLASM OF VENTRAL SURFACE OF TONGUE;
MALIGNANT NEOPLASM OF ANTERIOR TWO-THIRDS OF
C02.2 14,950.00 10,465.00 4,485.00
VENTRAL SURFACE OF TONGUE; MALIGNANT NEOPLASM OF
FRENULUM LINGUAE
MALIGNANT NEOPLASM OF ANTERIOR TWO-THIRDS OF
TONGUE, PART UNSPECIFIED; MALIGNANT NEOPLASM OF
C02.3 14,950.00 10,465.00 4,485.00
MIDDLE THIRD OF TONGUE NOS; MALIGNANT NEOPLASM
OF MOBILE PART OF TONGUE NOS
C02.4 MALIGNANT NEOPLASM OF LINGUAL TONSIL 14,950.00 10,465.00 4,485.00
MALIGNANT NEOPLASM OF OVERLAPPING LESION OF
C02.8 14,950.00 10,465.00 4,485.00
TONGUE
C02.9 MALIGNANT NEOPLASM OF TONGUE, UNSPECIFIED 14,950.00 10,465.00 4,485.00
C03.0 MALIGNANT NEOPLASM OF UPPER GUM 14,950.00 10,465.00 4,485.00
C03.1 MALIGNANT NEOPLASM OF LOWER GUM 14,950.00 10,465.00 4,485.00
Page 8 of 126
First Case Rate

C03.9 MALIGNANT NEOPLASM OF GUM, UNSPECIFIED 14,950.00 10,465.00 4,485.00
MALIGNANT NEOPLASM OF FLOOR OF MOUTH,
C04.9 14,950.00 10,465.00 4,485.00
UNSPECIFIED
C05.0 MALIGNANT NEOPLASM OF HARD PALATE 14,950.00 10,465.00 4,485.00
C05.1 MALIGNANT NEOPLASM OF SOFT PALATE 14,950.00 10,465.00 4,485.00
C05.9 MALIGNANT NEOPLASM OF PALATE, UNSPECIFIED 14,950.00 10,465.00 4,485.00
MALIGNANT NEOPLASM OF CHEEK MUCOSA; MALIGNANT
C06.0 NEOPLASM OF BUCCAL MUCOSA NOS; MALIGNANT 14,950.00 10,465.00 4,485.00
NEOPLASM OF INTERNAL CHEEK
MALIGNANT NEOPLASM OF VESTIBULE OF MOUTH;
MALIGNANT NEOPLASM OF UPPER BUCCAL SULCUS;
C06.1 MALIGNANT NEOPLASM OF LOWER BUCCAL SULCUS; 14,950.00 10,465.00 4,485.00
MALIGNANT NEOPLASM OF UPPER LABIAL SULCUS;
MALIGNANT NEOPLASM OF LOWER LABIAL SULCUS
C06.2 MALIGNANT NEOPLASM OF RETROMOLAR AREA 14,950.00 10,465.00 4,485.00
MALIGNANT NEOPLASM OF MOUTH, UNSPECIFIED; MINOR
MALIGNANT NEOPLASM OF MINOR SALIVARY GLAND,
C06.9 14,950.00 10,465.00 4,485.00
UNSPECIFIED SITE; MALIGNANT NEOPLASM OF ORAL
CAVITY NOS
C07 MALIGNANT NEOPLASM OF PAROTID GLAND 14,950.00 10,465.00 4,485.00
MALIGNANT NEOPLASM OF SUBMANDIBULAR GLAND;
C08.0 14,950.00 10,465.00 4,485.00
MALIGNANT NEOPLASM OF SUBMAXILLARY GLAND
C08.1 MALIGNANT NEOPLASM OF SUBLINGUAL GLAND 14,950.00 10,465.00 4,485.00
MALIGNANT NEOPLASM OF MAJOR SALIVARY GLAND,
C08.9 UNSPECIFIED; MALIGNANT NEOPLASM OF MAJOR SALIVARY 14,950.00 10,465.00 4,485.00
GLAND NOS
C09.0 MALIGNANT NEOPLASM OF TONSILLAR FOSSA 14,950.00 10,465.00 4,485.00
MALIGNANT NEOPLASM OF TONSIL, UNSPECIFIED;
MALIGNANT NEOPLASM OF TONSIL NOS; MALIGNANT
C09.9 14,950.00 10,465.00 4,485.00
NEOPLASM OF FAUCIAL TONSIL; MALIGNANT NEOPLASM OF
PALATINE TONSIL
C10.0 MALIGNANT NEOPLASM OF VALLECULA 14,950.00 10,465.00 4,485.00
MALIGNANT NEOPLASM OF POSTERIOR WALL OF
C10.3 14,950.00 10,465.00 4,485.00
OROPHARYNX
MALIGNANT NEOPLASM OF BRANCHIAL CLEFT; MALIGNANT
C10.4 14,950.00 10,465.00 4,485.00
NEOPLASM OF BRANCHIAL CYST
C10.9 MALIGNANT NEOPLASM OF OROPHARYNX, UNSPECIFIED 14,950.00 10,465.00 4,485.00
MALIGNANT NEOPLASM OF SUPERIOR WALL OF
C11.0 NASOPHARYNX; MALIGNANT NEOPLASM OF ROOF OF 14,950.00 10,465.00 4,485.00
NASOPHARYNX
MALIGNANT NEOPLASM OF POSTERIOR WALL OF
C11.1 NASOPHARYNX; MALIGNANT NEOPLASM OF ADENOID; 14,950.00 10,465.00 4,485.00
MALIGNANT NEOPLASM OF PHARYNGEAL TONSIL
MALIGNANT NEOPLASM OF LATERAL WALL OF
NASOPHARYNX; MALIGNANT NEOPLASM OF FOSSA OF
C11.2 ROSENMüLLER; MALIGNANT NEOPLASM OF OPENING OF 14,950.00 10,465.00 4,485.00
AUDITORY TUBE; MALIGNANT NEOPLASM OF PHARYNGEAL
RECESS
MALIGNANT NEOPLASM OF ANTERIOR WALL OF
NASOPHARYNX; MALIGNANT NEOPLASM OF A NTERIOR
NASOPHARYNGEAL SURFACE OF SOFT PALATE; MALIGNANT
C11.3 14,950.00 10,465.00 4,485.00
NEOPLASM OF POSTERIOR NASOPHARYNGEAL SURFACE
OF SOFT PALATE; MALIGNANT NEOPLASM OF POSTERIOR
MARGIN OF NASAL CHOANA; M
C11.9 MALIGNANT NEOPLASM OF NASOPHARYNX, UNSPECIFIED 14,950.00 10,465.00 4,485.00
MALIGNANT NEOPLASM OF ARYEPIGLOTTIC FOLD,

HYPOPHARYNGEAL ASPECT HYPOPHARYNX ; MALIGNANT
C13.1 NEOPLASM OF ARYEPIGLOTTIC FOLD, HYPOPHARYNX NOS; 14,950.00 10,465.00 4,485.00
MALIGNANT NEOPLASM OF ARYEPIGLOTTIC FOLD,
MARGINAL ZONE, HYPOPHARYNX
MALIGNANT NEOPLASM OF HYPOPHARYNX, UNSPECIFIED;

C13.9 14,950.00 10,465.00 4,485.00
MALIGNANT NEOPLASM OF HYPOPHARYNGEAL WALL NOS
C14.0 MALIGNANT NEOPLASM OF PHARYNX, UNSPECIFIED 14,950.00 10,465.00 4,485.00
MALIGNANT NEOPLASM OF OVERLAPPING LESION OF LIP,
C14.8 14,950.00 10,465.00 4,485.00
ORAL CAVITY AND PHARYNX
MALIGNANT NEOPLASM OF CERVICAL PART OF
C15.0 18,460.00 12,922.00 5,538.00
OESOPHAGUS
MALIGNANT NEOPLASM OF ABDOMINAL PART OF
C15.2 18,460.00 12,922.00 5,538.00
OESOPHAGUS
C15.3 MALIGNANT NEOPLASM OF UPPER THIRD OF OESOPHAGUS 18,460.00 12,922.00 5,538.00
MALIGNANT NEOPLASM OF MIDDLE THIRD OF
C15.4 18,460.00 12,922.00 5,538.00
OESOPHAGUS
C15.5 MALIGNANT NEOPLASM OF LOWER THIRD OF OESOPHAGUS 18,460.00 12,922.00 5,538.00
Page 9 of 126
First Case Rate

C15.8 18,460.00 12,922.00 5,538.00
OESOPHAGUS
C15.9 MALIGNANT NEOPLASM OF OESOPHAGUS, UNSPECIFIED 18,460.00 12,922.00 5,538.00
DERMATO(POLY)MYOSITIS IN MALIGNANT NEOPLASM OF
C16 18,460.00 12,922.00 5,538.00
STOMACH
MALIGNANT NEOPLASM OF CARDIA; MALIGNANT
NEOPLASM OF CARDIAC ORIFICE; MALIGNANT NEOPLASM
OF CARDIO-OESOPHAGEAL JUNCTION; MALIGNANT
C16.0 18,460.00 12,922.00 5,538.00
NEOPLASM OF
GASTRO-OESOPHAGEAL JUNCTION; MALIGNANT NEOPLASM
OF OESOPHAGUS AND STOMACH
C16.1 MALIGNANT NEOPLASM OF FUNDUS OF STOMACH 18,460.00 12,922.00 5,538.00
C16.2 MALIGNANT NEOPLASM OF BODY OF STOMACH 18,460.00 12,922.00 5,538.00
MALIGNANT NEOPLASM OF PYLORIC ANTRUM; MALIGNANT
C16.3 18,460.00 12,922.00 5,538.00
NEOPLASM OF GASTRIC ANTRUM
MALIGNANT NEOPLASM OF PYLORUS; MALIGNANT
C16.4 NEOPLASM OF PREPYLORUS; MALIGNANT NEOPLASM OF 18,460.00 12,922.00 5,538.00
PYLORIC CANAL
MALIGNANT NEOPLASM OF LESSER CURVATURE OF
C16.5 18,460.00 12,922.00 5,538.00
STOMACH, UNSPECIFIED
MALIGNANT NEOPLASM OF GREATER CURVATURE OF
C16.6 18,460.00 12,922.00 5,538.00
STOMACH, UNSPECIFIED
C16.9 MALIGNANT NEOPLASM OF STOMACH, UNSPECIFIED 18,460.00 12,922.00 5,538.00
C17.0 MALIGNANT NEOPLASM OF DUODENUM 18,460.00 12,922.00 5,538.00
C17.1 MALIGNANT NEOPLASM OF JEJUNUM 18,460.00 12,922.00 5,538.00
C17.2 MALIGNANT NEOPLASM OF ILEUM 18,460.00 12,922.00 5,538.00
MALIGNANT NEOPLASM OF SMALL INTESTINE,
C17.9 18,460.00 12,922.00 5,538.00
UNSPECIFIED
MALIGNANT NEOPLASM OF CAECUM; MALIGNANT
C18.0 18,460.00 12,922.00 5,538.00
NEOPLASM OF ILEOCAECAL VALVE
C18.1 MALIGNANT NEOPLASM OF APPENDIX 18,460.00 12,922.00 5,538.00
C18.2 MALIGNANT NEOPLASM OF ASCENDING COLON 18,460.00 12,922.00 5,538.00
C18.3 MALIGNANT NEOPLASM OF HEPATIC FLEXURE 18,460.00 12,922.00 5,538.00
C18.4 MALIGNANT NEOPLASM OF TRANSVERSE COLON 18,460.00 12,922.00 5,538.00
C18.5 MALIGNANT NEOPLASM OF SPLENIC FLEXURE 18,460.00 12,922.00 5,538.00
C18.6 MALIGNANT NEOPLASM OF DESCENDING COLON 18,460.00 12,922.00 5,538.00
MALIGNANT NEOPLASM OF SIGMOID COLON; MALIGNANT
C18.7 18,460.00 12,922.00 5,538.00
NEOPLASM OF SIGMOID FLEXURE
C18.8 18,460.00 12,922.00 5,538.00
COLON
MALIGNANT NEOPLASM OF COLON, UNSPECIFIED;
C18.9 18,460.00 12,922.00 5,538.00
MALIGNANT NEOPLASM OF LARGE INTESTINE NOS
MALIGNANT NEOPLASM OF RECTOSIGMOID JUNCTION;
C19 MALIGNANT NEOPLASM OF COLON WITH RECTUM; 18,460.00 12,922.00 5,538.00
MALIGNANT NEOPLASM OF RECTOSIGMOID COLON
MALIGNANT NEOPLASM OF RECTUM; MALIGNANT
C20 18,460.00 12,922.00 5,538.00
NEOPLASM OF RECTAL AMPULLA
C21.0 MALIGNANT NEOPLASM OF ANUS, UNSPECIFIED 18,460.00 12,922.00 5,538.00
MALIGNANT NEOPLASM OF ANAL CANAL; MALIGNANT
C21.1 18,460.00 12,922.00 5,538.00
NEOPLASM OF ANAL SPHINCTER
RECTUM, ANUS AND ANAL CANAL; MALIGNANT NEOPLASM
C21.8 18,460.00 12,922.00 5,538.00
OF ANORECTAL JUNCTION; MALIGNANT NEOPLASM OF
ANORECTUM
LIVER CELL CARCINOMA; HEPATOCELLULAR CARCINOMA
C22.0 18,460.00 12,922.00 5,538.00
HEPATOMA
INTRAHEPATIC BILE DUCT CARCINOMA;
C22.1 18,460.00 12,922.00 5,538.00
CHOLANGIOCARCINOMA
C22.2 HEPATOBLASTOMA 18,460.00 12,922.00 5,538.00
C22.3 ANGIOSARCOMA OF LIVER; KUPFFER CELL SARCOMA 18,460.00 12,922.00 5,538.00
C22.4 OTHER SARCOMAS OF LIVER 18,460.00 12,922.00 5,538.00
C22.7 OTHER SPECIFIED CARCINOMAS OF LIVER 18,460.00 12,922.00 5,538.00
C22.9 LIVER, UNSPECIFIED 18,460.00 12,922.00 5,538.00
C23 MALIGNANT NEOPLASM OF GALLBLADDER 18,460.00 12,922.00 5,538.00
MALIGNANT NEOPLASM OF EXTRAHEPATIC BILE DUCT;
MALIGNANT NEOPLASM OF BILIARY DUCT OR PASSAGE
C24.0 NOS; MALIGNANT NEOPLASM OF COMMON BILE DUCT; 18,460.00 12,922.00 5,538.00
MALIGNANT NEOPLASM OF CYSTIC DUCT; MALIGNANT
NEOPLASM OF HEPATIC DUCT
C24.1 MALIGNANT NEOPLASM OF AMPULLA OF VATER 18,460.00 12,922.00 5,538.00
C24.8 18,460.00 12,922.00 5,538.00
BILIARY TRACT
C24.9 MALIGNANT NEOPLASM OF BILIARY TRACT, UNSPECIFIED 18,460.00 12,922.00 5,538.00
C25.0 MALIGNANT NEOPLASM OF HEAD OF PANCREAS 18,460.00 12,922.00 5,538.00
C25.1 MALIGNANT NEOPLASM OF BODY OF PANCREAS 18,460.00 12,922.00 5,538.00
C25.2 MALIGNANT NEOPLASM OF TAIL OF PANCREAS 18,460.00 12,922.00 5,538.00
C25.3 MALIGNANT NEOPLASM OF PANCREATIC DUCT 18,460.00 12,922.00 5,538.00
MALIGNANT NEOPLASM OF ENDOCRINE PANCREAS;
C25.4 18,460.00 12,922.00 5,538.00
MALIGNANT NEOPLASM OF ISLETS OF LANGERHANS
Page 10 of 126
First Case Rate

MALIGNANT NEOPLASM OF OTHER PARTS OF PANCREAS;
C25.7 18,460.00 12,922.00 5,538.00
MALIGNANT NEOPLASM OF NECK OF PANCREAS
C25.8 18,460.00 12,922.00 5,538.00
PANCREAS
C25.9 MALIGNANT NEOPLASM OF PANCREAS, UNSPECIFIED 18,460.00 12,922.00 5,538.00
MALIGNANT NEOPLASM OF INTESTINAL TRACT, PART
C26.0 18,460.00 12,922.00 5,538.00
UNSPECIFIED; MALIGNANT NEOPLASM OF INTESTINE NOS
C26.1 MALIGNANT NEOPLASM OF SPLEEN 18,460.00 12,922.00 5,538.00
C26.8 18,460.00 12,922.00 5,538.00
DIGESTIVE SYSTEM
MALIGNANT NEOPLASM OF ILL-DEFINED SITES WITHIN
THE DIGESTIVE SYSTEM; MALIGNANT NEOPLASM OF
C26.9 18,460.00 12,922.00 5,538.00
ALIMENTARY CANAL OR TRACT NOS; MALIGNANT
NEOPLASM OF GASTROINTESTINAL TRACT NOS
MALIGNANT NEOPLASM OF NASAL CAVITY; MALIGNANT

NEOPLASM OF CARTILAGE OF NOSE; MALIGNANT
C30.0 NEOPLASM OF NASAL CONCHA; MALIGNANT NEOPLASM OF 13,390.00 9,373.00 4,017.00
INTERNAL NOSE; MALIGNANT NEOPLASM OF SEPTUM OF
NOSE; MALIGNANT NEOPLASM OF VESTIBULE OF NOSE
MALIGNANT NEOPLASM OF MIDDLE EAR; MALIGNANT

NEOPLASM OF EUSTACHIAN TUBE; MALIGNANT NEOPLASM
C30.1 13,390.00 9,373.00 4,017.00
OF INNER EAR; MALIGNANT NEOPLASM OF
MASTOID AIR CELLS
MALIGNANT NEOPLASM OF MAXILLARY SINUS; MALIGNANT
C31.0 NEOPLASM OF ANTRUM (HIGHMORE); MALIGNANT 14,950.00 10,465.00 4,485.00
NEOPLASM OF ANTRUM (MAXILLARY)
C31.1 MALIGNANT NEOPLASM OF ETHMOIDAL SINUS 14,950.00 10,465.00 4,485.00
C31.2 MALIGNANT NEOPLASM OF FRONTAL SINUS 14,950.00 10,465.00 4,485.00
C31.3 MALIGNANT NEOPLASM OF SPHENOIDAL SINUS 14,950.00 10,465.00 4,485.00
C31.8 14,950.00 10,465.00 4,485.00
ACCESSORY SINUSES
MALIGNANT NEOPLASM OF ACCESSORY SINUS,
C31.9 14,950.00 10,465.00 4,485.00
UNSPECIFIED
MALIGNANT NEOPLASM OF GLOTTIS; MALIGNANT
C32.0 NEOPLASM OF INTRINSIC LARYNX; MALIGNANT NEOPLASM 18,980.00 13,286.00 5,694.00
OF TRUE VOCAL CORD NOS
MALIGNANT NEOPLASM OF SUPRAGLOTTIS: MALIGNANT
NEOPLASM OF ARYEPIGLOTTIC FOLD, LARYNGEAL ASPECT;
MALIGNANT NEOPLASM OF EPIGLOTTIS (SUPRAHYOID
C32.1 18,980.00 13,286.00 5,694.00
PORTION) NOS; MALIGNANT NEOPLASM OF EXTRINSIC
LARYNX; MALIGNANT NEOPLASM OF FALSE VOCAL CORD;
MALIGNANT NEOPLASM
C32.2 MALIGNANT NEOPLASM OF SUBGLOTTIS 18,980.00 13,286.00 5,694.00
C32.3 MALIGNANT NEOPLASM OF LARYNGEAL CARTILAGE 18,980.00 13,286.00 5,694.00
C32.9 MALIGNANT NEOPLASM OF LARYNX, UNSPECIFIED 18,980.00 13,286.00 5,694.00
C33 MALIGNANT NEOPLASM OF TRACHEA 18,980.00 13,286.00 5,694.00
MALIGNANT NEOPLASM OF MAIN BRONCHUS; MALIGNANT
C34.0 NEOPLASM OF CARINA; MALIGNANT NEOPLASM OF HILUS 18,980.00 13,286.00 5,694.00
OF LUNG
MALIGNANT NEOPLASM OF UPPER LOBE, BRONCHUS OR
C34.1 18,980.00 13,286.00 5,694.00
LUNG
MALIGNANT NEOPLASM OF MIDDLE LOBE, BRONCHUS OR
C34.2 18,980.00 13,286.00 5,694.00
LUNG
MALIGNANT NEOPLASM OF LOWER LOBE, BRONCHUS OR
C34.3 18,980.00 13,286.00 5,694.00
LUNG
C34.8 18,980.00 13,286.00 5,694.00
BRONCHUS AND LUNG
MALIGNANT NEOPLASM OF BRONCHUS OR LUNG,
C34.9 18,980.00 13,286.00 5,694.00
UNSPECIFIED
C37 MALIGNANT NEOPLASM OF THYMUS 18,980.00 13,286.00 5,694.00
MALIGNANT NEOPLASM OF HEART; MALIGNANT NEOPLASM
C38.0 18,980.00 13,286.00 5,694.00
OF PERICARDIUM
C38.1 MALIGNANT NEOPLASM OF ANTERIOR MEDIASTINUM 18,980.00 13,286.00 5,694.00
MALIGNANT NEOPLASM OF MEDIASTINUM, PART
C38.3 18,980.00 13,286.00 5,694.00
UNSPECIFIED
C38.4 MALIGNANT NEOPLASM OF PLEURA 18,980.00 13,286.00 5,694.00
C38.8 18,980.00 13,286.00 5,694.00
HEART, MEDIASTINUM AND PLEURA
MALIGNANT NEOPLASM OF UPPER RESPIRATORY TRACT,
C39.0 18,980.00 13,286.00 5,694.00
PART UNSPECIFIED
C39.8 18,980.00 13,286.00 5,694.00
RESPIRATORY AND INTRATHORACIC ORGANS
MALIGNANT NEOPLASM OF ILL-DEFINED SITES WITHIN
C39.9 18,980.00 13,286.00 5,694.00
THE RESPIRATORY SYSTEM; RESPIRATORY TRACT NOS
Page 11 of 126
First Case Rate

MALIGNANT NEOPLASM OF SCAPULA AND LONG BONES OF
C40.0 21,450.00 15,015.00 6,435.00
UPPER LIMB
C40.1 MALIGNANT NEOPLASM OF SHORT BONES OF UPPER LIMB 21,450.00 15,015.00 6,435.00
C40.2 MALIGNANT NEOPLASM OF LONG BONES OF LOWER LIMB 21,450.00 15,015.00 6,435.00
C40.3 MALIGNANT NEOPLASM OF SHORT BONES OF LOWER LIMB 21,450.00 15,015.00 6,435.00
MALIGNANT NEOPLASM OF BONE AND ARTICULAR
C40.9 21,450.00 15,015.00 6,435.00
CARTILAGE OF LIMB, UNSPECIFIED
MALIGNANT NEOPLASM OF BONES OF SKULL AND FACE;
C41.0 MALIGNANT NEOPLASM O F SUPERIOR MAXILLA; 21,450.00 15,015.00 6,435.00
MALIGNANT NEOPLASM OF ORBITAL BONE
MALIGNANT NEOPLASM OF MANDIBLE; MALIGNANT
C41.1 21,450.00 15,015.00 6,435.00
NEOPLASM OF LOWER JAW BONE
C41.2 MALIGNANT NEOPLASM OF VERTEBRAL COLUMN 21,450.00 15,015.00 6,435.00
C41.3 MALIGNANT NEOPLASM OF RIBS, STERNUM AND CLAVICLE 21,450.00 15,015.00 6,435.00
MALIGNANT NEOPLASM OF PELVIC BONES, SACRUM AND
C41.4 21,450.00 15,015.00 6,435.00
COCCYX
MALIGNANT NEOPLASM OF OVERLAPPING LESION OF BONE
C41.8 21,450.00 15,015.00 6,435.00
AND ARTICULAR CARTILAGE
MALIGNANT NEOPLASM OF BONE AND ARTICULAR
C41.9 21,450.00 15,015.00 6,435.00
CARTILAGE, UNSPECIFIED
C45.0 MESOTHELIOMA OF PLEURA 13,780.00 9,646.00 4,134.00
MESOTHELIOMA OF PERITONEUM; MESOTHELIOMA OF
MESENTERY; MESOTHELIOMA OF MESOCOLON;
C45.1 MESOTHELIOMA OF OMENTUM; MESOTHELIOMA OF 18,460.00 12,922.00 5,538.00
PARIETAL
PERITONEUM; MESOTHELIOMA OF PELVIC PERITONEUM
C45.2 MESOTHELIOMA OF PERICARDIUM 13,780.00 9,646.00 4,134.00
C45.7 MESOTHELIOMA OF OTHER SITES 13,780.00 9,646.00 4,134.00
C45.9 MESOTHELIOMA, UNSPECIFIED 13,780.00 9,646.00 4,134.00
C46.9 KAPOSI'S SARCOMA, UNSPECIFIED 15,600.00 10,920.00 4,680.00
MALIGNANT NEOPLASM OF PERIPHERAL NERVES OF HEAD,
C47.0 17,290.00 12,103.00 5,187.00
FACE AND NECK
MALIGNANT NEOPLASM OF PERIPHERAL NERVES OF UPPER
C47.1 17,290.00 12,103.00 5,187.00
LIMB, INCLUDING SHOULDER
MALIGNANT NEOPLASM OF PERIPHERAL NERVES OF
C47.2 17,290.00 12,103.00 5,187.00
LOWER LIMB, INCLUDING HIP
C47.3 17,290.00 12,103.00 5,187.00
THORAX
C47.4 17,290.00 12,103.00 5,187.00
ABDOMEN
C47.5 MALIGNANT NEOPLASM OF PERIPHERAL NERVES OF PELVIS 17,290.00 12,103.00 5,187.00
C47.6 17,290.00 12,103.00 5,187.00
TRUNK, UNSPECIFIED
MALIGNANT NEOPLASM OF PERIPHERAL NERVES AND
C47.9 17,290.00 12,103.00 5,187.00
AUTONOMIC NERVOUS SYSTEM, UNSPECIFIED
C48.0 MALIGNANT NEOPLASM OF RETROPERITONEUM 13,780.00 9,646.00 4,134.00
MALIGNANT NEOPLASM OF SPECIFIED PARTS OF
PERITONEUM; MALIGNANT NEOPLASM OF MESENTERY;
MALIGNANT NEOPLASM OF MESOCOLON; MALIGNANT
C48.1 18,460.00 12,922.00 5,538.00
NEOPLASM OF OMENTUM; MALIGNANT NEOPLASM OF
PARIETAL PERITONEUM; MALIGNANT NEOPLASM OF
PELVIC PERITONEUM
C48.2 MALIGNANT NEOPLASM OF PERITONEUM, UNSPECIFIED 18,460.00 12,922.00 5,538.00
MALIGNANT NEOPLASM OF CONNECTIVE AND SOFT TISSUE

OF HEAD, FACE AND NECK; MALIGNANT NEOPLASM OF
C49.0 15,600.00 10,920.00 4,680.00
CONNECTIVE TISSUE OF EAR; MALIGNANT NEOPLASM OF
CONNECTIVE TISSUE OF EYELID
C49.1 15,600.00 10,920.00 4,680.00
OF UPPER LIMB, INCLUDING SHOULDER
C49.2 15,600.00 10,920.00 4,680.00
OF LOWER LIMB, INCLUDING HIP
OF THORAX; MALIGNANT NEOPLASM OF CONNECTIVE AND
SOFT TISSUE OF AXILLA; MALIGNANT NEOPLASM OF
C49.3 15,600.00 10,920.00 4,680.00
CONNECTIVE AND SOFT TISSUE OF DIAPHRAGM;
OF GREAT VESSELS
OF ABDOMEN; MALIGNANT NEOPLASM OF CONNECTIVE
C49.4 AND SOFT TISSUE OF ABDOMINAL WALL; MALIGNANT 15,600.00 10,920.00 4,680.00
NEOPLASM OF CONNECTIVE AND SOFT TISSUE OF
HYPOCHONDRIUM
Page 12 of 126
First Case Rate

OF PELVIS; MALIGNANT NEOPLASM OF CONNECTIVE AND
SOFT TISSUE OF BUTTOCK; MALIGNANT NEOPLASM OF
C49.5 15,600.00 10,920.00 4,680.00
CONNECTIVE AND SOFT TISSUE OF GROIN; MALIGNANT
NEOPLASM OF CONNECTIVE AND SOFT TISSUE OF
PERINEUM
C49.6 OF TRUNK, UNSPECIFIED; MALIGNANT NEOPLASM OF 15,600.00 10,920.00 4,680.00
CONNECTIVE AND SOFT TISSUE OF BACK NOS
C49.8 15,600.00 10,920.00 4,680.00
CONNECTIVE AND SOFT TISSUE
MALIGNANT NEOPLASM OF CONNECTIVE AND SOFT TISSUE,
C49.9 15,600.00 10,920.00 4,680.00
UNSPECIFIED
C50.0 MALIGNANT NEOPLASM OF NIPPLE AND AREOLA, BREAST 15,340.00 10,738.00 4,602.00
C50.1 MALIGNANT NEOPLASM OF CENTRAL PORTION OF BREAST 15,340.00 10,738.00 4,602.00

MALIGNANT NEOPLASM OF UPPER-INNER QUADRANT OF
C50.2 15,340.00 10,738.00 4,602.00
BREAST
MALIGNANT NEOPLASM OF LOWER-INNER QUADRANT OF
C50.3 15,340.00 10,738.00 4,602.00
BREAST
MALIGNANT NEOPLASM OF UPPER-OUTER QUADRANT OF
C50.4 15,340.00 10,738.00 4,602.00
BREAST
C50.6 MALIGNANT NEOPLASM OF AXILLARY TAIL OF BREAST 15,340.00 10,738.00 4,602.00
C50.8 15,340.00 10,738.00 4,602.00
BREAST
C50.9 MALIGNANT NEOPLASM OF BREAST, UNSPECIFIED 15,340.00 10,738.00 4,602.00
MALIGNANT NEOPLASM OF LABIUM MAJUS; MALIGNANT
C51.0 NEOPLASM OF BARTHOLIN'S [GREATER VESTIBULAR] 14,820.00 10,374.00 4,446.00
GLAND
C51.1 MALIGNANT NEOPLASM OF LABIUM MINUS 14,820.00 10,374.00 4,446.00
C51.2 MALIGNANT NEOPLASM OF CLITORIS 14,820.00 10,374.00 4,446.00
MALIGNANT NEOPLASM OF VULVA, UNSPECIFIED;
C51.9 MALIGNANT NEOPLASM OF EXTERNAL FEMALE GENITALIA 14,820.00 10,374.00 4,446.00
NOS; MALIGNANT NEOPLASM OF PUDENDUM
C52 MALIGNANT NEOPLASM OF VAGINA 14,820.00 10,374.00 4,446.00
C53.0 MALIGNANT NEOPLASM OF ENDOCERVIX 14,820.00 10,374.00 4,446.00
C53.1 MALIGNANT NEOPLASM OF EXOCERVIX 14,820.00 10,374.00 4,446.00
C53.8 14,820.00 10,374.00 4,446.00
CERVIX UTERI
C53.9 MALIGNANT NEOPLASM OF CERVIX UTERI, UNSPECIFIED 14,820.00 10,374.00 4,446.00
MALIGNANT NEOPLASM OF ISTHMUS UTERI; MALIGNANT

C54.0 14,820.00 10,374.00 4,446.00
NEOPLASM OF LOWER UTERINE SEGMENT
C54.1 MALIGNANT NEOPLASM OF ENDOMETRIUM 14,820.00 10,374.00 4,446.00
C54.2 MALIGNANT NEOPLASM OF MYOMETRIUM 14,820.00 10,374.00 4,446.00
C54.3 MALIGNANT NEOPLASM OF FUNDUS UTERI 14,820.00 10,374.00 4,446.00
C54.8 14,820.00 10,374.00 4,446.00
CORPUS UTERI
C54.9 CORPUS UTERI, UNSPECIFIED 14,820.00 10,374.00 4,446.00
C55 MALIGNANT NEOPLASM OF UTERUS, PART UNSPECIFIED 14,820.00 10,374.00 4,446.00
C56 MALIGNANT NEOPLASM OF OVARY 14,820.00 10,374.00 4,446.00
MALIGNANT NEOPLASM OF FALLOPIAN TUBE; MALIGNANT
C57.0 NEOPLASM OF OVIDUCT; MALIGNANT NEOPLASM OF 14,820.00 10,374.00 4,446.00
UTERINE TUBE
MALIGNANT NEOPLASM OF PARAMETRIUM; MALIGNANT
C57.3 14,820.00 10,374.00 4,446.00
NEOPLASM OF UTERINE LIGAMENT NOS
MALIGNANT NEOPLASM OF UTERINE ADNEXA,
C57.4 14,820.00 10,374.00 4,446.00
UNSPECIFIED
MALIGNANT NEOPLASM OF OTHER SPECIFIED FEMALE
C57.7 GENITAL ORGANS; MALIGNANT NEOPLASM OF WOLFFIAN 14,820.00 10,374.00 4,446.00
BODY OR DUCT
FEMALE GENITAL ORGANS; MALIGNANT NEOPLASM OF
C57.8 14,820.00 10,374.00 4,446.00
TUBO-OVARIAN; MALIGNANT NEOPLASM OF UTERO-
OVARIAN
MALIGNANT NEOPLASM OF FEMALE GENITAL ORGAN,
C57.9 UNSPECIFIED; MALIGNANT NEOPLASM OF FEMALE 14,820.00 10,374.00 4,446.00
GENITOURINARY TRACT NOS
MALIGNANT NEOPLASM OF PLACENTA; CHORIOCARCINOMA
C58 14,820.00 10,374.00 4,446.00
NOS; CHORIONEPITHELIOMA NOS
MALIGNANT NEOPLASM OF PENIS, UNSPECIFIED;
C60.9 17,420.00 12,194.00 5,226.00
MALIGNANT NEOPLASM OF SKIN OF PENIS NOS
C61 MALIGNANT NEOPLASM OF PROSTATE 17,420.00 12,194.00 5,226.00
MALIGNANT NEOPLASM OF UNDESCENDED TESTIS;
C62.0 ECTOPIC TESTIS ; MALIGNANT NEOPLASM OF RETAINED 17,420.00 12,194.00 5,226.00
TESTIS
Page 13 of 126
First Case Rate

MALIGNANT NEOPLASM OF DESCENDED TESTIS;
C62.1 17,420.00 12,194.00 5,226.00
MALIGNANT NEOPLASM OF SCROTAL TESTIS
C62.9 MALIGNANT NEOPLASM OF TESTIS, UNSPECIFIED 17,420.00 12,194.00 5,226.00
C63.0 MALIGNANT NEOPLASM OF EPIDIDYMIS 17,420.00 12,194.00 5,226.00
C63.1 MALIGNANT NEOPLASM OF SPERMATIC CORD 17,420.00 12,194.00 5,226.00
MALIGNANT NEOPLASM OF SCROTUM; MALIGNANT
C63.2 17,420.00 12,194.00 5,226.00
NEOPLASM OF SKIN OF SCROTUM
MALIGNANT NEOPLASM OF SEMINAL VESICLE; MALIGNANT
C63.7 17,420.00 12,194.00 5,226.00
NEOPLASM OF TUNICA VAGINALIS
MALIGNANT NEOPLASM OF MALE GENITAL ORGAN,
C63.9 17,420.00 12,194.00 5,226.00
UNSPECIFIED; MALE GENITOURINARY TRACT NOS
MALIGNANT NEOPLASM OF KIDNEY, EXCEPT RENAL PELVIS
C64 18,330.00 12,831.00 5,499.00
& RENAL CALYCES
MALIGNANT NEOPLASM OF RENAL PELVIS; MALIGNANT
C65 NEOPLASM OF PELVIURETERIC JUNCTION; MALIGNANT 18,330.00 12,831.00 5,499.00
NEOPLASM OF RENAL CALYCES
C66 MALIGNANT NEOPLASM OF URETER 18,330.00 12,831.00 5,499.00
C67.0 MALIGNANT NEOPLASM OF TRIGONE OF BLADDER 18,330.00 12,831.00 5,499.00
C67.1 MALIGNANT NEOPLASM OF DOME OF BLADDER 18,330.00 12,831.00 5,499.00
C67.2 MALIGNANT NEOPLASM OF LATERAL WALL OF BLADDER 18,330.00 12,831.00 5,499.00
C67.3 MALIGNANT NEOPLASM OF ANTERIOR WALL OF BLADDER 18,330.00 12,831.00 5,499.00
MALIGNANT NEOPLASM OF BLADDER NECK; MALIGNANT

C67.5 18,330.00 12,831.00 5,499.00
NEOPLASM OF INTERNAL URETHRAL ORIFICE
C67.6 MALIGNANT NEOPLASM OF URETERIC ORIFICE 18,330.00 12,831.00 5,499.00
C67.7 MALIGNANT NEOPLASM OF URACHUS 18,330.00 12,831.00 5,499.00
C67.8 18,330.00 12,831.00 5,499.00
BLADDER
C67.9 MALIGNANT NEOPLASM OF BLADDER, UNSPECIFIED 18,330.00 12,831.00 5,499.00
C68.0 MALIGNANT NEOPLASM OF URETHRA 18,330.00 12,831.00 5,499.00
MALIGNANT NEOPLASM OF URINARY ORGAN,
C68.9 UNSPECIFIED; MALIGNANT NEOPLASM OF URINARY 18,330.00 12,831.00 5,499.00
SYSTEM NOS
C69.1 MALIGNANT NEOPLASM OF CORNEA 21,970.00 15,379.00 6,591.00
C69.2 MALIGNANT NEOPLASM OF RETINA 21,970.00 15,379.00 6,591.00
C69.3 MALIGNANT NEOPLASM OF CHOROID 21,970.00 15,379.00 6,591.00
MALIGNANT NEOPLASM OF CILIARY BODY; MALIGNANT
C69.4 21,970.00 15,379.00 6,591.00
NEOPLASM OF EYEBALL
MALIGNANT NEOPLASM OF LACRIMAL GLAND AND DUCT;
C69.5 MALIGNANT NEOPLASM OF LACRIMAL SAC; MALIGNANT 21,970.00 15,379.00 6,591.00
NEOPLASM OF NASOLACRIMAL DUCT
MALIGNANT NEOPLASM OF ORBIT; MALIGNANT
NEOPLASM OF CONNECTIVE TISSUE OF ORBIT; MALIGNANT
NEOPLASM OF EXTRAOCULAR MUSCLE; MALIGNANT
C69.6 21,970.00 15,379.00 6,591.00
NEOPLASM OF PERIPHERAL NERVES OF ORBIT;
MALIGNANT NEOPLASM OF RETROBULBAR TISSUE;
MALIGNANT NEOPLASM OF RETRO-OCULAR
C69.9 MALIGNANT NEOPLASM OF EYE, UNSPECIFIED 21,970.00 15,379.00 6,591.00
C70.0 MALIGNANT NEOPLASM OF CEREBRAL MENINGES 21,970.00 15,379.00 6,591.00
C70.1 MALIGNANT NEOPLASM OF SPINAL MENINGES 21,970.00 15,379.00 6,591.00
C70.9 MALIGNANT NEOPLASM OF MENINGES, UNSPECIFIED 21,970.00 15,379.00 6,591.00
MALIGNANT NEOPLASM OF CEREBRUM, EXCEPT LOBES AND
C71.0 VENTRICLES; MALIGNANT NEOPLASM OF 21,970.00 15,379.00 6,591.00
SUPRATENTORIAL NOS
C71.1 MALIGNANT NEOPLASM OF FRONTAL LOBE 21,970.00 15,379.00 6,591.00
C71.2 MALIGNANT NEOPLASM OF TEMPORAL LOBE 21,970.00 15,379.00 6,591.00
C71.3 MALIGNANT NEOPLASM OF PARIETAL LOBE 21,970.00 15,379.00 6,591.00
C71.4 MALIGNANT NEOPLASM OF OCCIPITAL LOBE 21,970.00 15,379.00 6,591.00
C71.5 MALIGNANT NEOPLASM OF CEREBRAL VENTRICLE 21,970.00 15,379.00 6,591.00
C71.6 MALIGNANT NEOPLASM OF CEREBELLUM 21,970.00 15,379.00 6,591.00
MALIGNANT NEOPLASM OF BRAIN STEM; MALIGNANT
C71.7 NEOPLASM OF FOURTH VENTRICLE; MALIGNANT 21,970.00 15,379.00 6,591.00
NEOPLASM OF INFRATENTORIAL NOS
C71.8 21,970.00 15,379.00 6,591.00
BRAIN
C71.9 MALIGNANT NEOPLASM OF BRAIN, UNSPECIFIED 21,970.00 15,379.00 6,591.00
C72.0 MALIGNANT NEOPLASM OF SPINAL CORD 21,970.00 15,379.00 6,591.00
C72.1 MALIGNANT NEOPLASM OF CAUDA EQUINA 21,970.00 15,379.00 6,591.00
MALIGNANT NEOPLASM OF OLFACTORY NERVE;
C72.2 21,970.00 15,379.00 6,591.00
MALIGNANT NEOPLASM OF OLFACTORY BULB
C72.3 MALIGNANT NEOPLASM OF OPTIC NERVE 21,970.00 15,379.00 6,591.00
C72.4 MALIGNANT NEOPLASM OF ACOUSTIC NERVE 21,970.00 15,379.00 6,591.00
MALIGNANT NEOPLASM OF OTHER AND UNSPECIFIED
C72.5 CRANIAL NERVES; MALIGNANT NEOPLASM OF CRANIAL 21,970.00 15,379.00 6,591.00
NERVE NOS
C72.8 21,970.00 15,379.00 6,591.00
BRAIN AND OTHER PARTS OF CENTRAL NERVOUS SYSTEM
Page 14 of 126
First Case Rate

MALIGNANT NEOPLASM OF CENTRAL NERVOUS SYSTEM,
C72.9 UNSPECIFIED; MALIGNANT NEOPLASM OF NERVOUS 21,970.00 15,379.00 6,591.00
SYSTEM NOS
C73 MALIGNANT NEOPLASM OF THYROID GLAND 14,820.00 10,374.00 4,446.00
C74.0 MALIGNANT NEOPLASM OF CORTEX OF ADRENAL GLAND 14,820.00 10,374.00 4,446.00
C74.1 MALIGNANT NEOPLASM OF MEDULLA OF ADRENAL GLAND 14,820.00 10,374.00 4,446.00
C74.9 MALIGNANT NEOPLASM OF ADRENAL GLAND, UNSPECIFIED 14,820.00 10,374.00 4,446.00

C75.0 MALIGNANT NEOPLASM OF PARATHYROID GLAND 14,820.00 10,374.00 4,446.00
C75.1 MALIGNANT NEOPLASM OF PITUITARY GLAND 14,820.00 10,374.00 4,446.00
C75.3 MALIGNANT NEOPLASM OF PINEAL GLAND 14,820.00 10,374.00 4,446.00
MALIGNANT NEOPLASM OF AORTIC BODY AND OTHER
C75.5 14,820.00 10,374.00 4,446.00
PARAGANGLIA
MALIGNANT NEOPLASM OF ENDOCRINE GLAND,
C75.9 14,820.00 10,374.00 4,446.00
UNSPECIFIED
MALIGNANT NEOPLASM OF HEAD, FACE AND NECK;
C76.0 MALIGNANT NEOPLASM OF CHEEK NOS; MALIGNANT 14,950.00 10,465.00 4,485.00
NEOPLASM OF NOSE NOS
MALIGNANT NEOPLASM OF THORAX; MALIGNANT
NEOPLASM OF AXILLA NOS; MALIGNANT NEOPLASM OF
C76.1 18,980.00 13,286.00 5,694.00
INTRATHORACIC NOS; MALIGNANT NEOPLASM OF
THORACIC NOS
C76.2 MALIGNANT NEOPLASM OF ABDOMEN 18,460.00 12,922.00 5,538.00
MALIGNANT NEOPLASM OF PELVIS; MALIGNANT

NEOPLASM OF GROIN NOS; MALIGNANT NEOPLASM OF
C76.3 20,930.00 14,651.00 6,279.00
SITES OVERLAPPING SYSTEMS WITHIN THE PELVIS, SUCH
AS RECTOVAGINAL (SEPTUM) & RECTOVESICAL (SEPTUM)
C76.4 MALIGNANT NEOPLASM OF UPPER LIMB 20,930.00 14,651.00 6,279.00

C76.5 MALIGNANT NEOPLASM OF LOWER LIMB 20,930.00 14,651.00 6,279.00
C76.7 MALIGNANT NEOPLASM OF OTHER ILL-DEFINED SITES 20,930.00 14,651.00 6,279.00
C76.8 20,930.00 14,651.00 6,279.00
OTHER AND ILL-DEFINED SITES
SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM OF
C77.0 LYMPH NODES OF HEAD, FACE AND NECK; MALIGNANT 14,950.00 10,465.00 4,485.00
NEOPLASM OF SUPRACLAVICULAR LYMPH NODES
C77.1 18,980.00 13,286.00 5,694.00
INTRATHORACIC LYMPH NODES
C77.2 18,460.00 12,922.00 5,538.00
INTRA-ABDOMINAL LYMPH NODES
AXILLARY AND UPPER LIMB LYMPH NODES; SECONDARY
C77.3 20,930.00 14,651.00 6,279.00
AND UNSPECIFIED MALIGNANT NEOPLASM OF PECTORAL
LYMPH NODES
C77.9 20,930.00 14,651.00 6,279.00
LYMPH NODE, UNSPECIFIED
C78.0 SECONDARY MALIGNANT NEOPLASM OF LUNG 18,980.00 13,286.00 5,694.00
C78.1 SECONDARY MALIGNANT NEOPLASM OF MEDIASTINUM 18,980.00 13,286.00 5,694.00
SECONDARY MALIGNANT NEOPLASM OF PLEURA;
C78.2 18,980.00 13,286.00 5,694.00
MALIGNANT PLEURAL EFFUSION NOS
SECONDARY MALIGNANT NEOPLASM OF OTHER AND
C78.3 18,980.00 13,286.00 5,694.00
UNSPECIFIED RESPIRATORY ORGANS
C78.4 SECONDARY MALIGNANT NEOPLASM OF SMALL INTESTINE 18,460.00 12,922.00 5,538.00
SECONDARY MALIGNANT NEOPLASM OF LARGE INTESTINE
C78.5 18,460.00 12,922.00 5,538.00
AND RECTUM
SECONDARY MALIGNANT NEOPLASM OF
C78.6 RETROPERITONEUM AND PERITONEUM; MALIGNANT 18,460.00 12,922.00 5,538.00
ASCITES NOS
C78.7 SECONDARY MALIGNANT NEOPLASM OF LIVER 18,460.00 12,922.00 5,538.00
C78.8 18,460.00 12,922.00 5,538.00
UNSPECIFIED DIGESTIVE ORGANS
SECONDARY MALIGNANT NEOPLASM OF KIDNEY AND
C79.0 18,330.00 12,831.00 5,499.00
RENAL PELVIS
SECONDARY MALIGNANT NEOPLASM OF BLADDER AND
C79.1 18,330.00 12,831.00 5,499.00
OTHER AND UNSPECIFIED URINARY ORGANS
SECONDARY MALIGNANT NEOPLASM OF BRAIN AND
C79.3 21,970.00 15,379.00 6,591.00
CEREBRAL MENINGES
C79.4 21,970.00 15,379.00 6,591.00
UNSPECIFIED PARTS OF NERVOUS SYSTEM
SECONDARY MALIGNANT NEOPLASM OF BONE AND BONE
C79.5 21,450.00 15,015.00 6,435.00
MARROW
C79.6 SECONDARY MALIGNANT NEOPLASM OF OVARY 14,820.00 10,374.00 4,446.00
C79.7 SECONDARY MALIGNANT NEOPLASM OF ADRENAL GLAND 20,930.00 14,651.00 6,279.00
SECONDARY MALIGNANT NEOPLASM OF OTHER SPECIFIED
C79.8 20,930.00 14,651.00 6,279.00
SITES
Page 15 of 126
First Case Rate

MALIGNANT NEOPLASM WITHOUT SPECIFICATION OF SITE;
UNSPECIFIED SITE WHETHER PRIMARY OR SECONDARY
[CANCER, CARCINOMA, CARCINOMATOSIS, GENERALIZED
C80 20,930.00 14,651.00 6,279.00
CANCER, GENERALIZED MALIGNANCY, MALIGNANCY,
MULTIPLE CANCER]; MALIGNANT CACHEXIA; MALIGNANT
NEOPLASM OF PRIMARY
HODGKIN'S DISEASE (LYMPHOCYTIC PREDOMINANCE);
C81.0 HODGKIN'S DISEASE (LYMPHOCYTIC-HISTIOCYTIC 18,070.00 12,649.00 5,421.00
PREDOMINANCE)
C81.1 HODGKIN'S DISEASE( NODULAR SCLEROSIS) 18,070.00 12,649.00 5,421.00
C81.9 HODGKIN'S DISEASE, UNSPECIFIED 18,070.00 12,649.00 5,421.00
SMALL CLEAVED CELL, FOLLICULAR NON-HODGKIN'S
C82.0 18,070.00 12,649.00 5,421.00
LYMPHOMA
MIXED SMALL CLEAVED NON-HODGKIN'S LYMPHOMA AND
C82.1 18,070.00 12,649.00 5,421.00
LARGE CELL, FOLLICULAR NON-HODGKIN'S LYMPHOMA
C82.2 LARGE CELL, FOLLICULAR NON-HODGKIN'S LYMPHOMA 18,070.00 12,649.00 5,421.00
C82.7 OTHER TYPES OF FOLLICULAR NON-HODGKIN'S LYMPHOMA 18,070.00 12,649.00 5,421.00
FOLLICULAR NON-HODGKIN'S LYMPHOMA, UNSPECIFIED;

C82.9 18,070.00 12,649.00 5,421.00
NODULAR NON-HODGKIN'S LYMPHOMA NOS
C83.0 SMALL CELL DIFFUSE NON-HODGKIN'S LYMPHOMA 18,070.00 12,649.00 5,421.00
MIXED SMALL AND LARGE CELL DIFFUSE NON-HODGKIN'S
C83.2 18,070.00 12,649.00 5,421.00
LYMPHOMA
C83.3 LARGE CELL DIFFUSE NON-HODGKIN'S LYMPHOMA 18,070.00 12,649.00 5,421.00
C83.4 IMMUNOBLASTIC DIFFUSE NON-HODGKIN'S LYMPHOMA 18,070.00 12,649.00 5,421.00
C83.5 LYMPHOBLASTIC DIFFUSE NON-HODGKIN'S LYMPHOMA 18,070.00 12,649.00 5,421.00

C83.7 BURKITT'S TUMOUR 18,070.00 12,649.00 5,421.00
C83.8 OTHER TYPES OF DIFFUSE NON-HODGKIN'S LYMPHOMA 18,070.00 12,649.00 5,421.00
C83.9 DIFFUSE NON-HODGKIN'S LYMPHOMA, UNSPECIFIED 18,070.00 12,649.00 5,421.00
C84.0 MYCOSIS FUNGOIDES 18,070.00 12,649.00 5,421.00
C84.1 SéZARY'S DISEASE 18,070.00 12,649.00 5,421.00
C84.3 LYMPHOEPITHELIOID LYMPHOMA; LENNERT'S LYMPHOMA 18,070.00 12,649.00 5,421.00
C84.4 PERIPHERAL T-CELL LYMPHOMA 18,070.00 12,649.00 5,421.00
C84.5 OTHER AND UNSPECIFIED T-CELL LYMPHOMAS 18,070.00 12,649.00 5,421.00
C85.0 LYMPHOSARCOMA 18,070.00 12,649.00 5,421.00
C85.1 B-CELL LYMPHOMA, UNSPECIFIED 18,070.00 12,649.00 5,421.00
OTHER SPECIFIED TYPES OF NON-HODGKIN'S LYMPHOMA;
C85.7 MALIGNANT RETICULOENDOTHELIOSIS; MALIGNANT 18,070.00 12,649.00 5,421.00
RETICULOSIS; MICROGLIOMA
NON-HODGKIN'S LYMPHOMA, UNSPECIFIED TYPE;
C85.9 18,070.00 12,649.00 5,421.00
LYMPHOMA NOS
C90.0 MULTIPLE MYELOMA; KAHLER'S DISEASE; MYELOMATOSIS 18,070.00 12,649.00 5,421.00
C90.1 PLASMA CELL LEUKAEMIA 18,070.00 12,649.00 5,421.00
EXTRAMEDULLARY PLASMACYTOMA; MALIGNANT PLASMA
C90.2 CELL TUMOUR NOS; PLASMACYTOMA NOS ; SOLITARY 18,070.00 12,649.00 5,421.00
MYELOMA
ACUTE LYMPHOBLASTIC LEUKEMIA; ACUTE LYMPHOCYTIC
C91.0 18,070.00 12,649.00 5,421.00
LEUKEMIA
C91.1 CHRONIC LYMPHOCYTIC LEUKAEMIA 18,070.00 12,649.00 5,421.00
C91.2 SUBACUTE LYMPHOCYTIC LEUKAEMIA 18,070.00 12,649.00 5,421.00
C91.3 PROLYMPHOCYTIC LEUKAEMIA 18,070.00 12,649.00 5,421.00
HAIRY-CELL LEUKAEMIA; LEUKAEMIC
C91.4 18,070.00 12,649.00 5,421.00
RETICULOENDOTHELIOSIS
C91.5 ADULT T-CELL LEUKAEMIA 18,070.00 12,649.00 5,421.00
C91.7 OTHER LYMPHOID LEUKAEMIA 18,070.00 12,649.00 5,421.00
C91.9 LYMPHOID LEUKAEMIA, UNSPECIFIED 18,070.00 12,649.00 5,421.00
C92.0 ACUTE MYELOID LEUKAEMIA 18,070.00 12,649.00 5,421.00
C92.1 CHRONIC MYELOID LEUKAEMIA 18,070.00 12,649.00 5,421.00
C92.2 SUBACUTE MYELOID LEUKAEMIA 18,070.00 12,649.00 5,421.00
MYELOID SARCOMA; CHLOROMA; GRANULOCYTIC
C92.3 18,070.00 12,649.00 5,421.00
SARCOMA
C92.4 ACUTE PROMYELOCYTIC LEUKAEMIA 18,070.00 12,649.00 5,421.00
C92.5 ACUTE MYELOMONOCYTIC LEUKAEMIA 18,070.00 12,649.00 5,421.00
C92.7 OTHER MYELOID LEUKAEMIA 18,070.00 12,649.00 5,421.00
C92.9 MYELOID LEUKAEMIA, UNSPECIFIED 18,070.00 12,649.00 5,421.00
C93.0 ACUTE MONOCYTIC LEUKAEMIA 18,070.00 12,649.00 5,421.00
C93.1 CHRONIC MONOCYTIC LEUKAEMIA 18,070.00 12,649.00 5,421.00
C93.9 MONOCYTIC LEUKAEMIA, UNSPECIFIED 18,070.00 12,649.00 5,421.00
ACUTE ERYTHRAEMIA AND ERYTHROLEUKAEMIA; ACUTE
C94.0 18,070.00 12,649.00 5,421.00
ERYTHRAEMIC MYELOSIS; DI GUGLIELMO'S DISEASE
ACUTE MEGAKARYOBLASTIC LEUKAEMIA; ACUTE
C94.2 18,070.00 12,649.00 5,421.00
MEGAKARYOCYTIC LEUKAEMIA
Page 16 of 126
First Case Rate

C94.4 ACUTE PANMYELOSIS 18,070.00 12,649.00 5,421.00
C94.5 ACUTE MYELOFIBROSIS 18,070.00 12,649.00 5,421.00
ACUTE LEUKAEMIA OF UNSPECIFIED CELL TYPE; BLAST
C95.0 18,070.00 12,649.00 5,421.00
CELL LEUKAEMIA; STEM CELL LEUKAEMIA
C95.1 CHRONIC LEUKAEMIA OF UNSPECIFIED CELL TYPE 18,070.00 12,649.00 5,421.00
C95.2 SUBACUTE LEUKAEMIA OF UNSPECIFIED CELL TYPE 18,070.00 12,649.00 5,421.00
C95.7 OTHER LEUKAEMIA OF UNSPECIFIED CELL TYPE 18,070.00 12,649.00 5,421.00
C95.9 LEUKAEMIA, UNSPECIFIED 18,070.00 12,649.00 5,421.00
LETTERER-SIWE DISEASE; NONLIPID
C96.0 18,070.00 12,649.00 5,421.00
RETICULOENDOTHELIOSIS; NONLIPID RETICULOSIS
MALIGNANT HISTIOCYTOSIS; HISTIOCYTIC MEDULLARY
C96.1 18,070.00 12,649.00 5,421.00
RETICULOSIS
MALIGNANT MAST CELL TUMOUR; MALIGNANT
C96.2 MASTOCYTOMA; MALIGNANT MASTOCYTOSIS; MAST CELL 18,070.00 12,649.00 5,421.00
SARCOMA
OTHER SPECIFIED MALIGNANT NEOPLASMS OF LYMPHOID,
C96.7 18,070.00 12,649.00 5,421.00
HAEMATOPOIETIC AND RELATED TISSUE
MALIGNANT NEOPLASM OF LYMPHOID, HAEMATOPOIETIC
C96.9 18,070.00 12,649.00 5,421.00
AND RELATED TISSUE, UNSPECIFIED
BENIGN NEOPLASM OF LIP; BENIGN NEOPLASM OF
FRENULUM OF LIP; BENIGN NEOPLASM OF INNER ASPECT
D10.0 12,350.00 8,645.00 3,705.00
OF LIP; BENIGN NEOPLASM OF MUCOSA OF LIP; VERMILION
BORDER OF LIP
BENIGN NEOPLASM OF TONGUE;BENIGN NEOPLASM OF
D10.1 12,350.00 8,645.00 3,705.00
LINGUAL TONSIL
BENIGN NEOPLASM OF OTHER AND UNSPECIFIED PARTS OF
D10.3 MOUTH; BENIGN NEOPLASM OF MINOR SALIVARY GLAND 12,350.00 8,645.00 3,705.00
NOS
BENIGN NEOPLASM OF NASOPHARYNX; BENIGN NEOPLASM
D10.6 OF PHARYNGEAL TONSIL; BENIGN NEOPLASM OF 12,350.00 8,645.00 3,705.00
POSTERIOR MARGIN OF SEPTUM AND CHOANAE
D10.7 BENIGN NEOPLASM OF HYPOPHARYNX 12,350.00 8,645.00 3,705.00
D10.9 BENIGN NEOPLASM OF PHARYNX, UNSPECIFIED 12,350.00 8,645.00 3,705.00
D11.0 BENIGN NEOPLASM OF PAROTID GLAND 12,350.00 8,645.00 3,705.00
D11.7 BENIGN NEOPLASM OF OTHER MAJOR SALIVARY GLANDS 12,350.00 8,645.00 3,705.00
BENIGN NEOPLASM OF MAJOR SALIVARY GLAND,
D11.9 12,350.00 8,645.00 3,705.00
UNSPECIFIED
BENIGN NEOPLASM OF CAECUM;BENIGN NEOPLASM OF
D12.0 11,310.00 7,917.00 3,393.00
ILEOCAECAL VALVE
D12.1 BENIGN NEOPLASM OF APPENDIX 11,310.00 7,917.00 3,393.00
BENIGN NEOPLASM OF TRANSVERSE COLON; BENIGN
D12.3 NEOPLASM OF HEPATIC FLEXURE; BENIGN NEOPLASM OF 11,310.00 7,917.00 3,393.00
SPLENIC FLEXURE
D12.4 BENIGN NEOPLASM OF DESCENDING COLON 11,310.00 7,917.00 3,393.00
D12.5 BENIGN NEOPLASM OF SIGMOID COLON 11,310.00 7,917.00 3,393.00
BENIGN NEOPLASM OF COLON, UNSPECIFIED;
D12.6 ADENOMATOSIS OF COLON; BENIGN NEOPLASM OF LARGE 11,310.00 7,917.00 3,393.00
INTESTINE NOS; HEREDITARY POLYPOSIS OF COLON
BENIGN NEOPLASM OF RECTOSIGMOID JUNCTION;

D12.7 ADENOMATOSIS OF COLON; BENIGN NEOPLASM OF LARGE 11,310.00 7,917.00 3,393.00
INTESTINE NOS; HEREDITARY POLYPOSIS OF COLON
D12.8 BENIGN NEOPLASM OF RECTUM 11,310.00 7,917.00 3,393.00
D12.9 BENIGN NEOPLASM OF ANUS AND ANAL CANAL 11,310.00 7,917.00 3,393.00
D13.0 BENIGN NEOPLASM OF OESOPHAGUS 11,310.00 7,917.00 3,393.00
D13.1 BENIGN NEOPLASM OF STOMACH 11,310.00 7,917.00 3,393.00
D13.2 BENIGN NEOPLASM OF DUODENUM 11,310.00 7,917.00 3,393.00
BENIGN NEOPLASM OF OTHER AND UNSPECIFIED PARTS OF
D13.3 11,310.00 7,917.00 3,393.00
SMALL INTESTINE
BENIGN NEOPLASM OF LIVER; BENIGN NEOPLASM OF
D13.4 11,310.00 7,917.00 3,393.00
INTRAHEPATIC BILE DUCTS
D13.5 BENIGN NEOPLASM OF EXTRAHEPATIC BILE DUCTS 11,310.00 7,917.00 3,393.00
D13.6 BENIGN NEOPLASM OF PANCREAS 11,310.00 7,917.00 3,393.00
BENIGN NEOPLASM OF ENDOCRINE PANCREAS; BENIGN
D13.7 NEOPLASM OF ISLET CELL TUMOUR; BENIGN NEOPLASM OF 11,310.00 7,917.00 3,393.00
ISLETS OF LANGERHANS
BENIGN NEOPLASM OF ILL-DEFINED SITES WITHIN THE
DIGESTIVE SYSTEM; BENIGN NEOPLASM OF DIGESTIVE
D13.9 11,310.00 7,917.00 3,393.00
SYSTEM NOS; BENIGN NEOPLASM OF INTESTINE NOS;
BENIGN NEOPLASM OF SPLEEN
BENIGN NEOPLASM OF LARYNX; BENIGN NEOPLASM OF
D14.1 12,350.00 8,645.00 3,705.00
SUPRAHYOID PORTION OF EPIGLOTTIS
D14.2 BENIGN NEOPLASM OF TRACHEA 12,350.00 8,645.00 3,705.00
D14.3 BENIGN NEOPLASM OF BRONCHUS AND LUNG 13,130.00 9,191.00 3,939.00
BENIGN NEOPLASM OF RESPIRATORY SYSTEM,
D14.4 13,130.00 9,191.00 3,939.00
UNSPECIFIED
D15.0 BENIGN NEOPLASM OF THYMUS 13,130.00 9,191.00 3,939.00
D15.1 BENIGN NEOPLASM OF HEART 13,130.00 9,191.00 3,939.00
D15.2 BENIGN NEOPLASM OF MEDIASTINUM 13,130.00 9,191.00 3,939.00
Page 17 of 126
First Case Rate

BENIGN NEOPLASM OF INTRATHORACIC ORGAN,
D15.9 13,130.00 9,191.00 3,939.00
UNSPECIFIED
BENIGN NEOPLASM OF SCAPULA AND LONG BONES OF
D16.0 13,650.00 9,555.00 4,095.00
UPPER LIMB
D16.1 BENIGN NEOPLASM OF SHORT BONES OF UPPER LIMB 13,650.00 9,555.00 4,095.00
D16.2 BENIGN NEOPLASM OFLONG BONES OF LOWER LIMB 13,650.00 9,555.00 4,095.00
D16.3 BENIGN NEOPLASM OF SHORT BONES OF LOWER LIMB 13,650.00 9,555.00 4,095.00
BENIGN NEOPLASM OF BONES OF SKULL AND FACE; BENIGN
D16.4 NEOPLASM OF SUPERIOR MAXILLA; BENIGN NEOPLASM OF 13,650.00 9,555.00 4,095.00
ORBITAL BONE
D16.5 BENIGN NEOPLASM OF LOWER JAW BONE 13,650.00 9,555.00 4,095.00
D16.6 BENIGN NEOPLASM OF VERTEBRAL COLUMN 13,650.00 9,555.00 4,095.00
D16.7 BENIGN NEOPLASM OF RIBS, STERNUM AND CLAVICLE 13,650.00 9,555.00 4,095.00
BENIGN NEOPLASM OF PELVIC BONES, SACRUM AND
D16.8 13,650.00 9,555.00 4,095.00
COCCYX
BENIGN NEOPLASM OF BONE AND ARTICULAR CARTILAGE,
D16.9 13,650.00 9,555.00 4,095.00
UNSPECIFIED
BENIGN LIPOMATOUS NEOPLASM OF INTRATHORACIC
D17.4 13,130.00 9,191.00 3,939.00
ORGANS
BENIGN LIPOMATOUS NEOPLASM OF INTRA-ABDOMINAL
D17.5 11,310.00 7,917.00 3,393.00
ORGANS
D17.6 BENIGN LIPOMATOUS NEOPLASM OF SPERMATIC CORD 11,310.00 7,917.00 3,393.00
BENIGN LIPOMATOUS NEOPLASM OF OTHER SITES; BENIGN

D17.7 LIPOMATOUS NEOPLASM OF PERITONEUM; BENIGN 11,310.00 7,917.00 3,393.00
LIPOMATOUS NEOPLASM OF RETROPERITONEUM
D18.0 HAEMANGIOMA, ANY SITE; ANGIOMA NOS 11,700.00 8,190.00 3,510.00
D18.1 LYMPHANGIOMA, ANY SITE 11,700.00 8,190.00 3,510.00
BENIGN NEOPLASM OF OF SOFT TISSUE OF
D20.0 11,310.00 7,917.00 3,393.00
RETROPERITONEUM
D20.1 BENIGN NEOPLASM OF OF SOFT TISSUE OF PERITONEUM 11,310.00 7,917.00 3,393.00
BENIGN NEOPLASM OF CONNECTIVE AND OTHER SOFT
TISSUE OF THORAX; BENIGN NEOPLASM OF CONNECTIVE
AND OTHER SOFT TISSUE OF AXILLA; BENIGN NEOPLASM
D21.3 13,130.00 9,191.00 3,939.00
OF CONNECTIVE AND OTHER SOFT TISSUE OF DIAPHRAGM;
TISSUE OF GREAT V
D21.4 11,310.00 7,917.00 3,393.00
TISSUE OF ABDOMEN
D25.0 SUBMUCOUS LEIOMYOMA OF UTERUS 12,480.00 8,736.00 3,744.00
D25.1 INTRAMURAL LEIOMYOMA OF UTERUS 12,480.00 8,736.00 3,744.00
D25.2 SUBSEROSAL LEIOMYOMA OF UTERUS 12,480.00 8,736.00 3,744.00
D25.9 LEIOMYOMA OF UTERUS, UNSPECIFIED 12,480.00 8,736.00 3,744.00
D26.0 OTHER BENIGN NEOPLASM OF CERVIX UTERI 12,480.00 8,736.00 3,744.00
D26.1 OTHER BENIGN NEOPLASM OF CORPUS UTERI 12,480.00 8,736.00 3,744.00
D26.7 OTHER BENIGN NEOPLASM OF OTHER PARTS OF UTERUS 12,480.00 8,736.00 3,744.00
D26.9 OTHER BENIGN NEOPLASM OF UTERUS, UNSPECIFIED 12,480.00 8,736.00 3,744.00
D27 BENIGN NEOPLASM OF OVARY 12,480.00 8,736.00 3,744.00
D28.0 BENIGN NEOPLASM OF VULVA 12,480.00 8,736.00 3,744.00
D28.1 BENIGN NEOPLASM OF VAGINA 12,480.00 8,736.00 3,744.00
BENIGN NEOPLASM OF UTERINE TUBES AND LIGAMENTS;
BENIGN NEOPLASM OF FALLOPIAN TUBES; BENIGN
D28.2 12,480.00 8,736.00 3,744.00
NEOPLASM OF UTERINE BROAD LIGAMENT; BENIGN
NEOPLASM OF UTERINE ROUND LIGAMENT
BENIGN NEOPLASM OF OTHER SPECIFIED FEMALE GENITAL
D28.7 12,480.00 8,736.00 3,744.00
ORGANS
BENIGN NEOPLASM OF FEMALE GENITAL ORGAN,
D28.9 12,480.00 8,736.00 3,744.00
UNSPECIFIED
D29.0 BENIGN NEOPLASM OF PENIS 10,010.00 7,007.00 3,003.00
D29.1 BENIGN NEOPLASM OF PROSTATE 10,010.00 7,007.00 3,003.00
D29.2 BENIGN NEOPLASM OF TESTIS 10,010.00 7,007.00 3,003.00
BENIGN NEOPLASM OF SCROTUM; BENIGN NEOPLASM OF
D29.4 10,010.00 7,007.00 3,003.00
SKIN OF SCROTUM
D30.0 BENIGN NEOPLASM OF KIDNEY 10,790.00 7,553.00 3,237.00
D30.1 BENIGN NEOPLASM OF RENAL PELVIS 10,790.00 7,553.00 3,237.00
BENIGN NEOPLASM OF BLADDER; BENIGN NEOPLASM OF
D30.3 URETHRAL ORIFICE OF BLADDER; BENIGN NEOPLASM OF 10,790.00 7,553.00 3,237.00
URETERIC ORIFICE OF BLADDER
D30.4 BENIGN NEOPLASM OF URETHRA 10,790.00 7,553.00 3,237.00
BENIGN NEOPLASM OF URINARY ORGAN, UNSPECIFIED;
D30.9 10,790.00 7,553.00 3,237.00
BENIGN NEOPLASM OF URINARY SYSTEM NOS
D32.0 BENIGN NEOPLASM OF CEREBRAL MENINGES 19,240.00 13,468.00 5,772.00
D32.1 BENIGN NEOPLASM OF SPINAL MENINGES 19,240.00 13,468.00 5,772.00
BENIGN NEOPLASM OF MENINGES, UNSPECIFIED;
D32.9 19,240.00 13,468.00 5,772.00
MENINGIOMA NOS
Page 18 of 126
First Case Rate

BENIGN NEOPLASM OF BRAIN, SUPRATENTORIAL; BENIGN
NEOPLASM OF CEREBRAL VENTRICLE; BENIGN NEOPLASM
OF CEREBRUM; BENIGN NEOPLASM OF FRONTAL LOBE;
D33.0 19,240.00 13,468.00 5,772.00
BENIGN NEOPLASM OF OCCIPITAL LOBE; BENIGN
NEOPLASM OF PARIETAL LOBE; BENIGN NEOPLASM OF
TEMPORAL LOBE
BENIGN NEOPLASM OF BRAIN, INFRATENTORIAL; BENIGN

D33.1 NEOPLASM OF BRAIN STEM; BENIGN NEOPLASM OF 19,240.00 13,468.00 5,772.00
CEREBELLUM; BENIGN NEOPLASM OF FOURTH VENTRICLE
D33.2 BENIGN NEOPLASM OF BRAIN, UNSPECIFIED 19,240.00 13,468.00 5,772.00
BENIGN NEOPLASM OF CRANIAL NERVES; BENIGN
D33.3 19,240.00 13,468.00 5,772.00
NEOPLASM OF OLFACTORY BULB
D33.4 BENIGN NEOPLASM OF SPINAL CORD 19,240.00 13,468.00 5,772.00
BENIGN NEOPLASM OF OTHER SPECIFIED PARTS OF
D33.7 19,240.00 13,468.00 5,772.00
CENTRAL NERVOUS SYSTEM
BENIGN NEOPLASM OF CENTRAL NERVOUS SYSTEM,
D33.9 19,240.00 13,468.00 5,772.00
UNSPECIFIED; CENTRAL NERVOUS SYSTEM NOS
D34 BENIGN NEOPLASM OF THYROID GLAND 15,600.00 10,920.00 4,680.00
D35.0 BENIGN NEOPLASM OF ADRENAL GLAND 15,600.00 10,920.00 4,680.00
D35.1 BENIGN NEOPLASM OF PARATHYROID GLAND 15,600.00 10,920.00 4,680.00
D35.2 BENIGN NEOPLASM OF PITUITARY GLAND 15,600.00 10,920.00 4,680.00
D35.3 BENIGN NEOPLASM OF CRANIOPHARYNGEAL DUCT 15,600.00 10,920.00 4,680.00
D35.4 BENIGN NEOPLASM OF PINEAL GLAND 15,600.00 10,920.00 4,680.00
D35.9 BENIGN NEOPLASM OF ENDOCRINE GLAND, UNSPECIFIED 15,600.00 10,920.00 4,680.00
BENIGN NEOPLASM OF PERIPHERAL NERVES AND
D36.1 19,240.00 13,468.00 5,772.00
AUTONOMIC NERVOUS SYSTEM
NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR OF
LIP, ORAL CAVITY AND PHARYNX; NEOPLASM OF
UNCERTAIN OR UNKNOWN BEHAVIOUR OF ARYEPIGLOTTIC
D37.0 15,860.00 11,102.00 4,758.00
FOLD NOS; NEOPLASM OF UNCERTAIN OR UNKNOWN
BEHAVIOUR OF HYPOPHARYNGEAL ASPECT OF
ARYEPIGLOTTIC FOLD ; NEOPLASM OF UN
D37.1 15,860.00 11,102.00 4,758.00
STOMACH
D37.2 15,860.00 11,102.00 4,758.00
SMALL INTESTINE
D37.3 15,860.00 11,102.00 4,758.00
APPENDIX
D37.4 15,860.00 11,102.00 4,758.00
COLON
D37.5 RECTUM; NEOPLASM OF UNCERTAIN OR UNKNOWN 15,860.00 11,102.00 4,758.00
BEHAVIOUR OF RECTOSIGMOID JUNCTION
LIVER, GALLBLADDER AND BILE DUCTS; NEOPLASM OF
D37.6 15,860.00 11,102.00 4,758.00
UNCERTAIN OR UNKNOWN BEHAVIOUR OF AMPULLA OF
VATER
OTHER DIGESTIVE ORGANS; NEOPLASM OF UNCERTAIN OR
UNKNOWN BEHAVIOUR OF ANAL CANAL; NEOPLASM OF
D37.7 15,860.00 11,102.00 4,758.00
UNCERTAIN OR UNKNOWN BEHAVIOUR OF ANAL
SPHINCTER; NEOPLASM OF UNCERTAIN OR UNKNOWN
BEHAVIOUR OF ANUS NOS; NEOPLASM
D37.9 15,860.00 11,102.00 4,758.00
DIGESTIVE ORGAN, UNSPECIFIED
LARYNX; NEOPLASM OF UNCERTAIN OR UNKNOWN
D38.0 BEHAVIOUR OF LARYNGEAL ASPECT OF ARYEPIGLOTTIC 15,860.00 11,102.00 4,758.00
FOLD; NEOPLASM OF UNCERTAIN OR UNKNOWN
BEHAVIOUR OF SUPRAHYOID PORTION OF EPIGLOTTIS
D38.1 15,860.00 11,102.00 4,758.00
TRACHEA, BRONCHUS AND LUNG
D38.2 15,860.00 11,102.00 4,758.00
PLEURA
D38.3 15,860.00 11,102.00 4,758.00
MEDIASTINUM
D38.4 15,860.00 11,102.00 4,758.00
THYMUS
OTHER RESPIRATORY ORGANS; NEOPLASM OF UNCERTAIN
OR UNKNOWN BEHAVIOUR OF ACCESSORY SINUSES;
D38.5 15,860.00 11,102.00 4,758.00
CARTILAGE OF NOSE; NEOPLASM OF UNCERTAIN OR
UNKNOWN BEHAVIOUR OF MIDDLE
Page 19 of 126
First Case Rate

D38.6 15,860.00 11,102.00 4,758.00
RESPIRATORY ORGAN, UNSPECIFIED
D39.0 15,860.00 11,102.00 4,758.00
UTERUS
D39.1 15,860.00 11,102.00 4,758.00
OVARY
D39.2 PLACENTA; CHORIOADENOMA DESTRUENS; INVASIVE 15,860.00 11,102.00 4,758.00
HYDATIDIFORM MOLE; MALIGNANT HYDATIDIFORM MOLE
OTHER FEMALE GENITAL ORGANS; NEOPLASM OF
D39.7 15,860.00 11,102.00 4,758.00
UNCERTAIN OR UNKNOWN BEHAVIOUR OF SKIN OF
FEMALE GENITAL ORGANS
D39.9 15,860.00 11,102.00 4,758.00
FEMALE GENITAL ORGAN, UNSPECIFIED
D40.0 15,860.00 11,102.00 4,758.00
PROSTATE
D40.1 15,860.00 11,102.00 4,758.00
TESTIS
OTHER MALE GENITAL ORGANS; NEOPLASM OF UNCERTAIN
D40.7 15,860.00 11,102.00 4,758.00
OR UNKNOWN BEHAVIOUR OF SKIN OF MALE GENITAL
ORGANS
D40.9 15,860.00 11,102.00 4,758.00
MALE GENITAL ORGAN, UNSPECIFIED
D41.0 15,860.00 11,102.00 4,758.00
KIDNEY
D41.1 15,860.00 11,102.00 4,758.00
RENAL PELVIS
D41.2 15,860.00 11,102.00 4,758.00
URETER
D41.3 15,860.00 11,102.00 4,758.00
URETHRA
D41.4 15,860.00 11,102.00 4,758.00
BLADDER
D41.9 15,860.00 11,102.00 4,758.00
URINARY ORGAN, UNSPECIFIED
D42.0 15,860.00 11,102.00 4,758.00
CEREBRAL MENINGES
D42.1 15,860.00 11,102.00 4,758.00
SPINAL MENINGES
D42.9 15,860.00 11,102.00 4,758.00
MENINGES, UNSPECIFIED
BRAIN, SUPRATENTORIAL; NEOPLASM OF UNCERTAIN OR
UNKNOWN BEHAVIOUR OF CEREBRAL VENTRICLE;
D43.0 15,860.00 11,102.00 4,758.00
CEREBRUM; NEOPLASM OF UNCERTAIN OR UNKNOWN
BEHAVIOUR OF FRONTAL LOBE; NEOP

BRAIN, INFRATENTORIAL; NEOPLASM OF UNCERTAIN OR
UNKNOWN BEHAVIOUR OF BRAIN STEM; NEOPLASM OF
D43.1 15,860.00 11,102.00 4,758.00
UNCERTAIN OR UNKNOWN BEHAVIOUR OF CEREBELLUM;
FOURTH VENTRICLE
D43.2 15,860.00 11,102.00 4,758.00
BRAIN, UNSPECIFIED
D43.3 15,860.00 11,102.00 4,758.00
CRANIAL NERVES
D43.4 15,860.00 11,102.00 4,758.00
SPINAL CORD
D43.7 15,860.00 11,102.00 4,758.00
OTHER PARTS OF CENTRAL NERVOUS SYSTEM

CENTRAL NERVOUS SYSTEM, UNSPECIFIED; NEOPLASM OF
D43.9 15,860.00 11,102.00 4,758.00
UNCERTAIN OR UNKNOWN BEHAVIOUR OF CENTRAL
NERVOUS SYSTEM NOS
D44.0 15,860.00 11,102.00 4,758.00
THYROID GLAND
D44.1 15,860.00 11,102.00 4,758.00
ADRENAL GLAND
D44.2 15,860.00 11,102.00 4,758.00
PARATHYROID GLAND
D44.3 15,860.00 11,102.00 4,758.00
PITUITARY GLAND
D44.4 15,860.00 11,102.00 4,758.00
CRANIOPHARYNGEAL DUCT
Page 20 of 126
First Case Rate

D44.5 15,860.00 11,102.00 4,758.00
PINEAL GLAND
D44.6 15,860.00 11,102.00 4,758.00
CAROTID BODY
D44.7 15,860.00 11,102.00 4,758.00
AORTIC BODY AND OTHER PARAGANGLIA
D44.8 PLURIGLANDULAR INVOLVEMENT; MULTIPLE ENDOCRINE 15,860.00 11,102.00 4,758.00
ADENOMATOSIS
D44.9 15,860.00 11,102.00 4,758.00
ENDOCRINE GLAND, UNSPECIFIED
D45 POLYCYTHAEMIA VERA 15,860.00 11,102.00 4,758.00
D46 MYELODYSPLASTIC SYNDROMES 15,860.00 11,102.00 4,758.00
D46.7 OTHER MYELODYSPLASTIC SYNDROMES 15,860.00 11,102.00 4,758.00
MYELODYSPLASTIC SYNDROME, UNSPECIFIED;
D46.9 MYELODYSPLASTIC SYNDROME NOS; MYELODYSPLASIA 15,860.00 11,102.00 4,758.00
NOS; PRELEUKAEMIA SYNDROME NOS
HISTIOCYTIC AND MAST CELL TUMOURS OF UNCERTAIN
D47.0 AND UNKNOWN BEHAVIOUR; MAST CELL TUMOUR NOS; 15,860.00 11,102.00 4,758.00
MASTOCYTOMA NOS
CHRONIC MYELOPROLIFERATIVE DISEASE; MYELOFIBROSIS
WITH MYELOID METAPLASIA; MYELOPROLIFERATIVE
D47.1 15,860.00 11,102.00 4,758.00
DISEASE, UNSPECIFIED; MEGAKARYOCYTIC
MYELOSCLEROSIS WITH MYELOID METAPLASIA
D47.2 MONOCLONAL GAMMOPATHY 15,860.00 11,102.00 4,758.00
ESSENTIAL THROMBOCYTHAEMIA; HAEMORRHAGIC
D47.3 THROMBOCYTHAEMIA; IDIOPATHIC HAEMORRHAGIC 15,860.00 11,102.00 4,758.00
THROMBOCYTHAEMIA
OTHER SPECIFIED NEOPLASMS OF UNCERTAIN OR
D47.7 UNKNOWN BEHAVIOUR OF LYMPHOID, HAEMATOPOIETIC 15,860.00 11,102.00 4,758.00
AND RELATED TISSUE
D47.9 LYMPHOID, HAEMATOPOIETIC AND RELATED TISSUE, 15,860.00 11,102.00 4,758.00
UNSPECIFIED; LYMPHOPROLIFERATIVE DISEASE NOS
D48.0 15,860.00 11,102.00 4,758.00
BONE AND ARTICULAR CARTILAGE
CONNECTIVE AND OTHER SOFT TISSUE; NEOPLASM OF
D48.1 UNCERTAIN OR UNKNOWN BEHAVIOUR OF CONNECTIVE 15,860.00 11,102.00 4,758.00
TISSUE OF EAR; NEOPLASM OF UNCERTAIN OR UNKNOWN
BEHAVIOUR OF EYELID

D48.2 15,860.00 11,102.00 4,758.00
PERIPHERAL NERVES AND AUTONOMIC NERVOUS SYSTEM
D48.3 15,860.00 11,102.00 4,758.00
RETROPERITONEUM
D48.4 15,860.00 11,102.00 4,758.00
PERITONEUM
BREAST; NEOPLASM OF UNCERTAIN OR UNKNOWN
D48.6 15,860.00 11,102.00 4,758.00
BEHAVIOUR OF CONNECTIVE TISSUE OF BREAST;
CYSTOSARCOMA PHYLLODES
OTHER SPECIFIED SITES; NEOPLASM OF UNCERTAIN OR
UNKNOWN BEHAVIOUR OF EYE; NEOPLASM OF UNCERTAIN
D48.7 15,860.00 11,102.00 4,758.00
OR UNKNOWN BEHAVIOUR OF HEART; NEOPLASM OF
UNCERTAIN OR UNKNOWN BEHAVIOUR OF PERIPHERAL
NERVES OF ORBIT
NEOPLASM OF UNCERTAIN OR UNKNOWN BEHAVIOUR,

D48.9 UNSPECIFIED; "GROWTH" NOS ; NEOPLASM NOS; 15,860.00 11,102.00 4,758.00
NEW GROWTH NOS; TUMOUR NOS
IRON DEFICIENCY ANAEMIA SECONDARY TO BLOOD LOSS

D50.0 13,000.00 9,100.00 3,900.00
(CHRONIC); POSTHAEMORRHAGIC ANAEMIA (CHRONIC)
SIDEROPENIC DYSPHAGIA; KELLY-PATERSON SYNDROME;
D50.1 13,000.00 9,100.00 3,900.00
PLUMMER-VINSON SYNDROME
D50.8 OTHER IRON DEFICIENCY ANAEMIAS 13,000.00 9,100.00 3,900.00
D50.9 IRON DEFICIENCY ANAEMIA, UNSPECIFIED 13,000.00 9,100.00 3,900.00
VITAMIN B12 DEFICIENCY ANAEMIA DUE TO INTRINSIC
FACTOR DEFICIENCY; ADDISON ANAEMIA; BIERMER
D51.0 13,000.00 9,100.00 3,900.00
ANAEMIA; CONGENITALPERNICIOUS ANAEMIA;
CONGENITAL INTRINSIC FACTOR DEFICIENCY
D51.8 OTHER VITAMIN B12 DEFICIENCY ANAEMIAS 13,000.00 9,100.00 3,900.00
D51.9 VITAMIN B12 DEFICIENCY ANAEMIA, UNSPECIFIED 13,000.00 9,100.00 3,900.00
D52.1 DRUG-INDUCED FOLATE DEFICIENCY ANAEMIA 13,000.00 9,100.00 3,900.00
Page 21 of 126
First Case Rate

FOLATE DEFICIENCY ANAEMIA, UNSPECIFIED; FOLIC ACID
D52.9 13,000.00 9,100.00 3,900.00
DEFICIENCY ANAEMIA NOS
PROTEIN DEFICIENCY ANAEMIA; AMINO-ACID DEFICIENCY
D53.0 13,000.00 9,100.00 3,900.00
ANAEMIA; OROTACIDURIC ANAEMIA
OTHER MEGALOBLASTIC ANAEMIAS, NOT ELSEWHERE
D53.1 13,000.00 9,100.00 3,900.00
CLASSIFIED; MEGALOBLASTIC ANAEMIA NOS
D53.2 SCORBUTIC ANAEMIA 13,000.00 9,100.00 3,900.00
OTHER SPECIFIED NUTRITIONAL ANAEMIAS; ANAEMIA
ASSOCIATED WITH DEFICIENCY OF COPPER; ANAEMIA
D53.8 13,000.00 9,100.00 3,900.00
ASSOCIATED WITH DEFICIENCY OF MOLYBDENUM;
ANAEMIA ASSOCIATED WITH DEFICIENCY OF ZINC
NUTRITIONAL ANAEMIA, UNSPECIFIED; SIMPLE CHRONIC
D53.9 13,000.00 9,100.00 3,900.00
ANAEMIA
ANAEMIA DUE TO GLUCOSE-6-PHOSPHATE
D55.0 DEHYDROGENASE [G6PD] DEFICIENCY; FAVISM; 13,000.00 9,100.00 3,900.00
G6PD DEFICIENCY ANAEMIA
ANAEMIA DUE TO OTHER DISORDERS OF GLUTATHIONE
METABOLISM; ANAEMIA DUE TO ENZYME DEFICIENCIES,
D55.1 EXCEPT G6PD, RELATED TO THE HEXOSE MONOPHOSPHATE 13,000.00 9,100.00 3,900.00
[HMP] SHUNT PATHWAY; ANAEMIA DUE TO HAEMOLYTIC
NONSPHEROCYTIC HEREDITARY, TYPE I
ANAEMIA DUE TO DISORDERS OF GLYCOLYTIC ENZYMES;

HAEMOLYTIC NONSPHEROCYTIC HEREDITARY ANAEMIA,
D55.2 TYPE II; HEXOKINASE DEFICIENCY ANAEMIA; PYRUVATE 13,000.00 9,100.00 3,900.00
KINASE [PK] DEFICIENCY ANAEMIA; TRIOSE-PHOSPHATE
ISOMERASE DEFICIENCY ANAEMIA
D55.8 OTHER ANAEMIAS DUE TO ENZYME DISORDERS 13,000.00 9,100.00 3,900.00
D55.9 ANAEMIA DUE TO ENZYME DISORDER, UNSPECIFIED 13,000.00 9,100.00 3,900.00
D56.0 ALPHA THALASSAEMIA 7,280.00 5,096.00 2,184.00
BETA THALASSAEMIA; COOLEY'S ANAEMIA; SEVERE BETA
D56.1 THALASSAEMIA; THALASSAEMIA INTERMEDIA; 7,280.00 5,096.00 2,184.00
THALASSAEMIA MAJOR;
D56.2 DELTA-BETA THALASSAEMIA 7,280.00 5,096.00 2,184.00
D56.3 THALASSAEMIA TRAIT 7,280.00 5,096.00 2,184.00
HEREDITARY PERSISTENCE OF FETAL HAEMOGLOBIN
D56.4 7,280.00 5,096.00 2,184.00
[HPFH]
D56.8 OTHER THALASSAEMIAS 7,280.00 5,096.00 2,184.00
MEDITERRANEAN ANAEMIA; MEDITERRANEAN ANAEMIA
WITH OTHER HAEMOGLOBINOPATHY; THALASSAEMIA
D56.9 MINOR WITH OTHER HAEMOGLOBINOPATHY; 13,000.00 9,100.00 3,900.00
THALASSAEMIA MIXED WITH OTHER
HAEMOGLOBINOPATHY;
SICKLE-CELL ANAEMIA WITH CRISIS; HB-SS DISEASE WITH
D57.0 13,000.00 9,100.00 3,900.00
CRISIS
SICKLE-CELL ANAEMIA WITHOUT CRISIS; SICKLE-CELL
D57.1 ANAEMIA NOS; SICKLE-CELL DISEASE NOS ; SICKLE-CELL 13,000.00 9,100.00 3,900.00
DISORDER NOS
SICKLE-CELL TRAIT; HB-S TRAIT ; HETEROZYGOUS
D57.3 13,000.00 9,100.00 3,900.00
HAEMOGLOBIN S
D57.8 OTHER SICKLE-CELL DISORDERS 13,000.00 9,100.00 3,900.00
HEREDITARY SPHEROCYTOSIS; ACHOLURIC (FAMILIAL)
D58.0 JAUNDICE; CONGENITAL (SPHEROCYTIC) HAEMOLYTIC 13,000.00 9,100.00 3,900.00
ICTERUS; MINKOWSKI-CHAUFFARD SYNDROME
HEREDITARY ELLIPTOCYTOSIS; CONGENITAL
D58.1 ELLIPTOCYTOSIS; CONGENITAL OVALOCYTOSIS; 13,000.00 9,100.00 3,900.00
HEREDITARY OVALOCYTOSIS
OTHER HAEMOGLOBINOPATHIES; ABNORMAL
HAEMOGLOBIN NOS; CONGENITAL HEINZ BODY ANAEMIA;
D58.2 HB-C DISEASE; HB-C DISEASE; HB-D DISEASE; HB-E 13,000.00 9,100.00 3,900.00
DISEASE; HAEMOGLOBINOPATHY NOS; UNSTABLE
HAEMOGLOBIN HAEMOLYTIC DISEASE
OTHER SPECIFIED HEREDITARY HAEMOLYTIC ANAEMIAS;
D58.8 13,000.00 9,100.00 3,900.00
STOMATOCYTOSIS
HEREDITARY HAEMOLYTIC ANAEMIA, UNSPECIFIED;
D58.9 13,000.00 9,100.00 3,900.00
ACQUIRED HAEMOLYTIC ANAEMIA
D59.0 DRUG-INDUCED AUTOIMMUNE HAEMOLYTIC ANAEMIA 13,000.00 9,100.00 3,900.00
OTHER AUTOIMMUNE HAEMOLYTIC ANAEMIAS;
AUTOIMMUNE HAEMOLYTIC DISEASE, COLD TYPE;
(AUTOIMMUNE HAEMOLYTIC DISEASE, WARM TYPE;
D59.1 CHRONIC COLD HAEMAGGLUTININ DISEASE; COLD 13,000.00 9,100.00 3,900.00
AGGLUTININ DISEASE; COLD AGGLUTININ
HAEMOGLOBINURIA; SECONDARY SYMPTOMATIC
HAEMOLYTIC A
DRUG-INDUCED NONAUTOIMMUNE HAEMOLYTIC
D59.2 13,000.00 9,100.00 3,900.00
ANAEMIA; DRUG-INDUCED ENZYME DEFICIENCY ANAEMIA
Page 22 of 126
First Case Rate

D59.3 HAEMOLYTIC-URAEMIC SYNDROME 26,260.00 18,382.00 7,878.00
OTHER NONAUTOIMMUNE HAEMOLYTIC ANAEMIAS;
D59.4 MECHANICAL HAEMOLYTIC ANAEMIA; MICROANGIOPATHIC 13,000.00 9,100.00 3,900.00
HAEMOLYTIC ANAEMIA; TOXIC HAEMOLYTIC ANAEMIA
PAROXYSMAL NOCTURNAL HAEMOGLOBINURIA
D59.5 13,000.00 9,100.00 3,900.00
[MARCHIAFAVA-MICHELI]
HAEMOGLOBINURIA DUE TO HAEMOLYSIS FROM OTHER
EXTERNAL CAUSES; HAEMOGLOBINURIA FROM EXERTION;
D59.6 13,000.00 9,100.00 3,900.00
HAEMOGLOBINURIA MARCH; HAEMOGLOBINURIA
PAROXYSMAL COLD
D59.8 OTHER ACQUIRED HAEMOLYTIC ANAEMIAS 13,000.00 9,100.00 3,900.00
ACQUIRED HAEMOLYTIC ANAEMIA, UNSPECIFIED; CHRONIC
D59.9 13,000.00 9,100.00 3,900.00
IDIOPATHIC HAEMOLYTIC ANAEMIA
D60.0 CHRONIC ACQUIRED PURE RED CELL APLASIA 9,490.00 6,643.00 2,847.00
D60.1 TRANSIENT ACQUIRED PURE RED CELL APLASIA 13,000.00 9,100.00 3,900.00
D60.8 OTHER ACQUIRED PURE RED CELL APLASIAS 9,490.00 6,643.00 2,847.00
D60.9 ACQUIRED PURE RED CELL APLASIA, UNSPECIFIED 9,490.00 6,643.00 2,847.00
CONSTITUTIONAL APLASTIC ANAEMIA; CONGENITAL PURE
RED CELL APLASIA; PURE RED CELL APLASIA OF INFANTS;
D61.0 PRIMARY PURE RED CELL APLASIA; BLACKFAN-DIAMOND 13,000.00 9,100.00 3,900.00
SYNDROME; FAMILIAL HYPOPLASTIC ANAEMIA; FANCONI'S
ANAEMIA; PANCYTOPENIA WITH MALFORMATIONS
D61.1 DRUG-INDUCED APLASTIC ANAEMIA 13,000.00 9,100.00 3,900.00
D61.2 APLASTIC ANAEMIA DUE TO OTHER EXTERNAL AGENTS 13,000.00 9,100.00 3,900.00
D61.3 IDIOPATHIC APLASTIC ANAEMIA 13,000.00 9,100.00 3,900.00
D61.8 OTHER SPECIFIED APLASTIC ANAEMIAS 13,000.00 9,100.00 3,900.00
APLASTIC ANAEMIA, UNSPECIFIED; HYPOPLASTIC ANAEMIA
D61.9 13,000.00 9,100.00 3,900.00
NOS; MEDULLARY HYPOPLASIA; PANMYELOPHTHISIS
D62 ACUTE POSTHAEMORRHAGIC ANAEMIA 13,000.00 9,100.00 3,900.00
D63.0* ANAEMIA IN NEOPLASTIC DISEASE 13,000.00 9,100.00 3,900.00
ANAEMIA IN OTHER CHRONIC DISEASES CLASSIFIED
D63.8* 13,000.00 9,100.00 3,900.00
ELSEWHERE
HEREDITARY SIDEROBLASTIC ANAEMIA; SEX-LINKED
D64.0 13,000.00 9,100.00 3,900.00
HYPOCHROMIC SIDEROBLASTIC ANAEMIA
D64.1 SECONDARY SIDEROBLASTIC ANAEMIA DUE TO DISEASE 13,000.00 9,100.00 3,900.00
SECONDARY SIDEROBLASTIC ANAEMIA DUE TO DRUGS AND
D64.2 13,000.00 9,100.00 3,900.00
TOXINS
OTHER SIDEROBLASTIC ANAEMIAS; SIDEROBLASTIC
D64.3 ANAEMIA NOS; PYRIDOXINE-RESPONSIVE NEC 13,000.00 9,100.00 3,900.00
SIDEROBLASTIC ANAEMIA
CONGENITAL DYSERYTHROPOIETIC ANAEMIA; CONGENITAL
D64.4 5,200.00 3,640.00 1,560.00
DYSHAEMATOPOIETIC ANAEMIA
OTHER SPECIFIED ANAEMIAS; INFANTILE
D64.8 13,000.00 9,100.00 3,900.00
PSEUDOLEUKAEMIA; LEUKOERYTHROBLASTIC ANAEMIA
D64.9 ANAEMIA, UNSPECIFIED 13,000.00 9,100.00 3,900.00
DISSEMINATED INTRAVASCULAR COAGULATION
[DEFIBRINATION SYNDROME]; ACQUIRED
AFIBRINOGENAEMIA; CONSUMPTION COAGULOPATHY;
D65 DIFFUSE OR DISSEMINATED INTRAVASCULAR 41,600.00 29,120.00 12,480.00
COAGULATION [DIC] ; ACQUIRED FIBRINOLYTIC
HAEMORRHAGE; FIBRINOLYTIC PURPURA; PURPURA
FULMINANS;
HEREDITARY FACTOR VIII DEFICIENCY; DEFICIENCY
D66 FACTOR VIII (WITH FUNCTIONAL DEFECT); HAEMOPHILIA 16,640.00 11,648.00 4,992.00
NOS; HAEMOPHILIA A; CLASSICAL HAEMOPHILIA
HEREDITARY FACTOR IX DEFICIENCY; CHRISTMAS DISEASE;
FACTOR IX DEFICIENCY (WITH FUNCTIONAL DEFECT);
D67 16,640.00 11,648.00 4,992.00
PLASMA THROMBOPLASTIN COMPONENT [PTC]
DEFICIENCY; HAEMOPHILIA B
VON WILLEBRAND'S DISEASE; ANGIOHAEMOPHILIA;
D68.0 FACTOR VIII DEFICIENCY WITH VASCULAR DEFECT; 16,640.00 11,648.00 4,992.00
VASCULAR HAEMOPHILIA
HEREDITARY FACTOR XI DEFICIENCY; HAEMOPHILIA C
D68.1 16,640.00 11,648.00 4,992.00
PLASMA THROMOPLASTIN ANTECEDENT [PTA] DEFICIENCY
HEREDITARY DEFICIENCY OF OTHER CLOTTING FACTORS;

CONGENITAL AFIBRINOGENAEMIA; AC GLOBULIN
DEFICIENCY; PROACCELERIN DEFICIENCY; DEFICIENCY OF
D68.2 16,640.00 11,648.00 4,992.00
FACTOR I [FIBRINOGEN]; DEFICIENCY OF FACTOR II
[PROTHROMBIN]; DEFICIENCY OF FACTOR V [LABILE];
DEFICIENCY OF FAC
Page 23 of 126
First Case Rate

HAEMORRHAGIC DISORDER DUE TO CIRCULATING
ANTICOAGULANTS; HAEMORRHAGE DURING LONG TERM
USE OF ANTICOAGULANTS; HYPERHEPARINAEMIA;
D68.3 16,640.00 11,648.00 4,992.00
INCREASE IN ANTITHROMBIN; INCREASE IN ANTI-VIIIA;
INCREASE IN ANTI-IXA; INCREASE IN ANTI-XA; INCREASE IN
ANTI-XIA
ACQUIRED COAGULATION FACTOR DEFICIENCY;
DEFICIENCY OF COAGULATION FACTOR DUE TO LIVER
D68.4 16,640.00 11,648.00 4,992.00
DISEASE; DEFICIENCY OF COAGULATION FACTOR DUE TO
VITAMIN K DEFICIENCY
OTHER SPECIFIED COAGULATION DEFECTS; PRESENCE OF
D68.8 16,640.00 11,648.00 4,992.00
SYSTEMIC LUPUS ERYTHEMATOSUS [SLE] INHIBITOR
D68.9 COAGULATION DEFECT, UNSPECIFIED 16,640.00 11,648.00 4,992.00
ALLERGIC PURPURA; ANAPHYLACTOID PURPURA;
HENOCH(-SCHöNLEIN) PURPURA;
D69.0 NONTHROMBOCYTOPENIC PURPURA; HAEMORRHAGIC 16,640.00 11,648.00 4,992.00
PURPURA; IDIOPATHIC PURPURA; VASCULAR PURPURA;
ALLERGICVASCULITIS
QUALITATIVE PLATELET DEFECTS; BERNARD-SOULIER
[GIANT PLATELET] SYNDROME; GLANZMANN'S DISEASE;
D69.1 GREY PLATELET SYNDROME; HAEMORRHAGIC 16,640.00 11,648.00 4,992.00
THROMBOASTHENIA; HEREDITARY THROMBOASTHENIA;
THROMBOCYTOPATHY ;
OTHER NONTHROMBOCYTOPENIC PURPURA; PURPURA
D69.2 16,640.00 11,648.00 4,992.00
NOS; SENILE PURPURA; SIMPLEX PURPURA
IDIOPATHIC THROMBOCYTOPENIC PURPURA; EVANS'
D69.3 16,640.00 11,648.00 4,992.00
SYNDROME
OTHER SPECIFIED HAEMORRHAGIC CONDITIONS;
D69.8 HEREDITARY CAPILLARY FRAGILITY; VASCULAR 16,640.00 11,648.00 4,992.00
PSEUDOHAEMOPHILIA
AGRANULOCYTOSIS; AGRANULOCYTIC ANGINA; INFANTILE
GENETIC AGRANULOCYTOSIS; KOSTMANN'S DISEASE;
NEUTROPENIA NOS; CONGENITAL NEUTROPENIA; CYCLIC
D70 15,730.00 11,011.00 4,719.00
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
D71 DISEASE; 15,730.00 11,011.00 4,719.00
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
D72.0 15,730.00 11,011.00 4,719.00
GRANULATION ANOMALY OR SYNDROME; MAY-HEGGLIN
GRANULOCYTE ANOMALY OR SYNDROME; PELGER-HUëT
GRANULOCYTE ANOMALY OR SYNDROME; P
OTHER SPECIFIED DISORDERS OF WHITE BLOOD CELLS;
LYMPHOCYTIC LEUKAEMOID REACTION; MONOCYTIC
LEUKAEMOID REACTION; MYELOCYTIC LEUKAEMOID
D72.8 15,730.00 11,011.00 4,719.00
REACTION; LEUKOCYTOSIS; SYMPTOMATIC
LYMPHOCYTOSIS; LYMPHOPENIA; SYMPTOMATIC
MONOCYTOSIS;
D73.2 CHRONIC CONGESTIVE SPLENOMEGALY 15,730.00 11,011.00 4,719.00
D73.3 ABSCESS OF SPLEEN 15,730.00 11,011.00 4,719.00
D73.4 CYST OF SPLEEN 15,730.00 11,011.00 4,719.00
INFARCTION OF SPLEEN; NONTRAUMATIC SPLENIC
D73.5 15,730.00 11,011.00 4,719.00
RUPTURE; TORSION OF SPLEEN
OTHER DISEASES OF SPLEEN; FIBROSIS OF SPLEEN NOS;
D73.8 15,730.00 11,011.00 4,719.00
PERISPLENITIS; SPLENITIS NOS
D74.0 CONGENITAL METHAEMOGLOBINAEMIA 5,200.00 3,640.00 1,560.00
D74.9 METHAEMOGLOBINAEMIA, UNSPECIFIED 15,730.00 11,011.00 4,719.00
FAMILIAL ERYTHROCYTOSIS; BENIGN POLYCYTHAEMIA;
D75.0 15,730.00 11,011.00 4,719.00
FAMILIAL POLYCYTHAEMIA
SECONDARY POLYCYTHAEMIA; ACQUIRED
POLYCYTHAEMIA DUE TO ERYTHROPOIETIN; ACQUIRED
POLYCYTHAEMIA DUE TO FALL IN PLASMA VOLUME;
D75.1 15,730.00 11,011.00 4,719.00
ACQUIRED POLYCYTHAEMIA DUE TO HIGH ALTITUDE;
ACQUIRED POLYCYTHAEMIA DUE TO STRESS; EMOTIONAL
POLYCYTHAEMIA; HYPOXAEMIC POLYCYTHA
D75.2 ESSENTIAL THROMBOCYTOSIS 15,730.00 11,011.00 4,719.00
OTHER SPECIFIED DISEASES OF BLOOD AND BLOOD-
D75.8 15,730.00 11,011.00 4,719.00
FORMING ORGANS
LANGERHANS' CELL HISTIOCYTOSIS, NOT ELSEWHERE
D76.0 15,730.00 11,011.00 4,719.00
CLASSIFIED
Page 24 of 126
First Case Rate

HAEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS;
D76.1 EOSINOPHILIC GRANULOMA; HAND-SCHüLLER-CHRISTIAN 15,730.00 11,011.00 4,719.00
DISEASE; CHRONIC HISTIOCYTOSIS X
D76.2 HAEMOPHAGOCYTIC SYNDROME, INFECTION-ASSOCIATED 15,730.00 11,011.00 4,719.00
OTHER HISTIOCYTOSIS SYNDROMES;
RETICULOHISTIOCYTOMA (GIANT-CELL); SINUS
D76.3 15,730.00 11,011.00 4,719.00
HISTIOCYTOSIS WITH MASSIVE LYMPHADENOPATHY;
XANTHOGRANULOMA
HEREDITARY HYPOGAMMAGLOBULINAEMIA; AUTOSOMAL
RECESSIVE AGAMMAGLOBULINAEMIA (SWISS TYPE); X-
D80.0 15,080.00 10,556.00 4,524.00
LINKED AGAMMAGLOBULINAEMIA [BRUTON] (WITH
GROWTH HORMONE DEFICIENCY)
D80.2 SELECTIVE DEFICIENCY OF IMMUNOGLOBULIN A [IGA] 15,080.00 10,556.00 4,524.00
D80.7 TRANSIENT HYPOGAMMAGLOBULINAEMIA OF INFANCY 15,080.00 10,556.00 4,524.00
OTHER IMMUNODEFICIENCIES WITH PREDOMINANTLY

D80.8 15,080.00 10,556.00 4,524.00
ANTIBODY DEFECTS; KAPPA LIGHT CHAIN DEFICIENCY
IMMUNODEFICIENCY WITH PREDOMINANTLY ANTIBODY
D80.9 15,080.00 10,556.00 4,524.00
DEFECTS, UNSPECIFIED
SEVERE COMBINED IMMUNODEFICIENCY [SCID] WITH LOW
D81.1 15,080.00 10,556.00 4,524.00
T- AND B-CELL NUMBERS
MAJOR HISTOCOMPATIBILITY COMPLEX CLASS I
D81.6 15,080.00 10,556.00 4,524.00
DEFICIENCY; BARE LYMPHOCYTE SYNDROME
COMBINED IMMUNODEFICIENCY, UNSPECIFIED; SEVERE
D81.9 15,080.00 10,556.00 4,524.00
COMBINED IMMUNODEFICIENCY DISORDER [SCID] NOS
WISKOTT-ALDRICH SYNDROME; IMMUNODEFICIENCY WITH

D82.0 15,080.00 10,556.00 4,524.00
THROMBOCYTOPENIA AND ECZEMA
DI GEORGE'S SYNDROME; PHARYNGEAL POUCH SYNDROME;
D82.1 THYMIC ALYMPHOPLASIA; THYMIC APLASIA OR 15,080.00 10,556.00 4,524.00
HYPOPLASIA WITH IMMUNODEFICIENCY
IMMUNODEFICIENCY FOLLOWING HEREDITARY DEFECTIVE
D82.3 RESPONSE TO EPSTEIN-BARR VIRUS; X-LINKED 15,080.00 10,556.00 4,524.00
LYMPHOPROLIFERATIVE DISEASE
D82.4 HYPERIMMUNOGLOBULIN E [IGE] SYNDROME 15,080.00 10,556.00 4,524.00
IMMUNODEFICIENCY ASSOCIATED WITH MAJOR DEFECT,
D82.9 15,080.00 10,556.00 4,524.00
UNSPECIFIED
COMMON VARIABLE IMMUNODEFICIENCY WITH
D83.0 PREDOMINANT ABNORMALITIES OF B-CELL NUMBERS AND 15,080.00 10,556.00 4,524.00
FUNCTION
COMMON VARIABLE IMMUNODEFICIENCY WITH
D83.1 15,080.00 10,556.00 4,524.00
PREDOMINANT IMMUNOREGULATORY T-CELL DISORDERS
D83.9 COMMON VARIABLE IMMUNODEFICIENCY, UNSPECIFIED 15,080.00 10,556.00 4,524.00

D84.8 OTHER SPECIFIED IMMUNODEFICIENCIES 15,080.00 10,556.00 4,524.00
D84.9 IMMUNODEFICIENCY, UNSPECIFIED 15,080.00 10,556.00 4,524.00
D86.1 SARCOIDOSIS OF LYMPH NODES 15,080.00 10,556.00 4,524.00
SARCOIDOSIS OF OTHER AND COMBINED SITES;
D86.8 15,080.00 10,556.00 4,524.00
UVEOPAROTID FEVER [HEERFORDT]
D86.9 SARCOIDOSIS, UNSPECIFIED 15,080.00 10,556.00 4,524.00
POLYCLONAL HYPERGAMMAGLOBULINAEMIA; BENIGN
D89.0 HYPERGAMMAGLOBULINAEMIC PURPURA; POLYCLONAL 15,080.00 10,556.00 4,524.00
GAMMOPATHY NOS
CRYOGLOBULINAEMIA; ESSENTIAL CRYOGLOBULINAEMIA;

IDIOPATHIC CRYOGLOBULINAEMIA; MIXED
D89.1 CRYOGLOBULINAEMIA; PRIMARY CRYOGLOBULINAEMIA; 15,080.00 10,556.00 4,524.00
SECONDARY CRYOGLOBULINAEMIA; CRYOGLOBULINAEMIC
PURPURA; CRYOGLOBULINAEMIC VASCULITIS
D89.2 HYPERGAMMAGLOBULINAEMIA, UNSPECIFIED 15,080.00 10,556.00 4,524.00

OTHER SPECIFIED DISORDERS INVOLVING THE IMMUNE
D89.8 15,080.00 10,556.00 4,524.00
MECHANISM, NOT ELSEWHERE CLASSIFIED
DISORDER INVOLVING THE IMMUNE MECHANISM,
D89.9 15,080.00 10,556.00 4,524.00
UNSPECIFIED; IMMUNE DISEASE NOS
CONGENITAL IODINE-DEFICIENCY SYNDROME,
E00.0 NEUROLOGICAL TYPE; ENDEMIC CRETINISM, 12,870.00 9,009.00 3,861.00
NEUROLOGICAL TYPE
E01.0 IODINE-DEFICIENCY-RELATED DIFFUSE (ENDEMIC) GOITRE 10,530.00 7,371.00 3,159.00
IODINE-DEFICIENCY-RELATED MULTINODULAR (ENDEMIC)

E01.1 10,530.00 7,371.00 3,159.00
GOITRE; IODINE-DEFICIENCY-RELATED NODULAR GOITRE
IODINE-DEFICIENCY-RELATED (ENDEMIC) GOITRE,
E01.2 10,530.00 7,371.00 3,159.00
UNSPECIFIED
OTHER IODINE-DEFICIENCY-RELATED THYROID
E01.8 10,530.00 7,371.00 3,159.00
DISORDERS AND ALLIED CONDITIONS
Page 25 of 126
First Case Rate

E02 SUBCLINICAL IODINE-DEFICIENCY HYPOTHYROIDISM 10,530.00 7,371.00 3,159.00
CONGENITAL HYPOTHYROIDISM WITH DIFFUSE GOITRE;
E03.0 NONTOXIC CONGENITAL GOITRE NOS; NONTOXIC 12,870.00 9,009.00 3,861.00
ONGENITAL PARENCHYMATOUS GOITRE
CONGENITAL HYPOTHYROIDISM WITHOUT GOITRE;
APLASIA OF THYROID (WITH MYXOEDEMA); CONGENITAL
E03.1 12,870.00 9,009.00 3,861.00
ATROPHY OF THYROID; CONGENITAL HYPOTHYROIDISM
NOS
HYPOTHYROIDISM DUE TO MEDICAMENTS AND OTHER
E03.2 10,530.00 7,371.00 3,159.00
EXOGENOUS SUBSTANCES
E03.5 MYXOEDEMA COMA 10,530.00 7,371.00 3,159.00
E03.8 OTHER SPECIFIED HYPOTHYROIDISM 10,530.00 7,371.00 3,159.00
E03.9 HYPOTHYROIDISM, UNSPECIFIED; 10,530.00 7,371.00 3,159.00
THYROTOXICOSIS WITH DIFFUSE GOITRE; EXOPHTHALMIC
E05.0 OR TOXIC GOITRE NOS; GRAVES' DISEASE; TOXIC DIFFUSE 11,050.00 7,735.00 3,315.00
GOITRE
THYROTOXICOSIS WITH TOXIC SINGLE THYROID NODULE;
E05.1 11,050.00 7,735.00 3,315.00
THYROTOXICOSIS WITH TOXIC UNINODULAR GOITRE
THYROTOXICOSIS WITH TOXIC MULTINODULAR GOITRE;
E05.2 11,050.00 7,735.00 3,315.00
TOXIC NODULAR GOITRE NOS
E05.3 THYROTOXICOSIS FROM ECTOPIC THYROID TISSUE 11,050.00 7,735.00 3,315.00
E05.4 THYROTOXICOSIS FACTITIA 11,050.00 7,735.00 3,315.00
E05.5 THYROID CRISIS OR STORM 11,050.00 7,735.00 3,315.00
OTHER THYROTOXICOSIS; OVERPRODUCTION OF THYROID-
E05.8 11,050.00 7,735.00 3,315.00
STIMULATING HORMONE
THYROTOXICOSIS, UNSPECIFIED; HYPERTHYROIDISM NOS;
E05.9 11,050.00 7,735.00 3,315.00
THYROIDITIS
ACUTE THYROIDITIS; ABSCESS OF THYROID; PYOGENIC
E06.0 11,050.00 7,735.00 3,315.00
THYROIDITIS; SUPPURATIVE THYROIDITIS
SUBACUTE THYROIDITIS; DE QUERVAIN THYROIDITIS;

E06.1 GIANT-CELL THYROIDITIS; GRANULOMATOUS 11,050.00 7,735.00 3,315.00
THYROIDITIS; NONSUPPURATIVE THYROIDITIS
E06.2 CHRONIC THYROIDITIS WITH TRANSIENT THYROTOXICOSIS 11,050.00 7,735.00 3,315.00
AUTOIMMUNE THYROIDITIS; HASHIMOTO'S THYROIDITIS ;

E06.3 TRANSIENT HASHITOXICOSIS; LYMPHADENOID GOITRE; 11,050.00 7,735.00 3,315.00
LYMPHOCYTIC THYROIDITIS; STRUMA LYMPHOMATOSA
OTHER CHRONIC THYROIDITIS; CHRONIC THYROIDITIS
E06.5 NOS; CHRONIC FIBROUS THYROIDITIS; LIGNEOUS 11,050.00 7,735.00 3,315.00
THYROIDITIS; RIEDEL THYROIDITIS
E06.9 THYROIDITIS, UNSPECIFIED 11,050.00 7,735.00 3,315.00
HYPERSECRETION OF CALCITONIN; C-CELL HYPERPLASIA
E07.0 11,050.00 7,735.00 3,315.00
OF THYROID; HYPERSECRETION OF THYROCALCITONIN
DYSHORMOGENETIC GOITRE; FAMILIAL
E07.1 11,050.00 7,735.00 3,315.00
DYSHORMOGENETIC GOITRE; PENDRED'S SYNDROME
OTHER SPECIFIED DISORDERS OF THYROID; ABNORMALITY
OF THYROID-BINDING GLOBULIN; HAEMORRHAGE OF
E07.8 11,050.00 7,735.00 3,315.00
THYROID; INFARCTION OF THYROID; SICK-EUTHYROID
SYNDROME
INSULIN-DEPENDENT DIABETES MELLITUS WITH COMA;
BRITTLE DIABETES (MELLITUS) WITH COMA; JUVENILE-
E10.0 ONSET DIABETES (MELLITUS) WITHCOMA ; KETOSIS- 20,540.00 14,378.00 6,162.00
PRONE DIABETES (MELLITUS) WITH COMA; TYPE I
DIABETES (MELLITUS) WITH COMA;
INSULIN-DEPENDENT DIABETES MELLITUS WITH
ACIDIDOSIS/ KETOACIDOSIS WITHOUT MENTION OF COMA;
E10.1 20,540.00 14,378.00 6,162.00
DIABETIC ACIDIDOSIS WITHOUT MENTION OF COMA;
DIABETIC KETOACIDOSIS WITHOUT MENTION OF COMA;
INSULIN-DEPENDENT DIABETES MELLITUS WITH RENAL
E10.2+ N08.3* COMPLICATIONS; GLOMERULAR DISORDERS IN DIABETES 16,380.00 11,466.00 4,914.00
MELLITUS
INSULIN-DEPENDENT DIABETES MELLITUS WITH DIABETIC
E10.5 16,380.00 11,466.00 4,914.00
GANGRENE/ ULCER
INSULIN-DEPENDENT DIABETES MELLITUS WITH OTHER
E10.6 16,380.00 11,466.00 4,914.00
SPECIFIED COMPLICATIONS
E10.7 16,380.00 11,466.00 4,914.00
MULTIPLE COMPLICATIONS
E10.8 16,380.00 11,466.00 4,914.00
UNSPECIFIED COMPLICATIONS
INSULIN DEPENDENT DIABETES MELLITUS WITHOUT
E10.9 5,200.00 3,640.00 1,560.00
COMPLICATIONS
Page 26 of 126
First Case Rate

NON-INSULIN-DEPENDENT DIABETES MELLITUS WITH
COMA; NONOBESE DIABETES (MELLITUS) WITH COMA ;
OBESE DIABETES MELLITUS WITH COMA ; ADULT-ONSET
E11.0 20,540.00 14,378.00 6,162.00
DIABETES MELLITUS WITH COMA ; MATURITY-ONSET
DIABETES MELLITUS WITH COMA ; NONKETOTIC DIABETES
MELLITUS WITH COM

KETOACIDOSIS WITHOUT MENTION OF COMA; ; NONOBESE
DIABETES (MELLITUS) WITH KETOACIDOSIS WITHOUT
E11.1 20,540.00 14,378.00 6,162.00
MENTION OF COMA; OBESE DIABETES MELLITUS WITH
KETOACIDOSIS WITHOUT MENTION OF COMA; ADULT-
ONSET DIABETES MELLITU
E11.2+ N08.3* RENAL COMPLICATIONS; GLOMERULAR DISORDERS IN 16,380.00 11,466.00 4,914.00
DIABETES MELLITUS
DIABETIC GANGRENE/ ULCER; NONOBESE DIABETES
(MELLITUS) WITH DIABETIC GANGRENE/ ULCER; OBESE
E11.5 16,380.00 11,466.00 4,914.00
DIABETES MELLITUS WITH DIABETIC GANGRENE/ ULCER;
ADULT-ONSET DIABETES MELLITUS WITH DIABETIC
GANGRENE/ ULCER; MAT
E11.6 16,380.00 11,466.00 4,914.00
OTHER SPECIFIED COMPLICATIONS
MULTIPLE COMPLICATIONS ; NONOBESE DIABETES
(MELLITUS) WITH MULTIPLE COMPLICATIONS ; OBESE
E11.7 16,380.00 11,466.00 4,914.00
DIABETES MELLITUS WITH MULTIPLE COMPLICATIONS ;
ADULT-ONSET DIABETES MELLITUS WITH MULTIPLE
COMPLICATIONS ; MATUR
NON-INSULIN-DEPENDENT DIABETES MELLITUS WITHOUT
E11.9 5,200.00 3,640.00 1,560.00
COMPLICATIONS
MALNUTRITION-RELATED DIABETES MELLITUS WITH
COMA; INSULIN-DEPENDENT MALNUTRITION-RELATED
E12.0 DIABETES MELLITUS WITH COMA ; NON-INSULIN- 20,540.00 14,378.00 6,162.00
DEPENDENT MALNUTRITION-RELATED DIABETES
MELLITUS WITH COMA
MALNUTRITION-RELATED DIABETES; GLOMERULAR
E12.2+ N08.3* 16,380.00 11,466.00 4,914.00
DISORDERS IN DIABETES MELLITUS
DIABETIC GANGRENE/ ULCER; INSULIN-DEPENDENT
E12.5 16,380.00 11,466.00 4,914.00
DIABETIC GANGRENE/ ULCER; NON-INSULIN-DEPENDENT
DIABETIC GANGRENE/ ULCER
MALNUTRITION-RELTAED DIABETES MELLITUS WITH
E12.6 16,380.00 11,466.00 4,914.00
OTHER SPECIFIED COMPLICATIONS
UNSPECIFIED COMPLICATIONS; INSULIN-DEPENDENT
E12.8 16,380.00 11,466.00 4,914.00
UNSPECIFIED COMPLICATIONS; NON-INSULIN-DEPENDENT
UNSPECIFIED COMPLICATI
E13.0 OTHER SPECIFIED DIABETES MELLITUS WITH COMA 20,540.00 14,378.00 6,162.00
OTHER SPECIFIED DIABETES MELLITUS WITH ACIDIDOSIS/
E13.1 20,540.00 14,378.00 6,162.00
KETOACIDOSIS WITHOUT MENTION OF COMA
OTHER SPECIFIED DIABETES MELLITUS; GLOMERULAR
E13.2+ N08.3* 16,380.00 11,466.00 4,914.00
OTHER SPECIFIED DIABETES MELLITUS WITH DIABETIC
E13.5 16,380.00 11,466.00 4,914.00
GANGRENE/ ULCER
OTHER SPECIFIED DIABETES MELLITUS WITH OTHER
E13.6 16,380.00 11,466.00 4,914.00
SPECIFIED COMPLICATIONS
UNSPECIFIED DIABETES MELLITUS; DIABETES NOS WITH
E14.0 20,540.00 14,378.00 6,162.00
COMA
E14.1 20,540.00 14,378.00 6,162.00
ACIDIDOSIS/ KETOACIDOSIS WITHOUT MENTION OF COMA
UNSPECIFIED DIABETES MELLITUS; GLOMERULAR
E14.2+ N08.3* 16,380.00 11,466.00 4,914.00
E14.5 16,380.00 11,466.00 4,914.00
DIABETIC GANGRENE/ ULCER
UNSPECIFIED DIABETES MELLITUS WITH OTHER SPECIFIED
E14.6 16,380.00 11,466.00 4,914.00
COMPLICATIONS
E14.7 16,380.00 11,466.00 4,914.00
MULTIPLE COMPLICATIONS
Page 27 of 126
First Case Rate

NONDIABETIC HYPOGLYCAEMIC COMA; NONDIABETIC
HYPOGLYCAEMIC COMA; DRUG-INDUCED INSULIN COMA IN
E15 10,530.00 7,371.00 3,159.00
NONDIABETIC; HYPERINSULINISM WITH HYPOGLYCAEMIC
COMA; HYPOGLYCAEMIC COMA NOS
E16.0 DRUG-INDUCED HYPOGLYCAEMIA WITHOUT COMA 10,530.00 7,371.00 3,159.00
OTHER HYPOGLYCAEMIA; FUNCTIONAL
NONHYPERINSULINAEMIC HYPOGLYCAEMIA;
E16.1 HYPERINSULINISM NOS; FUNCTIONAL HYPERINSULINISM; 10,530.00 7,371.00 3,159.00
HYPERPLASIA OF PANCREATIC ISLET BETA CELLS NOS;
POSTHYPOGLYCAEMIC COMA ENCEPHALOPATHY
E16.2 HYPOGLYCEMIA 5,200.00 3,640.00 1,560.00
INCREASED SECRETION OF GLUCAGON; HYPERPLASIA OF
PANCREATIC ENDOCRINE CELLS WITH GLUCAGON EXCESS;
E16.3 10,530.00 7,371.00 3,159.00
HYPERPLASIA OF PANCREATIC ENDOCRINE CELLS WITH
GLUCAGON EXCESS
E16.4 ABNORMAL SECRETION OF GASTRIN; HYPERGASTRINAEMIA 10,530.00 7,371.00 3,159.00
OTHER SPECIFIED DISORDERS OF PANCREATIC INTERNAL

SECRETION; INCREASED SECRETION FROM ENDOCRINE
PANCREAS OF GROWTH HORMONE-RELEASING HORMONE;
E16.8 10,530.00 7,371.00 3,159.00
INCREASED SECRETION FROM ENDOCRINE PANCREAS OF
PANCREATIC POLYPEPTIDE; INCREASED SECRETION FROM
ENDOCRINE PANCREA
DISORDER OF PANCREATIC INTERNAL SECRETION,
E16.9 UNSPECIFIED; ISLET-CELL HYPERPLASIA NOS; PANCREATIC 10,530.00 7,371.00 3,159.00
ENDOCRINE CELL HYPERPLASIA NOS
E20.0 IDIOPATHIC HYPOPARATHYROIDISM 12,090.00 8,463.00 3,627.00
E20.8 OTHER HYPOPARATHYROIDISM 12,090.00 8,463.00 3,627.00
HYPOPARATHYROIDISM, UNSPECIFIED; PARATHYROID
E20.9 12,090.00 8,463.00 3,627.00
TETANY
PRIMARY HYPERPARATHYROIDISM; HYPERPLASIA OF
E21.0 PARATHYROID; OSTEITIS FIBROSA CYSTICA GENERALISATA 12,090.00 8,463.00 3,627.00
[VON RECKLINGHAUSEN'S DISEASE OF BONE]
E21.4 OTHER SPECIFIED DISORDERS OF PARATHYROID GLAND 12,090.00 8,463.00 3,627.00

E21.5 DISORDER OF PARATHYROID GLAND, UNSPECIFIED 12,090.00 8,463.00 3,627.00
SYNDROME OF INAPPROPRIATE SECRETION OF
E22.2 15,340.00 10,738.00 4,602.00
ANTIDIURETIC HORMONE
HYPOPITUITARISM; FERTILE EUNUCH SYNDROME;
HYPOGONADOTROPIC HYPOGONADISM; IDIOPATHIC
GROWTH HORMONE DEFICIENCY; ISOLATED DEFICIENCY
E23.0 15,340.00 10,738.00 4,602.00
OF GONADOTROPIN; ISOLATED DEFICIENCY OF GROWTH
HORMONE; ISOLATED DEFICIENCY OF PITUITARY
HORMONE; KALLMANN'S SYNDROME; LORAI
E23.2 DIABETES INSIPIDUS 13,130.00 9,191.00 3,939.00
PITUITARY-DEPENDENT CUSHING'S DISEASE;
E24.0 OVERPRODUCTION OF PITUITARY ACTH; PITUITARY- 12,350.00 8,645.00 3,705.00
DEPENDENT HYPERADRENOCORTICISM
E24.1 NELSON'S SYNDROME 12,350.00 8,645.00 3,705.00
E24.2 DRUG-INDUCED CUSHING'S SYNDROME 12,350.00 8,645.00 3,705.00
E24.3 ECTOPIC ACTH SYNDROME 12,350.00 8,645.00 3,705.00
E24.8 OTHER CUSHING'S SYNDROME 12,350.00 8,645.00 3,705.00
E24.9 CUSHING'S SYNDROME, UNSPECIFIED 12,350.00 8,645.00 3,705.00
CONGENITAL ADRENOGENITAL DISORDERS ASSOCIATED
WITH ENZYME DEFICIENCY; CONGENITAL ADRENAL
E25.0 10,140.00 7,098.00 3,042.00
HYPERPLASIA; 21-HYDROXYLASE DEFICIENCY; SALT-
LOSING CONGENITAL ADRENAL HYPERPLASIA
ADRENOGENITAL DISORDER, UNSPECIFIED;
E25.9 14,170.00 9,919.00 4,251.00
ADRENOGENITAL SYNDROME NOS
PRIMARY HYPERALDOSTERONISM; CONN'S SYNDROME;
E26.0 PRIMARY ALDOSTERONISM DUE TO ADRENAL HYPERPLASIA 12,870.00 9,009.00 3,861.00
(BILATERAL)
E26.1 SECONDARY HYPERALDOSTERONISM 12,870.00 9,009.00 3,861.00
E26.8 OTHER HYPERALDOSTERONISM; BARTTER'S SYNDROME 12,870.00 9,009.00 3,861.00
HYPERALDOSTERONISM, UNSPECIFIED; OTHER DISORDERS
E26.9 12,870.00 9,009.00 3,861.00
OF ADRENAL GLAND
PRIMARY ADRENOCORTICAL INSUFFICIENCY; ADDISON'S
E27.1 12,870.00 9,009.00 3,861.00
DISEASE; AUTOIMMUNE ADRENALITIS
ADDISONIAN CRISIS; ADRENAL CRISIS; ADRENOCORTICAL
E27.2 12,870.00 9,009.00 3,861.00
CRISIS
E27.3 DRUG-INDUCED ADRENOCORTICAL INSUFFICIENCY 12,870.00 9,009.00 3,861.00
Page 28 of 126
First Case Rate

OTHER AND UNSPECIFIED ADRENOCORTICAL
INSUFFICIENCY; ADRENAL HAEMORRHAGE; ADRENAL
E27.4 INFARCTION; 12,870.00 9,009.00 3,861.00
ADRENOCORTICAL INSUFFICIENCY NOS;
HYPOALDOSTERONISM
OTHER SPECIFIED DISORDERS OF ADRENAL GLAND;
E27.8 12,870.00 9,009.00 3,861.00
ABNORMALITY OF CORTISOL-BINDING GLOBULIN
E28.8 OTHER OVARIAN DYSFUNCTION 14,170.00 9,919.00 4,251.00
TESTICULAR HYPOFUNCTION; DEFECTIVE BIOSYNTHESIS
OF TESTICULAR ANDROGEN NOS; 5-A-REDUCTASE
E29.1 14,170.00 9,919.00 4,251.00
DEFICIENCY (WITH MALE PSEUDOHERMAPHRODITISM);
TESTICULAR HYPOGONADISM NOS
E29.9 TESTICULAR DYSFUNCTION, UNSPECIFIED 14,170.00 9,919.00 4,251.00
E31.0 AUTOIMMUNE POLYGLANDULAR FAILURE 14,170.00 9,919.00 4,251.00
E31.1 POLYGLANDULAR HYPERFUNCTION 14,170.00 9,919.00 4,251.00
E31.9 POLYGLANDULAR DYSFUNCTION, UNSPECIFIED 14,170.00 9,919.00 4,251.00
PERSISTENT HYPERPLASIA OF THYMUS; HYPERTROPHY OF
E32.0 14,170.00 9,919.00 4,251.00
THYMUS
E32.8 OTHER DISEASES OF THYMUS 14,170.00 9,919.00 4,251.00
E32.9 DISEASE OF THYMUS, UNSPECIFIED 14,170.00 9,919.00 4,251.00
E34.0 CARCINOID SYNDROME 14,170.00 9,919.00 4,251.00
OTHER SPECIFIED ENDOCRINE DISORDERS; PINEAL GLAND
E34.8 14,170.00 9,919.00 4,251.00
DYSFUNCTION; PROGERIA
ENDOCRINE DISORDER, UNSPECIFIED; ENDOCRINE
E34.9 14,170.00 9,919.00 4,251.00
DISTURBANCE NOS; HORMONE DISTURBANCE NOS
E40 KWASHIORKOR 15,210.00 10,647.00 4,563.00
NUTRITIONAL MARASMUS; SEVERE MALNUTRITION WITH
E41 15,210.00 10,647.00 4,563.00
MARASMUS
MARASMIC KWASHIORKOR; SEVERE PROTEIN-ENERGY
MALNUTRITION, INTERMEDIATE FORM; SEVERE PROTEIN-
E42 15,210.00 10,647.00 4,563.00
ENERGY MALNUTRITION WITH SIGNS OF BOTH
KWASHIORKOR AND MARASMUS
E43 UNSPECIFIED SEVERE PROTEIN-ENERGY MALNUTRITION 15,210.00 10,647.00 4,563.00
E44.0 MODERATE PROTEIN-ENERGY MALNUTRITION 15,210.00 10,647.00 4,563.00
E44.1 MILD PROTEIN-ENERGY MALNUTRITION 15,210.00 10,647.00 4,563.00
RETARDED DEVELOPMENT FOLLOWING PROTEIN-ENERGY
MALNUTRITION; NUTRITIONAL SHORT STATURE;
E45 15,210.00 10,647.00 4,563.00
NUTRITIONAL STUNTING; PHYSICAL RETARDATION DUE TO
MALNUTRITION
UNSPECIFIED PROTEIN-ENERGY MALNUTRITION;
E46 15,210.00 10,647.00 4,563.00
MALNUTRITION NOS; PROTEIN-ENERGY IMBALANCE NOS
E50.0 VITAMIN A DEFICIENCY WITH CONJUNCTIVAL XEROSIS 11,960.00 8,372.00 3,588.00

VITAMIN A DEFICIENCY WITH BITOT'S SPOT AND
E50.1 CONJUNCTIVAL XEROSIS; BITOT'S SPOT IN THE YOUNG 11,960.00 8,372.00 3,588.00
CHILD
E50.8 OTHER MANIFESTATIONS OF VITAMIN A DEFICIENCY 11,960.00 8,372.00 3,588.00
VITAMIN A DEFICIENCY, UNSPECIFIED; HYPOVITAMINOSIS
E50.9 11,960.00 8,372.00 3,588.00
A NOS
E51.1 DRY BERIBERI 11,960.00 8,372.00 3,588.00
E51.2 WERNICKE'S ENCEPHALOPATHY 11,960.00 8,372.00 3,588.00
E51.8 OTHER MANIFESTATIONS OF THIAMINE DEFICIENCY 11,960.00 8,372.00 3,588.00
E51.9 THIAMINE DEFICIENCY, UNSPECIFIED 11,960.00 8,372.00 3,588.00
E53.1 PYRIDOXINE DEFICIENCY; VITAMIN B6 DEFICIENCY 11,960.00 8,372.00 3,588.00
DEFICIENCY OF OTHER SPECIFIED B GROUP VITAMINS;
BIOTIN DEFICIENCY; CYANOCOBALAMIN DEFICIENCY;
E53.8 11,960.00 8,372.00 3,588.00
FOLATE DEFICIENCY; FOLIC ACID DEFICIENCY;
PANTOTHENIC ACID DEFICIENCY; VITAMIN B12 DEFICIENCY
E53.9 VITAMIN B DEFICIENCY, UNSPECIFIED 11,960.00 8,372.00 3,588.00
ASCORBIC ACID DEFICIENCY; DEFICIENCY OF VITAMIN C;
E54 11,960.00 8,372.00 3,588.00
SCURVY
RICKETS, ACTIVE; INFANTILE OSTEOMALACIA; JUVENILE
E55.0 11,960.00 8,372.00 3,588.00
OSTEOMALACIA
E55.9 VITAMIN D DEFICIENCY, UNSPECIFIED; AVITAMINOSIS D 11,960.00 8,372.00 3,588.00
E56.0 DEFICIENCY OF VITAMIN E 11,960.00 8,372.00 3,588.00
E56.1 DEFICIENCY OF VITAMIN K 11,960.00 8,372.00 3,588.00
E56.8 DEFICIENCY OF OTHER VITAMINS 11,960.00 8,372.00 3,588.00
E56.9 VITAMIN DEFICIENCY, UNSPECIFIED 11,960.00 8,372.00 3,588.00
E58 DIETARY CALCIUM DEFICIENCY 11,960.00 8,372.00 3,588.00
E60 DIETARY ZINC DEFICIENCY 11,960.00 8,372.00 3,588.00
E61.1 IRON DEFICIENCY 11,960.00 8,372.00 3,588.00
E61.2 MAGNESIUM DEFICIENCY 11,960.00 8,372.00 3,588.00
E61.6 VANADIUM DEFICIENCY 11,960.00 8,372.00 3,588.00
E61.9 DEFICIENCY OF NUTRIENT ELEMENT, UNSPECIFIED 11,960.00 8,372.00 3,588.00
E63.1 IMBALANCE OF CONSTITUENTS OF FOOD INTAKE 11,960.00 8,372.00 3,588.00
E63.8 OTHER SPECIFIED NUTRITIONAL DEFICIENCIES 11,960.00 8,372.00 3,588.00
E63.9 NUTRITIONAL DEFICIENCY, UNSPECIFIED 11,960.00 8,372.00 3,588.00
E64.8 SEQUELAE OF OTHER NUTRITIONAL DEFICIENCIES 11,440.00 8,008.00 3,432.00
Page 29 of 126
First Case Rate

E64.9 SEQUELAE OF UNSPECIFIED NUTRITIONAL DEFICIENCY 11,960.00 8,372.00 3,588.00
EXTREME OBESITY WITH ALVEOLAR HYPOVENTILATION;
E66.2 17,680.00 12,376.00 5,304.00
PICKWICKIAN SYNDROME
E67.0 HYPERVITAMINOSIS A 11,960.00 8,372.00 3,588.00
E67.1 HYPERCAROTENAEMIA 11,960.00 8,372.00 3,588.00
E67.3 HYPERVITAMINOSIS D 11,960.00 8,372.00 3,588.00
E70.0 CLASSICAL PHENYLKETONURIA 13,780.00 9,646.00 4,134.00
E70.1 OTHER HYPERPHENYLALANINAEMIAS 13,780.00 9,646.00 4,134.00
DISORDERS OF TYROSINE METABOLISM; ALKAPTONURIA;
E70.2 HYPERTYROSINAEMIA; OCHRONOSIS; TYROSINAEMIA; 13,780.00 9,646.00 4,134.00
TYROSINOSIS
ALBINISM; OCULARALBINISM; OCULOCUTANEOUS
ALBINISM
E70.3 13,780.00 9,646.00 4,134.00
CHEDIAK(-STEINBRINCK)-HIGASHI SYNDROME; CROSS
SYNDROME; HERMANSKY-PUDLAK SYNDROME
OTHER DISORDERS OF AROMATIC AMINO-ACID
E70.8 METABOLISM; DISORDERS OF HISTIDINE METABOLISM; 13,780.00 9,646.00 4,134.00
DISORDERS OF TRYPTOPHAN METABOLISM
E71.0 MAPLE-SYRUP-URINE DISEASE 13,780.00 9,646.00 4,134.00
OTHER DISORDERS OF BRANCHED-CHAIN AMINO-ACID

METABOLISM; HYPERLEUCINE-ISOLEUCINAEMIA;
E71.1 13,780.00 9,646.00 4,134.00
HYPERVALINAEMIA; ISOVALERIC ACIDAEMIA;
METHYLMALONIC ACIDAEMIA; PROPIONIC ACIDAEMIA
DISORDERS OF FATTY-ACID METABOLISM;

E71.3 ADRENOLEUKODYSTROPHY [ADDISON-SCHILDER]; MUSCLE 13,780.00 9,646.00 4,134.00
CARNITINE PALMITYLTRANSFERASE DEFICIENCY
DISORDERS OF AMINO-ACID TRANSPORT; CYSTINOSIS;

E72.0 CYSTINURIA; FANCONI(-DE TONI)(-DEBRé) SYNDROME; 13,780.00 9,646.00 4,134.00
HARTNUP'S DISEASE; LOWE'S SYNDROME
DISORDERS OF UREA CYCLE METABOLISM; ARGININAEMIA;
E72.2 ARGININOSUCCINIC ACIDURIA; CITRULLINAEMIA; 13,780.00 9,646.00 4,134.00
HYPERAMMONAEMIA
E72.3 DISORDERS OF LYSINE AND HYDROXYLYSINE METABOLISM 13,780.00 9,646.00 4,134.00
DISORDERS OF GLYCINE METABOLISM;
HYPERHYDROXYPROLINAEMIA; HYPERPROLINAEMIA (TYPE
E72.5 13,780.00 9,646.00 4,134.00
I) , HYPERPROLINAEMIA TYPE II; NON-KETOTIC
HYPERGLYCINAEMIA; SARCOSINAEMIA
E73.0 CONGENITAL LACTASE DEFICIENCY 7,540.00 5,278.00 2,262.00
GLYCOGEN STORAGE DISEASE; CARDIAC GLYCOGENOSIS;
ANDERSEN DISEASE; CORI DISEASE; FORBES DISEASE;
E74.0 HERS DISEASE; MCARDLE DISEASE; POMPE DISEASE; TAURI 7,540.00 5,278.00 2,262.00
DISEASE; VON GIERKE DISEASE; LIVER PHOSPHORYLASE
DEFICIENCY
DISORDERS OF FRUCTOSE METABOLISM; ESSENTIAL
E74.1 FRUCTOSURIA; FRUCTOSE-1,6-DIPHOSPHATASE 7,540.00 5,278.00 2,262.00
DEFICIENCY; HEREDITARY FRUCTOSE INTOLERANCE
DISORDERS OF GALACTOSE METABOLISM; GALACTOKINASE
E74.2 7,540.00 5,278.00 2,262.00
DEFICIENCY; GALACTOSAEMIA
OTHER DISORDERS OF INTESTINAL CARBOHYDRATE
E74.3 ABSORPTION; GLUCOSE-GALACTOSE MALABSORPTION; 7,540.00 5,278.00 2,262.00
SUCRASE DEFICIENCY
OTHER SPECIFIED DISORDERS OF CARBOHYDRATE
E74.8 7,540.00 5,278.00 2,262.00
METABOLISM
OTHER SPHINGOLIPIDOSIS; FABRY(-ANDERSON) DISEASE;
GAUCHER DISEASE; KRABBE DISEASE; NIEMANN-PICK
E75.2 10,530.00 7,371.00 3,159.00
DISEASE; FABER'S SYNDROME; METACHROMATIC
LEUKODYSTROPHY; SULFATASE DEFICIENCY
NEURONAL CEROID LIPOFUSCINOSIS; BATTEN DISEASE;
E75.4 BIELSCHOWSKY-JANSKY DISEASE; KUFS DISEASE; 10,530.00 7,371.00 3,159.00
PIELMEYER-VOGT DISEASE
OTHER LIPID STORAGE DISORDERS; CEREBROTENDINOUS
E75.5 CHOLESTEROSIS [VAN BOGAERT-SCHERER-EPSTEIN]; 10,530.00 7,371.00 3,159.00
WOLMAN'S DISEASE
E75.6 LIPID STORAGE DISORDER, UNSPECIFIED 10,530.00 7,371.00 3,159.00
MUCOPOLYSACCHARIDOSIS, TYPE I; HURLER SYNDROME;
E76.0 14,170.00 9,919.00 4,251.00
HURLER-SCHEIE SYNDROME; SCHEIE SYNDROME
E76.1 MUCOPOLYSACCHARIDOSIS, TYPE II; HUNTER'S SYNDROME 14,170.00 9,919.00 4,251.00
Page 30 of 126
First Case Rate

OTHER MUCOPOLYSACCHARIDOSES; ß-GLUCURONIDASE

DEFICIENCY; MUCOPOLYSACCHARIDOSIS, TYPE III;
MUCOPOLYSACCHARIDOSIS IV, MUCOPOLYSACCHARIDOSIS
E76.2 14,170.00 9,919.00 4,251.00
VI, MUCOPOLYSACCHARIDOSIS VII;
MILD MAROTEAUX-LAMY SYNDROME; SEVERE MAROTEAUX-
LAMY SYNDROME; MORQUIO-LIKE SYNDROME;
E76.3 MUCOPOLYSACCHARIDOSIS, UNSPECIFIED 14,170.00 9,919.00 4,251.00

OTHER DISORDERS OF GLUCOSAMINOGLYCAN
E76.8 14,170.00 9,919.00 4,251.00
METABOLISM
E77.8 OTHER DISORDERS OF GLYCOPROTEIN METABOLISM 13,780.00 9,646.00 4,134.00
PURE HYPERCHOLESTEROLAEMIA; FAMILIAL
HYPERCHOLESTEROLAEMIA; FREDRICKSON'S
HYPERLIPOPROTEINAEMIA, TYPE IIA;
E78.0 8,580.00 6,006.00 2,574.00
HYPERBETALIPOPROTEINAEMIA; HYPERLIPIDAEMIA,
GROUP A; LOW-DENSITY-LIPOPROTEIN-TYPE [LDL]
HYPERLIPOPROTEINAEMIA
PURE HYPERGLYCERIDAEMIA; ENDOGENOUS
HYPERGLYCERIDAEMIA; FREDRICKSON'S
HYPERLIPOPROTEINAEMIA, TYPE IV; HYPERLIPIDAEMIA,
E78.1 8,580.00 6,006.00 2,574.00
GROUP B; HYPERPREBETALIPOPROTEINAEMIA'; VERY-LOW-
DENSITY-LIPOPROTEIN-TYPE [VLDL]
HYPERLIPOPROTEINAEMIA
MIXED HYPERLIPIDAEMIA; BROAD- OR FLOATING-

BETALIPOPROTEINAEMIA; FREDRICKSON'S
HYPERLIPOPROTEINAEMIA, TYPE IIB; FREDRICKSON'S
E78.2 HYPERLIPOPROTEINAEMIA TYPE III; 8,580.00 6,006.00 2,574.00
HYPERBETALIPOPROTEINAEMIA WITH
PREBETALIPOPROTEINAEMIA; HYPERCHOLESTEROLAEMIA
WITH ENDOGENOUS HYPE
HYPERCHYLOMICRONAEMIA; FREDRICKSON'S
HYPERLIPOPROTEINAEMIA, TYPE I; FREDRICKSON'S
E78.3 8,580.00 6,006.00 2,574.00
HYPERLIPOPROTEINAEMIA, TYPE V; HYPERLIPIDAEMIA,
GROUP D; MIXED HYPERGLYCERIDAEMIA
OTHER HYPERLIPIDAEMIA; FAMILIAL COMBINED
E78.4 8,580.00 6,006.00 2,574.00
HYPERLIPIDAEMIA
LIPOPROTEIN DEFICIENCY; ABETALIPOPROTEINAEMIA;

HIGH-DENSITY LIPOPROTEIN DEFICIENCY;
E78.6 HYPOALPHALIPOPROTEINAEMIA; FAMILIAL 8,580.00 6,006.00 2,574.00
HYPOBETALIPOPROTEINAEMIA; LECITHIN CHOLESTEROL
ACYLTRANSFERASE DEFICIENCY; TANGIER DISEASE
E78.8 OTHER DISORDERS OF LIPOPROTEIN METABOLISM 8,580.00 6,006.00 2,574.00

OTHER DISORDERS OF PURINE AND PYRIMIDINE
E79.8 9,100.00 6,370.00 2,730.00
METABOLISM; HEREDITARY XANTHINURIA
HEREDITARY ERYTHROPOIETIC PORPHYRIA; CONGENITAL
E80.0 ERYTHROPOIETIC PORPHYRIA; ERYTHROPOIETIC 12,740.00 8,918.00 3,822.00
PROTOPORPHYRIA
OTHER PORPHYRIA; HEREDITARY COPROPORPHYRIA
E80.2 PORPHYRIA NOS; ACUTE INTERMITTENT (HEPATIC) 12,740.00 8,918.00 3,822.00
PORPHYRIA
E80.4 GILBERT'S SYNDROME 12,740.00 8,918.00 3,822.00
E80.5 CRIGLER-NAJJAR SYNDROME 12,740.00 8,918.00 3,822.00
OTHER DISORDERS OF BILIRUBIN METABOLISM; DUBIN-
E80.6 12,740.00 8,918.00 3,822.00
JOHNSON SYNDROME; ROTOR'S SYNDROME
DISORDERS OF COPPER METABOLISM; MENKES' KINKY
E83.0 HAIR DISEASE; MENKES' STEELY HAIR DISEASE; WILSON'S 9,490.00 6,643.00 2,847.00
DISEASE
E83.1 DISORDERS OF IRON METABOLISM; HAEMOCHROMATOSIS 9,490.00 6,643.00 2,847.00
DISORDERS OF ZINC METABOLISM; ACRODERMATITIS
E83.2 9,490.00 6,643.00 2,847.00
ENTEROPATHICA
DISORDERS OF PHOSPHORUS METABOLISM; ACID
PHOSPHATASE DEFICIENCY; FAMILIAL
E83.3 HYPOPHOSPHATAEMIA; HYPOPHOSPHATASIA; VITAMIN-D- 9,490.00 6,643.00 2,847.00
RESISTANT OSTEOMALACIA; VITAMIN-D-RESISTANT
RICKETS
DISORDERS OF MAGNESIUM METABOLISM;
E83.4 9,490.00 6,643.00 2,847.00
HYPERMAGNESAEMIA; HYPOMAGNESAEMIA
DISORDERS OF CALCIUM METABOLISM; FAMILIAL
E83.5 HYPOCALCIURIC HYPERCALCAEMIA; IDIOPATHIC 9,490.00 6,643.00 2,847.00
HYPERCALCIURIA
E83.8 OTHER DISORDERS OF MINERAL METABOLISM 9,490.00 6,643.00 2,847.00
E84.0 CYSTIC FIBROSIS WITH PULMONARY MANIFESTATIONS 9,490.00 6,643.00 2,847.00
E84.1 CYSTIC FIBROSIS WITH INTESTINAL MANIFESTATIONS 9,490.00 6,643.00 2,847.00
Page 31 of 126
First Case Rate

CYSTIC FIBROSIS WITH OTHER MANIFESTATIONS; CYSTIC
E84.8 9,490.00 6,643.00 2,847.00
FIBROSIS WITH COMBINED MANIFESTATIONS
E84.9 CYSTIC FIBROSIS, UNSPECIFIED 9,490.00 6,643.00 2,847.00
E85.8 OTHER AMYLOIDOSIS; LOCALIZED AMYLOIDOSIS 14,430.00 10,101.00 4,329.00
E86.1 MODERATE DEHYDRATION 5,200.00 3,640.00 1,560.00
E86.2 SEVERE DEHYDRATION 5,200.00 3,640.00 1,560.00
HYPEROSMOLALITY AND HYPERNATRAEMIA; SODIUM [NA]
E87.0 11,050.00 7,735.00 3,315.00
EXCESS; SODIUM [NA] OVERLOAD
E87.1 HYPO-OSMOLALITY AND HYPONATRAEMIA 11,050.00 7,735.00 3,315.00
ACIDOSIS; ACIDOSIS NOS; LACTIC ACIDOSIS; METABOLIC
E87.2 11,050.00 7,735.00 3,315.00
ACIDOSIS; RESPIRATORY ACIDOSIS
ALKALOSIS; ALKALOSIS NOS; METABOLIC ALKALOSIS;
E87.3 11,050.00 7,735.00 3,315.00
RESPIRATORY ALKALOSIS
E87.4 MIXED DISORDER OF ACID-BASE BALANCE 11,050.00 7,735.00 3,315.00
HYPERKALAEMIA; POTASSIUM [K] EXCESS; POTASSIUM [K]
E87.5 11,050.00 7,735.00 3,315.00
OVERLOAD
E87.6 HYPOKALAEMIA; POTASSIUM [K] DEFICIENCY 11,050.00 7,735.00 3,315.00
E87.7 FLUID OVERLOAD 11,050.00 7,735.00 3,315.00
OTHER DISORDERS OF ELECTROLYTE AND FLUID BALANCE,
NOT ELSEWHERE CLASSIFIED; ELECTROLYTE IMBALANCE
E87.8 NOS; 11,050.00 7,735.00 3,315.00
HYPERCHLORAEMIA; HYPOCHLORAEMIA; OTHER
METABOLIC DISORDERS
DISORDERS OF PLASMA-PROTEIN METABOLISM, NOT
E88.0 ELSEWHERE CLASSIFIED; A-1-ANTITRYPSIN DEFICIENCY; 13,910.00 9,737.00 4,173.00
BISALBUMINAEMIA
LIPODYSTROPHY, NOT ELSEWHERE CLASSIFIED;
E88.1 13,910.00 9,737.00 4,173.00
LIPODYSTROPHY NOS
OTHER SPECIFIED METABOLIC DISORDERS; LAUNOIS-
E88.8 13,910.00 9,737.00 4,173.00
BENSAUDE ADENOLIPOMATOSIS; TRIMETHYLAMINURIA
E88.9 METABOLIC DISORDER, UNSPECIFIED 13,910.00 9,737.00 4,173.00
POSTPROCEDURAL HYPOTHYROIDISM; POSTIRRADIATION
E89.0 13,390.00 9,373.00 4,017.00
HYPOTHYROIDISM; POSTSURGICAL HYPOTHYROIDISM
POSTPROCEDURAL HYPOPARATHYROIDISM;
E89.2 13,390.00 9,373.00 4,017.00
PARATHYROPRIVAL TETANY
POSTPROCEDURAL HYPOPITUITARISM; POSTIRRADIATION
E89.3 13,390.00 9,373.00 4,017.00
HYPOPITUITARISM
E89.4 POSTPROCEDURAL OVARIAN FAILURE 13,390.00 9,373.00 4,017.00
E89.5 POSTPROCEDURAL TESTICULAR HYPOFUNCTION 13,390.00 9,373.00 4,017.00
POSTPROCEDURAL ADRENOCORTICAL HYPOFUNCTION;
E89.6 13,390.00 9,373.00 4,017.00
POSTPROCEDURAL ADRENO-MEDULLARY HYPOFUNCTION
OTHER POSTPROCEDURAL ENDOCRINE AND METABOLIC
E89.8 13,390.00 9,373.00 4,017.00
DISORDERS
F01.0 VASCULAR DEMENTIA OF ACUTE ONSET 10,660.00 7,462.00 3,198.00
MULTI-INFARCT DEMENTIA; PREDOMINANTLY CORTICAL
F01.1 10,140.00 7,098.00 3,042.00
DEMENTIA
F01.8 OTHER VASCULAR DEMENTIA 10,140.00 7,098.00 3,042.00
F01.9 VASCULAR DEMENTIA, UNSPECIFIED 10,140.00 7,098.00 3,042.00
UNSPECIFIED DEMENTIA; PRESENILE DEMENTIA NOS;
PRESENILE PSYCHOSIS NOS; SENILE DEMENTIA NOS;
F03 10,140.00 7,098.00 3,042.00
SENILE DEMENTIA DEPRESSED OR PARANOID TYPE; SENILE
PSYCHOSIS NOS
ORGANIC AMNESIC SYNDROME, NOT INDUCED BY ALCOHOL
F04 AND OTHER PSYCHOACTIVE SUBSTANCES; KORSAKOV'S 10,140.00 7,098.00 3,042.00
PSYCHOSIS OR SYNDROME, NONALCOHOLIC
DELIRIUM NOT SUPERIMPOSED ON DEMENTIA, SO
F05.0 10,140.00 7,098.00 3,042.00
DESCRIBED
F05.8 OTHER DELIRIUM 10,140.00 7,098.00 3,042.00
F05.9 OTHER DELIRIUM 10,140.00 7,098.00 3,042.00
ORGANIC HALLUCINOSIS; ORGANIC HALLUCINATORY
F06.0 10,140.00 7,098.00 3,042.00
STATE (NONALCOHOLIC)
ORGANIC DELUSIONAL [SCHIZOPHRENIA-LIKE] DISORDER;
F06.2 PARANOID AND PARANOID-HALLUCINATORY ORGANIC 10,140.00 7,098.00 3,042.00
STATES; SCHIZOPHRENIA-LIKE PSYCHOSIS IN EPILEPSY
F06.3 ORGANIC MOOD [AFFECTIVE] DISORDERS 10,140.00 7,098.00 3,042.00
F06.4 ORGANIC ANXIETY DISORDER 10,140.00 7,098.00 3,042.00
F06.7 MILD COGNITIVE DISORDER 10,140.00 7,098.00 3,042.00
OTHER SPECIFIED MENTAL DISORDERS DUE TO BRAIN
F06.8 DAMAGE AND DYSFUNCTION AND TO PHYSICAL DISEASE; 10,140.00 7,098.00 3,042.00
EPILEPTIC PSYCHOSIS NOS
UNSPECIFIED MENTAL DISORDER DUE TO BRAIN DAMAGE
F06.9 AND DYSFUNCTION AND TO PHYSICAL DISEASE; ORGANIC 10,140.00 7,098.00 3,042.00
BRAIN SYNDROME NOS; ORGANIC MENTAL DISORDER NOS
Page 32 of 126
First Case Rate

ORGANIC PERSONALITY DISORDER; ORGANIC
PSEUDOPSYCHOPATHIC PERSONALITY;
ORGANIC PSEUDORETARDED PERSONALITY; FRONTAL
F07.0 10,140.00 7,098.00 3,042.00
LOBE SYNDROME; LIMBIC EPILEPSY
PERSONALITYSYNDROME ; LOBOTOMY SYNDROME;
POSTLEUCOTOMY SYNDROME
F07.1 POSTENCEPHALITIC SYNDROME 10,140.00 7,098.00 3,042.00
POSTCONCUSSIONAL SYNDROME; POSTCONTUSIONAL
F07.2 SYNDROME (ENCEPHALOPATHY); POST-TRAUMATIC BRAIN 10,140.00 7,098.00 3,042.00
SYNDROME, NONPSYCHOTIC
UNSPECIFIED ORGANIC PERSONALITY AND BEHAVIOURAL

F07.9 DISORDER DUE TO BRAIN DISEASE, DAMAGE AND 10,140.00 7,098.00 3,042.00
DYSFUNCTION; ORGANIC PSYCHOSYNDROME
UNSPECIFIED ORGANIC OR SYMPTOMATIC MENTAL
F09 DISORDER; ORGANIC PSYCHOSIS NOS; SYMPTOMATIC 10,140.00 7,098.00 3,042.00
PSYCHOSIS NOS
MENTAL AND BEHAVIOURAL DISORDERS DUE TO USE OF
F10.0 10,140.00 7,098.00 3,042.00
ALCOHOL IN ACUTE INTOXICATION
F10.1 10,140.00 7,098.00 3,042.00
ALCOHOL:HARMFUL USE
F10.2 10,140.00 7,098.00 3,042.00
ALCOHOL: DEPENDENCY SYNDROME
F10.3 10,140.00 7,098.00 3,042.00
ALCOHOL:WITHDRAWAL STATE
F10.4 10,140.00 7,098.00 3,042.00
ALCOHOL: WITHDRAWAL STATE WITH DELIRIUM
F10.5 10,140.00 7,098.00 3,042.00
ALCOHOL: PSYCHOTIC DISORDER
F10.6 10,140.00 7,098.00 3,042.00
ALCOHOL: AMNESIC SYNDROME
F10.7 ALCOHOL: RESIDUAL AND LATE-ONSET PSYCHOTIC 10,140.00 7,098.00 3,042.00
DISORDER
F10.8 10,140.00 7,098.00 3,042.00
ALCOHOL: OTHER MENTAL AND BEHAVIOURAL DISORDERS
F10.9 ALCOHOL: UNSPECIFIED MENTAL AND BEHAVIOURAL 10,140.00 7,098.00 3,042.00
DISORDER
F11.1 10,140.00 7,098.00 3,042.00
OPIOIDS: HARMFUL USE
F11.2 10,140.00 7,098.00 3,042.00
OPIOIDS: DEPENDENCE SYNDROME
F11.5 10,140.00 7,098.00 3,042.00
OPIOIDS: PSYCHOTIC DISORDER
F11.9 OPIOIDS: UNSPECIFIED MENTAL AND BEHAVIOURAL 10,140.00 7,098.00 3,042.00
DISORDER
F12.0 10,140.00 7,098.00 3,042.00
CANNABINOIDS: ACUTE INTOXICATION
F12.5 10,140.00 7,098.00 3,042.00
CANNABINOIDS: PSYCHOTIC DISORDER
F13.1 10,140.00 7,098.00 3,042.00
SEDATIVES OR HYPNOTICS: HARMFUL USE
F13.2 10,140.00 7,098.00 3,042.00
SEDATIVES OR HYPNOTICS: DEPENDENCE SYNDROME
F13.3 10,140.00 7,098.00 3,042.00
SEDATIVES OR HYPNOTICS: WITHDRAWAL STATE
F13.4 SEDATIVES OR HYPNOTICS: WITHDRAWAL STATE WITH 10,140.00 7,098.00 3,042.00
DELIRIUM
F13.5 10,140.00 7,098.00 3,042.00
SEDATIVES OR HYPNOTICS: PSYCHOTIC DISORDER
F13.7 SEDATIVES OR HYPNOTICS: RESIDUAL AND LATE-ONSET 10,140.00 7,098.00 3,042.00
PSYCHOTIC DISORDER
F14.0 10,140.00 7,098.00 3,042.00
COCAINE: ACUTE INTOXICATION
F14.2 10,140.00 7,098.00 3,042.00
COCAINE: DEPENDENCE SYNDROME
F14.5 10,140.00 7,098.00 3,042.00
COCAINE: PSYCHOTIC DISORDER
F14.6 10,140.00 7,098.00 3,042.00
COCAINE: AMNESIC SYNDROME
F14.9 COCAINE: UNSPECIFIED MENTAL AND BEHAVIOURAL 10,140.00 7,098.00 3,042.00
DISORDER
F15.0 OTHER STIMULANTS, INCLUDING CAFFEINE: ACUTE 10,140.00 7,098.00 3,042.00
INTOXICATION
Page 33 of 126
First Case Rate

F15.1 10,140.00 7,098.00 3,042.00
OTHER STIMULANTS, INCLUDING CAFFEINE: HARMFUL USE
F15.2 OTHER STIMULANTS, INCLUDING CAFFEINE: DEPENDENCE 10,140.00 7,098.00 3,042.00
SYNDROME
F15.3 OTHER STIMULANTS, INCLUDING CAFFEINE: WITHDRAWAL 10,140.00 7,098.00 3,042.00
STATE
F15.5 OTHER STIMULANTS, INCLUDING CAFFEINE: PSYCHOTIC 10,140.00 7,098.00 3,042.00
DISORDER
F15.8 OTHER STIMULANTS, INCLUDING CAFFEINE: OTHER 10,140.00 7,098.00 3,042.00
MENTAL AND BEHAVIOURAL DISORDERS
F15.9 OTHER STIMULANTS, INCLUDING CAFFEINE: UNSPECIFIED 10,140.00 7,098.00 3,042.00
MENTAL AND BEHAVIOURAL DISORDER
F16.0 10,140.00 7,098.00 3,042.00
HALLUCINOGENS: ACUTE INTOXICATION
F16.1 10,140.00 7,098.00 3,042.00
HALLUCINOGENS: HARMFUL USE
F16.2 10,140.00 7,098.00 3,042.00
HALLUCINOGENS: DEPENDENCE SYNDROME
F16.5 10,140.00 7,098.00 3,042.00
HALLUCINOGENS: PSYCHOTIC DISORDER
F17.2 10,140.00 7,098.00 3,042.00
TOBACCO: DEPENDENCE SYNDROME
F17.3 10,140.00 7,098.00 3,042.00
TOBACCO: WITHDRAWAL STATE
F18.0 10,140.00 7,098.00 3,042.00
VOLATILE SOLVENTS: ACUTE INTOXICATION
F18.4 VOLATILE SOLVENTS: WITHDRAWAL STATE WITH 10,140.00 7,098.00 3,042.00
DELIRIUM
F18.6 10,140.00 7,098.00 3,042.00
VOLATILE SOLVENTS: AMNESIC SYNDROME
MENTAL AND BEHAVIOURAL DISORDERS DUE TO MULTIPLE
F19.1 DRUG USE AND USE OF OTHER PSYCHOACTIVE 10,140.00 7,098.00 3,042.00
SUBSTANCES; MISUSE OF DRUGS NOS: HARMFUL USE
DRUG USE AND USE OF OTHER PSYCHOACTIVE
F19.2 10,140.00 7,098.00 3,042.00
SUBSTANCES; MISUSE OF DRUGS NOS: DEPENDENCE
SYNDROME
F19.3 DRUG USE AND USE OF OTHER PSYCHOACTIVE 10,140.00 7,098.00 3,042.00
SUBSTANCES; MISUSE OF DRUGS NOS: WITHDRAWAL STATE
F19.5 10,140.00 7,098.00 3,042.00
SUBSTANCES; MISUSE OF DRUGS NOS: PSYCHOTIC
DISORDER
F19.7 10,140.00 7,098.00 3,042.00
SUBSTANCES; MISUSE OF DRUGS NOS: RESIDUAL AND LATE-
ONSET PSYCHOTIC DISORDER
F19.8 10,140.00 7,098.00 3,042.00
SUBSTANCES; MISUSE OF DRUGS NOS: OTHER MENTAL AND
BEHAVIOURAL DISORDERS
F19.9 10,140.00 7,098.00 3,042.00
SUBSTANCES; MISUSE OF DRUGS NOS: UNSPECIFIED
MENTAL AND BEHAVIOURAL DISORDER
PARANOID SCHIZOPHRENIA; PARAPHRENIC
F20.0 10,140.00 7,098.00 3,042.00
SCHIZOPHRENIA
HEBEPHRENIC SCHIZOPHRENIA; DISORGANIZED
F20.1 10,140.00 7,098.00 3,042.00
SCHIZOPHRENIA; HEBEPHRENIA
CATATONIC SCHIZOPHRENIA; CATATONIC STUPOR;
F20.2 SCHIZOPHRENIC CATALEPSY; SCHIZOPHRENIC CATATONIA; 10,140.00 7,098.00 3,042.00
SCHIZOPHRENIC FLEXIBILITAS CEREA
UNDIFFERENTIATED SCHIZOPHRENIA; ATYPICAL
F20.3 10,140.00 7,098.00 3,042.00
SCHIZOPHRENIA
RESIDUAL SCHIZOPHRENIA; CHRONIC UNDIFFERENTIATED
F20.5 SCHIZOPHRENIA; RESTZUSTAND (SCHIZOPHRENIC); 10,140.00 7,098.00 3,042.00
SCHIZOPHRENIC RESIDUAL STATE
F20.6 SIMPLE SCHIZOPHRENIA 10,140.00 7,098.00 3,042.00
Page 34 of 126
First Case Rate

OTHER SCHIZOPHRENIA; CENESTHOPATHIC
F20.8 SCHIZOPHRENIA; SCHIZOPHRENIFORM DISORDER NOS; 10,140.00 7,098.00 3,042.00
SCHIZOPHRENIFORM PSYCHOSIS NOS
F20.9 SCHIZOPHRENIA, UNSPECIFIED 10,140.00 7,098.00 3,042.00
SCHIZOTYPAL DISORDER; LATENT SCHIZOPHRENIC
REACTION; SCHIZOPHRENIA BORDERLINE;
SCHIZOPHRENIA LATENT; SCHIZOPHRENIA PREPSYCHOTIC;
F21 SCHIZOPHRENIA PRODROMAL; SCHIZOPHRENIA 10,140.00 7,098.00 3,042.00
PSEUDONEUROTIC;
SCHIZOPHRENIA PSEUDOPSYCHOPATHIC; SCHIZOTYPAL
PERSONALITY DISORDER
DELUSIONAL DISORDER; PARANOIA; PARANOID PSYCHOSIS;
F22.0 PARANOID STATE; PARAPHRENIA (LATE); SENSITIVER 10,140.00 7,098.00 3,042.00
BEZIEHUNGSWAHN
OTHER PERSISTENT DELUSIONAL DISORDERS; DELUSIONAL
F22.8 DYSMORPHOPHOBIA; INVOLUTIONAL PARANOID STATE; 10,140.00 7,098.00 3,042.00
PARANOIA QUERULANS
ACUTE POLYMORPHIC PSYCHOTIC DISORDER WITHOUT
SYMPTOMS OF SCHIZOPHRENIA; BOUFFéE DéLIRANTE
F23.0 WITHOUT SYMPTOMS OF SCHIZOPHRENIA OR 10,140.00 7,098.00 3,042.00
UNSPECIFIED; CYCLOID PSYCHOSIS WITHOUT SYMPTOMS
OF SCHIZOPHRENIA OR UNSPECIFIED
ACUTE POLYMORPHIC PSYCHOTIC DISORDER WITH

SYMPTOMS OF SCHIZOPHRENIA; BOUFFéE DéLIRANTE WITH
F23.1 10,140.00 7,098.00 3,042.00
SYMPTOMS OF SCHIZOPHRENIA; CYCLOID PSYCHOSIS WITH
SYMPTOMS OF SCHIZOPHRENIA
ACUTE SCHIZOPHRENIA-LIKE PSYCHOTIC DISORDER;ACUTE
(UNDIFFERENTIATED) SCHIZOPHRENIA;BRIEF
F23.2 SCHIZOPHRENIFORM DISORDER; BRIEF 10,140.00 7,098.00 3,042.00
SCHIZOPHRENIFORM PSYCHOSIS; ONEIROPHRENIA;
SCHIZOPHRENIC REACTION
OTHER ACUTE PREDOMINANTLY DELUSIONAL PSYCHOTIC
F23.3 DISORDERS; PARANOID REACTION; PSYCHOGENIC 10,140.00 7,098.00 3,042.00
PARANOID PSYCHOSIS
F23.8 OTHER ACUTE AND TRANSIENT PSYCHOTIC DISORDERS 10,140.00 7,098.00 3,042.00
ACUTE AND TRANSIENT PSYCHOTIC DISORDER,
F23.9 UNSPECIFIED; BRIEF REACTIVE PSYCHOSIS NOS; REACTIVE 10,140.00 7,098.00 3,042.00
PSYCHOSIS
INDUCED DELUSIONAL DISORDER; FOLIE à DEUX; INDUCED
F24 10,140.00 7,098.00 3,042.00
PARANOID DISORDER; INDUCED PSYCHOTIC DISORDER
SCHIZOAFFECTIVE DISORDER, MANIC TYPE;
F25.0 SCHIZOAFFECTIVE PSYCHOSIS, MANIC TYPE; 10,140.00 7,098.00 3,042.00
SCHIZOPHRENIFORM PSYCHOSIS, MANIC TYPE
SCHIZOAFFECTIVE DISORDER, DEPRESSIVE TYPE;
F25.1 SCHIZOAFFECTIVE PSYCHOSIS, DEPRESSIVE TYPE; 10,140.00 7,098.00 3,042.00
SCHIZOPHRENIFORM PSYCHOSIS, DEPRESSIVE TYPE
SCHIZOAFFECTIVE DISORDER, MIXED TYPE; CYCLIC
F25.2 SCHIZOPHRENIA; MIXED SCHIZOPHRENIC AND AFFECTIVE 10,140.00 7,098.00 3,042.00
PSYCHOSIS
F25.8 OTHER SCHIZOAFFECTIVE DISORDERS 10,140.00 7,098.00 3,042.00
SCHIZOAFFECTIVE DISORDER, UNSPECIFIED;
F25.9 10,140.00 7,098.00 3,042.00
SCHIZOAFFECTIVE PSYCHOSIS NOS
OTHER NONORGANIC PSYCHOTIC DISORDERS; CHRONIC
F28 10,140.00 7,098.00 3,042.00
HALLUCINATORY PSYCHOSIS
F29 UNSPECIFIED NONORGANIC PSYCHOSIS; PSYCHOSIS NOS 10,140.00 7,098.00 3,042.00
F30.0 HYPOMANIA 10,140.00 7,098.00 3,042.00
F30.1 MANIA WITHOUT PSYCHOTIC SYMPTOMS 10,140.00 7,098.00 3,042.00
MANIA WITH PSYCHOTIC SYMPTOMS; MANIA WITH MOOD-
F30.2 CONGRUENT PSYCHOTIC SYMPTOMS; MANIA WITH MOOD- 10,140.00 7,098.00 3,042.00
INCONGRUENT PSYCHOTIC SYMPTOMS; MANIC STUPOR
F30.9 MANIC EPISODE, UNSPECIFIED; MANIA NOS 10,140.00 7,098.00 3,042.00
BIPOLAR AFFECTIVE DISORDER, CURRENT EPISODE
F31.0 10,140.00 7,098.00 3,042.00
HYPOMANIC
BIPOLAR AFFECTIVE DISORDER, CURRENT EPISODE MANIC
F31.1 10,140.00 7,098.00 3,042.00
WITHOUT PSYCHOTIC SYMPTOMS
BIPOLAR AFFECTIVE DISORDER, CURRENT EPISODE MANIC
F31.2 10,140.00 7,098.00 3,042.00
WITH PSYCHOTIC SYMPTOMS
BIPOLAR AFFECTIVE DISORDER, CURRENT EPISODE MILD
F31.3 10,140.00 7,098.00 3,042.00
OR MODERATE DEPRESSION
BIPOLAR AFFECTIVE DISORDER, CURRENT EPISODE SEVERE
F31.5 10,140.00 7,098.00 3,042.00
DEPRESSION WITH PSYCHOTIC SYMPTOMS
F31.6 BIPOLAR AFFECTIVE DISORDER, CURRENT EPISODE MIXED 10,140.00 7,098.00 3,042.00
F31.7 BIPOLAR AFFECTIVE DISORDER, CURRENTLY IN REMISSION 10,140.00 7,098.00 3,042.00

OTHER BIPOLAR AFFECTIVE DISORDERS; BIPOLAR II
F31.8 10,140.00 7,098.00 3,042.00
DISORDER; RECURRENT MANIC EPISODES NOS
Page 35 of 126
First Case Rate

F31.9 BIPOLAR AFFECTIVE DISORDER, UNSPECIFIED 10,140.00 7,098.00 3,042.00
F32.0 MILD DEPRESSIVE EPISODE 10,140.00 7,098.00 3,042.00
F32.1 MODERATE DEPRESSIVE EPISODE 10,140.00 7,098.00 3,042.00
SEVERE DEPRESSIVE EPISODE WITHOUT PSYCHOTIC
SYMPTOMS; [AGITATED DEPRESSION, MAJOR DEPRESSION,
F32.2 10,140.00 7,098.00 3,042.00
VITAL DEPRESSION] SINGLE EPISODE WITHOUT PSYCHOTIC
SYMPTOMS
SEVERE DEPRESSIVE EPISODE WITH PSYCHOTIC
SYMPTOMS; SINGLE EPISODES OF MAJOR DEPRESSION
WITH PSYCHOTIC SYMPTOMS; SINGLE EPISODES OF
F32.3 10,140.00 7,098.00 3,042.00
PSYCHOGENIC DEPRESSIVE PSYCHOSIS; SINGLE EPISODES
OF PSYCHOTIC DEPRESSION; SINGLE EPISODES OF
REACTIVE DEPRESSIVE PSYCHOSIS
OTHER DEPRESSIVE EPISODES; ATYPICAL DEPRESSION;

F32.8 10,140.00 7,098.00 3,042.00
SINGLE EPISODES OF "MASKED" DEPRESSION NOS
DEPRESSIVE EPISODE, UNSPECIFIED; DEPRESSION NOS;
F32.9 10,140.00 7,098.00 3,042.00
DEPRESSIVE DISORDER NOS
RECURRENT DEPRESSIVE DISORDER, CURRENT EPISODE
SEVERE WITHOUT PSYCHOTIC SYMPTOMS; ENDOGENOUS
DEPRESSION WITHOUT PSYCHOTIC SYMPTOMS; MAJOR
F33.2 10,140.00 7,098.00 3,042.00
DEPRESSION, RECURRENT WITHOUT PSYCHOTIC
SYMPTOMS; MANIC-DEPRESSIVE PSYCHOSIS, DEPRESSED
TYPE WITHOUT PSYCHOTIC SYMPTO
RECURRENT DEPRESSIVE DISORDER, CURRENT EPISODE

SEVERE WITH PSYCHOTIC SYMPTOMS INCLUDING
ENDOGENOUS DEPRESSION WITH PSYCHOTIC SYMPTOMS;
F33.3 10,140.00 7,098.00 3,042.00
MANIC-DEPRESSIVE PSYCHOSIS, DEPRESSED TYPE WITH
PSYCHOTIC SYMPTOMS; RECURRENT SEVERE EPISODES OF
MAJOR DEPRESSION WITH
F33.8 OTHER RECURRENT DEPRESSIVE DISORDERS 10,140.00 7,098.00 3,042.00
RECURRENT DEPRESSIVE DISORDER, UNSPECIFIED;
F33.9 10,140.00 7,098.00 3,042.00
MONOPOLAR DEPRESSION NOS
CYCLOTHYMIA; AFFECTIVE PERSONALITY DISORDER;
F34.0 10,140.00 7,098.00 3,042.00
CYCLOID PERSONALITY; CYCLOTHYMIC PERSONALITY
DYSTHYMIA; DEPRESSIVE NEUROSIS; DEPRESSIVE
F34.1 PERSONALITY DISORDER; NEUROTIC DEPRESSION; 10,140.00 7,098.00 3,042.00
PERSISTENT ANXIETY DEPRESSION
PREDOMINANTLY COMPULSIVE ACTS [OBSESSIONAL
F42.1 10,140.00 7,098.00 3,042.00
RITUALS]
F42.2 MIXED OBSESSIONAL THOUGHTS AND ACTS 10,140.00 7,098.00 3,042.00
F42.8 OTHER OBSESSIVE-COMPULSIVE DISORDERS 10,140.00 7,098.00 3,042.00
F42.9 OBSESSIVE-COMPULSIVE DISORDER, UNSPECIFIED 10,140.00 7,098.00 3,042.00
ACUTE STRESS REACTION INCLUDING ACUTE CRISIS
F43.0 REACTION; ACUTE REACTION TO STRESS; COMBAT 10,140.00 7,098.00 3,042.00
FATIGUE; CRISIS STATE; PSYCHIC SHOCK
POST-TRAUMATIC STRESS DISORDER; TRAUMATIC
F43.1 10,140.00 7,098.00 3,042.00
NEUROSIS
ADJUSTMENT DISORDERS; CULTURE SHOCK; GRIEF
F43.2 10,140.00 7,098.00 3,042.00
REACTION; HOSPITALISM IN CHILDREN
F43.8 OTHER REACTIONS TO SEVERE STRESS 10,140.00 7,098.00 3,042.00
F44.0 DISSOCIATIVE AMNESIA 10,140.00 7,098.00 3,042.00
DISSOCIATIVE MOTOR DISORDERS; PSYCHOGENIC
F44.4 10,140.00 7,098.00 3,042.00
APHONIA; PSYCHOGENIC DYSPHONIA
OTHER DISSOCIATIVE [CONVERSION] DISORDERS;
GANSER'S SYNDROME; MULTIPLE PERSONALITY;
F44.8 10,140.00 7,098.00 3,042.00
PSYCHOGENIC CONFUSION; PSYCHOGENIC TWILIGHT
STATE
F44.9 DISSOCIATIVE [CONVERSION] DISORDER, UNSPECIFIED 10,140.00 7,098.00 3,042.00
SOMATIZATION DISORDER; BRIQUET’S DISORDER;
F45.0 10,140.00 7,098.00 3,042.00
MULTIPLE PSYCHOSOMATIC DISORDER
UNDIFFERENTIATED SOMATOFORM DISORDER;
F45.1 10,140.00 7,098.00 3,042.00
UNDIFFERENTIATED PSYCHOSOMATIC DISORDER
HYPOCHONDRIACAL DISORDER; BODY DYSMORPHIC
DISORDER; DYSMORPHOPHOBIA (NONDELUSIONAL);
F45.2 10,140.00 7,098.00 3,042.00
HYPOCHONDRIACAL NEUROSIS; HYPOCHONDRIASIS;
NOSOPHOBIA
SOMATOFORM AUTONOMIC DYSFUNCTION; CARDIAC
NEUROSIS; DA COSTA'S SYNDROME; GASTRIC NEUROSIS ;
NEUROCIRCULATORY ASTHENIA
F45.3 10,140.00 7,098.00 3,042.00
PSYCHOGENIC FORMS OF AEROPHAGY; PSYCHOGENIC
FORMS OF COUGH, PSYCHOGENIC FORMS OF DIARRHEA;
PSYCHOGENIC FORMS OF DYSPEPSIA; PSYCHOGENIC
PERSISTENT SOMATOFORM PAIN DISORDER; PSYCHALGIA;

F45.4 PSYCHOGENIC BACKACHE; PSYCHOGENIC HEADACHE; 10,140.00 7,098.00 3,042.00
SOMATOFORM PAIN DISORDER
Page 36 of 126
First Case Rate

OTHER SOMATOFORM DISORDERS; PSYCHOGENIC
DYSMENORRHOEA; PSYCHOGENIC DYSPHAGIA, INCLUDING
F45.8 10,140.00 7,098.00 3,042.00
"GLOBUS HYSTERICUS"; PSYCHOGENIC PRURITUS;
PSYCHOGENIC TORTICOLLIS; TEETH-GRINDING
SOMATOFORM DISORDER, UNSPECIFIED; PSYCHOSOMATIC
F45.9 10,140.00 7,098.00 3,042.00
DISORDER NOS
OTHER SPECIFIED NEUROTIC DISORDERS; DHAT
SYNDROME; OCCUPATIONAL NEUROSIS, INCLUDING
F48.8 10,140.00 7,098.00 3,042.00
WRITER'S CRAMP; PSYCHASTHENIA; PSYCHASTHENIC
NEUROSIS; PSYCHOGENIC SYNCOPE
F48.9 NEUROTIC DISORDER, UNSPECIFIED; NEUROSIS NOS 10,140.00 7,098.00 3,042.00
F50.2 BULIMIA NERVOSA; BULIMIA NOS; HYPEROREXIA NERVOSA 10,140.00 7,098.00 3,042.00
MILD MENTAL AND BEHAVIOURAL DISORDERS ASSOCIATED
WITH THE PUERPERIUM, NOT ELSEWHERE CLASSIFIED;
F53.0 10,140.00 7,098.00 3,042.00
DEPRESSION POSTNATAL NOS; DEPRESSION POSTPARTUM
NOS
SEVERE MENTAL AND BEHAVIOURAL DISORDERS
F53.1 ASSOCIATED WITH THE PUERPERIUM, NOT ELSEWHERE 10,140.00 7,098.00 3,042.00
CLASSIFIED; PUERPERAL PSYCHOSIS NOS
F53.9 PUERPERAL MENTAL DISORDER, UNSPECIFIED 10,140.00 7,098.00 3,042.00
ABUSE OF NON-DEPENDENCE-PRODUCING SUBSTANCES;
ABUSE OF ANTACIDS; ABUSE OF HERBAL OR FOLK
F55 10,140.00 7,098.00 3,042.00
REMEDIES; ABUSE OF STEROIDS OR HORMONES; ABUSE OF
VITAMINS; LAXATIVE HABIT
UNSPECIFIED BEHAVIOURAL SYNDROMES ASSOCIATED
WITH PHYSIOLOGICAL DISTURBANCES AND PHYSICAL
F59 10,140.00 7,098.00 3,042.00
FACTORS; PSYCHOGENIC PHYSIOLOGICAL DYSFUNCTION
NOS
MILD MENTAL RETARDATION; FEEBLE-MINDEDNESS; MILD
F70.0 MENTAL SUBNORMALITY WITH THE STATEMENT OF NO, OR 10,140.00 7,098.00 3,042.00
MINIMAL, IMPAIRMENT OF BEHAVIOUR
SEVERE MENTAL RETARDATION; SEVERE MENTAL
F72.9 SUBNORMALITY WITHOUT MENTION OF IMPAIRMENT OF 10,140.00 7,098.00 3,042.00
BEHAVIOUR
OTHER MENTAL RETARDATION WITH SIGNIFICANT
F78.1 IMPAIRMENT OF BEHAVIOUR REQUIRING ATTENTION OR 10,140.00 7,098.00 3,042.00
TREATMENT
OTHER MENTAL RETARDATION WITH OTHER
F78.8 10,140.00 7,098.00 3,042.00
IMPAIRMENTS OF BEHAVIOUR
OTHER MENTAL RETARDATION WITHOUT MENTION OF
F78.9 10,140.00 7,098.00 3,042.00
IMPAIRMENT OF BEHAVIOUR
UNSPECIFIED MENTAL RETARDATION; MENTAL
F79.8 DEFICIENCY NOS; MENTAL SUBNORMALITY NOS WITH 10,140.00 7,098.00 3,042.00
OTHER IMPAIRMENTS OF BEHAVIOUR
F80.3 ACQUIRED APHASIA WITH EPILEPSY [LANDAU-KLEFFNER] 10,140.00 7,098.00 3,042.00
SPECIFIC DEVELOPMENTAL DISORDER OF MOTOR

F82 FUNCTION; CLUMSY CHILD SYNDROME; DEVELOPMENTAL 10,140.00 7,098.00 3,042.00
COORDINATION DISORDER; DEVELOPMENTAL DYSPRAXIA
CHILDHOOD AUTISM; AUTISTIC DISORDER; INFANTILE

F84.0 10,140.00 7,098.00 3,042.00
AUTISM; INFANTILE PSYCHOSIS; KANNER'S SYNDROME
F84.2 RETT'S SYNDROME 10,140.00 7,098.00 3,042.00
OTHER CHILDHOOD DISINTEGRATIVE DISORDER;
F84.3 DEMENTIA INFANTILIS; DISINTEGRATIVE PSYCHOSIS; 10,140.00 7,098.00 3,042.00
HELLER'S SYNDROME; SYMBIOTIC PSYCHOSIS
ASPERGER'S SYNDROME; AUTISTIC PSYCHOPATHY;
F84.5 10,140.00 7,098.00 3,042.00
SCHIZOID DISORDER OF CHILDHOOD
F84.9 PERVASIVE DEVELOPMENTAL DISORDER, UNSPECIFIED 10,140.00 7,098.00 3,042.00
UNSPECIFIED DISORDER OF PSYCHOLOGICAL
F89 10,140.00 7,098.00 3,042.00
DEVELOPMENT; DEVELOPMENTAL DISORDER NOS
F90.8 OTHER HYPERKINETIC DISORDERS 10,140.00 7,098.00 3,042.00
F92.0 DEPRESSIVE CONDUCT DISORDER 10,140.00 7,098.00 3,042.00
NONORGANIC ENCOPRESIS; FUNCTIONAL ENCOPRESIS;
F98.1 INCONTINENCE OF FAECES OF NONORGANIC ORIGIN; 10,140.00 7,098.00 3,042.00
PSYCHOGENIC ENCOPRESIS
MENTAL DISORDER, NOT OTHERWISE SPECIFIED; MENTAL
F99 10,140.00 7,098.00 3,042.00
ILLNESS NOS
HAEMOPHILUS MENINGITIS; MENINGITIS DUE TO
G00.0 33,410.00 23,387.00 10,023.00
HAEMOPHILUS INFLUENZAE
G00.1 PNEUMOCOCCAL MENINGITIS 33,410.00 23,387.00 10,023.00
G00.2 STREPTOCOCCAL MENINGITIS 33,410.00 23,387.00 10,023.00
G00.3 STAPHYLOCOCCAL MENINGITIS 33,410.00 23,387.00 10,023.00
Page 37 of 126
First Case Rate

OTHER BACTERIAL MENINGITIS; MENINGITIS DUE TO
G00.8 ESCHERICHIA COLI; MENINGITIS DUE TO FRIEDLäNDER 33,410.00 23,387.00 10,023.00
BACILLUS; MENINGITIS DUE TO KLEBSIELLA
BACTERIAL MENINGITIS, UNSPECIFIED; MENINGITIS
G00.9 PURULENT NOS; MENINGITIS PYOGENIC NOS; MENINGITIS 33,410.00 23,387.00 10,023.00
SUPPURATIVE NOS
G03.0 NONPYOGENIC MENINGITIS; NONBACTERIAL MENINGITIS 33,410.00 23,387.00 10,023.00
G03.1 CHRONIC MENINGITIS 33,410.00 23,387.00 10,023.00
G03.8 MENINGITIS DUE TO OTHER SPECIFIED CAUSES 33,410.00 23,387.00 10,023.00
G03.9 MENINGITIS, UNSPECIFIED; ARACHNOIDITIS (SPINAL) NOS 33,410.00 23,387.00 10,023.00
ACUTE DISSEMINATED ENCEPHALITIS;
G04.0 POSTIMMUNIZATION [ENCEPHALITIS; POSTIMMUNIZATION 28,080.00 19,656.00 8,424.00
ENCEPHALOMYELITIS
G04.1 TROPICAL SPASTIC PARAPLEGIA 28,080.00 19,656.00 8,424.00
BACTERIAL MENINGOENCEPHALITIS AND
G04.2 28,080.00 19,656.00 8,424.00
MENINGOMYELITIS, NOT ELSEWHERE CLASSIFIED
OTHER ENCEPHALITIS, MYELITIS AND
G04.8 ENCEPHALOMYELITIS; POSTINFECTIOUS ENCEPHALITIS 28,080.00 19,656.00 8,424.00
AND ENCEPHALOMYELITIS NOS
ENCEPHALITIS, MYELITIS AND ENCEPHALOMYELITIS,
G04.9 28,080.00 19,656.00 8,424.00
UNSPECIFIED; VENTRICULITIS (CEREBRAL) NOS
ENCEPHALITIS, MYELITIS AND ENCEPHALOMYELITIS IN
G05.8* 28,080.00 19,656.00 8,424.00
OTHER DISEASES CLASSIFIED ELSEWHERE
INTRACRANIAL ABSCESS AND GRANULOMA; ABSCESS
(EMBOLIC)(OF) BRAIN [ANY PART]; ABSCESS (EMBOLIC)(OF)
CEREBELLAR; ABSCESS (EMBOLIC)(OF) CEREBRAL; ABSCESS
G06.0 36,270.00 25,389.00 10,881.00
(EMBOLIC)(OF) OTOGENIC; IINTRACRANIAL ABSCESS OR
GRANULOMA, EPIDURAL; INTRACRANIAL ABSCESS OR
GRANULOM
INTRASPINAL ABSCESS AND GRANULOMA; ABSCESS

(EMBOLIC) OF SPINAL CORD [ANY PART]; INTRASPINAL
G06.1 ABSCESS OR GRANULOMA EPIDURAL; INTRASPINAL 36,270.00 25,389.00 10,881.00
ABSCESS OR GRANULOMA EXTRADURAL; INTRASPINAL
ABSCESS OR GRANULOMA SUBDURAL
ENCEPHALITIS, MYELITIS AND ENCEPHALOMYELITIS IN

G06.2 36,270.00 25,389.00 10,881.00
EXTRADURAL AND SUBDURAL ABSCESS, UNSPECIFIED
INTRACRANIAL AND INTRASPINAL ABSCESS AND
G07* 28,080.00 19,656.00 8,424.00
GRANULOMA IN DISEASES CLASSIFIED ELSEWHERE
INTRACRANIAL AND INTRASPINAL PHLEBITIS AND
THROMBOPHLEBITIS; SEPTIC [EMBOLISM, ENDOPHLEBITIS,
G08 PHLEBITIS, THROMBOPHLEBITIS, THROMBOSIS] OF 28,080.00 19,656.00 8,424.00
INTRACRANIAL OR INTRASPINAL VENOUS SINUSES AND
VEINS
SEQUELAE OF INFLAMMATORY DISEASES OF CENTRAL
G09 10,400.00 7,280.00 3,120.00
NERVOUS SYSTEM
G10 HUNTINGTON'S DISEASE; HUNTINGTON'S CHOREA 13,520.00 9,464.00 4,056.00
G11.0 CONGENITAL NONPROGRESSIVE ATAXIA 13,520.00 9,464.00 4,056.00
EARLY-ONSET CEREBELLAR ATAXIA INCLUDING EARLY-
ONSET CEREBELLAR ATAXIA WITH ESSENTIAL TREMOR;
EARLY-ONSET CEREBELLAR ATAXIA WITH MYOCLONUS
G11.1 13,520.00 9,464.00 4,056.00
[HUNT'S ATAXIA]; EARLY-ONSET CEREBELLAR ATAXIA
WITH RETAINED TENDON REFLEXES; FRIEDREICH'S ATAXIA
(AUTOSOMAL RECESSIV
CEREBELLAR ATAXIA WITH DEFECTIVE DNA REPAIR;
G11.3 13,520.00 9,464.00 4,056.00
ATAXIA TELANGIECTASIA [LOUIS-BAR]
HEREDITARY ATAXIA, UNSPECIFIED; HEREDITARY
CEREBELLAR ATAXIA NOS; HEREDITARY CEREBELLAR
G11.9 13,520.00 9,464.00 4,056.00
DEGENERATION; HEREDITARY CEREBELLAR DISEASE;
HEREDITARY CEREBELLAR SYNDROME
INFANTILE SPINAL MUSCULAR ATROPHY, TYPE I [WERDNIG-
G12.0 13,520.00 9,464.00 4,056.00
HOFFMAN]
OTHER INHERITED SPINAL MUSCULAR ATROPHY;
PROGRESSIVE BULBAR PALSY OF CHILDHOOD [FAZIO-
LONDE]; SPINAL MUSCULAR ATROPHY ADULT FORM
G12.1 13,520.00 9,464.00 4,056.00
SPINAL MUSCULAR ATROPHY CHILDHOOD FORM, TYPE II;
SPINAL MUSCULAR ATROPHY DISTAL; SPINAL MUSCULAR
ATROPHY JUVENILE FORM, TYPE
MOTOR NEURON DISEASE; FAMILIAL MOTOR NEURON
DISEASE; AMYOTROPHICLATERAL SCLEROSIS; PRIMARY
G12.2 13,520.00 9,464.00 4,056.00
LATERAL SCLEROSIS ; PROGRESSIVE BULBAR PALSY;
PROGRESSIVE SPINAL MUSCULAR ATROPHY
G12.9 SPINAL MUSCULAR ATROPHY, UNSPECIFIED 13,520.00 9,464.00 4,056.00
Page 38 of 126
First Case Rate

PARKINSON'S DISEASE; HEMIPARKINSONISM; PARALYSIS
AGITANS; PARKINSONISM OR PARKINSON'S DISEASE NOS;
G20 13,520.00 9,464.00 4,056.00
IDIOPATHIC PARKINSONISM OR PARKINSON'S DISEASE;
PRIMARY PARKINSONISM OR PARKINSON'S DISEASE
G21.0 MALIGNANT NEUROLEPTIC SYNDROME 10,790.00 7,553.00 3,237.00
G21.1 OTHER DRUG-INDUCED SECONDARY PARKINSONISM 10,790.00 7,553.00 3,237.00
G21.8 OTHER SECONDARY PARKINSONISM 10,790.00 7,553.00 3,237.00
G21.9 SECONDARY PARKINSONISM, UNSPECIFIED 10,790.00 7,553.00 3,237.00
HALLERVORDEN-SPATZ DISEASE; PIGMENTARY PALLIDAL
G23.0 10,790.00 7,553.00 3,237.00
DEGENERATION
PROGRESSIVE SUPRANUCLEAR OPHTHALMOPLEGIA
G23.1 10,790.00 7,553.00 3,237.00
[STEELE-RICHARDSON-OLSZEWSKI]
OTHER SPECIFIED DEGENERATIVE DISEASES OF BASAL
G23.8 10,790.00 7,553.00 3,237.00
GANGLIA; CALCIFICATION OF BASAL GANGLIA
G23.9 DEGENERATIVE DISEASE OF BASAL GANGLIA, UNSPECIFIED 10,790.00 7,553.00 3,237.00
CARCINOMATOUS NEUROMYOPATHY IN DRUG-INDUCED
G24.0 10,790.00 7,553.00 3,237.00
DYSTONIA
IDIOPATHIC FAMILIAL DYSTONIA; IDIOPATHIC DYSTONIA
G24.1 10,790.00 7,553.00 3,237.00
NOS
G24.3 SPASMODIC TORTICOLLIS 10,790.00 7,553.00 3,237.00
IDIOPATHIC OROFACIAL DYSTONIA; OROFACIAL
G24.4 10,790.00 7,553.00 3,237.00
DYSKINESIA
G24.8 OTHER DYSTONIA 10,790.00 7,553.00 3,237.00
G24.9 DYSTONIA, UNSPECIFIED; DYSKINESIA NOS 10,790.00 7,553.00 3,237.00
G25.3 MYOCLONUS; DRUG-INDUCED MYOCLONUS 10,790.00 7,553.00 3,237.00
G25.5 OTHER CHOREA; CHOREA NOS 10,790.00 7,553.00 3,237.00
OTHER SPECIFIED EXTRAPYRAMIDAL AND MOVEMENT
G25.8 DISORDERS; RESTLESS LEGS SYNDROME; STIFF-MAN 10,790.00 7,553.00 3,237.00
SYNDROME
EXTRAPYRAMIDAL AND MOVEMENT DISORDER,
G25.9 10,790.00 7,553.00 3,237.00
UNSPECIFIED
G30.0 ALZHEIMER'S DISEASE WITH EARLY ONSET 13,000.00 9,100.00 3,900.00
G30.1 ALZHEIMER'S DISEASE WITH LATE ONSET 13,000.00 9,100.00 3,900.00
G30.8 OTHER ALZHEIMER'S DISEASE 13,000.00 9,100.00 3,900.00
G30.9+F00.9* DEMENTIA IN ALZHEIMER'S DISEASE, UNSPECIFIED 13,000.00 9,100.00 3,900.00
CIRCUMSCRIBED BRAIN ATROPHY; PICK'S DISEASE;
G31.0 13,000.00 9,100.00 3,900.00
PROGRESSIVE ISOLATED APHASIA
SENILE DEGENERATION OF BRAIN, NOT ELSEWHERE
G31.1 13,000.00 9,100.00 3,900.00
CLASSIFIED
DEGENERATION OF NERVOUS SYSTEM DUE TO ALCOHOL;
ALCOHOLIC CEREBELLAR ATAXIA; ALCOHOLIC
CEREBELLAR DEGENERATION; ALCOHOLIC CEREBRAL
G31.2 13,000.00 9,100.00 3,900.00
DEGENERATION; ALCOHOLIC ENCEPHALOPATHY;
DYSFUNCTION OF AUTONOMIC NERVOUS SYSTEM DUE TO
ALCOHOL
OTHER SPECIFIED DEGENERATIVE DISEASES OF NERVOUS
SYSTEM; GREY-MATTER DEGENERATION [ALPERS]; LEWY
G31.8 13,000.00 9,100.00 3,900.00
BODY (IES) DEMENTIA; LEWY BODY (IES) DISEASE;
SUBACUTE NECROTIZING ENCEPHALOPATHY [LEIGH]
OTHER SPECIFIED DEGENERATIVE DISORDERS OF

G32.8* 13,000.00 9,100.00 3,900.00
NERVOUS SYSTEM IN DISEASES CLASSIFIED ELSEWHERE
MULTIPLE SCLEROSIS; MULTIPLE SCLEROSIS NOS;

MULTIPLE SCLEROSIS OF BRAIN STEM; MULTIPLE
G35 15,080.00 10,556.00 4,524.00
SCLEROSIS OF CORD; MULTIPLE SCLEROSIS,
DISSEMINATED; MULTIPLE SCLEROSIS, GENERALIZED
NEUROMYELITIS OPTICA [DEVIC]; DEMYELINATION IN
G36.0 15,080.00 10,556.00 4,524.00
OPTIC NEURITIS
ACUTE AND SUBACUTE HAEMORRHAGIC
G36.1 15,080.00 10,556.00 4,524.00
LEUKOENCEPHALITIS [HURST]
G36.8 OTHER SPECIFIED ACUTE DISSEMINATED DEMYELINATION 15,080.00 10,556.00 4,524.00
G36.9 ACUTE DISSEMINATED DEMYELINATION, UNSPECIFIED 15,080.00 10,556.00 4,524.00

DIFFUSE SCLEROSIS; PERIAXIAL ENCEPHALITIS;
G37.0 15,080.00 10,556.00 4,524.00
SCHILDER'S DISEASE
G37.1 CENTRAL DEMYELINATION OF CORPUS CALLOSUM 15,080.00 10,556.00 4,524.00
G37.2 CENTRAL PONTINE MYELINOLYSIS 15,080.00 10,556.00 4,524.00
ACUTE TRANSVERSE MYELITIS IN DEMYELINATING
G37.3 DISEASE OF CENTRAL NERVOUS SYSTEM; ACUTE 15,080.00 10,556.00 4,524.00
TRANSVERSE MYELITIS NOS
G37.4 SUBACUTE NECROTIZING MYELITIS 15,080.00 10,556.00 4,524.00
OTHER SPECIFIED DEMYELINATING DISEASES OF CENTRAL
G37.8 15,080.00 10,556.00 4,524.00
NERVOUS SYSTEM
DEMYELINATING DISEASE OF CENTRAL NERVOUS SYSTEM,
G37.9 15,080.00 10,556.00 4,524.00
UNSPECIFIED
Page 39 of 126
First Case Rate

LOCALIZATION-RELATED FOCAL IDIOPATHIC EPILEPSY AND
EPILEPTIC SYNDROMES WITH SEIZURES OF LOCALIZED
ONSET; LOCALIZATION-RELATED PARTIAL IDIOPATHIC
G40.0 10,140.00 7,098.00 3,042.00
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
G40.1 10,140.00 7,098.00 3,042.00
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
G40.2 10,140.00 7,098.00 3,042.00
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
G40.3 10,140.00 7,098.00 3,042.00
ABSENCE EPILEPSY [PYKNOLEPSY]; EPILEPSY WITH GRAND
MAL SEIZURES ON AWAKENING; JUVENILE ABSENCE
EPILEPSY; JUVENI
OTHER GENERALIZED EPILEPSY AND EPILEPTIC
SYNDROMES; EPILEPSY WITH MYOCLONIC ABSENCES;
EPILEPSY WITH MYOCLONIC-ASTATIC SEIZURES;
G40.4 10,140.00 7,098.00 3,042.00
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;
G40.5 10,140.00 7,098.00 3,042.00
EPILEPTIC SEIZURES RELATED TO HORMONAL CHANGES;
EPILEPTIC SEIZURES RELATED TO SLEEP DEPRIVATION;
EPILEPTIC
GRAND MAL SEIZURES, UNSPECIFIED (WITH OR WITHOUT
G40.6 10,140.00 7,098.00 3,042.00
PETIT MAL)
G40.7 PETIT MAL, UNSPECIFIED, WITHOUT GRAND MAL SEIZURES 10,140.00 7,098.00 3,042.00
OTHER EPILEPSY; EPILEPSIES AND EPILEPTIC SYNDROMES
G40.8 UNDETERMINED AS TO WHETHER THEY ARE FOCAL OR 10,140.00 7,098.00 3,042.00
GENERALIZED
EPILEPSY, UNSPECIFIED; EPILEPTIC CONVULSIONS NOS;
G40.9 10,140.00 7,098.00 3,042.00
EPILEPTIC FITS NOS; EPILEPTIC SEIZURES NOS
GRAND MAL STATUS EPILEPTICUS; TONIC-CLONIC STATUS
G41.0 20,280.00 14,196.00 6,084.00
EPILEPTICUS
PETIT MAL STATUS EPILEPTICUS; EPILEPTIC ABSENCE
G41.1 20,280.00 14,196.00 6,084.00
STATUS
G41.2 COMPLEX PARTIAL STATUS EPILEPTICUS 20,280.00 14,196.00 6,084.00
G41.8 OTHER STATUS EPILEPTICUS 20,280.00 14,196.00 6,084.00
G41.9 STATUS EPILEPTICUS, UNSPECIFIED 20,280.00 14,196.00 6,084.00
G43.0 MIGRAINE WITHOUT AURA [COMMON MIGRAINE] 7,150.00 5,005.00 2,145.00
MIGRAINE WITH AURA [CLASSICAL MIGRAINE]; MIGRAINE
AURA WITHOUT HEADACHE; MIGRAINE, BASILAR;
MIGRAINE EQUIVALENTS; FAMILIAL HEMIPLEGIC
G43.1 7,150.00 5,005.00 2,145.00
MIGRAINE; MIGRAINE WITH ACUTE-ONSET AURA;
MIGRAINE WITH PROLONGED AURA; MIGRAINE WITH
TYPICAL AURA
G43.2 STATUS MIGRAINOSUS 7,150.00 5,005.00 2,145.00
G43.3 COMPLICATED MIGRAINE 7,150.00 5,005.00 2,145.00
OTHER MIGRAINE; OPHTHALMOPLEGIC MIGRAINE;
G43.8 7,150.00 5,005.00 2,145.00
RETINAL MIGRAINE
G43.9 MIGRAINE, UNSPECIFIED 7,150.00 5,005.00 2,145.00
CLUSTER HEADACHE SYNDROME; CHRONIC PAROXYSMAL
G44.0 HEMICRANIA; CHRONIC CLUSTER HEADACHE; EPISODIC 7,150.00 5,005.00 2,145.00
CLUSTER HEADACHE
VASCULAR HEADACHE, NOT ELSEWHERE CLASSIFIED;
G44.1 7,150.00 5,005.00 2,145.00
VASCULAR HEADACHE NOS
TENSION-TYPE HEADACHE; CHRONIC TENSION-TYPE
G44.2 HEADACHE; EPISODIC TENSION HEADACHE; TENSION 7,150.00 5,005.00 2,145.00
HEADACHE NOS
G44.3 CHRONIC POST-TRAUMATIC HEADACHE 7,150.00 5,005.00 2,145.00
G44.4 DRUG-INDUCED HEADACHE, NOT ELSEWHERE CLASSIFIED 7,150.00 5,005.00 2,145.00
G44.8 OTHER SPECIFIED HEADACHE SYNDROMES 7,150.00 5,005.00 2,145.00
G45.0 VERTEBRO-BASILAR ARTERY SYNDROME 9,490.00 6,643.00 2,847.00
G45.1 HEMISPHERIC CAROTID ARTERY SYNDROME 9,490.00 6,643.00 2,847.00
Page 40 of 126
First Case Rate

MULTIPLE AND BILATERAL PRECEREBRAL ARTERY
G45.2 9,490.00 6,643.00 2,847.00
SYNDROMES
G45.3 AMAUROSIS FUGAX 9,490.00 6,643.00 2,847.00
G45.4 TRANSIENT GLOBAL AMNESIA 9,490.00 6,643.00 2,847.00
OTHER TRANSIENT CEREBRAL ISCHAEMIC ATTACKS AND
G45.8 9,490.00 6,643.00 2,847.00
RELATED SYNDROMES
TRANSIENT CEREBRAL ISCHAEMIC ATTACK, UNSPECIFIED;
G45.9 SPASM OF CEREBRAL ARTERY; TRANSIENT CEREBRAL 9,490.00 6,643.00 2,847.00
ISCHAEMIA NOS
SLEEP APNOEA; SLEEP APNOEA, CENTRAL; SLEEP APNOEA,
G47.3 14,040.00 9,828.00 4,212.00
OBSTRUCTIVE
TRIGEMINAL NEURALGIA; SYNDROME OF PAROXYSMAL
G50.0 9,620.00 6,734.00 2,886.00
FACIAL PAIN; TIC DOULOUREUX
G50.8 OTHER DISORDERS OF TRIGEMINAL NERVE 9,620.00 6,734.00 2,886.00
G51.0 BELL'S PALSY; FACIAL PALSY 9,620.00 6,734.00 2,886.00
G51.1 GENICULATE GANGLIONITIS 9,620.00 6,734.00 2,886.00
G51.3 CLONIC HEMIFACIAL SPASM 9,620.00 6,734.00 2,886.00
G51.4 FACIAL MYOKYMIA 9,620.00 6,734.00 2,886.00
G51.8 OTHER DISORDERS OF FACIAL NERVE 9,620.00 6,734.00 2,886.00
G51.9 DISORDER OF FACIAL NERVE, UNSPECIFIED 9,620.00 6,734.00 2,886.00
DISORDERS OF OLFACTORY NERVE; DISORDER OF 1ST
G52.0 9,620.00 6,734.00 2,886.00
CRANIAL NERVE
DISORDERS OF GLOSSOPHARYNGEAL NERVE; DISORDER OF
G52.1 9,620.00 6,734.00 2,886.00
9TH CRANIAL NERVE; GLOSSOPHARYNGEAL NEURALGIA
DISORDERS OF VAGUS NERVE; DISORDER OF
G52.2 9,620.00 6,734.00 2,886.00
PNEUMOGASTRIC [10TH] NERVE
DISORDERS OF MULTIPLE CRANIAL NERVES; POLYNEURITIS
G52.7 9,620.00 6,734.00 2,886.00
CRANIALIS
G52.8 DISORDERS OF OTHER SPECIFIED CRANIAL NERVES 9,620.00 6,734.00 2,886.00
BRACHIAL PLEXUS DISORDERS; THORACIC OUTLET
G54.0 10,270.00 7,189.00 3,081.00
SYNDROME
G54.1 LUMBOSACRAL PLEXUS DISORDERS 10,270.00 7,189.00 3,081.00
G54.2 CERVICAL ROOT DISORDERS, NOT ELSEWHERE CLASSIFIED 10,270.00 7,189.00 3,081.00
G54.3 THORACIC ROOT DISORDERS, NOT ELSEWHERE CLASSIFIED 10,270.00 7,189.00 3,081.00
LUMBOSACRAL ROOT DISORDERS, NOT ELSEWHERE
G54.4 10,270.00 7,189.00 3,081.00
CLASSIFIED
NEURALGIC AMYOTROPHY; PARSONAGE-ALDREN-TURNER
G54.5 10,270.00 7,189.00 3,081.00
SYNDROME; SHOULDER-GIRDLE NEURITIS
G54.8 OTHER NERVE ROOT AND PLEXUS DISORDERS 10,270.00 7,189.00 3,081.00
G54.9 NERVE ROOT AND PLEXUS DISORDER, UNSPECIFIED 10,270.00 7,189.00 3,081.00
NERVE ROOT AND PLEXUS COMPRESSIONS IN OTHER
G55.8* 10,270.00 7,189.00 3,081.00
DISEASES CLASSIFIED ELSEWHERE
HEREDITARY MOTOR AND SENSORY NEUROPATHY;
DISEASE CHARCOT-MARIE-TOOTH; DISEASE DéJERINE-
SOTTAS; HEREDITARY MOTOR AND SENSORY NEUROPATHY,
G60.0 13,780.00 9,646.00 4,134.00
TYPES I-IV; HYPERTROPHIC NEUROPATHY OF INFANCY;
PERONEAL MUSCULAR ATROPHY AXONAL TYPE; PERONEAL
MUSCULAR ATROPHY HYPERT
G60.1 REFSUM'S DISEASE 13,780.00 9,646.00 4,134.00
G60.2 NEUROPATHY IN ASSOCIATION WITH HEREDITARY ATAXIA 13,780.00 9,646.00 4,134.00
G60.3 IDIOPATHIC PROGRESSIVE NEUROPATHY 13,780.00 9,646.00 4,134.00
OTHER HEREDITARY AND IDIOPATHIC NEUROPATHIES;
MORVAN'S DISEASE; NELATON'S SYNDROME; SENSORY
G60.8 13,780.00 9,646.00 4,134.00
NEUROPATHY DOMINANTLY INHERITED; SENSORY
NEUROPATHY RECESSIVELY INHERITED
G60.9 HEREDITARY AND IDIOPATHIC NEUROPATHY, UNSPECIFIED 13,780.00 9,646.00 4,134.00
GUILLAIN-BARRé SYNDROME; ACUTE POST- INFECTIVE

G61.0 13,780.00 9,646.00 4,134.00
POLYNEURITIS; ACUTE INFECTIVE POLYNEURITIS
G61.8 OTHER INFLAMMATORY POLYNEUROPATHIES 13,780.00 9,646.00 4,134.00
G61.9 INFLAMMATORY POLYNEUROPATHY, UNSPECIFIED 13,780.00 9,646.00 4,134.00
G62.0 DRUG-INDUCED POLYNEUROPATHY 13,780.00 9,646.00 4,134.00
G62.1 ALCOHOLIC POLYNEUROPATHY 13,780.00 9,646.00 4,134.00
G62.2 POLYNEUROPATHY DUE TO OTHER TOXIC AGENTS 13,780.00 9,646.00 4,134.00
OTHER SPECIFIED POLYNEUROPATHIES; RADIATION-
G62.8 13,780.00 9,646.00 4,134.00
INDUCED POLYNEUROPATHY
G62.9 POLYNEUROPATHY, UNSPECIFIED; NEUROPATHY NOS 13,780.00 9,646.00 4,134.00
POLYNEUROPATHY IN OTHER DISEASES CLASSIFIED
G63.8* 13,780.00 9,646.00 4,134.00
ELSEWHERE
OTHER DISORDERS OF PERIPHERAL NERVOUS SYSTEM;
G64 13,780.00 9,646.00 4,134.00
DISORDER OF PERIPHERAL NERVOUS SYSTEM NOS
G70.0 MYASTHENIA GRAVIS 10,270.00 7,189.00 3,081.00
G70.2 CONGENITAL AND DEVELOPMENTAL MYASTHENIA 10,270.00 7,189.00 3,081.00
G70.8 OTHER SPECIFIED MYONEURAL DISORDERS 10,270.00 7,189.00 3,081.00
Page 41 of 126
First Case Rate

G70.9 MYONEURAL DISORDER, UNSPECIFIED 10,270.00 7,189.00 3,081.00
MUSCULAR DYSTROPHY; MUSCULAR DYSTROPHY
AUTOSOMAL RECESSIVE, CHILDHOOD TYPE, RESEMBLING
DUCHENNE OR BECKER; MUSCULAR DYSTROPHY BENIGN
G71.0 10,270.00 7,189.00 3,081.00
[BECKER]; MUSCULAR DYSTROPHY BENIGN;
CAPULOPERONEAL WITH EARLY CONTRACTURES [EMERY-
DREIFUSS]; MUSCULAR DYSTROPHY DISTAL;
MYOTONIC DISORDERS; DYSTROPHIA MYOTONICA

[STEINERT]; MYOTONIA, CHONDRODYSTROPHIC;
MYOTONIA, DRUG-INDUCED; MYOTONIA, SYMPTOMATIC;
G71.1 10,270.00 7,189.00 3,081.00
MYOTONIA, CONGENITA NOS; MYOTONIA, CONGENITA
DOMINANT [THOMSEN]; MYOTONIA, CONGENITAL
RECESSIVE [BECKER]; NEUROMYOTONIA [ISAAC
CONGENITAL MYOPATHIES; CONGENITAL MUSCULAR

DYSTROPHY NOS; CONGENITAL MUSCULAR DYSTROPHY
WITH SPECIFIC MORPHOLOGICAL ABNORMALITIES OF THE
G71.2 10,270.00 7,189.00 3,081.00
MUSCLE FIBRE; CENTRAL COREDISEASE ; MINICORE
DISEASE ; MULTICOREDISEASE ; FIBRE-TYPE
DISPROPORTION; MYOPATHY MYOTUBULA
PRIMARY DISORDER OF MUSCLE, UNSPECIFIED;
G71.9 10,270.00 7,189.00 3,081.00
HEREDITARY MYOPATHY NOS
G72.0 DRUG-INDUCED MYOPATHY 10,270.00 7,189.00 3,081.00
G72.1 ALCOHOLIC MYOPATHY 10,270.00 7,189.00 3,081.00
G72.2 MYOPATHY DUE TO OTHER TOXIC AGENTS 10,270.00 7,189.00 3,081.00
PERIODIC PARALYSIS; PERIODIC PARALYSIS (FAMILIAL)
HYPERKALAEMIC; PERIODIC PARALYSIS (FAMILIAL)
G72.3 HYPOKALAEMIC; PERIODIC PARALYSIS (FAMILIAL) 10,270.00 7,189.00 3,081.00
MYOTONIC; PERIODIC PARALYSIS (FAMILIAL)
NORMOKALAEMIC
G72.4 INFLAMMATORY MYOPATHY, NOT ELSEWHERE CLASSIFIED 10,270.00 7,189.00 3,081.00
G72.8 OTHER SPECIFIED MYOPATHIES 10,270.00 7,189.00 3,081.00
G72.9 MYOPATHY, UNSPECIFIED 10,270.00 7,189.00 3,081.00
SPASTIC CEREBRAL PALSY; CONGENITAL SPASTIC
G80.0 PARALYSIS (CEREBRAL); SPASTIC TETRAPLEGIC CEREBRAL 12,350.00 8,645.00 3,705.00
PALSY
G80.1 SPASTIC DIPLEGIA; SPASTIC CEREBRAL PALSY NOS 12,350.00 8,645.00 3,705.00
G80.2 INFANTILE HEMIPLEGIA 12,350.00 8,645.00 3,705.00
DYSKINETIC CEREBRAL PALSY; ATHETOID CEREBRAL
G80.3 12,350.00 8,645.00 3,705.00
PALSY; DYSTONIC CEREBRAL PALSY
G80.4 ATAXIC CEREBRAL PALSY 12,350.00 8,645.00 3,705.00
OTHER INFANTILE CEREBRAL PALSY; MIXED CEREBRAL
G80.8 12,350.00 8,645.00 3,705.00
PALSY SYNDROMES
INFANTILE CEREBRAL PALSY, UNSPECIFIED; CEREBRAL
G80.9 12,350.00 8,645.00 3,705.00
PALSY NOS
CAUDA EQUINA SYNDROME; NEUROGENIC BLADDER DUE
G83.4 TO CAUDA EQUINA SYNDROME 11,440.00 8,008.00 3,432.00
EXCLUDES: CORD BLADDER NOS (G95.8)
IDIOPATHIC PERIPHERAL AUTONOMIC NEUROPATHY;
G90.0 20,540.00 14,378.00 6,162.00
CAROTID SINUS SYNCOPE
G90.1 FAMILIAL DYSAUTONOMIA [RILEY-DAY] 20,540.00 14,378.00 6,162.00
G90.2 HORNER'S SYNDROME; BERNARD(-HORNER) SYNDROME 20,540.00 14,378.00 6,162.00
G90.4 AUTONOMIC DYSREFLEXIA 20,540.00 14,378.00 6,162.00
DISORDER OF AUTONOMIC NERVOUS SYSTEM,
G90.9 20,540.00 14,378.00 6,162.00
UNSPECIFIED; ACQUIRED HYDROCEPHALUS
G91.0 COMMUNICATING HYDROCEPHALUS 22,490.00 15,743.00 6,747.00
G91.1 OBSTRUCTIVE HYDROCEPHALUS 22,490.00 15,743.00 6,747.00
G91.2 NORMAL-PRESSURE HYDROCEPHALUS 22,490.00 15,743.00 6,747.00
G91.3 POST-TRAUMATIC HYDROCEPHALUS, UNSPECIFIED 22,490.00 15,743.00 6,747.00
G91.8 OTHER HYDROCEPHALUS 22,490.00 15,743.00 6,747.00
G91.9 HYDROCEPHALUS, UNSPECIFIED 22,490.00 15,743.00 6,747.00
G92 TOXIC ENCEPHALOPATHY 28,860.00 20,202.00 8,658.00
CEREBRAL CYSTS; ARACHNOID CYST; PORENCEPHALIC
G93.0 20,540.00 14,378.00 6,162.00
CYST, ACQUIRED
G93.1 ANOXIC BRAIN DAMAGE, NOT ELSEWHERE CLASSIFIED 28,860.00 20,202.00 8,658.00
G93.2 BENIGN INTRACRANIAL HYPERTENSION 20,540.00 14,378.00 6,162.00
POSTVIRAL FATIGUE SYNDROME; BENIGN MYALGIC
G93.3 20,540.00 14,378.00 6,162.00
ENCEPHALOMYELITIS
G93.4 ENCEPHALOPATHY, UNSPECIFIED 20,540.00 14,378.00 6,162.00
COMPRESSION OF BRAIN; [COMPRESSION, HERNIATION] OF
G93.5 29,120.00 20,384.00 8,736.00
BRAIN (STEM)
G93.7 REYE'S SYNDROME 20,540.00 14,378.00 6,162.00
G93.8 OTHER SPECIFIED DISORDERS OF BRAIN 20,540.00 14,378.00 6,162.00
G93.9 DISORDER OF BRAIN, UNSPECIFIED 20,540.00 14,378.00 6,162.00
OTHER SPECIFIED DISORDERS OF BRAIN IN DISEASES
G94.8* 20,540.00 14,378.00 6,162.00
CLASSIFIED ELSEWHERE
G95.0 SYRINGOMYELIA AND SYRINGOBULBIA 20,540.00 14,378.00 6,162.00
Page 42 of 126
First Case Rate

VASCULAR MYELOPATHIES; ACUTE INFARCTION OF SPINAL
CORD (EMBOLIC)(NONEMBOLIC); ARTERIAL THROMBOSIS
OF SPINAL CORD; HAEMATOMYELIA; NONPYOGENIC
G95.1 20,540.00 14,378.00 6,162.00
INTRASPINAL PHLEBITIS AND THROMBOPHLEBITIS;
OEDEMA OF SPINAL CORD; SUBACUTE NECROTIC
MYELOPATHY
G95.2 CORD COMPRESSION, UNSPECIFIED 20,540.00 14,378.00 6,162.00
OTHER SPECIFIED DISEASES OF SPINAL CORD; CORD
G95.8 BLADDER NOS; ELOPATHY DRUG-INDUCED; MYELOPATHY 20,540.00 14,378.00 6,162.00
RADIATION-INDUCED
G95.9 DISEASE OF SPINAL CORD, UNSPECIFIED; MYELOPATHY NOS 20,540.00 14,378.00 6,162.00
G96.0 CEREBROSPINAL FLUID LEAK 20,540.00 14,378.00 6,162.00
DISORDERS OF MENINGES, NOT ELSEWHERE CLASSIFIED;
G96.1 CEREBRAL MENINGEAL ADHESIONS; SPINAL MENINGEAL 20,540.00 14,378.00 6,162.00
ADHESIONS
OTHER SPECIFIED DISORDERS OF CENTRAL NERVOUS
G96.8 20,540.00 14,378.00 6,162.00
SYSTEM
G96.9 DISORDER OF CENTRAL NERVOUS SYSTEM, UNSPECIFIED 20,540.00 14,378.00 6,162.00
G97.1 OTHER REACTION TO SPINAL AND LUMBAR PUNCTURE 13,390.00 9,373.00 4,017.00
OTHER POSTPROCEDURAL DISORDERS OF NERVOUS
G97.8 13,390.00 9,373.00 4,017.00
SYSTEM
OTHER DISORDERS OF NERVOUS SYSTEM, NOT ELSEWHERE
G98 20,540.00 14,378.00 6,162.00
CLASSIFIED; NERVOUS SYSTEM DISORDER NOS
ACUTE INFLAMMATION OF ORBIT; ABSCESS OF
H05.0 ORBIT;CELLULITIS OF ORBIT; OSTEOMYELITIS OF ORBIT; 12,350.00 8,645.00 3,705.00
PERIOSTITIS OF ORBIT, TENONITIS OF ORBIT
EXOPHTHALMIC CONDITIONS; DISPLACEMENT OF GLOBE
H05.2 (LATERAL) NOS; HAEMORRHAGE OF ORBIT; OEDEMA OF 12,350.00 8,645.00 3,705.00
ORBIT
DISSEMINATED CHORIORETINAL INFLAMMATION;
DISSEMINATED CHORIORETINITIS; DISSEMINATED
H30.1 5,980.00 4,186.00 1,794.00
CHOROIDITIS; DISSEMINATED RETINITIS; DISSEMINATED
RETINOCHOROIDITIS
OTHER CHORIORETINAL INFLAMMATIONS; HARADA'S
H30.8 5,980.00 4,186.00 1,794.00
DISEASE
CHOROIDAL HAEMORRHAGE AND RUPTURE; CHOROIDAL
H31.3 HAEMORRHAGE NOS; CHOROIDAL HAEMORRHAGE 5,980.00 4,186.00 1,794.00
EXPULSIVE
H34.1 CENTRAL RETINAL ARTERY OCCLUSION 10,010.00 7,007.00 3,003.00
OTHER RETINAL ARTERY OCCLUSIONS; HOLLENHORST'S
PLAQUE; RETINAL ARTERY OCCLUSION; RETINAL ARTERY
H34.2 10,010.00 7,007.00 3,003.00
BRANCH OCCLUSION ; RETINAL ARTERY PARTIAL
OCCLUSION; RETINAL MICROEMBOLISM
OTHER RETINAL VASCULAR OCCLUSIONS; RETINAL
CENTRAL VEIN OCCLUSION ; RETINAL VEIN OCCLUSION
H34.8 10,010.00 7,007.00 3,003.00
INCIPIENT; RETINAL VEIN OCCLUSION PARTIAL; RETINAL
VEIN OCCLUSION TRIBUTARY
H34.9 RETINAL VASCULAR OCCLUSION, UNSPECIFIED 10,010.00 7,007.00 3,003.00
H40.0 GLAUCOMA SUSPECT; OCULAR HYPERTENSION 8,450.00 5,915.00 2,535.00
PRIMARY OPEN-ANGLE GLAUCOMA; PRIMARY CAPSULAR
WITH PSEUDOEXFOLIATION OF LENS GLAUCOMA;
RESIDUAL STAGE CAPSULAR WITH PSEUDOEXFOLIATION
H40.1 8,450.00 5,915.00 2,535.00
OF LENS; PRIMARY CHRONIC SIMPLE GLAUCOMA;
RESIDUAL STAGE CHRONIC SIMPLE GLAUCOMA; PRIMARY
LOW-TENSION GLAUCOMA; RESIDUAL
PRIMARY ANGLE-CLOSURE GLAUCOMA; PRIMARY ACUTE

ANGLE-CLOSURE GLAUCOMA ; ACUTE RESIDUAL STAGE
ANGLE-CLOSURE GLAUCOMA ; PRIMARY CHRONIC ANGLE-
H40.2 8,450.00 5,915.00 2,535.00
CLOSURE GLAUCOMA ; RESIDUAL STAGE CHRONIC ANGLE-
CLOSURE GLAUCOMA; PRIMARY INTERMITTENT ANGLE-
CLOURE GLAUCOMA; RESIDU
H40.3 GLAUCOMA SECONDARY TO EYE TRAUMA 8,450.00 5,915.00 2,535.00
H40.4 GLAUCOMA SECONDARY TO EYE INFLAMMATION 8,450.00 5,915.00 2,535.00
H40.5 GLAUCOMA SECONDARY TO OTHER EYE DISORDERS 8,450.00 5,915.00 2,535.00
H40.8 OTHER GLAUCOMA 8,450.00 5,915.00 2,535.00
H40.9 GLAUCOMA, UNSPECIFIED 8,450.00 5,915.00 2,535.00
H43.0 VITREOUS PROLAPSE 13,520.00 9,464.00 4,056.00
H43.1 VITREOUS HAEMORRHAGE 13,520.00 9,464.00 4,056.00
PURULENT ENDOPHTHALMITIS; PANOPHTHALMITIS;
H44.0 13,520.00 9,464.00 4,056.00
VITREOUS ABSCESS
OTHER ENDOPHTHALMITIS; PARASITIC ENDOPHTHALMITIS
H44.1 13,520.00 9,464.00 4,056.00
NOS; SYMPATHETIC UVEITIS
DEGENERATED CONDITIONS OF GLOBE; ABSOLUTE
H44.5 13,520.00 9,464.00 4,056.00
GLAUCOMA; ATROPHY OF GLOBE; PHTHISIS BULBI
Page 43 of 126
First Case Rate

OPTIC NEURITIS; OPTIC NEUROPATHY, EXCEPT ISCHAEMIC;
H46 9,620.00 6,734.00 2,886.00
OPTIC PAPILLITIS; RETROBULBAR NEURITIS NOS
DISORDERS OF OPTIC NERVE, NOT ELSEWHERE
CLASSIFIED; COMPRESSION OF OPTIC NERVE;
H47.0 9,620.00 6,734.00 2,886.00
HAEMORRHAGE IN OPTIC NERVE SHEATH; ISCHAEMIC
OPTIC NEUROPATHY
H59.0 VITREOUS SYNDROME FOLLOWING CATARACT SURGERY 13,390.00 9,373.00 4,017.00
OTHER POSTPROCEDURAL DISORDERS OF EYE AND
H59.8 ADNEXA; CHORIORETINAL SCARS AFTER SURGERY FOR 13,390.00 9,373.00 4,017.00
DETACHMENT
POSTPROCEDURAL DISORDER OF EYE AND ADNEXA,
H59.9 13,390.00 9,373.00 4,017.00
UNSPECIFIED
CELLULITIS OF EXTERNAL EAR; CELLULITIS OF AURICLE;
H60.1 11,700.00 8,190.00 3,510.00
CELLULITIS OF EXTERNAL AUDITORY CANAL
H60.2 MALIGNANT OTITIS EXTERNA 11,700.00 8,190.00 3,510.00
OTHER INFECTIVE OTITIS EXTERNA; DIFFUSE OTITIS
H60.3 EXTERNA ; HAEMORRHAGIC OTITIS EXTERNA ; SWIMMER'S 11,700.00 8,190.00 3,510.00
EAR
CHOLESTEATOMA OF EXTERNAL EAR; KERATOSIS
H60.4 11,700.00 8,190.00 3,510.00
OBTURANS OF EXTERNAL EAR (CANAL)
ACUTE SEROUS OTITIS MEDIA; ACUTE AND SUBACUTE
H65.0 10,140.00 7,098.00 3,042.00
SECRETORY OTITIS MEDIA
OTHER ACUTE NONSUPPURATIVE OTITIS MEDIA; ACUTE
OTITIS MEDIA; S UBACUTE OTITIS MEDIA; ACUTE MUCOID
ALLERGIC OTITIS MEDIA; SUBACUTE MUCOID ALLERGIC
H65.1 10,140.00 7,098.00 3,042.00
OTITIS MEDIA; ACUTE ALLERGIC SANGUINOUS OTITIS
MEDIA; SUBACUTE SANGUINOUS ALLERGIC OTITIS MEDIA;
ACUTE A
CHRONIC SEROUS OTITIS MEDIA; CHRONIC
H65.2 10,140.00 7,098.00 3,042.00
TUBOTYMPANAL CATARRH
CHRONIC MUCOID OTITIS MEDIA; GLUE EAR; OTITIS MEDIA,
H65.3 CHRONIC MUCINOUS; OTITIS MEDIA, CHRONIC SECRETORY; 10,140.00 7,098.00 3,042.00
OTITIS MEDIA, CHRONIC TRANSUDATIVE
OTHER CHRONIC NONSUPPURATIVE OTITIS MEDIA; OTITIS

MEDIA, CHRONIC ALLERGIC; OTITIS MEDIA, CHRONIC
H65.4 EXUDATIVE; OTITIS MEDIA, CHRONIC NONSUPPURATIVE 10,140.00 7,098.00 3,042.00
NOS; OTITIS MEDIA, CHRONIC SEROMUCINOUS; OTITIS
MEDIA, CHRONIC WITH EFFUSION (NONPURULENT)
NONSUPPURATIVE OTITIS MEDIA, UNSPECIFIED; ALLERGIC

OTITIS MEDIA ; CATARRHAL OTITIS MEDIA; EXUDATIVE
H65.9 OTITIS MEDIA ; MUCOID OTITIS MEDIA ; SECRETORY OTITIS 10,140.00 7,098.00 3,042.00
MEDIA ; SEROMUCINOUS OTITIS MEDIA; SEROUS OTITIS
MEDIA; TRANSUDATIVE OTITIS MEDIA; OTITIS MEDIA WITH
H66.0 ACUTE SUPPURATIVE OTITIS MEDIA 10,140.00 7,098.00 3,042.00
CHRONIC TUBOTYMPANIC SUPPURATIVE OTITIS MEDIA;
H66.1 BENIGN CHRONIC SUPPURATIVE OTITIS MEDIA; CHRONIC 10,140.00 7,098.00 3,042.00
TUBOTYMPANIC DISEASE
CHRONIC ATTICOANTRAL SUPPURATIVE OTITIS MEDIA;
H66.2 10,140.00 7,098.00 3,042.00
CHRONIC ATTICOANTRAL DISEASE
OTHER CHRONIC SUPPURATIVE OTITIS MEDIA; CHRONIC
H66.3 10,140.00 7,098.00 3,042.00
SUPPURATIVE OTITIS MEDIA NOS
SUPPURATIVE OTITIS MEDIA, UNSPECIFIED; PURULENT
H66.4 10,140.00 7,098.00 3,042.00
OTITIS MEDIA NOS
OTITIS MEDIA, UNSPECIFIED; OTITIS MEDIA NOS; ACUTE
H66.9 10,140.00 7,098.00 3,042.00
OTITIS MEDIA NOS; CHRONIC OTITIS MEDIA NOS
OBSTRUCTION OF EUSTACHIAN TUBE; COMPRESSION OF
H68.1 EUSTACHIAN TUBE; STENOSIS OF EUSTACHIAN TUBE; 13,520.00 9,464.00 4,056.00
STRICTURE OF EUSTACHIAN TUBE
H69.9 EUSTACHIAN TUBE DISORDER, UNSPECIFIED 13,520.00 9,464.00 4,056.00
ACUTE MASTOIDITIS; ABSCESS OF MASTOID; EMPYEMA OF
H70.0 13,520.00 9,464.00 4,056.00
MASTOID
CHRONIC MASTOIDITIS; CARIES OF MASTOID; FISTULA OF
H70.1 13,520.00 9,464.00 4,056.00
MASTOID
PETROSITIS; ACUTE INFLAMMATION OF PETROUS BONE;
H70.2 13,520.00 9,464.00 4,056.00
CHRONIC INFLAMMATION OF PETROUS BONE
H70.8 OTHER MASTOIDITIS AND RELATED CONDITIONS 13,520.00 9,464.00 4,056.00
H70.9 MASTOIDITIS, UNSPECIFIED 13,520.00 9,464.00 4,056.00
CHOLESTEATOMA OF MIDDLE EAR; CHOLESTEATOMA
TYMPANI; PERFORATION OF TYMPANIC MEMBRANE;
H71 13,520.00 9,464.00 4,056.00
PERSISTENT POST-TRAUMATIC PERFORATION OF EAR
DRUM; POSTINFLAMMATORY PERFORATION OF EAR DRUM
ACUTE MYRINGITIS; ACUTE TYMPANITIS; BULLOUS
H73.0 13,520.00 9,464.00 4,056.00
MYRINGITIS
H73.1 CHRONIC MYRINGITIS; CHRONIC TYMPANITIS 13,520.00 9,464.00 4,056.00
Page 44 of 126
First Case Rate

H73.8 OTHER SPECIFIED DISORDERS OF TYMPANIC MEMBRANE 13,520.00 9,464.00 4,056.00
H73.9 DISORDER OF TYMPANIC MEMBRANE, UNSPECIFIED 13,520.00 9,464.00 4,056.00
OTHER SPECIFIED DISORDERS OF MIDDLE EAR AND
H74.8 13,520.00 9,464.00 4,056.00
MASTOID
H74.9 DISORDER OF MIDDLE EAR AND MASTOID, UNSPECIFIED 13,520.00 9,464.00 4,056.00
MéNIèRE'S DISEASE; LABYRINTHINE HYDROPS; MéNIèRE'S
H81.0 7,410.00 5,187.00 2,223.00
SYNDROME OR VERTIGO
H81.1 BENIGN PAROXYSMAL VERTIGO 7,410.00 5,187.00 2,223.00
H81.2 VESTIBULAR NEURONITIS 7,410.00 5,187.00 2,223.00
OTHER PERIPHERAL VERTIGO; LERMOYEZ' SYNDROME;
H81.3 AURAL VERTIGO ; OTOGENIC VERTIGO; PERIPHERAL NOS 7,410.00 5,187.00 2,223.00
VERTIGO
VERTIGO OF CENTRAL ORIGIN; CENTRAL POSITIONAL
H81.4 7,410.00 5,187.00 2,223.00
NYSTAGMUS
H81.8 OTHER DISORDERS OF VESTIBULAR FUNCTION 7,410.00 5,187.00 2,223.00
DISORDER OF VESTIBULAR FUNCTION, UNSPECIFIED;
H81.9 7,410.00 5,187.00 2,223.00
VERTIGINOUS SYNDROME NOS
H83.0 LABYRINTHITIS 8,060.00 5,642.00 2,418.00
H83.1 LABYRINTHINE FISTULA 7,410.00 5,187.00 2,223.00
LABYRINTHINE DYSFUNCTION; HYPERSENSITIVITY OF
H83.2 LABYRINTH; HYPOFUNCTION OF LABYRINTH; LOSS OF 7,410.00 5,187.00 2,223.00
FUNCTION OF LABYRINTH
H83.8 OTHER SPECIFIED DISEASES OF INNER EAR 8,060.00 5,642.00 2,418.00
OTHER POSTPROCEDURAL DISORDERS OF EAR AND
H95.8 13,390.00 9,373.00 4,017.00
MASTOID PROCESS
RHEUMATIC FEVER WITHOUT MENTION OF HEART
I00 INVOLVEMENT; ARTHRITIS, RHEUMATIC, ACUTE OR 13,130.00 9,191.00 3,939.00
SUBACUTE INVOLVEMENT
I00+ J17.8* PNEUMONIA IN RHEUMATIC FEVER 19,500.00 13,650.00 5,850.00
ACUTE RHEUMATIC PERICARDITIS; ACUTE RHEUMATIC
I01.0 13,130.00 9,191.00 3,939.00
PERICARDITIS
ACUTE RHEUMATIC ENDOCARDITIS; ACUTE RHEUMATIC
I01.1 13,130.00 9,191.00 3,939.00
VALVULITIS
I01.2 ACUTE RHEUMATIC MYOCARDITIS; 13,130.00 9,191.00 3,939.00
OTHER ACUTE RHEUMATIC HEART DISEASE; ACUTE
I01.8 13,130.00 9,191.00 3,939.00
RHEUMATIC PANCARDITIS
ACUTE RHEUMATIC HEART DISEASE UNSPECIFIED; ACUTE
I01.9 RHEUMATIC CARDITIS; ACTIVE RHEUMATIC HEART 13,130.00 9,191.00 3,939.00
DISEASE; ACUTE RHEUMATIC HEART DISEASE
RHEUMATIC CHOREA WITH HEART INVOLVEMENT;
I02.0 13,130.00 9,191.00 3,939.00
CHOREA NOS WITH HEART INVOLVEMENT
RHEUMATIC CHOREA WITHOUT HEART INVOLVEMENT;
I02.9 13,130.00 9,191.00 3,939.00
RHEUMATIC CHOREA NOS
MITRAL STENOSIS; RHEUMATIC MITRAL VALVE
I05.0 16,640.00 11,648.00 4,992.00
OBSTRUCTION
RHEUMATIC MITRAL INSUFFICIENCY; RHEUMATIC MITRAL
I05.1 16,640.00 11,648.00 4,992.00
INCOMPETENCE; RHEUMATIC MITRAL REGURGITATION
MITRAL STENOSIS WITH INSUFFICIENCY; MITRAL STENOSIS

I05.2 16,640.00 11,648.00 4,992.00
WITH INCOMPETENCE OR REGURGITATION
I05.8 OTHER MITRAL VALVE DISEASES; MITRAL VALVE FAILURE 16,640.00 11,648.00 4,992.00
MITRAL VALVE DISEASE UNSPECIFIED; CHRONIC MITRAL
I05.9 16,640.00 11,648.00 4,992.00
VALVE DISORDER NOS
RHEUMATIC AORTIC STENOSIS; RHEUMATIC AORTIC VALVE
I06.0 16,640.00 11,648.00 4,992.00
OBSTRUCTION
RHEUMATIC AORTIC INSUFFICIENCY; RHEUMATIC AORTIC
I06.1 16,640.00 11,648.00 4,992.00
INCOMPETENCE; RHEUMATIC AORTIC REGURGITATION
RHEUMATIC AORTIC STENOSIS WITH INSUFFICIENCY;
I06.2 RHEUMATIC AORTIC STENOSIS WITH INCOMPETENCE OR 16,640.00 11,648.00 4,992.00
REGURGITATION
I06.8 OTHER RHEUMATIC AORTIC VALVE DISEASES 16,640.00 11,648.00 4,992.00
RHEUMATIC AORTIC VALVE DISEASE UNSPECIFIED;
I06.9 16,640.00 11,648.00 4,992.00
RHEUMATIC AORTIC VALVE DISEASE NOS
TRICUSPID STENOSIS; RHEUMATIC TRICUSPID VALVE
I07.0 16,640.00 11,648.00 4,992.00
STENOSIS
TRICUSPID INSUFFICIENCY; RHEUMATIC TRICUSPID VALVE
I07.1 16,640.00 11,648.00 4,992.00
INSUFFICIENCY
TRICUSPID VALVE DISEASE UNSPECIFIED; TRICUSPID
I07.9 16,640.00 11,648.00 4,992.00
VALVE DISORDER NOS
DISORDERS OF BOTH MITRAL AND AORTIC VALVES;
INVOLVEMENT OF BOTH MITRAL AND AORTIC VALVES
I08.0 16,640.00 11,648.00 4,992.00
WHETHER SPECIFIED AS RHEUMATIC OR OF UNSPECIFIED
ORIGIN
I08.1 DISORDERS OF BOTH MITRAL AND TRICUSPID VALVES 16,640.00 11,648.00 4,992.00
I08.2 DISORDERS OF BOTH AORTIC AND TRICUSPID VALVES 16,640.00 11,648.00 4,992.00
COMBINED DISORDERS OF MITRAL AORTIC AND TRICUSPID
I08.3 16,640.00 11,648.00 4,992.00
VALVES
Page 45 of 126
First Case Rate

I08.8 OTHER MULTIPLE VALVE DISEASES 16,640.00 11,648.00 4,992.00
I08.9 MULTIPLE VALVE DISEASE, UNSPECIFIED 16,640.00 11,648.00 4,992.00
I09.0 RHEUMATIC MYOCARDITIS 16,640.00 11,648.00 4,992.00
RHEUMATIC DISEASES OF ENDOCARDIUM, VALVE
I09.1 UNSPECIFIED; CHRONIC RHEUMATIC ENDOCARDITIS; 16,640.00 11,648.00 4,992.00
CHRONIC RHEUMATIC VALVULITIS
CHRONIC RHEUMATIC PERICARDITIS; RHEUMATIC
ADHERENT PERICARDIUM; CHRONIC RHEUMATIC
I09.2 16,640.00 11,648.00 4,992.00
MEDIASTINOPERICARDITIS; CHRONIC RHEUMATIC
MYOPERICARDITIS
OTHER SPECIFIED RHEUMATIC HEART DISEASES;
I09.8 16,640.00 11,648.00 4,992.00
RHEUMATIC DISEASE OF PULMONARY VALVE
RHEUMATIC HEART DISEASE, UNSPECIFIED; RHEUMATIC
I09.9 20,410.00 14,287.00 6,123.00
CARDITIS; RHEUMATIC HEART FAILURE
I10.1 HYPERTENSION, STAGE II 11,700.00 8,190.00 3,510.00
I10.9 ESSENTIAL HYPERTENSION; MALIGNANT HYPERTENSION 11,700.00 8,190.00 3,510.00
HYPERTENSIVE HEART DISEASE WITH (CONGESTIVE)
I11.0 11,700.00 8,190.00 3,510.00
HEART FAILURE; HYPERTENSIVE HEART FAILURE
HYPERTENSIVE HEART DISEASE WITHOUT (CONGESTIVE)
I11.9 11,700.00 8,190.00 3,510.00
HEART FAILURE; HYPERTENSIVE HEART DISEASE NOS
HYPERTENSIVE RENAL DISEASE WITH RENAL FAILURE;
I12.0 11,700.00 8,190.00 3,510.00
HYPERTENSIVE RENAL FAILURE
HYPERTENSIVE RENAL DISEASE WITHOUT RENAL FAILURE;
I12.9 11,700.00 8,190.00 3,510.00
HYPERTENSIVE RENAL DISEASE NOS
HYPERTENSIVE HEART AND RENAL DISEASE WITH
I13.0 11,700.00 8,190.00 3,510.00
(CONGESTIVE) HEART FAILURE
HYPERTENSIVE HEART AND RENAL DISEASE WITH RENAL
I13.1 11,700.00 8,190.00 3,510.00
FAILURE
HYPERTENSIVE HEART AND RENAL DISEASE WITH BOTH
I13.2 11,700.00 8,190.00 3,510.00
(CONGESTIVE) HEART FAILURE AND RENAL FAILURE
I13.9 HYPERTENSIVE HEART AND RENAL DISEASE, UNSPECIFIED 11,700.00 8,190.00 3,510.00
I15.0 RENOVASCULAR HYPERTENSION 11,700.00 8,190.00 3,510.00
I15.1 HYPERTENSION SECONDARY TO OTHER RENAL DISORDERS 11,700.00 8,190.00 3,510.00
I15.2 HYPERTENSION SECONDARY TO ENDOCRINE DISORDERS 11,700.00 8,190.00 3,510.00

I15.8 OTHER SECONDARY HYPERTENSION 11,700.00 8,190.00 3,510.00
I15.9 SECONDARY HYPERTENSION, UNSPECIFIED 11,700.00 8,190.00 3,510.00
UNSTABLE ANGINA; ANGINA CRESCENDO; ANGINA DE NOVO
I20.0 EFFORT; ANGINA WORSENING EFFORT; INTERMEDIATE 15,600.00 10,920.00 4,680.00
CORONARY SYNDROME; PREINFARCTION SYNDROME
ANGINA PECTORIS WITH DOCUMENTED SPASM;
I20.1 ANGIOSPASTIC ANGINA ; PRINZMETAL ANGINA ; SPASM- 15,600.00 10,920.00 4,680.00
INDUCED ANGINA ; VARIANT ANGINA
OTHER FORMS OF ANGINA PECTORIS; ANGINA OF EFFORT;
I20.8 15,600.00 10,920.00 4,680.00
STENOCARDIA
ANGINA PECTORIS, UNSPECIFIED; ANGINA NOS; CARDIAC
I20.9 15,600.00 10,920.00 4,680.00
ANGINA ; ANGINAL SYNDROME; ISCHAEMIC CHEST PAIN
ACUTE TRANSMURAL MYOCARDIAL INFARCTION OF

ANTERIOR WALL [OR DURATION OF <4 WEEKS] KILLIPS
STAGE UNSPECIFIED; ACUTE TRANSMURAL INFARCTION OF
I21.0 24,570.00 17,199.00 7,371.00
ANTERIOR WALL NOS [OR DURATION OF <4 WEEKS] KILLIPS
STAGE UNSPECIFIED; ACUTE ANTEROAPICAL TRANSMURAL
INFARCTION [OR
INFERIOR WALL [OR DURATION OF <4 WEEKS] KILLIPS I;
ACUTE TRANSMURAL INFARCTION OF DIAPHRAGMATIC
I21.1 24,570.00 17,199.00 7,371.00
WALL [OR DURATION OF <4 WEEKS] KILLIPS I; ACUTE
TRANSMURAL INFARCTION OF INFERIOR WALL NOS [OR
DURATION OF <4 WEEKS]
ACUTE TRANSMURAL MYOCARDIAL INFARCTION OF OTHER
SITES [OR DURATION OF <4 WEEKS] KILLIPS II; ACUTE
APICAL-LATERAL TRANSMURAL INFARCTION [OR
I21.2 24,570.00 17,199.00 7,371.00
DURATION OF <4 WEEKS] KILLIPS II; ACUTE BASAL-
LATERAL TRANSMURAL INFARCTION [OR DURATION OF <4
WEEKS] KILLIPS I
I21.3 UNSPECIFIED SITE; TRANSMURAL MYOCARDIAL 24,570.00 17,199.00 7,371.00
INFARCTION NOS
ACUTE SUBENDOCARDIAL MYOCARDIAL INFARCTION;
I21.4 24,570.00 17,199.00 7,371.00
NONTRANSMURAL MYOCARDIAL INFARCTION NOS
Page 46 of 126
First Case Rate

SUBSEQUENT MYOCARDIAL INFARCTION OF ANTERIOR
WALL; ACUTE SUBSEQUENT INFARCTION OF ANTERIOR
WALL NOS; ACUTE SUBSEQUENT INFARCTION OF
I22.0 24,570.00 17,199.00 7,371.00
ANTEROAPICAL WALL; ACUTE SUBSEQUENT INFARCTION
OF ANTEROLATERAL WALL; ACUTE SUBSEQUENT
INFARCTION OF ANTEROSEPTAL WALL
SUBSEQUENT MYOCARDIAL INFARCTION OF INFERIOR

WALL; ACUTE SUBSEQUENT INFARCTION OF
DIAPHRAGMATIC WALL; ACUTE SUBSEQUENT INFARCTION
I22.1 24,570.00 17,199.00 7,371.00
OF INFERIOR WALL NOS; ACUTE SUBSEQUENT INFARCTION
OF INFEROLATERAL WALL; ACUTE SUBSEQUENT
INFARCTION OF INFEROPOSTERIOR WALL
SUBSEQUENT MYOCARDIAL INFARCTION OF OTHER SITES;

ACUTE MYOCARDIAL INFARCTION OF APICAL-LATERAL
WALL; ACUTE MYOCARDIAL INFARCTION OF BASAL-
I22.8 24,570.00 17,199.00 7,371.00
LATERAL WALL; ACUTE MYOCARDIAL INFARCTION OF HIGH
LATERAL WALL; ACUTE MYOCARDIAL INFARCTION OF
LATERAL WALL NOS; ACUT
SUBSEQUENT MYOCARDIAL INFARCTION OF UNSPECIFIED
I22.9 24,570.00 17,199.00 7,371.00
SITE
HAEMOPERICARDIUM AS CURRENT COMPLICATION
I23.0 24,570.00 17,199.00 7,371.00
FOLLOWING ACUTE MYOCARDIAL INFARCTION
ATRIAL SEPTAL DEFECT AS CURRENT COMPLICATION
I23.1 24,570.00 17,199.00 7,371.00
VENTRICULAR SEPTAL DEFECT AS CURRENT
I23.2 COMPLICATION FOLLOWING ACUTE MYOCARDIAL 24,570.00 17,199.00 7,371.00
INFARCTION
RUPTURE OF CARDIAC WALL WITHOUT
I23.3 HAEMOPERICARDIUM AS CURRENT COMPLICATION 24,570.00 17,199.00 7,371.00
RUPTURE OF CHORDAE TENDINEAE AS CURRENT
INFARCTION
RUPTURE OF PAPILLARY MUSCLE AS CURRENT
INFARCTION
OTHER CURRENT COMPLICATIONS FOLLOWING ACUTE
I23.8 24,570.00 17,199.00 7,371.00
MYOCARDIAL INFARCTION
CORONARY THROMBOSIS NOT RESULTING IN MYOCARDIAL
INFARCTION; CORONARY ARTERY EMBOLISM NOT
RESULTING IN MYOCARDIAL INFACTION; CORONARY VEIN
I24.0 15,600.00 10,920.00 4,680.00
EMBOLISM NOT RESULTING IN MYOCARDIAL INFARCTION;
CORONARY ARTERY OCCLUSION NOT RESULTING IN
MYOCARDIAL INFARCTION; CO
DRESSLER'S SYNDROME; POSTMYOCARDIAL INFARCTION
I24.1 24,570.00 17,199.00 7,371.00
SYNDROME
OTHER FORMS OF ACUTE ISCHAEMIC HEART DISEASE;
I24.8 15,600.00 10,920.00 4,680.00
CORONARY FAILURE; CORONARY INSUFFICIENCY
ATHEROSCLEROTIC CARDIOVASCULARDISEASE, SO
I25.0 5,200.00 3,640.00 1,560.00
DESCRIBED
ATHEROSCLEROTIC HEAR TDISEASE; CORONARY ARTERY
ATHEROMA; CORONARY ARTERY ATHEROSCLEROSIS;
I25.1 5,200.00 3,640.00 1,560.00
CORONARY ARTERY DISEASE; CORONARY ARTERY
SCLEROSIS
ANEURYSM OF HEART; MURAL ANEURYSM; VENTICULAR
I25.3 5,200.00 3,640.00 1,560.00
ANEURYSM
CORONARY ARTERY ANEURYSM; CORONARY
I25.4 5,200.00 3,640.00 1,560.00
ARTERIOVENOUS FISTULA, ACQUIRED
I25.5 ISCHAEMIC CARDIOMYOPATHY 15,600.00 10,920.00 4,680.00
I25.6 SILENT MYOCARDIAL ISCHAEMIA 15,600.00 10,920.00 4,680.00
I25.8 OTHER FORMS OF CHRONIC ISCHAEMIC HEART DISEASE 15,600.00 10,920.00 4,680.00
CHRONIC ISCHAEMIC HEART DISEASE, UNSPECIFIED;
I25.9 15,600.00 10,920.00 4,680.00
CHRONIC ISCHAEMIC HEART DISEASE NOS
PULMONARY EMBOLISM WITH MENTION OF ACUTE COR
I26.0 31,590.00 22,113.00 9,477.00
PULMONALE; ACUTE COR PULMONALE NOS
PULMONARY EMBOLISM WITHOUT MENTION OF ACUTE
I26.9 31,590.00 22,113.00 9,477.00
COR PULMONALE; PULMONARY EMBOLISM NOS
I27.0 PRIMARY PULMONARY HYPERTENSION 18,330.00 12,831.00 5,499.00
I27.1 KYPHOSCOLIOTIC HEART DISEASE 18,330.00 12,831.00 5,499.00
OTHER SECONDARY PULMONARY HYPERTENSION;
I27.2 18,330.00 12,831.00 5,499.00
PULMONARY ARTERY HYPERTENSION
I27.8 OTHER SPECIFIED PULMONARY HEART DISEASES 18,330.00 12,831.00 5,499.00
PULMONARY HEART DISEASE, UNSPECIFIED; CHRONIC
I27.9 CARDIOPULMONARY DISEASE; CHRONIC COR PULMONALE 18,330.00 12,831.00 5,499.00
NOS
Page 47 of 126
First Case Rate

OTHER SPECIFIED DISEASES OF PULMONARY VESSELS;
I28.8 RUPTURE OF PULMONARY VESSEL; STENOSIS OF 17,030.00 11,921.00 5,109.00
PULMONARY VESSEL; STRICTURE OF PULMONARY VESSEL
I30.0 ACUTE NONSPECIFIC IDIOPATHIC PERICARDITIS 18,720.00 13,104.00 5,616.00
INFECTIVE PERICARDITIS; PNEUMOCOCCAL PERICARDITIS;
PURULENT PERICARDITIS; STAPHYLOCOCCAL
I30.1 18,720.00 13,104.00 5,616.00
PERICARDITIS; STREPTOCOCCAL PERICARDITIS; VIRAL
PERICARDITIS; PYOPERICARDITIS
I30.8 OTHER FORMS OF ACUTE PERICARDITIS 18,720.00 13,104.00 5,616.00
I30.9 ACUTE PERICARDITIS, UNSPECIFIED 18,720.00 13,104.00 5,616.00
CHRONIC ADHESIVE PERICARDITIS; ACCRETIO CORDIS;
I31.0 ADHERENT PERICARDIUM; ADHESIVE 18,720.00 13,104.00 5,616.00
MEDIASTINOPERICARDITIS
CHRONIC CONSTRICTIVE PERICARDITIS; CONCRETIO
I31.1 18,720.00 13,104.00 5,616.00
CORDIS; PERICARDIAL CALCIFICATION
ACUTE AND SUBACUTE INFECTIVE ENDOCARDITIS; ACUTE
BACTERIAL ENDOCARDITIS; SUBACUTE BACTERIAL
ENDOCARDITIS; ACUTE INFECTIVE ENDOCARDITIS NOS;
I33.0 18,720.00 13,104.00 5,616.00
SUBACUTE INFECTIVE ENDOCARDITIS NOS; ACUTE LENTA
ENDOCARDITIS; SUBACUTE LENTA ENDOCARDITIS; ACUTE
MALIGNANT ENDOCAR
ACUTE ENDOCARDITIS, UNSPECIFIED; ENDOCARDITIS,

I33.9 ACUTE OR SUBACUTE; MYOENDOCARDITIS, ACUTE OR 18,720.00 13,104.00 5,616.00
SUBACUTE; PERIENDOCARDITIS, ACUTE OR SUBACUTE
MITRAL (VALVE) INSUFFICIENCY; INCOMPETENCE MITRAL
VALVE NOS OR OF SPECIFIED CAUSE, EXCEPT RHEUMATIC;
I34.0 10,920.00 7,644.00 3,276.00
REGURGITATION MITRAL VALVE NOS OR OF SPECIFIED
CAUSE, EXCEPT RHEUMATIC
MITRAL (VALVE) PROLAPSE; FLOPPY MITRAL VALVE
I34.1 10,920.00 7,644.00 3,276.00
SYNDROME
I34.2 NONRHEUMATIC MITRAL (VALVE) STENOSIS 10,920.00 7,644.00 3,276.00
I34.8 OTHER NONRHEUMATIC MITRAL HEART VALVE DISORDERS 10,920.00 7,644.00 3,276.00
I34.9 NONRHEUMATIC MITRAL VALVE DISORDER, UNSPECIFIED 10,920.00 7,644.00 3,276.00

I35.0 AORTIC (VALVE) STENOSIS 10,920.00 7,644.00 3,276.00
AORTIC (VALVE) INSUFFICIENCY; INCOMPETENCE AORTIC
VALVE NOS OR OF SPECIFIED CAUSE, EXCEPT RHEUMATIC;
I35.1 10,920.00 7,644.00 3,276.00
AORTIC VALVE REGURGITATION NOS OR OF SPECIFIED
CAUSE, EXCEPT RHEUMATIC
I35.2 AORTIC (VALVE) STENOSIS WITH INSUFFICIENCY 10,920.00 7,644.00 3,276.00
I35.8 OTHER AORTIC HEART VALVE DISORDERS 10,920.00 7,644.00 3,276.00
I35.9 AORTIC VALVE DISORDER, UNSPECIFIED 10,920.00 7,644.00 3,276.00
I36.0 NONRHEUMATIC TRICUSPID (VALVE) STENOSIS 10,920.00 7,644.00 3,276.00
NONRHEUMATIC TRICUSPID (VALVE) INSUFFICIENCY;
INCOMPETENCE TRICUSPID VALVE OF SPECIFIED CAUSE,
I36.1 10,920.00 7,644.00 3,276.00
EXCEPT RHEUMATIC; TRICUSPID VALVE REGURGITATION
OF SPECIFIED CAUSE, EXCEPT RHEUMATIC
I36.8 OTHER NONRHEUMATIC TRICUSPID VALVE DISORDERS 10,920.00 7,644.00 3,276.00

NONRHEUMATIC TRICUSPID VALVE DISORDER,
I36.9 10,920.00 7,644.00 3,276.00
UNSPECIFIED
I37.0 PULMONARY VALVE STENOSIS 10,920.00 7,644.00 3,276.00
PULMONARY VALVE INSUFFICIENCY; INCOMPETENCE
PULMONARY VALVE NOS OR SPECIFIED CAUSE, EXCEPT
I37.1 10,920.00 7,644.00 3,276.00
RHEUMATIC; PULMONARY VALVE REGURGITATION NOS OR
OF SPECIFIED CAUSE, EXCEPT RHEUMATIC
I37.8 OTHER PULMONARY HEART VALVE DISORDERS 10,920.00 7,644.00 3,276.00
I37.9 PULMONARY VALVE DISORDER, UNSPECIFIED 10,920.00 7,644.00 3,276.00
ENDOCARDITIS, VALVE UNSPECIFIED; CHRONIC
ENDOCARDITIS NOS; VALVULAR INCOMPETENCE OF
UNSPECIFIED VALVE NOS OR OF SPECIFIED CAUSE, EXCEPT
I38 18,720.00 13,104.00 5,616.00
RHEUMATIC OR CONGENITAL; VALVULAR INSUFFICIENCY
OF UNSPECIFIED VALVE NOS OR OF SPECIFIED CAUSE,
EXCEPT RHEUMATIC OR CON
I40.0 INFECTIVE MYOCARDITIS; SEPTIC MYOCARDITIS 18,720.00 13,104.00 5,616.00
I40.1 ISOLATED MYOCARDITIS 18,720.00 13,104.00 5,616.00
I40.8 OTHER ACUTE MYOCARDITIS 18,720.00 13,104.00 5,616.00
I40.9 ACUTE MYOCARDITIS, UNSPECIFIED 18,720.00 13,104.00 5,616.00
DILATED CARDIOMYOPATHY; CONGESTIVE
I42.0 17,420.00 12,194.00 5,226.00
CARDIOMYOPATHY
OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY;
I42.1 17,420.00 12,194.00 5,226.00
HYPERTROPHIC SUBAORTIC STENOSIS
OTHER HYPERTROPHIC CARDIOMYOPATHY;
I42.2 17,420.00 12,194.00 5,226.00
NONOBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY
Page 48 of 126
First Case Rate

ENDOMYOCARDIAL (EOSINOPHILIC) DISEASE;
I42.3 ENDOMYOCARDIAL (TROPICAL) FIBROSIS; LöFFLER'S 17,420.00 12,194.00 5,226.00
ENDOCARDITIS
ENDOCARDIAL FIBROELASTOSIS; CONGENITAL
I42.4 17,420.00 12,194.00 5,226.00
CARDIOMYOPATHY
I42.5 OTHER RESTRICTIVE CARDIOMYOPATHY 17,420.00 12,194.00 5,226.00
I42.6 ALCOHOLIC CARDIOMYOPATHY 17,420.00 12,194.00 5,226.00
CARDIO MYOPATHY DUE TO DRUGS AND OTHER EXTERNAL
I42.7 17,420.00 12,194.00 5,226.00
AGENTS
I42.8 OTHER CARDIOMYOPATHIES 17,420.00 12,194.00 5,226.00
CARDIO MYOPATHY, UNSPECIFIED; PRIMARY
I42.9 CARDIOMYOPATHY NOS; SECONDARY CARDIOMYOPATHY 17,420.00 12,194.00 5,226.00
NOS
ATRIOVENTRICULAR BLOCK, COMPLETE; COMPLETE HEART
I44.2 15,990.00 11,193.00 4,797.00
BLOCK NOS; THIRD-DEGREE BLOCK
OTHER AND UNSPECIFIED ATRIOVENTRICULAR BLOCK;
I44.3 15,990.00 11,193.00 4,797.00
ATRIOVENTRICULAR BLOCK NOS
I44.4 LEFT ANTERIOR FASCICULAR BLOCK 15,990.00 11,193.00 4,797.00
OTHER SPECIFIED HEART BLOCKL; SINOATRIAL NOS;
I45.5 15,990.00 11,193.00 4,797.00
SINOAURICULAR BLOCK
PRE-EXCITATION SYNDROME; ANOMALOUS
ATRIOVENTICULAR EXCITATION; ATRIOVENTRICULAR
CONDUCTION, ACCELERATED; ATRIOVENTICULAR
I45.6 15,990.00 11,193.00 4,797.00
CONDUCTION, ACCESORY; ATRIOVENTICULAR
CONDUCTION PRE-EXCITATION; LOWN-GANONG-LEVINE
SYNDROME; WOLFF-PARKINSON-WHITE SYNDROME
OTHER SPECIFIED HEART CONDUCTION DISORDERSS;
I45.8 ATRIOVENTICULAR [AV] DISSOCIATION; INTERFERENCE 15,990.00 11,193.00 4,797.00
DISSOCIATION
HEART CONDUCTION DISORDERS, UNSPECIFIED; HEART
I45.9 15,990.00 11,193.00 4,797.00
BLOCK NOS; STOKES-ADAMS SYNDROME
I47.0 RE-ENTRY VENTRICULAR ARRHYTHMIA 15,860.00 11,102.00 4,758.00
SUPRAVENTRICULAR TACHYCARDIA; ATRIAL PAROXYSMAL
TACHYCARDIA; ATRIOVENTRICULAR [AV] PAROXYSMAL
I47.1 15,860.00 11,102.00 4,758.00
TACHYCARDIA; JUNCTIONAL PAROXYSMAL TACHYCARDIA;
NODAL PAROXYSMAL TACHYCARDIA
I47.2 VENTRICULAR TACHYCARDIA 15,860.00 11,102.00 4,758.00
PAROXYSMAL TACHYCARDIA, UNSPECIFIED; BOUVERET (-
I47.9 15,860.00 11,102.00 4,758.00
HOFFMANN) SYNDROME
I48 ATRIAL FIBRILLATION AND FLUTTER 15,860.00 11,102.00 4,758.00
I49.0 VENTRICULAR FIBRILLATION AND FLUTTER 15,860.00 11,102.00 4,758.00
ATRIAL PREMATURE DEPOLARIZATION; ATRIAL
I49.1 15,860.00 11,102.00 4,758.00
PREMATURE BEATS
I49.2 JUNCTIONAL PREMATURE DEPOLARIZATION 15,860.00 11,102.00 4,758.00
I49.3 VENTRICULAR PREMATURE DEPOLARIZATION 15,860.00 11,102.00 4,758.00
OTHER AND UNSPECIFIED PREMATURE DEPOLARIZATION;
ECTOPIC BEATS; EXTRASYSTOLES; EXTRASYSTOLIC
I49.4 15,860.00 11,102.00 4,758.00
ARRHYTHMIAS; PREMATURE BEATS NOS; PREMATURE
CONTRACTIONS
SICK SINUS SYNDROME; TACHYCARDIA-BRADYCARDIA
I49.5 15,860.00 11,102.00 4,758.00
SYNDROME
OTHER SPECIFIED CARDIAC ARRHYTHMIAS; CORONARY
I49.8 SINUS RHYTHM DISORDER; ECTOPIC RHYTHM DISORDER; 15,860.00 11,102.00 4,758.00
NODAL RHYTHM DISORDER
CARDIAC ARRHYTHMIA, UNSPECIFIED; CARDIAC
I49.9 15,860.00 11,102.00 4,758.00
ARRHYTHMIA NOS
CONGESTIVE HEART FAILURE; CONGESTIVE HEART
I50.0 DISEASE; RIGHT VENTICULAR FAILURE (SECONDARY TO 20,410.00 14,287.00 6,123.00
LEFT HEART FAILURE)
ADVANCED CONGESTIVE HEART FAILURE; GRAVE
I50.00 CONGESTIVE HEART FAILURE; SEVERE CONGESTIVE HEART 20,410.00 14,287.00 6,123.00
FAILURE
LEFT VENTRICULAR FAILURE; ACUTE OEDEMA OF LUNG
WITH MENTION OF HEART DISEASE NOS OR HEART
FAILURE; ACUTE PULMONARY OEDEMA WITH MENTION OF
I50.1 20,410.00 14,287.00 6,123.00
HEART DISEASE NOS OR HEART FAILURE; CARDIAC
ASTHMA WITH MENTION OF HEART DISEASE NOS OR
HEART FAILURE; LEFT HEART FAI
HEART FAILURE, UNSPECIFIED; CARDIAC, HEART OR
I50.9 20,410.00 14,287.00 6,123.00
MYOCARDIAL FAILURE NOS
CARDIAC SEPTAL DEFECT, ACQUIRED; ACQUIRED ATRIAL
SEPTAL DEFECT OLD; ACQUIRED AURICULAR SEPTAL
I51.0 18,720.00 13,104.00 5,616.00
DEFECT OLD ; ACQUIRED VENTRICULAR SEPTAL DEFECT
OLD
RUPTURE OF CHORDAE TENDINEAE, NOT ELSEWHERE
I51.1 18,720.00 13,104.00 5,616.00
CLASSIFIED
RUPTURE OF PAPILLARY MUSCLE, NOT ELSEWHERE
I51.2 18,720.00 13,104.00 5,616.00
CLASSIFIED
Page 49 of 126
First Case Rate

INTRA CARDIAC THROMBOSIS, NOTEL SEWHERE
CLASSIFIED; OLD APICAL THROMBOSIS; OLD ATRIAL
I51.3 18,720.00 13,104.00 5,616.00
THROMBOSIS; OLD AURICULAR THROMBOSIS; OLD
VENTICULAR THROMBOSIS
MYOCARDITIS, UNSPECIFIED; MYOCARDIAL FIBROSIS;
I51.4 18,720.00 13,104.00 5,616.00
MYOCARDITIS NOS; CHRONIC INTERSTITIAL MYOCARDITIS
MYOCARDIAL DEGENERATION; FATTY DEGENERATION OF

I51.5 HEART OR MYOCARDIUM FATTY; SENILE DEGENERATION 18,720.00 13,104.00 5,616.00
OF HEART OR MYOCARDIUM; MYOCARDIAL DISEASE
OTHER ILL-DEFINED HEART DISEASES; ACUTE CARDITIS;
I51.8 CHRONIC CARDITIS; ACUTE PANCARDITIS; CHRONIC 18,720.00 13,104.00 5,616.00
PANCARDITIS
I65.2 OCCLUSION AND STENOSIS OF CAROTID ARTERY 19,760.00 13,832.00 5,928.00
I67.0 DISSECTION OF CEREBRAL ARTERIES, NONRUPTURED 19,760.00 13,832.00 5,928.00
CEREBRAL ANEURYSM, NONRUPTURED; CEREBRAL
I67.1 ANEURYSM NOS; CEREBRAL ARTERIOVENOUS FISTULA, 19,760.00 13,832.00 5,928.00
ACQUIRED
CEREBRAL ATHEROSCLEROSIS; ATHEROMA OF CEREBRAL
I67.2 19,760.00 13,832.00 5,928.00
ARTERIES
PROGRESSIVE VASCULAR LEUKOENCEPHALOPATHY;
I67.3 19,760.00 13,832.00 5,928.00
BINSWANGER'S DISEASE
I67.4 HYPERTENSIVE ENCEPHALOPATHY 28,860.00 20,202.00 8,658.00
I67.5 MOYAMOYA DISEASE 19,760.00 13,832.00 5,928.00
NONPYOGENIC THROMBOSIS OF INTRACRANIAL VENOUS
SYSTEM; NONPYOGENIC THROMBOSIS OF CEREBRAL VEIN;
I67.6 19,760.00 13,832.00 5,928.00
NONPYOGENIC THROMBOSIS OF INTRACRANNIAL VENOUS
SINUS
I67.7 CEREBRAL ARTERITIS, NOT ELSEWHERE CLASSIFIED 19,760.00 13,832.00 5,928.00
OTHER SPECIFIED CEREBROVASCULAR DISEASES; ACUTE
I67.8 CEREBROVASCULAR INSUFFICIENCY NOS; CHRONIC 19,760.00 13,832.00 5,928.00
CEREBRAL ISCHAEMIA
OTHER LACUNAR SYNDROME IN UNSPECIFIED
I67.9+G46.7* 19,760.00 13,832.00 5,928.00
CEREBROVASCULAR DISEASE
OTHER VASCULAR SYNDROME IN UNSPECIFIED
I67.9+G46.8* 19,760.00 13,832.00 5,928.00
CEREBROVASCULAR DISEASE
I69.0 SEQUELAE OF SUBARACHNOID HAEMORRHAGE 13,390.00 9,373.00 4,017.00
I69.1 SEQUELAE OF INTRACEREBRAL HAEMORRHAGE 13,390.00 9,373.00 4,017.00
SEQUELAE OF OTHER NONTRAUMATIC INTRACRANIAL
I69.2 13,390.00 9,373.00 4,017.00
HAEMORRHAGE
I69.3 SEQUELAE OF CEREBRAL INFARCTION 13,390.00 9,373.00 4,017.00
SEQUELAE OF STROKE, NOT SPECIFIED AS HAEMORRHAGE
I69.4 13,390.00 9,373.00 4,017.00
OR INFARCTION
SEQUELAE OF OTHER AND UNSPECIFIED
I69.8 13,390.00 9,373.00 4,017.00
CEREBROVASCULAR DISEASES
DISSECTION OF AORTA [ANYPART]; DISSECTING ANEURYSM
I71.0 17,030.00 11,921.00 5,109.00
OF AORTA (RUPTURED) [ANY PART]
AORTIC ANEURYSM OF UNSPECIFIED SITE WITHOUT
I71.9 MENTION OF RUPTURE; ANEURYSM OF AORTA; DILATATION 17,030.00 11,921.00 5,109.00
OF AORTA; HYALINE NECROSIS OF AORTA
EMBOLISM AND THROMBOSIS OF ABDOMINAL AORTA;

I74.0 17,030.00 11,921.00 5,109.00
AORTIC BIFURCATION SYNDROME; LERICHE'S SYNDROME
EMBOLISM AND THROMBOSIS OF OTHER AND UNSPECIFIED
I74.1 17,030.00 11,921.00 5,109.00
PARTS OF AORTA
EMBOLISM AND THROMBOSIS OF ARTERIES OF UPPER
I74.2 17,030.00 11,921.00 5,109.00
EXTREMITIES
EMBOLISM AND THROMBOSIS OF ARTERIES OF LOWER
I74.3 17,030.00 11,921.00 5,109.00
EXTREMITIES
EMBOLISM AND THROMBOSIS OF ARTERIES OF
I74.4 EXTREMITIES, UNSPECIFIED; PERIPHERAL ARTERIAL 17,030.00 11,921.00 5,109.00
EMBOLISM
I74.5 EMBOLISM AND THROMBOSIS OF ILIAC ARTERY 17,030.00 11,921.00 5,109.00
I74.8 EMBOLISM AND THROMBOSIS OF OTHER ARTERIES 17,030.00 11,921.00 5,109.00
I74.9 EMBOLISM AND THROMBOSIS OF UNSPECIFIED ARTERY 17,030.00 11,921.00 5,109.00
I77.4 COELIAC ARTERY COMPRESSION SYNDROME 17,030.00 11,921.00 5,109.00
ARTERITIS, UNSPECIFIED; AORTITIS NOS; ENDARTERITIS
I77.6 17,030.00 11,921.00 5,109.00
NOS
OTHER SPECIFIED DISORDERS OF ARTERIES AND
I77.8 17,030.00 11,921.00 5,109.00
ARTERIOLES
PHLEBITIS AND THROMBOPHLEBITIS OF SUPERFICIAL
I80.0 16,120.00 11,284.00 4,836.00
VESSELS OF LOWER EXTREMITIES
I80.1 PHLEBITIS AND THROMBOPHLEBITIS OF FEMORAL VEIN 16,120.00 11,284.00 4,836.00
PHLEBITIS AND THROMBOPHLEBITIS OF OTHER DEEP
I80.2 VESSELS OF LOWER EXTREMITIES; DEEP VEIN 16,120.00 11,284.00 4,836.00
THROMBOSIS NOS
PHLEBITIS AND THROMBOPHLEBITIS OF LOWER
I80.3 EXTREMITIES, UNSPECIFIED; EMBOLISM OR THROMBOSIS 16,120.00 11,284.00 4,836.00
OF LOWER EXTERMITY NOS
Page 50 of 126
First Case Rate

I80.8 PHLEBITIS AND THROMBOPHLEBITIS OF OTHER SITES 16,120.00 11,284.00 4,836.00
I80.9 PHLEBITIS AND THROMBOPHLEBITIS OF UNSPECIFIED SITE 16,120.00 11,284.00 4,836.00
I81 PORTAL VEIN THROMBOSIS; PORTAL (VEIN) OBSTRUCTION 16,120.00 11,284.00 4,836.00
I82.0 BUDD-CHIARI SYNDROME 16,120.00 11,284.00 4,836.00
I82.1 THROMBOPHLEBITIS MIGRANS 16,120.00 11,284.00 4,836.00
I82.2 EMBOLISM AND THROMBOSIS OF VENA CAVA 16,120.00 11,284.00 4,836.00
I82.3 EMBOLISM AND THROMBOSIS OF RENAL VEIN 16,120.00 11,284.00 4,836.00
I82.8 EMBOLISM AND THROMBOSIS OF OTHER SPECIFIED VEINS 16,120.00 11,284.00 4,836.00
I82.9 EMBOLISM AND THROMBOSIS OF UNSPECIFIED VEIN 16,120.00 11,284.00 4,836.00
I85.0 OESOPHAGEAL VARICES WITH BLEEDING 17,030.00 11,921.00 5,109.00
COMPRESSION OF VEIN; STRICTURE OF VEIN; INFERIOR
I87.1 17,030.00 11,921.00 5,109.00
VENA CAVA SYNDROME; SUPERIOR VENA CAVA SYNDROME
NONSPECIFIC MESENTERIC LYMPHADENITIS; ACUTE
I88.0 MESENTERIC LYMPHADENITIS; CHRONIC MESENTERIC 8,840.00 6,188.00 2,652.00
LYMPHADENITIS
LYMPHANGITIS; LYMPHANGITIS NOS; CHRONIC
I89.1 11,570.00 8,099.00 3,471.00
LYMPHANGITIS; SUBACUTE LYMPHANGITIS
OTHER SPECIFIED NONINFECTIVE DISORDERS OF
I89.8 LYMPHATIC VESSELS AND LYMPH NODES; CHYLOCELE 11,570.00 8,099.00 3,471.00
(NONFILARIAL); LIPOMELANOTIC RETICULOSIS
NONINFECTIVE DISORDER OF LYMPHATIC VESSELS AND
I89.9 LYMPH NODES, UNSPECIFIED; DISEASE OF LYMPHATIC 11,570.00 8,099.00 3,471.00
VESSELS NOS
I97.0 POSTCARDIOTOMY SYNDROME 13,390.00 9,373.00 4,017.00
POSTMASTECTOMY LYMPHOEDEMA SYNDROME;
I97.2 ELEPHANTIASIS DUE TO MASTECTOMY; OBLITERATION OF 13,390.00 9,373.00 4,017.00
LYMPHATIC VESSELS DUE TO MASTECTOMY
J03.0 STREPTOCOCCAL TONSILLITIS 5,200.00 3,640.00 1,560.00
J03.8 ACUTE TONSILLITIS DUE TO OTHER SPECIFIED ORGANISMS 5,200.00 3,640.00 1,560.00
ACUTE TONSILLITIS, UNSPECIFIED; ACUTE TONSILLITIS

NOS; ACUTE FOLLICULAR TONSILLITIS; ACUTE
J03.9 5,200.00 3,640.00 1,560.00
GANGRENOUS TONSILLITIS; ACUTE INFECTIVE
TONSILLITIS; ACUTE ULCERATIVE TONSILLITIS
ACUTE OBSTRUCTIVE LARYNGITIS [CROUP]; OBSTRUCTIVE
J05.0 10,660.00 7,462.00 3,198.00
LARYNGITIS NOS
J05.1 ACUTE EPIGLOTTITIS; EPIGLOTTITIS NOS 12,610.00 8,827.00 3,783.00
J06.0 ACUTE LARYNGOPHARYNGITIS 5,200.00 3,640.00 1,560.00
OTHER ACUTE UPPER RESPIRATORY INFECTIONS OF
J06.8 5,200.00 3,640.00 1,560.00
MULTIPLE SITES
ACUTE UPPER RESPIRATORY INFECTION, UNSPECIFIED;
J06.9 ACUTE UPPER RESPIRATORY DISEASE; UPPER RESPIRATORY 5,200.00 3,640.00 1,560.00
INFECTION NOS
J09 INFLUENZA A H5N1 (AVIAN INFLUENZA) 8,580.00 6,006.00 2,574.00
INFLUENZA WITH PNEUMONIA, INFLUENZA VIRUS
J10.0 IDENTIFIED; INFLUENZAL (BRONCHO) PNEUMONIA, 8,580.00 6,006.00 2,574.00
INFLUENZA VIRUS INDENTIFIED
INFLUENZA WITH OTHER RESPIRATORY MANIFESTATIONS,
INFLUENZA VIRUS IDENTIFIED; INFLUENZA, INFLUENZA
VIRUS IDENTIFIED; ACUTE UPPER RESPIRATORY
J10.1 8,580.00 6,006.00 2,574.00
INFLUENZAL INFECTION, INFLUENZA VIRUS IDENTIFIED;
INFLUENZAL LARYNGITIS, INFLUENZA VIRUS IDENTIFIED;
INFLUENZAL PHA
INFLUENZA WITH OTHER MANIFESTATIONS, INFLUENZA

VIRUS IDENTIFIED; ENCEPHALOPATHY DUE TO INFLUENZA,
J10.8 INFLUENZA VIRUS IDENTIFIED; INFLUENZAL 8,580.00 6,006.00 2,574.00
GASTROENTERITIS, INFLUENZA VIRUS IDENTIFIED; ACUTE
INFLUENZAL MYOCARDITIS, INFLUENZA VIRUS IDENTIFIED
INFLUENZA WITH PNEUMONIA, VIRUS NOT IDENTIFIED;
J11.0 INFLUENZAL (BRONCHO) PNEUMONIA, UNSPECIFIED OR 8,580.00 6,006.00 2,574.00
SPECIFIC VIRUS NOT IDENTIFIED
INFLUENZA WITH OTHER RESPIRATORY MANIFESTATIONS,
VIRUS NOT IDENTIFIED; INFLUENZA NOS; INFLUENZAL
ACUTE UPPER RESPIRATORY INFECTION, UNSPECIFIED OR
J11.1 8,580.00 6,006.00 2,574.00
SPECIFIC VIRUS NOT IDENTIFIED; INFLUENZAL
LARYNGITIS, UNSPECIFIED OR SPECIFIC VIRUS NOT
IDENTIFIED; INFLUEN
Page 51 of 126
First Case Rate

INFLUENZA WITH OTHER MANIFESTATIONS, VIRUS NOT
IDENTIFIED; ENCEPHALOPATHY DUE TO INFLUENZA,
UNSPECIFIED OR SPECIFIC VIRUS NOT IDENTIFIED;
J11.8 8,580.00 6,006.00 2,574.00
INFLUENZAL GASTROENTIRITIS, UNSPECIFIED OR SPECIFIC
VIRUS NOT IDENTIFIED; ACUTE INFLUENZAL MYOCARDITIS,
UNSPECIFIED O
J11.8+ I41.1* ACUTE INFLUENZAL MYOCARDITIS, VIRUS NOT IDENTIFIED 8,580.00 6,006.00 2,574.00
J12.02 ADENOVIRAL PNEUMONIA, MODERATE RISK 19,500.00 13,650.00 5,850.00
RESPIRATORY SYNCYTIAL VIRUS PNEUMONIA, MODERATE
J12.12 19,500.00 13,650.00 5,850.00
RISK
J12.22 PARAINFLUENZA VIRUS PNEUMONIA, MODERATE RISK 19,500.00 13,650.00 5,850.00
HUMAN METAPNEUMOVIRUS PNEUMONIA, MODERATE
J12.32 19,500.00 13,650.00 5,850.00
RISK
J12.92 VIRAL PNEUMONIA, MODERATE RISK 19,500.00 13,650.00 5,850.00
PNEUMONIA [BRONCHOPNEUMONIA] DUE TO
J13.2 19,500.00 13,650.00 5,850.00
STREPTOCOCCUS PNEUMONIAE, MODERATE RISK
PNEUMONIA [BRONCHOPNEUMONIA]DUE TO
J14.2 19,500.00 13,650.00 5,850.00
HAEMOPHILUS INFLUENZAE, MODERATE RISK
PNEUMONIA DUE TO KLEBSIELLA PNEUMONIAE,
J15.02 19,500.00 13,650.00 5,850.00
MODERATE RISK
J15.12 PNEUMONIA DUE TO PSEUDOMONAS, MODERATE RISK 19,500.00 13,650.00 5,850.00
J15.22 PNEUMONIA DUE TO STAPHYLOCOCCUS, MODERATE RISK 19,500.00 13,650.00 5,850.00

PNEUMONIA DUE TO STREPTOCOCCUS, GROUP B,
J15.32 19,500.00 13,650.00 5,850.00
MODERATE RISK
PNEUMONIA DUE TO OTHER STREPTOCOCCI, MODERATE
J15.42 19,500.00 13,650.00 5,850.00
RISK
J15.52 PNEUMONIA DUE TO ESCHERICHIA COLI, MODERATE RISK 19,500.00 13,650.00 5,850.00
PNEUMONIA DUE TO OTHER AEROBIC GRAM-NEGATIVE
J15.62 BACTERIA; PNEUMONIA DUE TO SERRATIA MARCESCENS, 19,500.00 13,650.00 5,850.00
MODERATE RISK
PNEUMONIA DUE TO MYCOPLASMA PNEUMONIAE,
J15.72 19,500.00 13,650.00 5,850.00
MODERATE RISK
BACTERIAL PNEUMONIA [BRONCHOPNEUMONIA],
J15.92 19,500.00 13,650.00 5,850.00
MODERATE RISK
J16.02 CHLAMYDIAL PNEUMONIA, MODERATE RISK 19,500.00 13,650.00 5,850.00
J18.02 BRONCHOPNEUMONIA, MODERATE RISK 19,500.00 13,650.00 5,850.00
J18.12 LOBAR PNEUMONIA, MODERATE RISK 19,500.00 13,650.00 5,850.00
J18.22 HYPOSTATIC PNEUMONIA, MODERATE RISK 19,500.00 13,650.00 5,850.00
COMMUNITY-ACQUIRED PNEUMONIA III
(THIS CLASSIFICATION UTILIZED THE AMERICAN THORACIC
SOCIETY RECOMMENDATION. THIS IS EQUIVALENT TO CAP,
J18.92 19,500.00 13,650.00 5,850.00
MODERATE RISK IN THE PHILIPPINE CLINICAL PRACTICE
GUIDELINES ON THE DIAGNOSIS, EMPIRIC MANAGEMENT,
AND PREVENTION OF C
J20.0 ACUTE BRONCHITIS DUE TO MYCOPLASMA PNEUMONIAE 5,200.00 3,640.00 1,560.00
J20.1 ACUTE BRONCHITIS DUE TO HAEMOPHILUS INFLUENZAE 5,200.00 3,640.00 1,560.00

J20.2 ACUTE BRONCHITIS DUE TO STREPTOCOCCUS 5,200.00 3,640.00 1,560.00
J20.3 ACUTE BRONCHITIS DUE TO COXSACKIEVIRUS 5,200.00 3,640.00 1,560.00
J20.4 ACUTE BRONCHITIS DUE TO PARAINFLUENZA VIRUS 5,200.00 3,640.00 1,560.00
ACUTE BRONCHITIS DUE TO RESPIRATORY SYNCYTIAL
J20.5 5,200.00 1,560.00
VIRUS
J20.6 ACUTE BRONCHITIS DUE TO RHINOVIRUS 5,200.00 3,640.00 1,560.00
J20.7 ACUTE BRONCHITIS DUE TO ECHOVIRUS 5,200.00 3,640.00 1,560.00
J20.8 ACUTE BRONCHITIS DUE TO OTHER SPECIFIED ORGANISMS 5,200.00 3,640.00 1,560.00
J20.9 ACUTE BRONCHITIS, UNSPECIFIED 5,200.00 3,640.00 1,560.00
J22 UNSPECIFIED ACUTE LOWER RESPIRATORY INFECTION 5,200.00 3,640.00 1,560.00
PERITONSILLAR ABSCESS; ABSCESS OF TONSIL;
J36 13,000.00 9,100.00 3,900.00
PERITONSILLAR CELLULITIS; QUINSY
OTHER DISEASES OF LARYNX; ABSCESS OF LARYNX;
CELLULITIS OF LARYNX; DISEASE NOS OF LARYNX;
J38.7 13,000.00 9,100.00 3,900.00
NECROSIS OF LARYNX; PACHYDERMA OF LARYNX;
PERICHONDRITIS OF LARYNX; ULCER OF LARYNX
RETROPHARYNGEAL AND PARAPHARYNGEAL ABSCESS;
J39.0 13,000.00 9,100.00 3,900.00
PERIPHARYNGEAL ABSCESS
OTHER ABSCESS OF PHARYNX; CELLULITIS OF PHARYNX;
J39.1 13,000.00 9,100.00 3,900.00
NASOPHARYNGEAL ABSCESS
OTHER DISEASES OF PHARYNX; CYST OF PHARYNX OR
J39.2 13,000.00 9,100.00 3,900.00
NASOPHARYNX; OEDEMA OF PHARYNX OR NASOPHARYNX
J40 BRONCHITIS, NOT SPECIFIED AS ACUTE OR CHRONIC 5,200.00 3,640.00 1,560.00
MACLEOD'S SYNDROME; UNILATERAL EMPHYSEMA;
J43.0 14,820.00 10,374.00 4,446.00
UNILATERAL TRANSPARENCY OF LUNG
J43.1 PANLOBULAR EMPHYSEMA; PANACINAR EMPHYSEMA 14,820.00 10,374.00 4,446.00
Page 52 of 126
First Case Rate

J43.2 CENTRILOBULAR EMPHYSEMA 14,820.00 10,374.00 4,446.00
J43.8 OTHER EMPHYSEMA 14,820.00 10,374.00 4,446.00
EMPHYSEMA, UNSPECIFIED; LUNG EMPHYSEMA NOS;
PULMONARY EMPHYSEMA NOS; BULLOUS LUNG
J43.9 EMPHYSEMA; BULLOUS PULMONARY EMPHYSEMA; 14,820.00 10,374.00 4,446.00
VESICULAR LUNG EMPHYSEMA; VESUCULAR PULMONARY
EMPHYSEMA; EMPHYSEMATOUS BLEB
CHRONIC OBSTRUCTIVE/ ASTHMATIC/ EMPHYSEMATOUS
J44.0 PULMONARY DISEASE WITH ACUTE LOWER RESPIRATORY 15,860.00 11,102.00 4,758.00
INFECTION
CHRONIC OBSTRUCTIVE/ ASTHMATIC/ EMPHYSEMATOUS
J44.1 PULMONARY DISEASE WITH ACUTE EXACERBATION, 15,860.00 11,102.00 4,758.00
UNSPECIFIED
CHRONIC ASTHMATIC (OBSTRUCTIVE) BRONCHITIS NOS;
J44.8 CHRONIC EMPHYSEMATOUS BRONCHITIS NOS; CHRONIC 15,860.00 11,102.00 4,758.00
OBSTRUCTIVE BRONCHITIS NOS
CHRONIC OBSTRUCTIVE PULMONARY DISEASE,
J44.9 UNSPECIFIED; CHRONIC OBSTRUCTIVE AIRWAY DISEASE 15,860.00 11,102.00 4,758.00
NOS; CHRONIC OBSTRUCTIVE LUNG DISEASE NOS
PREDOMINANTLY ALLERGIC ASTHMA; ALLERGIC

BRONCHITIS NOS; ALLERGIC RHINITIS WITH ASTHMA;
J45.00 11,700.00 8,190.00 3,510.00
ATOPIC ASTHMA; EXTRINSIC ALLERGIC ASTHMA; HAY
FEVER WITH ASTHMA; IN ACUTE EXACERBATION
NONALLERGIC ASTHMA; IDIOSYNCRATIC ASTHMA;
J45.10 INTRINSIC NONALLERGIC ASTHMA, IN ACUTE 11,700.00 8,190.00 3,510.00
EXACERBATION
J45.80 MIXED ASTHMA, IN ACUTE EXACERBATION 11,700.00 8,190.00 3,510.00
J46 STATUS ASTHMATICUS; ACUTE SEVERE ASTHMA 11,700.00 8,190.00 3,510.00
COALWORKER'S PNEUMOCONIOSIS; ANTHRACOSILICOSIS;
J60 19,110.00 13,377.00 5,733.00
ANTHRACOSIS; COALWORKER'S LUNG
PNEUMOCONIOSIS DUE TO ASBESTOS AND OTHER MINERAL
J61 19,110.00 13,377.00 5,733.00
FIBRES; ASBESTOSIS
J62.0 PNEUMOCONIOSIS DUE TO TALC DUST 19,110.00 13,377.00 5,733.00
PNEUMOCONIOSIS DUE TO OTHER DUST CONTAINING
J62.8 19,110.00 13,377.00 5,733.00
SILICA; SILICOSIS NOS
J63.0 ALUMINOSIS (OF LUNG) 19,110.00 13,377.00 5,733.00
J63.3 GRAPHITE FIBROSIS (OF LUNG) 19,110.00 13,377.00 5,733.00
J63.4 SIDEROSIS 19,110.00 13,377.00 5,733.00
PNEUMOCONIOSIS DUE TO OTHER SPECIFIED INORGANIC
J63.8 19,110.00 13,377.00 5,733.00
DUSTS
J64 UNSPECIFIED PNEUMOCONIOSIS 19,110.00 13,377.00 5,733.00
J65 PNEUMOCONIOSIS ASSOCIATED WITH TUBERCULOSIS 19,110.00 13,377.00 5,733.00
J66.2 CANNABINOSIS 19,110.00 13,377.00 5,733.00
J66.8 AIRWAY DISEASE DUE TO OTHER SPECIFIC ORGANIC DUSTS 19,110.00 13,377.00 5,733.00
FARMER'S LUNG; HARVESTER'S LUNG; HAYMAKER'S LUNG;
J67.0 19,110.00 13,377.00 5,733.00
MOULDY HAY DISEASE
J67.1 BAGASSOSIS; BAGASSE DISEASE; BAGASSE PNEUMONITIS 19,110.00 13,377.00 5,733.00
J67.5 MUSHROOM-WORKER'S LUNG 19,110.00 13,377.00 5,733.00
AIR-CONDITIONER AND HUMIDIFIER LUNG; ALLERGIC
ALVEOLITIS DUE TO FUNGI, THERMOPHILIC
J67.7 19,110.00 13,377.00 5,733.00
ACTINOMYCETEES AND OTHER ORGANISMS GROWING IN
VENTILATION (AIR-CONDITIONING) SYSTEMS
HYPERSENSITIVITY PNEUMONITIS DUE TO OTHER ORGANIC
DUSTS; CHEESE-WASHER'S LUNG; COFFEE-WORKER'S
J67.8 19,110.00 13,377.00 5,733.00
LUNG; FISHMEAL-WORKER'S LUNG; FURRIER'S LUNG;
SEQUOIOSIS
HYPERSENSITIVITY PNEUMONITIS DUE TO UNSPECIFIED
J67.9 ORGANIC DUST; EXTRINSIC ALLERGIC ALVEOLITIS NOS; 19,110.00 13,377.00 5,733.00
HYPERSENSITIVITY PNEUMONITIS NOS
BRONCHITIS AND PNEUMONITIS DUE TO CHEMICALS,
J68.0 GASES, FUMES AND VAPOURS; ACUTE CHEMICAL 19,110.00 13,377.00 5,733.00
BRONCHITIS
ACUTE PULMONARY OEDEMA DUE TO CHEMICALS, GASES,
J68.1 FUMES AND VAPOURS; ACUTE CHEMICAL PULMONARY 19,110.00 13,377.00 5,733.00
OEDEMA
UPPER RESPIRATORY INFLAMMATION DUE TO CHEMICALS,
J68.2 GASES, FUMES AND VAPOURS, NOT ELSEWHERE 19,110.00 13,377.00 5,733.00
CLASSIFIED
OTHER ACUTE AND SUBACUTE RESPIRATORY CONDITIONS
DUE TO CHEMICALS, GASES, FUMES AND VAPOURS;
J68.3 19,110.00 13,377.00 5,733.00
REACTIVE AIRWAYS DYSFUNCTION SYNDROME;
HYPERACTIVE AIRWAY DISEASE
Page 53 of 126
First Case Rate

CHRONIC RESPIRATORY CONDITIONS DUE TO CHEMICALS,
GASES, FUMES AND VAPOURS; DIFFUSE EMPHYSEMA DUE
TO INHALATION OF CHEMICALS, GASES, FUMES AND
J68.4 19,110.00 13,377.00 5,733.00
VAPOURS; CHRONIC EMPHYSEMA DUE TO INHALATION OF
CHEMICALS, GASES, FUMES AND VAPOURS; CHRONIC
OBLITERATIVE BRONCHI
OTHER RESPIRATORY CONDITIONS DUE TO CHEMICALS,
J68.8 19,110.00 13,377.00 5,733.00
GASES, FUMES AND VAPOURS
UNSPECIFIED RESPIRATORY CONDITION DUE TO
J68.9 19,110.00 13,377.00 5,733.00
CHEMICALS, GASES, FUMES AND VAPOURS
PNEUMONITIS DUE TO FOOD AND VOMIT; ASPIRATION
PNEUMONIA DUE TO NOS; ASPIRATION PNEUMONIA DUE TO
J69.0 REGURGITATED FOOD; ASPIRATION PNEUMONIA DUE TO 19,110.00 13,377.00 5,733.00
GASTRIC SECRETIONS; ASPIRATION PNEUMONIA DUE TO
MILK; ASPIRATION PNEUMONIA DUE TO VOMIT
PNEUMONITIS DUE TO OILS AND ESSENCES; LIPID
J69.1 19,110.00 13,377.00 5,733.00
PNEUMONIA
PNEUMONITIS DUE TO OTHER SOLIDS AND LIQUIDS;
J69.8 19,110.00 13,377.00 5,733.00
PNEUMONITIS DUE TO ASPIRATION OF BLOOD
ACUTE PULMONARY MANIFESTATIONS DUE TO RADIATION;
J70.0 19,110.00 13,377.00 5,733.00
RADIATION PNEUMONITIS
J70.2 ACUTE DRUG-INDUCED INTERSTITIAL LUNG DISORDERS 19,110.00 13,377.00 5,733.00
DRUG-INDUCED INTERSTITIAL LUNG DISORDERS,
J70.4 19,110.00 13,377.00 5,733.00
UNSPECIFIED
RESPIRATORY CONDITIONS DUE TO OTHER SPECIFIED
J70.8 19,110.00 13,377.00 5,733.00
EXTERNAL AGENTS
RESPIRATORY CONDITIONS DUE TO UNSPECIFIED
J70.9 19,110.00 13,377.00 5,733.00
EXTERNAL AGENT
ADULT RESPIRATORY DISTRESS SYNDROME; ADULT
J80 41,600.00 29,120.00 12,480.00
HYALINE MEMBRANE DISEASE
PULMONARY OEDEMA; ACUTE OEDEMA OF LUNG; PASSIVE
J81 18,200.00 12,740.00 5,460.00
PULMONARY CONGESTION; LUNG DROPSY
PULMONARY EOSINOPHILIA, NOT ELSEWHERE CLASSIFIED;
J82 EOSINOPHILIC ASTHMA; LOFFLER'S PNEUMONIA; TROPICAL 18,200.00 12,740.00 5,460.00
PULMONARY EOSINOPHILIA NOS
ALVEOLAR AND PARIETOALVEOLAR CONDITIONS;
J84.0 ALVEOLAR PROTEINOSIS; PULMONARY ALVEOLAR 18,200.00 12,740.00 5,460.00
MICROLITHIASIS
OTHER INTERSTITIAL PULMONARY DISEASES WITH
FIBROSIS; DIFFUSE PULMONARY FIBROSIS; CRYPTOGENIC
J84.1 18,200.00 12,740.00 5,460.00
FIBROSING ALVEOLITIS; HAMMAN-RICH SYNDROME;
IDIOPATHIC PULMONARY FIBROSIS
J84.8 OTHER SPECIFIED INTERSTITIAL PULMONARY DISEASES 18,200.00 12,740.00 5,460.00

INTERSTITIAL PULMONARY DISEASE, UNSPECIFIED;
J84.9 18,200.00 12,740.00 5,460.00
INTERSTITIAL PNEUMONIA NOS
J85.0 GANGRENE AND NECROSIS OF LUNG 17,160.00 12,012.00 5,148.00
J85.1 ABSCESS OF LUNG WITH PNEUMONIA 13,000.00 9,100.00 3,900.00
ABSCESS OF LUNG WITHOUT PNEUMONIA; ABSCESS OF
J85.2 13,000.00 9,100.00 3,900.00
LUNG NOS
J85.3 ABSCESS OF MEDIASTINUM 13,000.00 9,100.00 3,900.00
J86.0 PYOTHORAX WITH FISTULA 13,000.00 9,100.00 3,900.00
PYOTHORAX WITHOUT FISTULA; ABSCESS OF PLEURA;
J86.9 13,000.00 9,100.00 3,900.00
ABSCESS OF THORAX; EMPYEMA; PYOPNEUMOTHORAX
PLEURAL EFFUSION, NOT ELSEWHERE CLASSIFIED;
J90 18,460.00 12,922.00 5,538.00
PLEURISY WITH EFFUSION
PLEURAL EFFUSION IN CONDITIONS CLASSIFIED
J91* 18,460.00 12,922.00 5,538.00
ELSEWHERE
PLEURAL PLAQUE WITHOUT ASBESTOS; PLEURAL PLAQUE
J92.9 17,550.00 12,285.00 5,265.00
NOS; PLEURAL THICKENING
J93.0 SPONTANEOUS TENSION PNEUMOTHORAX 19,890.00 13,923.00 5,967.00
J93.1 OTHER SPONTANEOUS PNEUMOTHORAX 19,890.00 13,923.00 5,967.00
J93.8 OTHER PNEUMOTHORAX 19,890.00 13,923.00 5,967.00
J93.9 PNEUMOTHORAX, UNSPECIFIED 19,890.00 13,923.00 5,967.00
J94.0 CHYLOUS EFFUSION; CHYLIFORM EFFUSION 17,550.00 12,285.00 5,265.00
J94.1 FIBROTHORAX 17,550.00 12,285.00 5,265.00
J94.8 OTHER SPECIFIED PLEURAL CONDITIONS; HYDROTHORAX 17,550.00 12,285.00 5,265.00
J94.9 PLEURAL CONDITION, UNSPECIFIED 17,550.00 12,285.00 5,265.00
TRACHEOSTOMY MALFUNCTION; HAEMORRHAGE FROM
TRACHEOSTOMY STOMA; OBSTRUCTION OF
J95.0 TRACHEOSTOMY AIRWAY; SEPSIS OF TRACHEOSTOMY 13,390.00 9,373.00 4,017.00
STOMA; TRACHEO-OESOPHAGEAL FISTULA FOLLOWING
TRACHEOSTOMY
ACUTE PULMONARY INSUFFICIENCY FOLLOWING
J95.1 13,390.00 9,373.00 4,017.00
THORACIC SURGERY
ACUTE PULMONARY INSUFFICIENCY FOLLOWING
J95.2 13,390.00 9,373.00 4,017.00
NONTHORACIC SURGERY
Page 54 of 126
First Case Rate

J95.4 MENDELSON'S SYNDROME 13,390.00 9,373.00 4,017.00
J95.5 POSTPROCEDURAL SUBGLOTTIC STENOSIS 13,390.00 9,373.00 4,017.00
J95.8 OTHER POSTPROCEDURAL RESPIRATORY DISORDERS 13,390.00 9,373.00 4,017.00
J95.9 POSTPROCEDURAL RESPIRATORY DISORDER, UNSPECIFIED 13,390.00 9,373.00 4,017.00
J96.0 ACUTE RESPIRATORY FAILURE 41,600.00 29,120.00 12,480.00
J96.1 CHRONIC RESPIRATORY FAILURE 41,600.00 29,120.00 12,480.00
J96.9 RESPIRATORY FAILURE, UNSPECIFIED 41,600.00 29,120.00 12,480.00
DISEASES OF BRONCHUS, NOT ELSEWHERE CLASSIFIED;
BRONCHOLITHIASIS; CALCIFICATION OF BRONCHUS;
J98.0 STENOSIS OF BRONCHUS; ULCER OF BRONCHUS; 13,260.00 9,282.00 3,978.00
TRACHEOBRONCHIAL COLLAPSE; TRACHEOBRONCHIAL
DYSKINESIA
PULMONARY COLLAPSE; ATELECTASIS; COLLAPSE OF LUNG;
J98.1 17,940.00 12,558.00 5,382.00
BROCK'S SYNDROME
J98.2 INTERSTITIAL EMPHYSEMA; MEDIASTINAL EMPHYSEMA 14,820.00 10,374.00 4,446.00
J98.3 COMPENSATORY EMPHYSEMA 14,820.00 10,374.00 4,446.00
OTHER DISORDERS OF LUNG; CALCIFICATION OF LUNG;
J98.4 ACQUIRED CYSTIC LUNG DISEASE; LUNG DISEASE NOS; 13,260.00 9,282.00 3,978.00
PULMOLITHIASIS
DISEASES OF MEDIASTINUM, NOT ELSEWHERE CLASSIFIED;
FIBROSIS OF MEDIASTINUM; HERNIA OF MEDIASTINUM;
J98.5 13,260.00 9,282.00 3,978.00
RETRACTION OF MEDIASTINUM; MEDIASTINITIS OF
MEDIASTINUM
DISORDERS OF DIAPHRAGM; DIAPHRAGMATITIS;
J98.6 13,260.00 9,282.00 3,978.00
PARALYSIS OF DIAPHRAGM; RELAXATION OF DIAPHRAGM
J98.8 OTHER SPECIFIED RESPIRATORY DISORDERS 13,260.00 9,282.00 3,978.00
RESPIRATORY DISORDER, UNSPECIFIED; CHRONIC
J98.9 13,260.00 9,282.00 3,978.00
RESPIRATORY DISEASE NOS
PULPITIS; PULPAL ABSCESS; PULPAL POLYP; ACUTE
K04.0 PULPITIS; HYPERPLASTIC CHRONIC PULPITIS; ULCERATIVE 5,200.00 3,640.00 1,560.00
CHRONIC PULPITIS; SUPPARATIVE PULPITIS
K04.1 NECROSIS OF PULP; PULPAL GANGRENE 5,200.00 3,640.00 1,560.00
PULP DEGENERATION; DENTICLES; PULPAL
K04.2 5,200.00 3,640.00 1,560.00
CALCIFICATIONS; PULPAL STONES
ABNORMAL HARD TISSUE FORMATION IN PULP;
K04.3 5,200.00 3,640.00 1,560.00
SECONDARY OR IRREGULAR DENTINE
ACUTE APICAL PERIODONTITIS OF PULPAL ORIGIN; ACUTE
K04.4 5,200.00 3,640.00 1,560.00
APICAL PERIODONTITIS NOS
CHRONIC APICAL PERIODONTITIS; APICAL OR PERIAPICAL
K04.5 5,200.00 3,640.00 1,560.00
GRANULOMA; APICAL PERIODONTITIS NOS
PERIAPICAL ABSCESS WITH SINUS; DENTAL ABSCESS WITH
K04.6 5,200.00 3,640.00 1,560.00
SINUS; DENTOALVEOLAR ABSCESS WITH SINUS
PERIAPICAL ABSCESS WITHOUT SINUS; DENTAL ABSCESS
K04.7 NOS; DENTOALVEOLAR ABSCESS NOS; PERIAPICAL ABSCESS 5,200.00 3,640.00 1,560.00
NOS
RADICULAR CYST; PERIODONTAL APICAL CYST; PERIAPICAL
K04.8 5,200.00 3,640.00 1,560.00
CYST; RESIDUAL RADICULAR CYST
OTHER AND UNSPECIFIED DISEASES OF PULP AND
K04.9 5,200.00 3,640.00 1,560.00
PERIAPICAL TISSUES
DEVELOPMENTAL ODONTOGENIC CYSTS; DENTIGEROUS
CYST; ERUPTION CYST; FOLLICULAR CYST; GINGIVAL CYST;
K09.0 10,790.00 7,553.00 3,237.00
LATERAL PERIODONTAL CYST; PRIMORDIAL CYST;
KERATOCYST
DEVELOPMENTAL (NONODONTOGENIC) CYSTS OF ORAL
REGION; CYST OF GLOBULOMAXILLARY; CYST OF INCISIVE
K09.1 10,790.00 7,553.00 3,237.00
CANAL; CYST OF MEDIAN PALATAL; CYST OF
NASOPALATINE; CYST OF PALATINE PAPILLA
OTHER CYSTS OF JAW; CYST OF JAW NOS; ANEURYSMAL
K09.2 CYST OF JAW; HAEMORRHAGIC CYST OF JAW; TRAUMATIC 10,790.00 7,553.00 3,237.00
CYST OF JAW
OTHER CYSTS OF ORAL REGION, NOT ELSEWHERE
CLASSIFIED; DERMOID CYST OF MOUTH; EPIDERMOID CYST
K09.8 10,790.00 7,553.00 3,237.00
OF MOUTH; LYMPHOEPITHELIAL CYST OF MOUTH;
EPSTEIN'S PEARL; NASOALVEOLAR CYST; NASOLABIAL CYST
K09.9 CYST OF ORAL REGION, UNSPECIFIED 10,790.00 7,553.00 3,237.00
DEVELOPMENTAL DISORDERS OF JAWS; LATENT BONE CYST
K10.0 OF JAW; STAFNE'S CYST; TORUS MANDIBULARIS; TORUS 10,790.00 7,553.00 3,237.00
PALATINUS
GIANT CELL GRANULOMA, CENTRAL; GIANT CELL
K10.1 10,790.00 7,553.00 3,237.00
GRANULOMA NOS
Page 55 of 126
First Case Rate

INFLAMMATORY CONDITIONS OF JAWS; ACUTE OSTEITIS OF
JAW; CHRONIC OSTEITIS OF JAW; SUPPARATIVE OSTEITIS
OF JAW; ACUTE NEONATAL OSTEOMYELITIS OF JAW;
K10.2 10,790.00 7,553.00 3,237.00
CHRONIC NEONATAL OSTEOMYELITIS OF JAW;
SUPPARATIVE NEONATAL OSTEOMYELITIS OF JAW; ACUTE
OSTEORADIONECROSIS O
K10.3 ALVEOLITIS OF JAWS; ALVEOLAR OSTEITIS; DRY SOCKET 10,790.00 7,553.00 3,237.00
OTHER SPECIFIED DISEASES OF JAWS; CHERUBISM OF JAW;
EXOSTOSIS OF JAW; FIBROUS DYSPLASIA OF JAW;
K10.8 10,790.00 7,553.00 3,237.00
UNILATERAL CONDYLAR HYPERPLASIA; UNILATERAL
CONDYLAR HYPOPLASIA
K11.2 SIALOADENITIS 10,790.00 7,553.00 3,237.00
K11.3 ABSCESS OF SALIVARY GLAND 10,790.00 7,553.00 3,237.00
K11.4 FISTULA OF SALIVARY GLAND 10,790.00 7,553.00 3,237.00
SIALOLITHIASIS; CALCULUS OF SALIVARY GLAND OR DUCT;
K11.5 10,790.00 7,553.00 3,237.00
STONE OF SALIVARY GLAND OR DUCT
MUCOCELE OF SALIVARY GLAND; MUCOUS EXTRAVASATION
K11.6 CYST OF SALIVARY GLAND; MUCOUS RETENTION CYST OF 10,790.00 7,553.00 3,237.00
SALIVARY GLAND; RANULA
OTHER DISEASES OF SALIVARY GLANDS; BENIGN
LYMPHOEPITHELIAL LESION OF SALIVARY GLAND;
K11.8 MIKULICZ' DISEASE; NECROTIZING SIALOMETAPLASIA; 10,790.00 7,553.00 3,237.00
SIALECTASIA; STENOSIS OF SALIVARY DUCT; STRICTURE OF
SALIVARY DUCT
DISEASE OF SALIVARY GLAND, UNSPECIFIED;
K11.9 10,790.00 7,553.00 3,237.00
SIALOADENOPATHY NOS
CELLULITIS AND ABSCESS OF MOUTH; CELLULITIS OF
K12.2 10,790.00 7,553.00 3,237.00
FLOOR OF MOUTH; SUBMANDIBULAR ABSCESS
GRANULOMA AND GRANULOMA-LIKE LESIONS OF ORAL
MUCOSA; EOSINOPHILIC GRANULOMA OF ORAL MUCOSA;
K13.4 10,790.00 7,553.00 3,237.00
GRANULOMA PYOGENICUM OF ORAL MUCOSA; VERRUCOUS
XANTHOMA OF ORAL MUCOSA
OTHER AND UNSPECIFIED LESIONS OF ORAL MUCOSA;
K13.7 10,790.00 7,553.00 3,237.00
FOCAL ORAL MUCINOSIS
OESOPHAGITIS; ABSCESS OF OESOPHAGUS; OESOPHAGITIS
K20 10,790.00 7,553.00 3,237.00
NOS; CHEMICAL OESOPHAGITIS; PEPTIC OESOPHAGITIS
GASTRO-OESOPHAGEAL REFLUX DISEASE WITH
K21.0 7,930.00 5,551.00 2,379.00
OESOPHAGITIS; REFLUX OESOPHAGITIS
GASTRO-OESOPHAGEAL REFLUX DISEASE WITHOUT
K21.9 7,930.00 5,551.00 2,379.00
OESOPHAGITIS; OESOPHAGEAL REFLUX NOS
K22.0 ACHALASIA OF CARDIA; ACHALASIA NOS; CARDIOSPASM 10,790.00 7,553.00 3,237.00
ULCER OF OESOPHAGUS; EROSION OF OESOPHAGUS; ULCER

OF OESOPHAGUS NOS; ULCER OF OESOPHAGUS DUE TO
K22.1 INGESTION OF CHEMICALS; ULCER OF OESOPHAGUS DUE 10,790.00 7,553.00 3,237.00
TO INGESTION OF DRUGS AND MEDICAMENTS; FUNGAL
ULCER OF OESOPHAGUS; PEPTIC ULCER OF OESOPHAGUS
OESOPHAGEAL OBSTRUCTION; COMPRESSION OF

K22.2 OESOPHAGUS; CONSTRICTION OF OESOPHAGUS; STENOSIS 10,790.00 7,553.00 3,237.00
OF OESOPHAGUS; STRICTURE OF OESOPHAGUS;
PERFORATION OF OESOPHAGUS; RUPTURE OF
K22.3 10,790.00 7,553.00 3,237.00
OESOPHAGUS
DYSKINESIA OF OESOPHAGUS; CORKSREW OESOPHAGUS;
K22.4 10,790.00 7,553.00 3,237.00
DIFFUSE OESOPHAGEAL SPASM; SPASM OF OESOPHAGUS
GASTRO-OESOPHAGEAL LACERATION-HAEMORRHAGE
K22.6 10,790.00 7,553.00 3,237.00
SYNDROME; MALLORY-WEISS SYNDROME
BARRETT'S ESOPHAGUS; BARRET'S DISEASE; BARETT'S
K22.7 10,790.00 7,553.00 3,237.00
SYNDROME
OTHER SPECIFIED DISEASES OF OESOPHAGUS;
K22.8 10,790.00 7,553.00 3,237.00
HAEMORRHAGE OF OESOPHAGUS NOS
K22.9 DISEASE OF OESOPHAGUS, UNSPECIFIED 10,790.00 7,553.00 3,237.00
GASTRIC ULCER, ACUTE / ACUTE EROSION OF STOMACH/
K25.0 PYLORUS PEPTIC ULCER / STOMACH PEPTIC ULCER WITH 16,640.00 11,648.00 4,992.00
HEMORRHAGE
GASTRIC ULCER, ACUTE/ ACUTE EROSION OF STOMACH/
PERFORATION
BOTH HAEMORRHAGE AND PERFORATION

K25.3 PYLORUS PEPTIC ULCER / STOMACH PEPTIC ULCER 7,930.00 5,551.00 2,379.00
WITHOUT HAEMORRHAGE OR PERFORATION
Page 56 of 126
First Case Rate

GASTRIC/ PEPTIC/ PYLORIC ULCER/ EROSION, CHRONIC OR
K25.4 16,640.00 11,648.00 4,992.00
UNSPECIFIED WITH HAEMORRHAGE
K25.5 16,640.00 11,648.00 4,992.00
UNSPECIFIED WITH PERFORATION
K25.6 UNSPECIFIED WITH BOTH HAEMORRHAGE AND 16,640.00 11,648.00 4,992.00
PERFORATION
GASTRIC/ PEPTIC/ PYLORIC ULCER/ EROSION, CHRONIC
K25.7 7,930.00 5,551.00 2,379.00
GASTRIC/ PEPTIC/ PYLORIC ULCER/ EROSION, UNSPECIFIED
K25.9 AS ACUTE OR CHRONIC, WITHOUT HAEMORRHAGE OR 7,930.00 5,551.00 2,379.00
PERFORATION
DUODENAL ULCER, ACUTE / ACUTE EROSION OF
K26.0 DUODENUM/ DUODENAL PEPTIC ULCER/ POSTPYLORIC 16,640.00 11,648.00 4,992.00
PEPTIC ULCER WITH HAEMORRHAGE
K26.1 DUODENUM/ DUODENAL PEPTIC ULCER/ POSTPYLORIC 16,640.00 11,648.00 4,992.00
PEPTIC ULCER WITH PERFORATION
DUODENUM/ DUODENAL PEPTIC ULCER/ POSTPYLORIC
K26.3 7,930.00 5,551.00 2,379.00
PEPTIC ULCER WITHOUT HAEMORRHAGE OR
PERFORATION
CHRONIC DUODENAL/ POSTPYLORIC ULCER/ EROSION, OR
K26.4 16,640.00 11,648.00 4,992.00
UNSPECIFIED WITH HAEMORRHAGE
K26.5 16,640.00 11,648.00 4,992.00
UNSPECIFIED WITH PERFORATION
K26.6 UNSPECIFIED WITH BOTH HAEMORRHAGE AND 16,640.00 11,648.00 4,992.00
PERFORATION
CHRONIC DUODENAL/ POSTPYLORIC ULCER/ EROSION,
K26.7 7,930.00 5,551.00 2,379.00
DUODENAL/ POSTPYLORIC ULCER/ EROSION, UNSPECIFIED
K26.9 AS ACUTE OR CHRONIC, WITHOUT HAEMORRHAGE OR 7,930.00 5,551.00 2,379.00
PERFORATION
ACUTE PEPTIC ULCER/ GASTRODUODENAL ULCER NOS, SITE
K27.0 16,640.00 11,648.00 4,992.00
UNSPECIFIED, WITH HAEMORRHAGE
ACUTE PEPTIC ULCER / GASTRODUODENAL ULCER, SITE
K27.1 16,640.00 11,648.00 4,992.00
UNSPECIFIED, WITH PERFORATION
ACUTE PEPTIC/ GASTRODUODENAL ULCER, SITE
K27.2 UNSPECIFIED, WITH BOTH HAEMORRHAGE AND 16,640.00 11,648.00 4,992.00
PERFORATION
ACUTE PEPTIC/ GASTRODUODENAL ULCER, SITE
K27.3 7,930.00 5,551.00 2,379.00
UNSPECIFIED, WITHOUT HAEMORRHAGE OR PERFORATION
CHRONIC OR UNSPECIFIED PEPTIC/ GASTRODUODENAL

K27.4 16,640.00 11,648.00 4,992.00
ULCER, SITE UNSPECIFIED, WITH HAEMORRHAGE

K27.5 16,640.00 11,648.00 4,992.00
ULCER, SITE UNSPECIFIED WITH PERFORATION
K27.6 ULCER, SITE UNSPECIFIED, WITH BOTH HAEMORRHAGE 16,640.00 11,648.00 4,992.00
AND PERFORATION
CHRONIC PEPTIC/ GASTRODUODENAL ULCER, SITE
K27.7 UNSPECIFIED, WITHOUT HAEMORRHAGE OR 7,930.00 5,551.00 2,379.00
PERFORATION
PEPTIC/ GASTRODUODENAL ULCER, UNSPECIFIED AS
K27.9 ACUTE OR CHRONIC, WITHOUT HAEMORRHAGE OR 7,930.00 5,551.00 2,379.00
PERFORATION
ACUTE GASTROJEJUNAL ULCER/ ANASTOMOTIC PEPTIC
ULCER OR EROSION/ GASTROCOLIC PEPTIC ULCER OR
EROSION/ GASTROINTESTINAL PEPTIC ULCER OR EROSION/
K28.0 16,640.00 11,648.00 4,992.00
GASTROJEJUNAL PEPTIC ULCER OR EROSION/ JEJUNAL
PEPTIC ULCER OR EROSION/ MARGINAL PEPTIC ULCER OR
EROSION/ STOMAL
K28.1 16,640.00 11,648.00 4,992.00
EROSION/ STOMAL
K28.2 16,640.00 11,648.00 4,992.00
EROSION/ STOMAL
Page 57 of 126
First Case Rate

K28.3 16,640.00 11,648.00 4,992.00
EROSION/ STOMAL
CHRONIC OR UNSPECIFIED GASTROJEJUNAL ULCER/
ANASTOMOTIC PEPTIC ULCER OR EROSION/ GASTROCOLIC
PEPTIC ULCER OR EROSION/ GASTROINTESTINAL PEPTIC
K28.4 16,640.00 11,648.00 4,992.00
ULCER OR EROSION/ GASTROJEJUNAL PEPTIC ULCER OR
EROSION/ JEJUNAL PEPTIC ULCER OR EROSION/ MARGINAL
PEPTIC ULCER O

K28.5 16,640.00 11,648.00 4,992.00
PEPTIC ULCER O

K28.6 16,640.00 11,648.00 4,992.00
PEPTIC ULCER O
CHRONIC GASTROJEJUNAL ULCER/ ANASTOMOTIC PEPTIC
K28.7 7,930.00 5,551.00 2,379.00
EROSION/ STOM
UNSPECIFIED AS ACUTE OR CHRONIC GASTROJEJUNAL
ULCER/ ANASTOMOTIC PEPTIC ULCER OR EROSION/
GASTROCOLIC PEPTIC ULCER OR EROSION/
K28.9 7,930.00 5,551.00 2,379.00
GASTROINTESTINAL PEPTIC ULCER OR EROSION/
PEPTIC ULCER OR EROSION/ MARGINAL PEPTI
ACUTE HAEMORRHAGIC GASTRITIS; ACUTE EROSIVE
K29.0 16,640.00 11,648.00 4,992.00
GASTRITIS WITH HAEMORRHAGE
K29.1 OTHER ACUTE GASTRITIS 7,930.00 5,551.00 2,379.00
K29.2 ALCOHOLIC GASTRITIS 7,930.00 5,551.00 2,379.00
K29.3 CHRONIC SUPERFICIAL GASTRITIS 7,930.00 5,551.00 2,379.00
K29.4 CHRONIC ATROPHIC GASTRITIS; GASTRIC ATROPHY 7,930.00 5,551.00 2,379.00
CHRONIC GASTRITIS, UNSPECIFIED; CHRONIC ANTRAL
K29.5 7,930.00 5,551.00 2,379.00
GASTRITIS; CHRONIC FUNDAL GASTRITIS
OTHER GASTRITIS; GIANT HYPERTROPHIC GASTRITIS;
K29.6 7,930.00 5,551.00 2,379.00
GRANULOMATOUS GASTRITIS; MENETRIER'S DISEASE
K29.7 GASTRITIS, UNSPECIFIED 7,930.00 5,551.00 2,379.00
K29.8 DUODENITIS 7,930.00 5,551.00 2,379.00
K29.9 GASTRODUODENITIS, UNSPECIFIED 7,930.00 5,551.00 2,379.00
K30 DYSPEPSIA 5,200.00 3,640.00 1,560.00
ACUTE DILATATION OF STOMACH; ACUTE DISTENSION OF
K31.0 5,200.00 3,640.00 1,560.00
STOMACH
ADULT HYPERTROPHIC PYLORIC STENOSIS; PYLORIC
K31.1 8,580.00 6,006.00 2,574.00
STENOSIS NOS
K31.2 HOURGLASS STRICTURE AND STENOSIS OF STOMACH 8,580.00 6,006.00 2,574.00
K31.3 PYLOROSPASM, NOT ELSEWHERE CLASSIFIED 8,580.00 6,006.00 2,574.00
K31.4 GASTRIC DIVERTICULUM 8,580.00 6,006.00 2,574.00
OBSTRUCTION OF DUODENUM; CONSTRICTION OF
K31.5 DUODENUM; STENOSIS OF DUODENUM; STRICTURE OF 8,580.00 6,006.00 2,574.00
DUODENUM; CHRONIC DUODENAL ILEUS
FISTULA OF STOMACH AND DUODENUM; GASTROCOLIC
K31.6 8,580.00 6,006.00 2,574.00
FISTULA; GASTROJEJUNOCOLIC FISTULA
K31.7 POLYP OF STOMACH AND DUODENUM 8,580.00 6,006.00 2,574.00
OTHER SPECIFIED DISEASES OF STOMACH AND
K31.8 DUODENUM; ACHLORHYDRIA; GASTROPTOSIS; HOURGLASS 8,580.00 6,006.00 2,574.00
CONTRACTION OF STOMACH
K31.9 DISEASE OF STOMACH AND DUODENUM, UNSPECIFIED 5,200.00 3,640.00 1,560.00
CROHN'S DISEASE OF SMALL INTESTINE; CROHN'S DISEASE
[REGIONAL ENTERITIS] OF DUODENUM; CROHN'S DISEASE
K50.0 [REGIONAL ENTERITIS] OF ILEUM; CROHN'S DISEASE 11,830.00 8,281.00 3,549.00
[REGIONAL ENTERITIS] OF JEJUNUM; REGIONAL ILEITIS;
TERMINAL ILEITIS
Page 58 of 126
First Case Rate

CROHN'S DISEASE OF LARGE INTESTINE; GRANULOMATOUS
COLITIS; REGIONAL COLITIS; CROHN'S DISEASE [REGIONAL
K50.1 ENTERITIS] OF COLON; CROHN'S DISEASE [REGIONAL 11,830.00 8,281.00 3,549.00
ENTERITIS] OF LARGE BOWEL; CROHN'S DISEASE
[REGIONAL ENTERITIS] OF RECTUM
OTHER CROHN'S DISEASE; CROHN'S DISEASE OF BOTH
K50.8 11,830.00 8,281.00 3,549.00
SMALL AND LARGE INTESTINE
CROHN'S DISEASE [REGIONAL ENTERITIS], UNSPECIFIED;
K50.9 CROHN'S DISEASE NOS; REGIONAL ENTERITIS NOS; 11,830.00 8,281.00 3,549.00
GRANULOMATOUS ENTERITIS NOS
K51.0 ULCERATIVE (CHRONIC) ENTEROCOLITIS 11,830.00 8,281.00 3,549.00
K51.1 ULCERATIVE (CHRONIC) ILEOCOLITIS 11,830.00 8,281.00 3,549.00
K51.2 ULCERATIVE (CHRONIC) PROCTITIS 11,830.00 8,281.00 3,549.00
K51.3 ULCERATIVE (CHRONIC) RECTOSIGMOIDITIS 11,830.00 8,281.00 3,549.00
K51.5 MUCOSAL PROCTOCOLITIS 11,830.00 8,281.00 3,549.00
K51.8 OTHER ULCERATIVE COLITIS 11,830.00 8,281.00 3,549.00
ULCERATIVE COLITIS, UNSPECIFIED; ULCERATIVE
K51.9 11,830.00 8,281.00 3,549.00
ENTERITIS NOS
K52.0 GASTROENTERITIS AND COLITIS DUE TO RADIATION 7,800.00 5,460.00 2,340.00
K52.1 TOXIC GASTROENTERITIS AND COLITIS 7,800.00 5,460.00 2,340.00
ALLERGIC AND DIETETIC GASTROENTERITIS AND COLITIS;
K52.2 7,800.00 5,460.00 2,340.00
FOOD HYPERSENSITIVITY GASTROENTERITIS OR COLITIS
OTHER SPECIFIED NONINFECTIVE GASTROENTERITIS AND

K52.8 7,800.00 5,460.00 2,340.00
COLITIS; EOSINOPHILIC GASTRITIS OR GASTROENTERITIS
NONINFECTIVE GASTROENTERITIS AND COLITIS,

UNSPECIFIED; DIARRHOEA SPECIFIED AS NONINFECTIVE,
OR NOS IN COUNTRIES WHERE THE CONDITIONS CAN BE
K52.9 7,800.00 5,460.00 2,340.00
PRESUMED TO BE OF NONINFECTIOUS ORIGIN; ENTERITIS
SPECIFIED AS NONINFECTIVE, OR NOS IN COUNTRIES
WHERE THE CONDITIO
ACUTE VASCULAR DISORDERS OF INTESTINE; ACUTE

FULMINANT ISCHAEMIC COLITIS; ACUTE INTESTINAL
INFARCTION; ACUTE SMALL INTESTINE ISCHAEMIA;
K55.0 12,350.00 8,645.00 3,705.00
MESENTRIC ARTERY EMBOLISM; MESENTRIC VEIN
EMBOLISM; MESENTRIC ARTERY INFARCTION; MESENTRIC
VEIN INFARCTION; MESENTRIC A
CHRONIC VASCULAR DISORDERS OF INTESTINE; CHRONIC

ISCHAEMIC COLITIS; CHRONIC ISCHAEMIC ENTERITIS;
K55.1 CHRONIC ISCHAEMIC ENTEROCOLITIS; ISCHAEMIC 12,350.00 8,645.00 3,705.00
STRICTURE OF INTESTINE; MESENTRIC ATHEROSCLEROSIS;
MESENTRIC VASCULAR INSUFFICIENCY
K55.2 ANGIODYSPLASIA OF COLON 12,350.00 8,645.00 3,705.00
VASCULAR DISORDER OF INTESTINE, UNSPECIFIED;
K55.9 ISCHAEMIC COLITIS NOS; ISCHAEMIC ENTERITIS NOS; 12,350.00 8,645.00 3,705.00
ISCHAEMIC ENTEROCOLITIS NOS
PARALYTIC ILEUS; PARALYSIS OF BOWEL; PARALYSIS OF
K56.0 13,130.00 9,191.00 3,939.00
COLON; PARALYSIS OF INTESTINE
INTUSSUSCEPTION; INTUSSUSCEPTION OR INVAGINATION
OF BOWEL; INTUSSUSCEPTION OR INVAGINATION OF
K56.1 COLON; INTUSSUSCEPTION OR INVAGINATION OF 13,130.00 9,191.00 3,939.00
INTESTINE; INTUSSUSCEPTION OR INVAGINATION OF
RECTUM
VOLVULUS; STRANGULATION OF COLON OR INTESTINE;
K56.2 TORSION OF COLON OR INTESTINE; TWIST OF COLON OR 13,130.00 9,191.00 3,939.00
INTESTINE
GALLSTONE ILEUS; OBSTRUCTION OF INTESTINE BY
K56.3 13,130.00 9,191.00 3,939.00
GALLSTONE
OTHER IMPACTION OF INTESTINE; ENTEROLITH;
K56.4 13,130.00 9,191.00 3,939.00
IMPACTION OF COLON; IMFACTION OF FAECAL
INTESTINAL ADHESIONS [BANDS] WITH OBSTRUCTION;
K56.5 PERITONEAL ADHESIONS [BANDS] WITH INTESTINAL 13,130.00 9,191.00 3,939.00
OBSTRUCTION
OTHER AND UNSPECIFIED INTESTINAL OBSTRUCTION;
ENTEROTENOSIS; OBSTRUCTIVE ILEUS NOS; OCCLUSION OF
K56.6 13,130.00 9,191.00 3,939.00
COLON OR INTESTINE; STENOSIS OF COLON OR INTESTINE;
STRICTURE OF COLON OR INTESTINE
K56.7 ILEUS, UNSPECIFIED 13,130.00 9,191.00 3,939.00
DIVERTICULAR DISEASE OF SMALL INTESTINE WITH
K57.0 PERFORATION AND ABSCESS; DIVERTICULAR DISEASE OF 12,350.00 8,645.00 3,705.00
SMALL INTESTINE WITH PERITONITIS
DIVERTICULAR DISEASE OF SMALL INTESTINE WITHOUT
K57.1 PERFORATION OR ABSCESS; DIVERTICULAR DISEASE OF 12,350.00 8,645.00 3,705.00
SMALL INTESTINE NOS
Page 59 of 126
First Case Rate

DIVERTICULAR DISEASE OF LARGE INTESTINE WITH
PERFORATION AND ABSCESS; DIVERTICULAR DISEASE/
K57.2 12,350.00 8,645.00 3,705.00
DIVERTICULITIS/ DIVERTICULOSIS/ DIVERTICULUM OF
COLON WITH PERITONITIS
DIVERTICULAR DISEASE OF LARGE INTESTINE WITHOUT
K57.3 PERFORATION OR ABSCESS; DIVERTICULAR DISEASE OF 12,350.00 8,645.00 3,705.00
COLON NOS
DIVERTICULAR DISEASE OF BOTH SMALL AND LARGE
INTESTINE WITH PERFORATION AND ABSCESS;
K57.4 12,350.00 8,645.00 3,705.00
INTESTINE WITH PERITONITIS
INTESTINE WITHOUT PERFORATION OR ABSCESS;
K57.5 12,350.00 8,645.00 3,705.00
INTESTINE NOS
DIVERTICULAR DISEASE OF INTESTINE, PART UNSPECIFIED,
K57.8 WITH PERFORATION AND ABSCESS; DIVERTICULAR 12,350.00 8,645.00 3,705.00
DISEASE OF INTESTINE NOS WITH PERITONITIS
DIVERTICULAR DISEASE OF INTESTINE, PART UNSPECIFIED,
K57.9 WITHOUT PERFORATION OR ABSCESS; DIVERTICULAR 12,350.00 8,645.00 3,705.00
DISEASE OF INTESTINE NOS
K58.0 IRRITABLE BOWEL SYNDROME WITH DIARRHOEA 7,800.00 5,460.00 2,340.00
K59.0 CONSTIPATION 5,200.00 3,640.00 1,560.00
MEGACOLON, NOT ELSEWHERE CLASSIFIED; DILATATION
K59.3 12,350.00 8,645.00 3,705.00
OF COLON; TOXIC MEGACOLON
OTHER SPECIFIED FUNCTIONAL INTESTINAL DISORDERS;
K59.8 12,350.00 8,645.00 3,705.00
ATONY OF COLON
K59.9 FUNCTIONAL INTESTINAL DISORDER, UNSPECIFIED 12,350.00 8,645.00 3,705.00
K63.0 ABSCESS OF INTESTINE 12,350.00 8,645.00 3,705.00
K63.1 NONTRAUMATIC PERFORATION OF INTESTINE 12,350.00 8,645.00 3,705.00
K63.2 FISTULA OF INTESTINE 12,350.00 8,645.00 3,705.00
ULCER OF INTESTINE; PRIMARY ULCER OF SMALL
K63.3 12,350.00 8,645.00 3,705.00
INTESTINE
K63.4 ENTEROPTOSIS 12,350.00 8,645.00 3,705.00
K63.5 POLYP OF COLON 12,350.00 8,645.00 3,705.00
K63.8 OTHER SPECIFIED DISEASES OF INTESTINE 12,350.00 8,645.00 3,705.00
K63.9 DISEASE OF INTESTINE, UNSPECIFIED 12,350.00 8,645.00 3,705.00
ACUTE PERITONITIS; ABDOMINOPELVIC ABSCESS;
MESENTERIC ABSCESS; ABSCESS OF OMENTUM; ABSCESS OF
PERITONEUM; RETROCAECAL ABSCESS; RETROPERITONEAL
K65.0 19,110.00 13,377.00 5,733.00
ABSCESS; SUBDIAPHRAGMATIC ABSCESS; SUBHEPATIC
ABSCESS; SUBPHRENIC ABSCESS; ACUTE GENERALIZED
PERITONITIS; ACUTE
OTHER PERITONITIS; CHRONIC PROLIFERATIVE
PERITONITIS; MESENTRIC FAT NECROSIS; MESENTRIC
K65.8 19,110.00 13,377.00 5,733.00
SAPONIFICATION; PERITONITIS DUE TO BILE; PERITONITIS
DUE TO URINE
K65.9 PERITONITIS, UNSPECIFIED 19,110.00 13,377.00 5,733.00
PERITONEAL ADHESIONS; ADHESIONS OF ABDOMINAL
WALL; ADHESIONS OF DIAPHRAGM; ADHESIONS OF
K66.0 INTESTINE; ADHESIONS OF MALE PELVIS; 14,040.00 9,828.00 4,212.00
MESENTERICADHESIONS; ADHESIONS OF OMENTUM;
ADHESIONS OF STOMACH; ADHESIVE BANDS
K66.8 OTHER SPECIFIED DISORDERS OF PERITONEUM 14,040.00 9,828.00 4,212.00
K66.9 DISORDER OF PERITONEUM, UNSPECIFIED 14,040.00 9,828.00 4,212.00
K70.0 ALCOHOLIC FATTY LIVER 15,340.00 10,738.00 4,602.00
K70.1 ALCOHOLIC HEPATITIS 15,340.00 10,738.00 4,602.00
K70.2 ALCOHOLIC FIBROSIS AND SCLEROSIS OF LIVER 15,340.00 10,738.00 4,602.00
ALCOHOLIC CIRRHOSIS OF LIVER; ALCOHOLIC CIRRHOSIS
K70.3 15,340.00 10,738.00 4,602.00
NOS; LAENNEC'S CIRRHOSIS
ALCOHOLIC HEPATIC FAILURE; ALCOHOLIC HEPATIC
FAILURE NOS; ACUTE ALCOHOLIC HEPATIC FAILURE;
K70.4 CHRONIC ALCOHOLIC HEPATIC FAILURE; SUBACUTE 26,780.00 18,746.00 8,034.00
ALCOHOLIC HEPATIC FAILURE; ALCOHOLIC HEPATIC
FAILURE WITH OR WITHOUT HEPATIC COMA
K70.9 ALCOHOLIC LIVER DISEASE, UNSPECIFIED 15,340.00 10,738.00 4,602.00
TOXIC LIVER DISEASE WITH CHOLESTASIS; CHOLESTATIS
K71.0 15,340.00 10,738.00 4,602.00
WITH HEPATOCYTE INJURY; PURE CHOLESTASIS
TOXIC LIVER DISEASE WITH HEPATIC NECROSIS; ACUTE
K71.1 HEPATIC FAILURE DUE TO DRUGS; CHRONIC HEPATIC 15,340.00 10,738.00 4,602.00
FAILURE DUE TO DRUGS
K71.2 TOXIC LIVER DISEASE WITH ACUTE HEPATITIS 15,340.00 10,738.00 4,602.00
TOXIC LIVER DISEASE WITH CHRONIC PERSISTENT
K71.3 15,340.00 10,738.00 4,602.00
HEPATITIS
K71.4 TOXIC LIVER DISEASE WITH CHRONIC LOBULAR HEPATITIS 19,630.00 13,741.00 5,889.00
TOXIC LIVER DISEASE WITH CHRONIC ACTIVE HEPATITIS;

K71.5 15,340.00 10,738.00 4,602.00
TOXIC LIVER DISEASE WITH LUPOID HEPATITIS
Page 60 of 126
First Case Rate

TOXIC LIVER DISEASE WITH HEPATITIS, NOT ELSEWHERE
K71.6 15,340.00 10,738.00 4,602.00
CLASSIFIED
TOXIC LIVER DISEASE WITH FIBROSIS AND CIRRHOSIS OF
K71.7 19,630.00 13,741.00 5,889.00
LIVER
TOXIC LIVER DISEASE WITH OTHER DISORDERS OF LIVER;
TOXIC LIVER DISEASE WITH FOCAL NODULAR
HYPERPLASIA; TOXIC LIVER DISEASE WITH HEPATIC
K71.8 15,340.00 10,738.00 4,602.00
GRANULOMAS; TOXIC LIVER DISEASE WITH PELIOSIS
HEPATIS; TOXIC LIVER DISEASE WITH VENO-OCCLUSIVE
DISEASE OF LIVER
K71.9 TOXIC LIVER DISEASE, UNSPECIFIED 15,340.00 10,738.00 4,602.00
K72.0 ACUTE AND SUBACUTE HEPATIC FAILURE 26,780.00 18,746.00 8,034.00
K72.1 CHRONIC HEPATIC FAILURE 26,780.00 18,746.00 8,034.00
K72.9 HEPATIC FAILURE 26,780.00 18,746.00 8,034.00
CHRONIC PERSISTENT HEPATITIS, NOT ELSEWHERE
K73.0 15,340.00 10,738.00 4,602.00
CLASSIFIED
CHRONIC ACTIVE HEPATITIS, NOT ELSEWHERE CLASSIFIED;
K73.2 15,340.00 10,738.00 4,602.00
LUPOID HEPATITIS NEC
K73.8 OTHER CHRONIC HEPATITIS, NOT ELSEWHERE CLASSIFIED 15,340.00 10,738.00 4,602.00
K73.9 CHRONIC HEPATITIS, UNSPECIFIED 15,340.00 10,738.00 4,602.00
K74.0 HEPATIC FIBROSIS 19,630.00 13,741.00 5,889.00
K74.1 HEPATIC SCLEROSIS 15,340.00 10,738.00 4,602.00
K74.2 HEPATIC FIBROSIS WITH HEPATIC SCLEROSIS 19,630.00 13,741.00 5,889.00
PRIMARY BILIARY CIRRHOSIS; CHRONIC NONSUPPARATIVE
K74.3 17,160.00 12,012.00 5,148.00
DESTRUCTIVE CHOLANGITIS
K74.4 SECONDARY BILIARY CIRRHOSIS 12,740.00 8,918.00 3,822.00
K74.5 BILIARY CIRRHOSIS, UNSPECIFIED 12,740.00 8,918.00 3,822.00
OTHER AND UNSPECIFIED CIRRHOSIS OF LIVER; CIRRHOSIS
OF LIVER NOS; CRYPTOGENIC CIRRHOSIS OF LIVER;
MACRONODULAR CIRRHOSIS OF LIVER; MICRONODULAR
K74.6 19,630.00 13,741.00 5,889.00
CIRRHOSIS OF LIVER; MIXED TYPE CIRRHOSIS OF LIVER;
PORTAL CIRRHOSIS OF LIVER; POSTNECROTIC CIRRHOSIS
OF LIVER;
OESOPHAGEAL VARICES IN OTHER AND UNSPECIFIED
K74.6+I98.2* 15,340.00 10,738.00 4,602.00
CIRRHOSIS OF LIVER
ABSCESS OF LIVER; HEPATIC ABSCESS NOS; CHOLANGITIC
HEPATIC ABSCESS; HAEMATOGENIC HEPATIC ABSCESS;
K75.0 15,340.00 10,738.00 4,602.00
LYMPHOGENIC HEPATIC ABSCESS; PYLEPHLEBITIC HEPATIC
ABSCESS
K75.1 PHLEBITIS OF PORTAL VEIN; PYLEPHLEBITIS 15,340.00 10,738.00 4,602.00
K75.2 NONSPECIFIC REACTIVE HEPATITIS 15,340.00 10,738.00 4,602.00
GRANULOMATOUS HEPATITIS, NOT ELSEWHERE
K75.3 15,340.00 10,738.00 4,602.00
CLASSIFIED
K75.4 AUTOIMMUNE HEPATITIS 15,340.00 10,738.00 4,602.00
K75.8 OTHER SPECIFIED INFLAMMATORY LIVER DISEASES 15,340.00 10,738.00 4,602.00
INFLAMMATORY LIVER DISEASE, UNSPECIFIED; HEPATITIS
K75.9 15,340.00 10,738.00 4,602.00
NOS
K76.0 FATTY (CHANGE OF) LIVER, NOT ELSEWHERE CLASSIFIED 15,340.00 10,738.00 4,602.00
CHRONIC PASSIVE CONGESTION OF LIVER; CARDIAC
K76.1 CIRRHOSIS (SO-CALLED) OF LIVER; CARDIAC SCLEROSIS OF 19,630.00 13,741.00 5,889.00
LIVER
K76.2 CENTRAL HAEMORRHAGIC NECROSIS OF LIVER 19,630.00 13,741.00 5,889.00
K76.3 INFARCTION OF LIVER 19,630.00 13,741.00 5,889.00
K76.4 PELIOSIS HEPATIS; HEPATIC ANGIOMATOSIS 19,630.00 13,741.00 5,889.00
K76.6 PORTAL HYPERTENSION 19,630.00 13,741.00 5,889.00
K76.7 HEPATORENAL SYNDROME 19,630.00 13,741.00 5,889.00
OTHER SPECIFIED DISEASES OF LIVER; FOCAL NODULAR
K76.8 15,340.00 10,738.00 4,602.00
HYPERPLASIA OF LIVER; HEPATOPTOSIS
K76.9 LIVER DISEASE, UNSPECIFIED 15,340.00 10,738.00 4,602.00
CALCULUS OF GALLBLADDER WITH ACUTE CHOLECYSTITIS;
K80.0 ANY CONDITION LISTED IN K80.2 WITH ACUTE 14,690.00 10,283.00 4,407.00
CHOLECYSTITIS
CALCULUS OF GALLBLADDER WITH OTHER CHOLECYSTITIS;
ANY CONDITION LISTED IN K80.2 WITH CHRONIC
K80.1 14,690.00 10,283.00 4,407.00
CHOLECYSTITIS; CHOLECYSTITIS WITH CHOLELITHIASIS
NOS
CALCULUS OF GALLBLADDER WITHOUT CHOLECYSTITIS;
CHOLECYSTOLITHIASIS UNSPECIFIED OR WITHOUT
CHOLECYSTITIS; CHOLELITHIASIS UNSPECIFIED OR
K80.2 12,740.00 8,918.00 3,822.00
WITHOUT CHOLECYSTITIS; RECURRENT COLIC OF
GALLBLADDER UNSPECIFIED OR WITHOUT CHOLECYSTITIS;
IMPACTED GALLSTONE OF CYSTIC
CALCULUS OF BILE DUCT WITH CHOLANGITIS; ANY
K80.3 17,160.00 12,012.00 5,148.00
CONDITION LISTED IN K80.5 WITH CHOLANGITIS
CALCULUS OF BILE DUCT WITH CHOLECYSTITIS; ANY
K80.4 CONDITION LISTED IN K80.5 WITH CHOLECYSTITIS (WITH 14,690.00 10,283.00 4,407.00
CHOLANGITIS)
Page 61 of 126
First Case Rate

CALCULUS OF BILE DUCT WITHOUT CHOLANGITIS OR
CHOLECYSTITIS; CHOLEDOCHOLITHIASIS UNSPECIFIED OR
WITHOUT CHOLANGITIS OR CHOLECYSTITIS; IMPACTED
K80.5 12,740.00 8,918.00 3,822.00
GALLSTONE OF BILE DUCT NOS UNSPECIFIED OR WITHOUT
CHOLANGITIS OR CHOLECYSTITIS; IMPACTED GALLSTONE
OF COMMON DUCT
K80.8 OTHER CHOLELITHIASIS 12,740.00 8,918.00 3,822.00
ACUTE CHOLECYSTITIS; ABSCESS OF GALLBLADDER
WITHOUT CALCULUS; ANGIOCHOLECYSTITIS WITHOUT
CALCULUS; ACUTE EMPHYSEMATOUS CHOLECYSTITIS
K81.0 14,690.00 10,283.00 4,407.00
WITHOUT CALCULUS; GANGRENOUS CHOLECYSTITIS
WITHOUT CALCULUS; SUPPARATIVE CHOLECYSTITIS
WITHOUT CALCULUS; EMPYEMA OF GALLBL
K81.1 CHRONIC CHOLECYSTITIS 14,690.00 10,283.00 4,407.00
K81.8 OTHER CHOLECYSTITIS 14,690.00 10,283.00 4,407.00
OBSTRUCTION OF GALLBLADDER; OCCLUSION OF CYSTIC
DUCT OF GALLBLADDER WITHOUT CALCULUS; STENOSIS OF
K82.0 CYSTIC DUCT OR GALLBLADDER WITHOUT CALCULUS; 12,740.00 8,918.00 3,822.00
STRICTURE OF CYSTIC DUCT OR GALLBLADDER WITHOUT
CALCULUS
K82.1 HYDROPS OF GALLBLADDER; MUCOCELE OF GALLBLADDER 12,740.00 8,918.00 3,822.00
PERFORATION OF GALLBLADDER; RUPTURE OF CYSTIC
K82.2 12,740.00 8,918.00 3,822.00
DUCT OR GALLBLADDER
FISTULA OF GALLBLADDER; CHOLECYSTOCOLIC FISTULA;
K82.3 12,740.00 8,918.00 3,822.00
CHOLECYSTODUODENAL FISTULA
CHOLESTEROLOSIS OF GALLBLADDER; STRAWBERRY
K82.4 12,740.00 8,918.00 3,822.00
GALLBLADDER
OTHER SPECIFIED DISEASES OF GALLBLADDER; ADHESIONS
OF CYSTIC DUCT OR GALLBLADDER; ATROPHY OF CYSTIC
DUCT OR GALLBLADDER; CYST OF CYSTIC DUCT OR
K82.8 12,740.00 8,918.00 3,822.00
GALLBLADDER; DYSKINESIA OF CYSTIC DUCT OR
GALLBLADDER; HYPERTROPHY OF CYSTIC DUCT OR
GALLBLADDER; NONFUNCTIONIN
CHOLANGITIS; CHOLANGITIS NOS; ASCENDING
CHOLANGITIS; PRIMARY CHOLANGITIS; RECURRENT
K83.0 CHOLANGITIS; SCLEROSING CHOLANGITIS; SECONDARY 12,740.00 8,918.00 3,822.00
CHOLANGITIS; STENOSING CHOLANGITIS; SUPPURATIVE
CHOLANGITIS
OBSTRUCTION OF BILE DUCT; OCCLUSION OF BILE DUCT
K83.1 WITHOUT CALCULUS; STENOSIS OF BILE DUCT WITHOUT 12,740.00 8,918.00 3,822.00
CALCULUS; STRICTURE OF BILE DUCT WITHOUT CALCULUS
K83.3 FISTULA OF BILE DUCT; CHOLEDOCHODUODENAL FISTULA 12,740.00 8,918.00 3,822.00

K83.4 SPASM OF SPHINCTER OF ODDI 12,740.00 8,918.00 3,822.00
K83.5 BILIARY CYST 12,740.00 8,918.00 3,822.00
OTHER SPECIFIED DISEASES OF BILIARY TRACT;
K83.8 ADHESIONS OF BILE DUCT; ATROPHY OF BILE DUCT; 12,740.00 8,918.00 3,822.00
HYPERTROPHY OF BILE DUCT; ULCER OF BILE DUCT
ACUTE PANCREATITIS; ABSCESS OF PANCREAS; ACUTE
NECROSIS OF PANCREAS; INFECTIVE NECROSIS OF
K85 PANCREAS; PANCREATITIS NOS; ACUTE RECURRENT 16,380.00 11,466.00 4,914.00
PANCREATITIS; HAEMORRHAGIC PANCREATITIS; SUBACUTE
PANCREATITIS; SUPPARATIVE PANCREATITIS
K85.0 IDIOPATHIC ACUTE PANCREATITIS 16,380.00 11,466.00 4,914.00
K85.1 BILIARY ACUTE PANCREATITIS; GALLSTONE PANCREATITIS 16,380.00 11,466.00 4,914.00
K85.2 ALCOHOL-INDUCED ACUTE PANCREATITIS 16,380.00 11,466.00 4,914.00
K85.8 OTHER ACUTE PANCREATITIS 16,380.00 11,466.00 4,914.00
ACUTE PANCREATITIS, UNSPECIFIED; OTHER DISEASES OF
K85.9 16,380.00 11,466.00 4,914.00
PANCREAS
K86.0 ALCOHOL-INDUCED CHRONIC PANCREATITIS 16,380.00 11,466.00 4,914.00
OTHER CHRONIC PANCREATITIS; CHRONIC PANCREATITIS
NOS; INFECTIOUS CHRONIC PANCREATITIS; RECURRENT
K86.1 16,380.00 11,466.00 4,914.00
CHRONIC PANCREATITIS; RELAPSING CHRONIC
PANCREATITIS
K86.2 CYST OF PANCREAS 16,380.00 11,466.00 4,914.00
K86.3 PSEUDOCYST OF PANCREAS 16,380.00 11,466.00 4,914.00
OTHER SPECIFIED DISEASES OF PANCREAS; ATROPHY OF
PANCREAS; CALCULUS OF PANCREAS; CIRRHOSIS OF
K86.8 PANCREAS; FIBROSIS OF PANCREAS; PANCREATIC 16,380.00 11,466.00 4,914.00
INFANTILISM; PANCREATIC NECROSIS NOS; ASEPTIC
PANCREATIC NECROSIS; FAT NECROSIS OF PANCREAS
COELIAC DISEASE; GLUTEN-SENSITIVE ENTEROPATHY;
K90.0 5,330.00 3,731.00 1,599.00
IDIOPATHIC STEATORRHOEA; NONTROPICAL SPRUE
K90.1 TROPICAL SPRUE; SPRUE NOS; TROPICAL STEATORRHOEA 5,330.00 3,731.00 1,599.00
Page 62 of 126
First Case Rate

BLIND LOOP SYNDROME, NOT ELSEWHERE CLASSIFIED;
K90.2 5,330.00 3,731.00 1,599.00
BLIND LOOP SYNDROME NOS
K90.3 PANCREATIC STEATORRHOEA 5,330.00 3,731.00 1,599.00
MALABSORPTION DUE TO INTOLERANCE, NOT ELSEWHERE
CLASSIFIED; MALABSORPTION DUE TO INTOLERANCE TO
CARBOHYDRATE; MALABSORPTION DUE TO INTOLERANCE
K90.4 5,330.00 3,731.00 1,599.00
TO FAT; MALABSORPTION DUE TO INTOLERANCE TO
PROTEIN; MALABSORPTION DUE TO INTOLERANCE TO
STARCH
K90.8 OTHER INTESTINAL MALABSORPTION 5,330.00 3,731.00 1,599.00
K90.9 INTESTINAL MALABSORPTION, UNSPECIFIED 5,330.00 3,731.00 1,599.00
K91.0 VOMITING FOLLOWING GASTROINTESTINAL SURGERY 13,390.00 9,373.00 4,017.00
POSTGASTRIC SURGERY SYNDROMES; DUMPING
K91.1 SYNDROME; POSTGASTRECTOMY SYNDROME; 13,390.00 9,373.00 4,017.00
POSTVAGOTOMY SYNDROME
POSTSURGICAL MALABSORPTION, NOT ELSEWHERE
K91.2 13,390.00 9,373.00 4,017.00
CLASSIFIED; POSTSURGICAL BLIND LOOP SYNDROME
K91.3 POSTOPERATIVE INTESTINAL OBSTRUCTION 13,390.00 9,373.00 4,017.00
K91.4 COLOSTOMY AND ENTEROSTOMY MALFUNCTION 13,390.00 9,373.00 4,017.00
K91.5 POSTCHOLECYSTECTOMY SYNDROME 13,390.00 9,373.00 4,017.00
OTHER POSTPROCEDURAL DISORDERS OF DIGESTIVE
K91.8 13,390.00 9,373.00 4,017.00
SYSTEM, NOT ELSEWHERE CLASSIFIED
POSTPROCEDURAL DISORDER OF DIGESTIVE SYSTEM,
K91.9 13,390.00 9,373.00 4,017.00
UNSPECIFIED
STAPHYLOCOCCAL SCALDED SKIN SYNDROME; PEMPHIGUS
L00 13,260.00 9,282.00 3,978.00
NEONATORUM; RITTER'S DISEASE
CUTANEOUS ABSCESS, FURUNCLE AND CARBUNCLE OF
L02.0 5,200.00 3,640.00 1,560.00
FACE
L02.1 5,200.00 3,640.00 1,560.00
NECK
TRUNK; CUTANEOUS ABSCESS, FURUNCLE AND CARBUNCLE
OF ABDOMINAL WALL; CUTANEOUS ABSCESS, FURUNCLE
L02.2 5,200.00 3,640.00 1,560.00
AND CARBUNCLE OF BACK [ANY PART, EXCEPT BUTTOCK];
CHEST WALL; CUTANEO
L02.3 BUTTOCK; CUTANEOUS ABSCESS, FURUNCLE AND 5,200.00 3,640.00 1,560.00
CARBUNCLE OF GLUTEAL REGION
L02.4 5,200.00 3,640.00 1,560.00
LIMB, AXILLA, HIP & SHOULDER
L02.8 5,200.00 3,640.00 1,560.00
OTHER SITES: HEAD [ANY PART, EXCEPT FACE]; SCALP
CUTANEOUS ABSCESS, FURUNCLE AND CARBUNCLE,
L02.9 5,200.00 3,640.00 1,560.00
UNSPECIFIED; FURUNCULOSIS NOS
CELLULITIS OF FINGER AND TOE; INFECTION OF NAIL;
L03.0 12,480.00 8,736.00 3,744.00
ONYCHIA; PARONYCHIA; PERIONYCHIA
CELLULITIS OF OTHER PARTS OF LIMB, AXILLA;
L03.1 12,480.00 8,736.00 3,744.00
CELLULITIS OF HIP;CELLULITIS OF SHOULDER
L03.2 CELLULITIS OF FACE 12,480.00 8,736.00 3,744.00
CELLULITIS OF TRUNK;CELLULITIS OF ABDOMINAL
WALL;CELLULITIS OF BACK [ANY PART]; CELLULITIS OF
L03.3 12,480.00 8,736.00 3,744.00
CHEST WALL;CELLULITIS OF GROIN;CELLULITIS OF
PERINEUM;CELLULITIS OF UMBILICUS
CELLULITIS OF OTHER SITES; CELLULITIS OF HEAD [ANY
L03.8 12,480.00 8,736.00 3,744.00
PART, EXCEPT FACE];CELLULITIS OF SCALP
L03.9 CELLULITIS, UNSPECIFIED 12,480.00 8,736.00 3,744.00
L10.0 PEMPHIGUS VULGARIS 15,600.00 10,920.00 4,680.00
L10.1 PEMPHIGUS VEGETANS 15,600.00 10,920.00 4,680.00
L10.2 PEMPHIGUS FOLIACEUS 15,600.00 10,920.00 4,680.00
L10.4 PEMPHIGUS ERYTHEMATOSUS; SENEAR-USHER SYNDROME 15,600.00 10,920.00 4,680.00
L10.8 OTHER PEMPHIGUS 15,600.00 10,920.00 4,680.00
L10.9 PEMPHIGUS, UNSPECIFIED 15,600.00 10,920.00 4,680.00
L11.0 ACQUIRED KERATOSIS FOLLICULARIS 15,600.00 10,920.00 4,680.00
L11.1 TRANSIENT ACANTHOLYTIC DERMATOSIS [GROVER] 15,600.00 10,920.00 4,680.00
L11.9 ACANTHOLYTIC DISORDER, UNSPECIFIED 15,600.00 10,920.00 4,680.00
L12.0 BULLOUS PEMPHIGOID 15,600.00 10,920.00 4,680.00
CICATRICIAL PEMPHIGOID; BENIGN MUCOUS MEMBRANE
L12.1 15,600.00 10,920.00 4,680.00
PEMPHIGOID
CHRONIC BULLOUS DISEASE OF CHILDHOOD; JUVENILE
L12.2 15,600.00 10,920.00 4,680.00
DERMATITIS HERPETIFORMIS
L12.3 ACQUIRED EPIDERMOLYSIS BULLOSA 15,600.00 10,920.00 4,680.00
L12.8 OTHER PEMPHIGOID 15,600.00 10,920.00 4,680.00
L13.0 DERMATITIS HERPETIFORMIS; DUHRING'S DISEASE 15,600.00 10,920.00 4,680.00
SUBCORNEAL PUSTULAR DERMATITIS; SNEDDON-
L13.1 15,600.00 10,920.00 4,680.00
WILKINSON DISEASE
L13.9 BULLOUS DISORDER, UNSPECIFIED 15,600.00 10,920.00 4,680.00
BULLOUS ERYTHEMA MULTIFORME; STEVENS-JOHNSON
L51.1 15,990.00 11,193.00 4,797.00
SYNDROME
Page 63 of 126
First Case Rate

L51.2 TOXIC EPIDERMAL NECROLYSIS [LYELL] 20,670.00 14,469.00 6,201.00
L72.0 EPIDERMAL CYST 5,200.00 3,640.00 1,560.00
L72.1 TRICHILEMMAL CYST; PILAR CYST; SEBACEOUS CYST 5,200.00 3,640.00 1,560.00
L72.2 STEATOCYSTOMA MULTIPLEX 5,200.00 3,640.00 1,560.00
OTHER FOLLICULAR CYSTS OF SKIN AND SUBCUTANEOUS
L72.8 5,200.00 3,640.00 1,560.00
TISSUE
FOLLICULAR CYST OF SKIN AND SUBCUTANEOUS TISSUE,
L72.9 5,200.00 3,640.00 1,560.00
UNSPECIFIED
PYODERMA GANGRENOSUM; DERMATITIS GANGRENOSA;
L88 17,160.00 12,012.00 5,148.00
PHAGEDENIC PYODERMA
DISCOID LUPUS ERYTHEMATOSUS; LUPUS
L93.0 15,470.00 10,829.00 4,641.00
ERYTHEMATOSUS
L93.1 SUBACUTE CUTANEOUS LUPUS ERYTHEMATOSUS 15,470.00 10,829.00 4,641.00
L93.2 LUPUS ERYMATOSUS PROFUNDUS; LUPUS PANNICULITIS 15,470.00 10,829.00 4,641.00
L98.3 EOSINOPHILIC CELLULITIS [WELLS] 12,480.00 8,736.00 3,744.00
PNEUMOCOCCAL ARTHRITIS AND POLYARTHRITIS, LOWER
M00.16 12,610.00 8,827.00 3,783.00
LEG
PNEUMOCOCCAL ARTHRITIS AND POLYARTHRITIS, SITE
M00.19 12,610.00 8,827.00 3,783.00
UNSPECIFIED
OTHER STREPTOCOCCAL ARTHRITIS AND POLYARTHRITIS,
M00.29 12,610.00 8,827.00 3,783.00
SITE UNSPECIFIED
ARTHRITIS AND POLYARTHRITIS DUE TO OTHER SPECIFIED
M00.82 12,610.00 8,827.00 3,783.00
BACTERIAL AGENTS UPPER ARM
PYOGENIC ARTHRITIS, UNSPECIFIED; INFECTIVE
M00.90 ARTHRITIS NOS 12,610.00 8,827.00 3,783.00
MULTIPLE SITES
M00.91 ARTHRITIS NOS 12,610.00 8,827.00 3,783.00
SHOULDER REGION
M00.93 ARTHRITIS NOS 12,610.00 8,827.00 3,783.00
FOREARM
M00.94 ARTHRITIS NOS 12,610.00 8,827.00 3,783.00
HAND
M00.95 ARTHRITIS NOS 12,610.00 8,827.00 3,783.00
PELVIC REGION AND THIGH
M00.96 ARTHRITIS NOS 12,610.00 8,827.00 3,783.00
LOWER LEG
M00.97 ARTHRITIS NOS 12,610.00 8,827.00 3,783.00
ANKLE AND FOOT
M00.98 ARTHRITIS NOS 12,610.00 8,827.00 3,783.00
OTHER SITES
M00.99 ARTHRITIS NOS 12,610.00 8,827.00 3,783.00
SITE UNSPECIFIED
M02.39 REITER'S DISEASE, SITE UNSPECIFIED 12,610.00 8,827.00 3,783.00
REACTIVE ARTHROPATHY, UNSPECIFIED, SITE
M02.99 9,100.00 6,370.00 2,730.00
UNSPECIFIED
SEROPOSITIVE RHEUMATOID ARTHRITIS, UNSPECIFIED,
M05.99 9,100.00 6,370.00 2,730.00
SITE UNSPECIFIED
SERONEGATIVE RHEUMATOID ARTHRITIS, SHOULDER
M06.01 9,100.00 6,370.00 2,730.00
REGION
SERONEGATIVE RHEUMATOID ARTHRITIS, SITE
M06.09 9,100.00 6,370.00 2,730.00
UNSPECIFIED
M06.19 ADULT-ONSET STILL'S DISEASE, SITE UNSPECIFIED 12,610.00 8,827.00 3,783.00
M06.36 RHEUMATOID NODULE, LOWER LEG 9,100.00 6,370.00 2,730.00
INFLAMMATORY POLYARTHROPATHY, PELVIC REGION AND
M06.45 9,100.00 6,370.00 2,730.00
THIGH
M06.49 INFLAMMATORY POLYARTHROPATHY, SITE UNSPECIFIED 9,100.00 6,370.00 2,730.00
OTHER SPECIFIED RHEUMATOID ARTHRITIS, SHOULDER
M06.81 9,100.00 6,370.00 2,730.00
REGION
M06.86 OTHER SPECIFIED RHEUMATOID ARTHRITIS, LOWER LEG 9,100.00 6,370.00 2,730.00
OTHER SPECIFIED RHEUMATOID ARTHRITIS, ANKLE AND
M06.87 9,100.00 6,370.00 2,730.00
FOOT
OTHER SPECIFIED RHEUMATOID ARTHRITIS, SITE
M06.89 9,100.00 6,370.00 2,730.00
UNSPECIFIED
M06.90 RHEUMATOID ARTHRITIS, UNSPECIFIED, MULTIPLE SITES 9,100.00 6,370.00 2,730.00
RHEUMATOID ARTHRITIS, UNSPECIFIED, SHOULDER
M06.91 9,100.00 6,370.00 2,730.00
REGION
M06.93 RHEUMATOID ARTHRITIS, UNSPECIFIED, FOREARM 9,100.00 6,370.00 2,730.00
M06.94 RHEUMATOID ARTHRITIS, UNSPECIFIED, HAND 9,100.00 6,370.00 2,730.00
RHEUMATOID ARTHRITIS, UNSPECIFIED, PELVIC REGION
M06.95 9,100.00 6,370.00 2,730.00
AND THIGH
M06.96 RHEUMATOID ARTHRITIS, UNSPECIFIED, LOWER LEG 9,100.00 6,370.00 2,730.00
Page 64 of 126
First Case Rate

M06.97 RHEUMATOID ARTHRITIS, UNSPECIFIED, ANKLE AND FOOT 9,100.00 6,370.00 2,730.00
M06.98 RHEUMATOID ARTHRITIS, UNSPECIFIED, OTHER SITES 9,100.00 6,370.00 2,730.00

RHEUMATOID ARTHRITIS, UNSPECIFIED, SITE
M06.99 9,100.00 6,370.00 2,730.00
UNSPECIFIED
JUVENILE RHEUMATOID ARTHRITIS; JUVENILE
M08.06 RHEUMATOID ARTHRITIS WITH OR WITHOUT 9,100.00 6,370.00 2,730.00
RHEUMATOID FACTOR LOWER LEG
RHEUMATOID FACTOR ANKLE AND FOOT
RHEUMATOID FACTOR SITE UNSPECIFIED
M08.19 JUVENILE ANKYLOSING SPONDYLITIS SITE UNSPECIFIED 9,100.00 6,370.00 2,730.00
JUVENILE ARTHRITIS WITH SYSTEMIC ONSET; STILL'S
M08.29 12,610.00 8,827.00 3,783.00
DISEASE NOS SITE UNSPECIFIED
M08.86 OTHER JUVENILE ARTHRITIS LOWER LEG 9,100.00 6,370.00 2,730.00
M08.89 OTHER JUVENILE ARTHRITIS SITE UNSPECIFIED 9,100.00 6,370.00 2,730.00
M08.91 JUVENILE ARTHRITIS, UNSPECIFIED SHOULDER REGION 9,100.00 6,370.00 2,730.00
M08.96 JUVENILE ARTHRITIS, UNSPECIFIED LOWER LEG 9,100.00 6,370.00 2,730.00
M08.99 JUVENILE ARTHRITIS, UNSPECIFIED SITE UNSPECIFIED 9,100.00 6,370.00 2,730.00
IDIOPATHIC GOUT; GOUTY BURSITIS; PRIMARY GOUT
M10.00 9,100.00 6,370.00 2,730.00
MULTIPLE SITES
M10.01 URATE TOPHUS OF HEART SHOULDER REGION 9,100.00 6,370.00 2,730.00
M10.02 URATE TOPHUS OF HEART UPPER ARM 9,100.00 6,370.00 2,730.00
M10.03 9,100.00 6,370.00 2,730.00
FOREARM
M10.04 URATE TOPHUS OF HEART HAND 9,100.00 6,370.00 2,730.00
M10.05 URATE TOPHUS OF HEART PELVIC REGION AND THIGH 9,100.00 6,370.00 2,730.00
M10.06 9,100.00 6,370.00 2,730.00
LOWER LEG
M10.07 URATE TOPHUS OF HEART ANKLE AND FOOT 9,100.00 6,370.00 2,730.00
M10.08 URATE TOPHUS OF HEART OTHER SITES 9,100.00 6,370.00 2,730.00
M10.09 URATE TOPHUS OF HEART SITE UNSPECIFIED 9,100.00 6,370.00 2,730.00
M10.10 LEAD-INDUCED GOUT MULTIPLE SITES 9,100.00 6,370.00 2,730.00
M10.29 DRUG-INDUCED GOUT SITE UNSPECIFIED 9,100.00 6,370.00 2,730.00
GOUT DUE TO IMPAIRMENT OF RENAL FUNCTION
M10.30 9,100.00 6,370.00 2,730.00
MULTIPLE SITES
GOUT DUE TO IMPAIRMENT OF RENAL FUNCTION LOWER
M10.36 9,100.00 6,370.00 2,730.00
LEG
GOUT DUE TO IMPAIRMENT OF RENAL FUNCTION SITE
M10.39 9,100.00 6,370.00 2,730.00
UNSPECIFIED
M10.40 OTHER SECONDARY GOUT MULTIPLE SITES 9,100.00 6,370.00 2,730.00
M10.49 OTHER SECONDARY GOUT SITE UNSPECIFIED 9,100.00 6,370.00 2,730.00
M10.90 GOUT, UNSPECIFIED MULTIPLE SITES 9,100.00 6,370.00 2,730.00
M10.91 GOUT, UNSPECIFIED SHOULDER REGION 9,100.00 6,370.00 2,730.00
M10.92 GOUT, UNSPECIFIED UPPER ARM 9,100.00 6,370.00 2,730.00
M10.93 GOUT, UNSPECIFIED FOREARM 9,100.00 6,370.00 2,730.00
M10.94 GOUT, UNSPECIFIED HAND 9,100.00 6,370.00 2,730.00
M10.96 GOUT, UNSPECIFIED LOWER LEG 9,100.00 6,370.00 2,730.00
M10.97 GOUT, UNSPECIFIED ANKLE AND FOOT 9,100.00 6,370.00 2,730.00
M10.98 GOUT, UNSPECIFIED OTHER SITES 9,100.00 6,370.00 2,730.00
M10.99 GOUT, UNSPECIFIED SITE UNSPECIFIED 9,100.00 6,370.00 2,730.00
OTHER SPECIFIED CRYSTAL ARTHROPATHIES SITE
M11.89 9,100.00 6,370.00 2,730.00
UNSPECIFIED
M11.90 CRYSTAL ARTHROPATHY, UNSPECIFIED MULTIPLE SITES 9,100.00 6,370.00 2,730.00
M11.99 CRYSTAL ARTHROPATHY, UNSPECIFIED SITE UNSPECIFIED 9,100.00 6,370.00 2,730.00
M12.26 VILLONODULAR SYNOVITIS (PIGMENTED) LOWER LEG 9,100.00 6,370.00 2,730.00

M12.39 PALINDROMIC RHEUMATISM SITE UNSPECIFIED 9,100.00 6,370.00 2,730.00
M12.50 TRAUMATIC ARTHROPATHY MULTIPLE SITES 9,100.00 6,370.00 2,730.00
M12.52 TRAUMATIC ARTHROPATHY UPPER ARM 9,100.00 6,370.00 2,730.00
M12.53 TRAUMATIC ARTHROPATHY FOREARM 9,100.00 6,370.00 2,730.00
M12.54 TRAUMATIC ARTHROPATHY HAND 9,100.00 6,370.00 2,730.00
M12.55 TRAUMATIC ARTHROPATHY PELVIC REGION AND THIGH 9,100.00 6,370.00 2,730.00
M12.56 TRAUMATIC ARTHROPATHY LOWER LEG 9,100.00 6,370.00 2,730.00
M12.57 TRAUMATIC ARTHROPATHY ANKLE AND FOOT 9,100.00 6,370.00 2,730.00
M12.58 TRAUMATIC ARTHROPATHY OTHER SITES 9,100.00 6,370.00 2,730.00
M12.59 TRAUMATIC ARTHROPATHY SITE UNSPECIFIED 9,100.00 6,370.00 2,730.00
OTHER SPECIFIC ARTHROPATHIES, NOT ELSEWHERE
M12.86 9,100.00 6,370.00 2,730.00
CLASSIFIED; TRANSIENT ARTHROPATHY LOWER LEG
OTHER SPECIFIC ARTHROPATHIES, NOT ELSEWHERE
M12.89 9,100.00 6,370.00 2,730.00
CLASSIFIED; TRANSIENT ARTHROPATHY SITE UNSPECIFIED
Page 65 of 126
First Case Rate

M13.00 POLYARTHRITIS, UNSPECIFIED MULTIPLE SITES 9,100.00 6,370.00 2,730.00
M13.01 POLYARTHRITIS, UNSPECIFIED SHOULDER REGION 9,100.00 6,370.00 2,730.00
M13.02 POLYARTHRITIS, UNSPECIFIED UPPER ARM 9,100.00 6,370.00 2,730.00
M13.06 POLYARTHRITIS, UNSPECIFIED LOWER LEG 9,100.00 6,370.00 2,730.00
M13.09 POLYARTHRITIS, UNSPECIFIED SITE UNSPECIFIED 9,100.00 6,370.00 2,730.00
M13.13 MONOARTHRITIS, NOT ELSEWHERE CLASSIFIED FOREARM 9,100.00 6,370.00 2,730.00
MONOARTHRITIS, NOT ELSEWHERE CLASSIFIED LOWER
M13.16 9,100.00 6,370.00 2,730.00
LEG
MONOARTHRITIS, NOT ELSEWHERE CLASSIFIED ANKLE
M13.17 9,100.00 6,370.00 2,730.00
AND FOOT
MONOARTHRITIS, NOT ELSEWHERE CLASSIFIED OTHER
M13.18 9,100.00 6,370.00 2,730.00
SITES
OTHER SPECIFIED ARTHRITIS; ALLERGIC ARTHRITIS
M13.80 9,100.00 6,370.00 2,730.00
MULTIPLE SITES
M13.81 9,100.00 6,370.00 2,730.00
SHOULDER REGION
M13.85 9,100.00 6,370.00 2,730.00
M13.86 9,100.00 6,370.00 2,730.00
LOWER LEG
M13.87 9,100.00 6,370.00 2,730.00
ANKLE AND FOOT
M13.88 9,100.00 6,370.00 2,730.00
OTHER SITES
OTHER SPECIFIED ARTHRITIS; ALLERGIC ARTHRITIS SITE
M13.89 9,100.00 6,370.00 2,730.00
UNSPECIFIED
ARTHRITIS, UNSPECIFIED; ARTHROPATHY NOS MULTIPLE
M13.90 9,100.00 6,370.00 2,730.00
SITES
ARTHRITIS, UNSPECIFIED; ARTHROPATHY NOS SHOULDER
M13.91 9,100.00 6,370.00 2,730.00
REGION
M13.92 ARTHRITIS, UNSPECIFIED; ARTHROPATHY NOS UPPER ARM 9,100.00 6,370.00 2,730.00
M13.93 ARTHRITIS, UNSPECIFIED; ARTHROPATHY NOS FOREARM 9,100.00 6,370.00 2,730.00

M13.94 ARTHRITIS, UNSPECIFIED; ARTHROPATHY NOS HAND 9,100.00 6,370.00 2,730.00
ARTHRITIS, UNSPECIFIED; ARTHROPATHY NOS PELVIC
M13.95 9,100.00 6,370.00 2,730.00
REGION AND THIGH
M13.96 ARTHRITIS, UNSPECIFIED; ARTHROPATHY NOS LOWER LEG 9,100.00 6,370.00 2,730.00
ARTHRITIS, UNSPECIFIED; ARTHROPATHY NOS ANKLE AND
M13.97 9,100.00 6,370.00 2,730.00
FOOT
ARTHRITIS, UNSPECIFIED; ARTHROPATHY NOS OTHER
M13.98 9,100.00 6,370.00 2,730.00
SITES
ARTHRITIS, UNSPECIFIED; ARTHROPATHY NOS SITE
M13.99 9,100.00 6,370.00 2,730.00
UNSPECIFIED
M15.0 PRIMARY GENERALIZED (OSTEO)ARTHROSIS 9,100.00 6,370.00 2,730.00
M15.2 BOUCHARD'S NODES (WITH ARTHROPATHY) 9,100.00 6,370.00 2,730.00
SECONDARY MULTIPLE ARTHROSIS; POST-TRAUMATIC
M15.3 9,100.00 6,370.00 2,730.00
POLYARTHROSIS
M15.4 EROSIVE (OSTEO)ARTHROSIS 9,100.00 6,370.00 2,730.00
M15.8 OTHER POLYARTHROSIS 9,100.00 6,370.00 2,730.00
POLYARTHROSIS, UNSPECIFIED; GENERALIZED
M15.9 9,100.00 6,370.00 2,730.00
OSTEOARTHRITIS NOS
M16.0 PRIMARY COXARTHROSIS, BILATERAL 9,100.00 6,370.00 2,730.00
OTHER PRIMARY COXARTHROSIS; PRIMARY
M16.1 COXARTHROSIS NOS; PRIMARY COXARTHROSIS 9,100.00 6,370.00 2,730.00
UNILATERAL
M16.2 COXARTHROSIS RESULTING FROM DYSPLASIA, BILATERAL 9,100.00 6,370.00 2,730.00
OTHER DYSPLASTIC COXARTHROSIS; DYSPLASTIC
M16.3 COXARTHROSIS NOS; DYSPLASTIC COXARTHROSIS 9,100.00 6,370.00 2,730.00
UNILATERAL
M16.9 COXARTHROSIS, UNSPECIFIED 9,100.00 6,370.00 2,730.00
M17.0 PRIMARY GONARTHROSIS, BILATERAL 9,100.00 6,370.00 2,730.00
OTHER PRIMARY GONARTHROSIS; PRIMARY
M17.1 GONARTHROSIS NOS; PRIMARY GONARTHROSIS 9,100.00 6,370.00 2,730.00
UNILATERAL
M17.2 POST-TRAUMATIC GONARTHROSIS, BILATERAL 9,100.00 6,370.00 2,730.00
OTHER POST-TRAUMATIC GONARTHROSIS; POST-
M17.3 TRAUMATIC GONARTHROSIS NOS; POST-TRAUMATIC 9,100.00 6,370.00 2,730.00
GONARTHROSIS UNILATERAL
OTHER SECONDARY GONARTHROSIS; SECONDARY
M17.5 GONARTHROSIS NOS; SECONDARY GONARTHROSIS 9,100.00 6,370.00 2,730.00
UNILATERAL
M17.9 GONARTHROSIS, UNSPECIFIED 9,100.00 6,370.00 2,730.00
PRIMARY ARTHROSIS OF FIRST CARPOMETACARPAL
M18.0 9,100.00 6,370.00 2,730.00
JOINTS, BILATERAL
ARTHROSIS OF FIRST CARPOMETACARPAL JOINT,
M18.9 9,100.00 6,370.00 2,730.00
UNSPECIFIED
PRIMARY ARTHROSIS OF OTHER JOINTS; PRIMARY
M19.00 9,100.00 6,370.00 2,730.00
ARTHROSIS NOSMULTIPLE SITES
Page 66 of 126
First Case Rate

M19.02 9,100.00 6,370.00 2,730.00
ARTHROSIS NOSUPPER ARM
M19.05 9,100.00 6,370.00 2,730.00
ARTHROSIS NOSPELVIC REGION AND THIGH
M19.06 9,100.00 6,370.00 2,730.00
ARTHROSIS NOSLOWER LEG
M19.08 9,100.00 6,370.00 2,730.00
ARTHROSIS NOSOTHER SITES
M19.09 9,100.00 6,370.00 2,730.00
ARTHROSIS NOSSITE UNSPECIFIED
POST-TRAUMATIC ARTHROSIS OF OTHER JOINTS; POST-
M19.10 9,100.00 6,370.00 2,730.00
TRAUMATIC ARTHROSIS NOS MULTIPLE SITES
M19.11 9,100.00 6,370.00 2,730.00
TRAUMATIC ARTHROSIS NOS SHOULDER REGION
M19.12 9,100.00 6,370.00 2,730.00
TRAUMATIC ARTHROSIS NOS UPPER ARM
M19.19 9,100.00 6,370.00 2,730.00
TRAUMATIC ARTHROSIS NOS SITE UNSPECIFIED
OTHER SECONDARY ARTHROSIS; SECONDARY ARTHROSIS
M19.21 9,100.00 6,370.00 2,730.00
NOS SHOULDER REGION
OTHER SECONDARY ARTHROSIS; SECONDARY ARTHROSIS
M19.29 9,100.00 6,370.00 2,730.00
NOS SITE UNSPECIFIED
M19.81 OTHER SPECIFIED ARTHROSIS SHOULDER REGION 9,100.00 6,370.00 2,730.00
M19.86 OTHER SPECIFIED ARTHROSIS LOWER LEG 9,100.00 6,370.00 2,730.00
M19.87 OTHER SPECIFIED ARTHROSIS ANKLE AND FOOT 9,100.00 6,370.00 2,730.00
M19.88 OTHER SPECIFIED ARTHROSIS OTHER SITES 9,100.00 6,370.00 2,730.00
M19.89 OTHER SPECIFIED ARTHROSIS SITE UNSPECIFIED 9,100.00 6,370.00 2,730.00
M19.90 ARTHROSIS, UNSPECIFIED MULTIPLE SITES 9,100.00 6,370.00 2,730.00
M19.91 ARTHROSIS, UNSPECIFIED SHOULDER REGION 9,100.00 6,370.00 2,730.00
M19.92 ARTHROSIS, UNSPECIFIED UPPER ARM 9,100.00 6,370.00 2,730.00
M19.93 ARTHROSIS, UNSPECIFIED FOREARM 9,100.00 6,370.00 2,730.00
M19.94 ARTHROSIS, UNSPECIFIED HAND 9,100.00 6,370.00 2,730.00
M19.95 ARTHROSIS, UNSPECIFIED PELVIC REGION AND THIGH 9,100.00 6,370.00 2,730.00
M19.96 ARTHROSIS, UNSPECIFIED LOWER LEG 9,100.00 6,370.00 2,730.00
M19.97 ARTHROSIS, UNSPECIFIED ANKLE AND FOOT 9,100.00 6,370.00 2,730.00
M19.98 ARTHROSIS, UNSPECIFIED OTHER SITES 9,100.00 6,370.00 2,730.00
M19.99 ARTHROSIS, UNSPECIFIED SITE UNSPECIFIED 9,100.00 6,370.00 2,730.00
DERANGEMENT OF MENISCUS DUE TO OLD TEAR OR
M23.20 11,960.00 8,372.00 3,588.00
INJURY; OLD BUCKET-HANDLE TEAR MULTIPLE SITES

M23.21 INJURY; OLD BUCKET-HANDLE TEAR ANTERIOR CRUCIATE 11,960.00 8,372.00 3,588.00
LIGAMENT OR ANTERIOR HORN OF MEDIAL MENISCUS

M23.22 INJURY; OLD BUCKET-HANDLE TEAR POSTERIOR CRUCIATE 11,960.00 8,372.00 3,588.00
LIGAMENT OR POSTERIOR HORN OF MEDIAL MENISCUS
M23.25 INJURY; OLD BUCKET-HANDLE TEAR POSTERIOR HORN OF 11,960.00 8,372.00 3,588.00
LATERAL MENISCUS
LOOSE BODY IN KNEEOTHER AND UNSPECIFIED LATERAL
M23.46 11,960.00 8,372.00 3,588.00
MENISCUS
M23.5 CHRONIC INSTABILITY OF KNEE 11,960.00 8,372.00 3,588.00
OTHER INTERNAL DERANGEMENTS OF KNEE; LAXITY OF
M23.80 11,960.00 8,372.00 3,588.00
LIGAMENT OF KNEE; SNAPPING KNEE MULTIPLE SITES
M23.9 INTERNAL DERANGEMENT OF KNEE 11,960.00 8,372.00 3,588.00
INTERNAL DERANGEMENT OF KNEE, UNSPECIFIED
M23.91 ANTERIOR CRUCIATE LIGAMENT OR ANTERIOR HORN OF 11,960.00 8,372.00 3,588.00
MEDIAL MENISCUS
M24.08 LOOSE BODY IN JOINT OTHER SITES 11,960.00 8,372.00 3,588.00
M24.1 OTHER ARTICULAR CARTILAGE DISORDERS 11,960.00 8,372.00 3,588.00
DISORDER OF LIGAMENT; INSTABILITY SECONDARY TO OLD
M24.2 11,960.00 8,372.00 3,588.00
LIGAMENT INJURY; LIGAMENTOUS LAXITY NOS
M24.4 RECURRENT DISLOCATION AND SUBLUXATION OF JOINT 11,960.00 8,372.00 3,588.00

RECURRENT DISLOCATION AND SUBLUXATION OF JOINT
M24.41 11,960.00 8,372.00 3,588.00
SHOULDER REGION
M24.50 CONTRACTURE OF JOINT MULTIPLE SITES 11,960.00 8,372.00 3,588.00
M24.54 CONTRACTURE OF JOINT HAND 11,960.00 8,372.00 3,588.00
M24.56 CONTRACTURE OF JOINT LOWER LEG 11,960.00 8,372.00 3,588.00
M24.6 ANKYLOSIS OF JOINT 11,960.00 8,372.00 3,588.00
M24.65 ANKYLOSIS OF JOINT PELVIC REGION AND THIGH 11,960.00 8,372.00 3,588.00
M24.66 ANKYLOSIS OF JOINT LOWER LEG 11,960.00 8,372.00 3,588.00
M24.69 ANKYLOSIS OF JOINT SITE UNSPECIFIED 11,960.00 8,372.00 3,588.00
M24.7 PROTRUSIO ACETABULI 11,960.00 8,372.00 3,588.00
Page 67 of 126
First Case Rate

OTHER SPECIFIC JOINT DERANGEMENTS, NOT ELSEWHERE
M24.88 11,960.00 8,372.00 3,588.00
CLASSIFIED; IRRITABLE HIP OTHER SITES
M25.00 HAEMARTHROSIS MULTIPLE SITES 10,140.00 7,098.00 3,042.00
M25.01 HAEMARTHROSIS SHOULDER REGION 10,140.00 7,098.00 3,042.00
M25.05 HAEMARTHROSIS PELVIC REGION AND THIGH 10,140.00 7,098.00 3,042.00
M25.06 HAEMARTHROSIS LOWER LEG 10,140.00 7,098.00 3,042.00
M25.07 HAEMARTHROSIS ANKLE AND FOOT 10,140.00 7,098.00 3,042.00
M25.08 HAEMARTHROSIS OTHER SITES 10,140.00 7,098.00 3,042.00
M25.09 HAEMARTHROSIS SITE UNSPECIFIED 10,140.00 7,098.00 3,042.00
M25.38 OTHER INSTABILITY OF JOINT OTHER SITES 10,140.00 7,098.00 3,042.00
M25.40 EFFUSION OF JOINT MULTIPLE SITES 10,140.00 7,098.00 3,042.00
M25.41 EFFUSION OF JOINT SHOULDER REGION 10,140.00 7,098.00 3,042.00
M25.46 EFFUSION OF JOINT LOWER LEG 10,140.00 7,098.00 3,042.00
M25.47 EFFUSION OF JOINT ANKLE AND FOOT 10,140.00 7,098.00 3,042.00
M30.0 POLYARTERITIS NODOSA 17,940.00 12,558.00 5,382.00
POLYARTERITIS WITH LUNG INVOLVEMENT [CHURG-
M30.1 17,940.00 12,558.00 5,382.00
STRAUSS]; ALLERGIC GRANULOMATOUS ANGIITIS
M30.2 JUVENILE POLYARTERITIS 17,940.00 12,558.00 5,382.00
M30.3 MUCOCUTANEOUS LYMPH NODE SYNDROME [KAWASAKI] 17,940.00 12,558.00 5,382.00
OTHER CONDITIONS RELATED TO POLYARTERITIS NODOSA;
M30.8 17,940.00 12,558.00 5,382.00
POLYANGIITIS OVERLAP SYNDROME
M31.0 HYPERSENSITIVITY ANGIITIS; GOODPASTURE'S SYNDROME 17,940.00 12,558.00 5,382.00
THROMBOTIC MICROANGIOPATHY; THROMBOTIC
M31.1 17,940.00 12,558.00 5,382.00
THROMBOCYTOPENIC PURPURA
WEGENER'S GRANULOMATOSIS; NECROTIZING
M31.3 17,940.00 12,558.00 5,382.00
RESPIRATORY GRANULOMATOSIS
M31.4 AORTIC ARCH SYNDROME [TAKAYASU] 17,940.00 12,558.00 5,382.00
M31.6 OTHER GIANT CELL ARTERITIS 17,940.00 12,558.00 5,382.00
OTHER SPECIFIED NECROTIZING VASCULOPATHIES;
M31.8 17,940.00 12,558.00 5,382.00
HYPOCOMPLEMENTAEMIC VASCULITIS
M31.9 NECROTIZING VASCULOPATHY, UNSPECIFIED 17,940.00 12,558.00 5,382.00
M32.0 DRUG-INDUCED SYSTEMIC LUPUS ERYTHEMATOSUS 15,470.00 10,829.00 4,641.00
M32.8 OTHER FORMS OF SYSTEMIC LUPUS ERYTHEMATOSUS 15,470.00 10,829.00 4,641.00
M32.9 SYSTEMIC LUPUS ERYTHEMATOSUS, UNSPECIFIED 15,470.00 10,829.00 4,641.00
M33.0 JUVENILE DERMATOMYOSITIS 17,940.00 12,558.00 5,382.00
M33.1 OTHER DERMATOMYOSITIS 17,940.00 12,558.00 5,382.00
M33.2 POLYMYOSITIS 17,940.00 12,558.00 5,382.00
M33.9 DERMATOPOLYMYOSITIS, UNSPECIFIED 17,940.00 12,558.00 5,382.00
M34.0 PROGRESSIVE SYSTEMIC SCLEROSIS 17,940.00 12,558.00 5,382.00
CR(E)ST SYNDROME; COMBINATION OF CALCINOSIS,
RAYNAUD'S PHENOMENON, (O)ESOPHAGEAL
M34.1 17,940.00 12,558.00 5,382.00
DYSFUNCTION,
SCLERODACTYLY, TELANGIECTASIA
M34.2 SYSTEMIC SCLEROSIS INDUCED BY DRUGS AND CHEMICALS 17,940.00 12,558.00 5,382.00
M34.9 SYSTEMIC SCLEROSIS, UNSPECIFIED 17,940.00 12,558.00 5,382.00
M35.0 SICCA SYNDROME [SJÖGREN] 17,940.00 12,558.00 5,382.00
OTHER OVERLAP SYNDROMES; MIXED CONNECTIVE TISSUE
M35.1 17,940.00 12,558.00 5,382.00
DISEASE
M35.2 BEHçET'S DISEASE 17,940.00 12,558.00 5,382.00
M35.3 POLYMYALGIA RHEUMATICA 17,940.00 12,558.00 5,382.00
M35.4 DIFFUSE (EOSINOPHILIC) FASCIITIS 17,940.00 12,558.00 5,382.00
OTHER SPECIFIED SYSTEMIC INVOLVEMENT OF
M35.8 17,940.00 12,558.00 5,382.00
CONNECTIVE TISSUE
SYSTEMIC INVOLVEMENT OF CONNECTIVE TISSUE,
M35.9 UNSPECIFIED; SYSTEMIC AUTOIMMUNE DISEASE NOS; 17,940.00 12,558.00 5,382.00
COLLAGEN (VASCULAR) DISEASE NOS
M42.1 ADULT OSTEOCHONDROSIS OF SPINE 9,880.00 6,916.00 2,964.00
M43.0 SPONDYLOLYSIS 10,790.00 7,553.00 3,237.00
M43.02 SPONDYLOLYSIS CERVICAL REGION 9,880.00 6,916.00 2,964.00
M43.03 SPONDYLOLYSIS CERVICOTHORACIC REGION 9,880.00 6,916.00 2,964.00
M43.04 SPONDYLOLYSIS THORACIC REGION 9,880.00 6,916.00 2,964.00
M43.06 SPONDYLOLYSIS LUMBAR REGION 9,880.00 6,916.00 2,964.00
M43.07 SPONDYLOLYSIS LUMBOSACRAL REGION 9,880.00 6,916.00 2,964.00
M43.09 SPONDYLOLYSIS SITE UNSPECIFIED 9,880.00 6,916.00 2,964.00
M43.1 SPONDYLOLISTHESIS 10,790.00 7,553.00 3,237.00
M43.10 SPONDYLOLISTHESIS MULTIPLE SITES IN SPINE 9,880.00 6,916.00 2,964.00
M43.12 SPONDYLOLISTHESIS CERVICAL REGION 9,880.00 6,916.00 2,964.00
M43.15 SPONDYLOLISTHESIS THORACOLUMBAR REGION 9,880.00 6,916.00 2,964.00
M43.16 SPONDYLOLISTHESIS LUMBAR REGION 9,880.00 6,916.00 2,964.00
M43.17 SPONDYLOLISTHESIS LUMBOSACRAL REGION 9,880.00 6,916.00 2,964.00
SPONDYLOLISTHESIS SACRAL AND SACROCOCCYGEAL
M43.18 9,880.00 6,916.00 2,964.00
REGION
M43.19 SPONDYLOLISTHESIS SITE UNSPECIFIED 9,880.00 6,916.00 2,964.00
M43.2 OTHER FUSION OF SPINE; ANKYLOSIS OF SPINAL JOINT 10,790.00 7,553.00 3,237.00
OTHER FUSION OF SPINE; ANKYLOSIS OF SPINAL JOINT
M43.22 9,880.00 6,916.00 2,964.00
CERVICAL REGION
Page 68 of 126
First Case Rate

M43.26 9,880.00 6,916.00 2,964.00
LUMBAR REGION
M43.27 9,880.00 6,916.00 2,964.00
LUMBOSACRAL REGION
OTHER FUSION OF SPINE; ANKYLOSIS OF SPINAL JOINT SITE
M43.29 9,880.00 6,916.00 2,964.00
UNSPECIFIED
OTHER RECURRENT ATLANTOAXIAL SUBLUXATION
M43.42 9,880.00 6,916.00 2,964.00
CERVICAL REGION
OTHER RECURRENT ATLANTOAXIAL SUBLUXATION SITE
M43.49 9,880.00 6,916.00 2,964.00
UNSPECIFIED
M43.5 OTHER RECURRENT VERTEBRAL SUBLUXATION 10,790.00 7,553.00 3,237.00
M43.6 TORTICOLLIS 10,790.00 7,553.00 3,237.00
M43.60 TORTICOLLIS MULTIPLE SITES IN SPINE 9,880.00 6,916.00 2,964.00
M43.62 TORTICOLLIS CERVICAL REGION 9,880.00 6,916.00 2,964.00
M43.64 TORTICOLLIS THORACIC REGION 9,880.00 6,916.00 2,964.00
M43.66 TORTICOLLIS LUMBAR REGION 9,880.00 6,916.00 2,964.00
M43.68 TORTICOLLIS SACRAL AND SACROCOCCYGEAL REGION 9,880.00 6,916.00 2,964.00
M43.69 TORTICOLLIS SITE UNSPECIFIED 9,880.00 6,916.00 2,964.00
M43.8 OTHER SPECIFIED DEFORMING DORSOPATHIES 9,880.00 6,916.00 2,964.00
OTHER SPECIFIED DEFORMING DORSOPATHIES CERVICAL
M43.82 9,880.00 6,916.00 2,964.00
REGION
OTHER SPECIFIED DEFORMING DORSOPATHIES
M43.85 9,880.00 6,916.00 2,964.00
THORACOLUMBAR REGION
OTHER SPECIFIED DEFORMING DORSOPATHIES LUMBAR
M43.86 9,880.00 6,916.00 2,964.00
REGION
OTHER SPECIFIED DEFORMING DORSOPATHIES
M43.87 9,880.00 6,916.00 2,964.00
LUMBOSACRAL REGION
OTHER SPECIFIED DEFORMING DORSOPATHIES SACRAL
M43.88 9,880.00 6,916.00 2,964.00
AND SACROCOCCYGEAL REGION
OTHER SPECIFIED DEFORMING DORSOPATHIES SITE
M43.89 9,880.00 6,916.00 2,964.00
UNSPECIFIED
DEFORMING DORSOPATHY, UNSPECIFIED; CURVATURE OF
M43.9 9,880.00 6,916.00 2,964.00
SPINE NOS
M43.94 9,880.00 6,916.00 2,964.00
SPINE NOS THORACIC REGION
M43.95 9,880.00 6,916.00 2,964.00
SPINE NOS THORACOLUMBAR REGION
M43.96 9,880.00 6,916.00 2,964.00
SPINE NOS LUMBAR REGION
M43.97 9,880.00 6,916.00 2,964.00
SPINE NOS LUMBOSACRAL REGION
M43.99 9,880.00 6,916.00 2,964.00
SPINE NOS SITE UNSPECIFIED
ANKYLOSING SPONDYLITIS; RHEUMATOID ARTHRITIS OF
M45 10,790.00 7,553.00 3,237.00
SPINE
SPINAL ENTHESOPATHY; DISORDER OF LIGAMENTOUS OR
M46.0 10,790.00 7,553.00 3,237.00
MUSCULAR ATTACHMENTS OF SPINE
M46.1 SACROILIITIS, NOT ELSEWHERE CLASSIFIED 10,790.00 7,553.00 3,237.00
SACROILIITIS, NOT ELSEWHERE CLASSIFIED LUMBAR
M46.16 10,790.00 7,553.00 3,237.00
REGION
SACROILIITIS, NOT ELSEWHERE CLASSIFIED SITE
M46.19 10,790.00 7,553.00 3,237.00
UNSPECIFIED
M46.2 OSTEOMYELITIS OF VERTEBRA 10,790.00 7,553.00 3,237.00
OSTEOMYELITIS OF VERTEBRA SACRAL AND
M46.28 10,790.00 7,553.00 3,237.00
SACROCOCCYGEAL REGION
M46.29 OSTEOMYELITIS OF VERTEBRA SITE UNSPECIFIED 10,790.00 7,553.00 3,237.00
M46.3 INFECTION OF INTERVERTEBRAL DISC (PYOGENIC) 10,790.00 7,553.00 3,237.00
INFECTION OF INTERVERTEBRAL DISC (PYOGENIC) LUMBAR
M46.36 10,790.00 7,553.00 3,237.00
REGION
M46.4 DISCITIS, UNSPECIFIED 10,790.00 7,553.00 3,237.00
M46.46 DISCITIS, UNSPECIFIED LUMBAR REGION 10,790.00 7,553.00 3,237.00
M46.47 DISCITIS, UNSPECIFIED LUMBOSACRAL REGION 10,790.00 7,553.00 3,237.00
M46.49 DISCITIS, UNSPECIFIED SITE UNSPECIFIED 10,790.00 7,553.00 3,237.00
M46.5 OTHER INFECTIVE SPONDYLOPATHIES 10,790.00 7,553.00 3,237.00
M46.8 OTHER SPECIFIED INFLAMMATORY SPONDYLOPATHIES 10,790.00 7,553.00 3,237.00
OTHER SPECIFIED INFLAMMATORY SPONDYLOPATHIES
M46.87 10,790.00 7,553.00 3,237.00
LUMBOSACRAL REGION
M46.9 INFLAMMATORY SPONDYLOPATHY, UNSPECIFIED 10,790.00 7,553.00 3,237.00
INFLAMMATORY SPONDYLOPATHY, UNSPECIFIED
M46.92 10,790.00 7,553.00 3,237.00
CERVICAL REGION
INFLAMMATORY SPONDYLOPATHY, UNSPECIFIED
M46.97 10,790.00 7,553.00 3,237.00
LUMBOSACRAL REGION
INFLAMMATORY SPONDYLOPATHY, UNSPECIFIED SACRAL
M46.98 10,790.00 7,553.00 3,237.00
AND SACROCOCCYGEAL REGION
INFLAMMATORY SPONDYLOPATHY, UNSPECIFIED SITE
M46.99 10,790.00 7,553.00 3,237.00
UNSPECIFIED
M47.1 OTHER SPONDYLOSIS WITH MYELOPATHY 10,790.00 7,553.00 3,237.00
M47.1+G99.2* MYELOPATHY IN OTHER SPONDYLOSIS WITH MYELOPATHY 10,790.00 7,553.00 3,237.00
Page 69 of 126
First Case Rate

M47.2 OTHER SPONDYLOSIS WITH RADICULOPATHY 10,790.00 7,553.00 3,237.00
OTHER SPONDYLOSIS WITH RADICULOPATHY MULTIPLE
M47.20 10,790.00 7,553.00 3,237.00
SITES IN SPINE
OTHER SPONDYLOSIS WITH RADICULOPATHY CERVICAL
M47.22 10,790.00 7,553.00 3,237.00
REGION
OTHER SPONDYLOSIS WITH RADICULOPATHY LUMBAR
M47.26 10,790.00 7,553.00 3,237.00
REGION
OTHER SPONDYLOSIS WITH RADICULOPATHY
M47.27 10,790.00 7,553.00 3,237.00
LUMBOSACRAL REGION
OTHER SPONDYLOSIS WITH RADICULOPATHY SITE
M47.29 10,790.00 7,553.00 3,237.00
UNSPECIFIED
CERVICAL SPONDYLOSIS WITHOUT MYELOPATHY OR
RADICULOPATHY; LUMBOSACRAL SPONDYLOSIS WITHOUT
M47.8 10,790.00 7,553.00 3,237.00
MYELOPATHY OR RADICULOPATHY; THORACIC
SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY
M47.80 MYELOPATHY OR RADICULOPATHY; THORACIC 10,790.00 7,553.00 3,237.00
MULTIPLE SITES IN SPINE
OCCIPITO-ATLANTO-AXIAL REGION
CERVICAL REGION
CERVICOTHORACIC REGION
THORACIC REGION
LUMBAR REGION
LUMBOSACRAL REGION
SACRAL AND SACROCOCCYGEAL REGION
SITE UNSPECIFIED
M47.9 SPONDYLOSIS, UNSPECIFIED 10,790.00 7,553.00 3,237.00
M47.90 SPONDYLOSIS, UNSPECIFIED MULTIPLE SITES IN SPINE 10,790.00 7,553.00 3,237.00
M47.92 SPONDYLOSIS, UNSPECIFIED CERVICAL REGION 10,790.00 7,553.00 3,237.00
M47.94 SPONDYLOSIS, UNSPECIFIED THORACIC REGION 10,790.00 7,553.00 3,237.00
M47.95 SPONDYLOSIS, UNSPECIFIED THORACOLUMBAR REGION 10,790.00 7,553.00 3,237.00
M47.96 SPONDYLOSIS, UNSPECIFIED LUMBAR REGION 10,790.00 7,553.00 3,237.00
M47.97 SPONDYLOSIS, UNSPECIFIED LUMBOSACRAL REGION 10,790.00 7,553.00 3,237.00
M47.99 SPONDYLOSIS, UNSPECIFIED SITE UNSPECIFIED 10,790.00 7,553.00 3,237.00
M48.0 SPINAL STENOSIS; CAUDAL STENOSIS 10,790.00 7,553.00 3,237.00
SPINAL STENOSIS; CAUDAL STENOSIS MULTIPLE SITES IN
M48.00 10,790.00 7,553.00 3,237.00
SPINE
M48.02 SPINAL STENOSIS; CAUDAL STENOSIS CERVICAL REGION 10,790.00 7,553.00 3,237.00
Page 70 of 126
First Case Rate

SPINAL STENOSIS; CAUDAL STENOSIS CERVICOTHORACIC
M48.03 10,790.00 7,553.00 3,237.00
REGION
M48.04 SPINAL STENOSIS; CAUDAL STENOSIS THORACIC REGION 10,790.00 7,553.00 3,237.00
SPINAL STENOSIS; CAUDAL STENOSIS THORACOLUMBAR
M48.05 10,790.00 7,553.00 3,237.00
REGION
M48.06 SPINAL STENOSIS; CAUDAL STENOSIS LUMBAR REGION 10,790.00 7,553.00 3,237.00
SPINAL STENOSIS; CAUDAL STENOSIS LUMBOSACRAL
M48.07 10,790.00 7,553.00 3,237.00
REGION
SPINAL STENOSIS; CAUDAL STENOSIS SACRAL AND
M48.08 10,790.00 7,553.00 3,237.00
M48.09 SPINAL STENOSIS; CAUDAL STENOSIS SITE UNSPECIFIED 10,790.00 7,553.00 3,237.00
ANKYLOSING HYPEROSTOSIS [FORESTIER]; DIFFUSE
M48.1 10,790.00 7,553.00 3,237.00
IDIOPATHIC SKELETAL HYPEROSTOSIS [DISH]
ANKYLOSING HYPEROSTOSIS [FORESTIER]; DIFFUSE
M48.16 IDIOPATHIC SKELETAL HYPEROSTOSIS [DISH] LUMBAR 10,790.00 7,553.00 3,237.00
REGION
M48.2 KISSING SPINE 10,790.00 7,553.00 3,237.00
M48.3 TRAUMATIC SPONDYLOPATHY 10,790.00 7,553.00 3,237.00
M48.32 TRAUMATIC SPONDYLOPATHY CERVICAL REGION 10,790.00 7,553.00 3,237.00
FATIGUE FRACTURE OF VERTEBRA; STRESS FRACTURE OF
M48.4 10,790.00 7,553.00 3,237.00
VERTEBRA
M48.5 COLLAPSED VERTEBRA NOS; WEDGING OF VERTEBRA NOS 10,790.00 7,553.00 3,237.00
COLLAPSED VERTEBRA NOS; WEDGING OF VERTEBRA NOS
M48.54 10,790.00 7,553.00 3,237.00
THORACIC REGION
M48.56 10,790.00 7,553.00 3,237.00
LUMBAR REGION
M48.57 10,790.00 7,553.00 3,237.00
LUMBOSACRAL REGION
M48.8 OSSIFICATION OF POSTERIOR LONGITUDINAL LIGAMENT 10,790.00 7,553.00 3,237.00
OSSIFICATION OF POSTERIOR LONGITUDINAL LIGAMENT
M48.80 10,790.00 7,553.00 3,237.00
M48.85 10,790.00 7,553.00 3,237.00
M48.86 10,790.00 7,553.00 3,237.00
LUMBAR REGION
M48.89 10,790.00 7,553.00 3,237.00
SITE UNSPECIFIED
M48.9 SPONDYLOPATHY, UNSPECIFIED 10,790.00 7,553.00 3,237.00
M48.92 SPONDYLOPATHY, UNSPECIFIED CERVICAL REGION 10,790.00 7,553.00 3,237.00
SPONDYLOPATHY, UNSPECIFIED THORACOLUMBAR
M48.95 10,790.00 7,553.00 3,237.00
REGION
M48.96 SPONDYLOPATHY, UNSPECIFIED LUMBAR REGION 10,790.00 7,553.00 3,237.00
SPONDYLOPATHY, UNSPECIFIED SACRAL AND
M48.98 10,790.00 7,553.00 3,237.00
M48.99 SPONDYLOPATHY, UNSPECIFIED SITE UNSPECIFIED 10,790.00 7,553.00 3,237.00
M49.0* POTT'S CURVATURE 10,790.00 7,553.00 3,237.00
SPONDYLOPATHY IN OTHER DISEASES CLASSIFIED
M49.8* 10,790.00 7,553.00 3,237.00
ELSEWHERE
M50.1 CERVICAL DISC DISORDER WITH RADICULOPATHY 10,140.00 7,098.00 3,042.00
M50.2 OTHER CERVICAL DISC DISPLACEMENT 10,140.00 7,098.00 3,042.00
M50.3 OTHER CERVICAL DISC DEGENERATION 10,140.00 7,098.00 3,042.00
M50.8 OTHER CERVICAL VERTEBRAL DISC DISORDERS 10,140.00 7,098.00 3,042.00
LUMBAR AND OTHER INTERVERTEBRAL DISC DISORDERS
M51.1 WITH RADICULOPATHY; SCIATICA DUE TO 10,140.00 7,098.00 3,042.00
INTERVERTEBRAL DISC DISORDER
OTHER SPECIFIED INTERVERTEBRAL DISC DISPLACEMENT
M51.2 LUMBAGO DUE TO DISPLACEMENT OF INTERVERTEBRAL 10,140.00 7,098.00 3,042.00
DISC
OTHER SPECIFIED INTERVERTEBRAL DISC
M51.3 10,140.00 7,098.00 3,042.00
DEGENERATIONS
M51.4 SCHMORL'S NODE 10,140.00 7,098.00 3,042.00
OTHER SPECIFIED INTERVERTEBRAL VERTEBRAL DISC
M51.8 10,140.00 7,098.00 3,042.00
DISORDERS
CERVICOCRANIAL SYNDROME; POSTERIOR CERVICAL
M53.0 9,880.00 6,916.00 2,964.00
SYMPATHETIC SYNDROME
M53.1 CERVICOBRACHIAL SYNDROME 9,880.00 6,916.00 2,964.00
M53.12 CERVICOBRACHIAL SYNDROME CERVICAL REGION 9,880.00 6,916.00 2,964.00
M53.19 CERVICOBRACHIAL SYNDROME SITE UNSPECIFIED 9,880.00 6,916.00 2,964.00
M53.2 SPINAL INSTABILITIES 9,880.00 6,916.00 2,964.00
M53.22 SPINAL INSTABILITIES CERVICAL REGION 9,880.00 6,916.00 2,964.00
M53.24 SPINAL INSTABILITIES THORACIC REGION 9,880.00 6,916.00 2,964.00
M53.26 SPINAL INSTABILITIES LUMBAR REGION 9,880.00 6,916.00 2,964.00
M53.27 SPINAL INSTABILITIES LUMBOSACRAL REGION 9,880.00 6,916.00 2,964.00
SPINAL INSTABILITIES SACRAL AND SACROCOCCYGEAL
M53.28 9,880.00 6,916.00 2,964.00
REGION
M53.29 SPINAL INSTABILITIES SITE UNSPECIFIED 9,880.00 6,916.00 2,964.00
M53.3 COCCYGODYNIA 9,880.00 6,916.00 2,964.00
Page 71 of 126
First Case Rate

M53.38 COCCYGODYNIA SACRAL AND SACROCOCCYGEAL REGION 9,880.00 6,916.00 2,964.00
M53.8 OTHER SPECIFIED DORSOPATHIES 9,880.00 6,916.00 2,964.00
M53.86 OTHER SPECIFIED DORSOPATHIES LUMBAR REGION 9,880.00 6,916.00 2,964.00
M53.87 OTHER SPECIFIED DORSOPATHIES LUMBOSACRAL REGION 9,880.00 6,916.00 2,964.00
M53.89 OTHER SPECIFIED DORSOPATHIES SITE UNSPECIFIED 9,880.00 6,916.00 2,964.00

M53.9 DORSOPATHY, UNSPECIFIED 9,880.00 6,916.00 2,964.00
M53.92 DORSOPATHY, UNSPECIFIED CERVICAL REGION 9,880.00 6,916.00 2,964.00
M53.95 DORSOPATHY, UNSPECIFIED THORACOLUMBAR REGION 9,880.00 6,916.00 2,964.00
M54 DORSALGIA 9,880.00 6,916.00 2,964.00
PANNICULITIS AFFECTING REGIONS OF NECK AND BACK
M54.01 8,320.00 5,824.00 2,496.00
M54.06 8,320.00 5,824.00 2,496.00
LUMBAR REGION
M54.08 8,320.00 5,824.00 2,496.00
RADICULOPATHY; BRACHIAL NEURITIS OR RADICULITIS
NOS; LUMBAR NEURITIS OR RADICULITIS NOS;
M54.10 LUMBOSACRAL; THORACIC NEURITIS OR RADICULITIS NOS 8,320.00 5,824.00 2,496.00
; RADICULITIS NOS
; RADICULITIS NOS
; RADICULITIS NOS
CERVICAL REGION
; RADICULITIS NOS
THORACIC REGION
; RADICULITIS NOS
; RADICULITIS NOS
LUMBAR REGION
; RADICULITIS NOS
LUMBOSACRAL REGION
; RADICULITIS NOS
; RADICULITIS NOS
SITE UNSPECIFIED
M54.2 CERVICALGIA 8,320.00 5,824.00 2,496.00
M54.20 CERVICALGIA MULTIPLE SITES IN SPINE 8,320.00 5,824.00 2,496.00
M54.22 CERVICALGIA CERVICAL REGION 8,320.00 5,824.00 2,496.00
M54.26 CERVICALGIA LUMBAR REGION 8,320.00 5,824.00 2,496.00
M54.3 SCIATICA 8,320.00 5,824.00 2,496.00
M54.30 SCIATICA MULTIPLE SITES IN SPINE 8,320.00 5,824.00 2,496.00
M54.31 SCIATICA OCCIPITO-ATLANTO-AXIAL REGION 8,320.00 5,824.00 2,496.00
M54.35 SCIATICA THORACOLUMBAR REGION 8,320.00 5,824.00 2,496.00
M54.36 SCIATICA LUMBAR REGION 8,320.00 5,824.00 2,496.00
M54.37 SCIATICA LUMBOSACRAL REGION 8,320.00 5,824.00 2,496.00
M54.38 SCIATICA SACRAL AND SACROCOCCYGEAL REGION 8,320.00 5,824.00 2,496.00
M54.39 SCIATICA SITE UNSPECIFIED 8,320.00 5,824.00 2,496.00
M54.4 LUMBAGO WITH SCIATICA 8,320.00 5,824.00 2,496.00
LUMBAGO WITH SCIATICA OCCIPITO-ATLANTO-AXIAL
M54.41 8,320.00 5,824.00 2,496.00
REGION
M54.44 LUMBAGO WITH SCIATICA THORACIC REGION 8,320.00 5,824.00 2,496.00
M54.46 LUMBAGO WITH SCIATICA LUMBAR REGION 8,320.00 5,824.00 2,496.00
LUMBAGO WITH SCIATICA SACRAL AND SACROCOCCYGEAL
M54.48 8,320.00 5,824.00 2,496.00
REGION
Page 72 of 126
First Case Rate

M54.49 LUMBAGO WITH SCIATICA SITE UNSPECIFIED 8,320.00 5,824.00 2,496.00
LOW BACK PAIN; LOIN PAIN; LOW BACK STRAIN; LUMBAGO
M54.5 8,320.00 5,824.00 2,496.00
NOS
M54.50 8,320.00 5,824.00 2,496.00
NOS MULTIPLE SITES IN SPINE
M54.51 8,320.00 5,824.00 2,496.00
NOS OCCIPITO-ATLANTO-AXIAL REGION
M54.52 8,320.00 5,824.00 2,496.00
NOS CERVICAL REGION
M54.84 OTHER DORSALGIA THORACIC REGION 8,320.00 5,824.00 2,496.00
OTHER DORSALGIA SACRAL AND SACROCOCCYGEAL
M54.88 8,320.00 5,824.00 2,496.00
REGION
DORSALGIA, UNSPECIFIED; BACKACHE NOS OCCIPITO-
M54.91 8,320.00 5,824.00 2,496.00
ATLANTO-AXIAL REGION
DORSALGIA, UNSPECIFIED; BACKACHE NOS
M54.93 8,320.00 5,824.00 2,496.00
CERVICOTHORACIC REGION
DORSALGIA, UNSPECIFIED; BACKACHE NOS LUMBAR
M54.96 8,320.00 5,824.00 2,496.00
REGION
DORSALGIA, UNSPECIFIED; BACKACHE NOS LUMBOSACRAL
M54.97 8,320.00 5,824.00 2,496.00
REGION
DORSALGIA, UNSPECIFIED; BACKACHE NOS SACRAL AND
M54.98 8,320.00 5,824.00 2,496.00
DORSALGIA, UNSPECIFIED; BACKACHE NOS SITE
M54.99 8,320.00 5,824.00 2,496.00
UNSPECIFIED
M60.0 INFECTIVE MYOSITIS; TROPICAL PYOMYOSITIS 8,450.00 5,915.00 2,535.00
INFECTIVE MYOSITIS; TROPICAL PYOMYOSITIS MULTIPLE
M60.00 8,450.00 5,915.00 2,535.00
SITE
INFECTIVE MYOSITIS; TROPICAL PYOMYOSITIS SHOULDER
M60.01 8,450.00 5,915.00 2,535.00
REGION
M60.02 INFECTIVE MYOSITIS; TROPICAL PYOMYOSITIS UPPER ARM 8,450.00 5,915.00 2,535.00
INFECTIVE MYOSITIS; TROPICAL PYOMYOSITIS PELVIC
M60.05 8,450.00 5,915.00 2,535.00
REGION AND THIGH
M60.06 INFECTIVE MYOSITIS; TROPICAL PYOMYOSITIS LOWER LEG 8,450.00 5,915.00 2,535.00
INFECTIVE MYOSITIS; TROPICAL PYOMYOSITIS ANKLE AND
M60.07 8,450.00 5,915.00 2,535.00
FOOT
M60.08 INFECTIVE MYOSITIS; TROPICAL PYOMYOSITIS OTHER 8,450.00 5,915.00 2,535.00
INFECTIVE MYOSITIS; TROPICAL PYOMYOSITIS SITE
M60.09 8,450.00 5,915.00 2,535.00
UNSPECIFIED
M60.1 INTERSTITIAL MYOSITIS 8,450.00 5,915.00 2,535.00
M60.11 INTERSTITIAL MYOSITIS SHOULDER REGION 8,450.00 5,915.00 2,535.00
FOREIGN BODY GRANULOMA OF SOFT TISSUE, NOT
M60.2 8,450.00 5,915.00 2,535.00
M60.21 8,450.00 5,915.00 2,535.00
ELSEWHERE CLASSIFIED SHOULDER REGION
M60.23 8,450.00 5,915.00 2,535.00
ELSEWHERE CLASSIFIED FOREARM
M60.27 8,450.00 5,915.00 2,535.00
ELSEWHERE CLASSIFIED ANKLE AND FOOT
M60.8 OTHER MYOSITIS 8,450.00 5,915.00 2,535.00
M60.80 OTHER MYOSITIS MULTIPLE SITE 8,450.00 5,915.00 2,535.00
M60.81 OTHER MYOSITIS SHOULDER REGION 8,450.00 5,915.00 2,535.00
M60.88 OTHER MYOSITIS OTHER 8,450.00 5,915.00 2,535.00
M60.89 OTHER MYOSITIS SITE UNSPECIFIED 8,450.00 5,915.00 2,535.00
M60.9 MYOSITIS, UNSPECIFIED 8,450.00 5,915.00 2,535.00
M60.90 MYOSITIS, UNSPECIFIED MULTIPLE SITE 8,450.00 5,915.00 2,535.00
M60.91 MYOSITIS, UNSPECIFIED SHOULDER REGION 8,450.00 5,915.00 2,535.00
M60.92 MYOSITIS, UNSPECIFIED UPPER ARM 8,450.00 5,915.00 2,535.00
M60.95 MYOSITIS, UNSPECIFIED PELVIC REGION AND THIGH 8,450.00 5,915.00 2,535.00
M60.96 MYOSITIS, UNSPECIFIED LOWER LEG 8,450.00 5,915.00 2,535.00
M60.98 MYOSITIS, UNSPECIFIED OTHER 8,450.00 5,915.00 2,535.00
M60.99 MYOSITIS, UNSPECIFIED SITE UNSPECIFIED 8,450.00 5,915.00 2,535.00
CALCIFICATION AND OSSIFICATION OF MUSCLES
M61.3 ASSOCIATED WITH BURNS; MYOSITIS OSSIFICANS 8,450.00 5,915.00 2,535.00
ASSOCIATED WITH BURNS
OTHER OSSIFICATION OF MUSCLE PELVIC REGION AND
M61.55 8,450.00 5,915.00 2,535.00
THIGH
M61.59 OTHER OSSIFICATION OF MUSCLE SITE UNSPECIFIED 8,450.00 5,915.00 2,535.00
CALCIFICATION AND OSSIFICATION OF MUSCLE,
M61.9 8,450.00 5,915.00 2,535.00
UNSPECIFIED
M62.0 DIASTASIS OF MUSCLE 8,450.00 5,915.00 2,535.00
M62.05 DIASTASIS OF MUSCLE PELVIC REGION AND THIGH 8,450.00 5,915.00 2,535.00
M62.08 DIASTASIS OF MUSCLE OTHER 8,450.00 5,915.00 2,535.00
M62.1 OTHER RUPTURE OF MUSCLE (NONTRAUMATIC) 8,450.00 5,915.00 2,535.00
M62.48 CONTRACTURE OF MUSCLE OTHER 8,450.00 5,915.00 2,535.00
M62.49 CONTRACTURE OF MUSCLE SITE UNSPECIFIED 8,450.00 5,915.00 2,535.00
MUSCLE WASTING AND ATROPHY, NOT ELSEWHERE
M62.56 8,450.00 5,915.00 2,535.00
CLASSIFIED; DISUSE ATROPHY NEC LOWER LEG
MUSCLE WASTING AND ATROPHY, NOT ELSEWHERE
M62.59 8,450.00 5,915.00 2,535.00
CLASSIFIED; DISUSE ATROPHY NEC SITE UNSPECIFIED
Page 73 of 126
First Case Rate

M62.60 MUSCLE STRAIN MULTIPLE SITE 8,450.00 5,915.00 2,535.00
M62.61 MUSCLE STRAIN SHOULDER REGION 8,450.00 5,915.00 2,535.00
M62.62 MUSCLE STRAIN UPPER ARM 8,450.00 5,915.00 2,535.00
M62.63 MUSCLE STRAIN FOREARM 8,450.00 5,915.00 2,535.00
M62.65 MUSCLE STRAIN PELVIC REGION AND THIGH 8,450.00 5,915.00 2,535.00
M62.66 MUSCLE STRAIN LOWER LEG 8,450.00 5,915.00 2,535.00
M62.67 MUSCLE STRAIN ANKLE AND FOOT 8,450.00 5,915.00 2,535.00
M62.68 MUSCLE STRAIN OTHER 8,450.00 5,915.00 2,535.00
M62.69 MUSCLE STRAIN SITE UNSPECIFIED 8,450.00 5,915.00 2,535.00
M62.8 MUSCLE (SHEATH) HERNIA 8,450.00 5,915.00 2,535.00
M62.80 MUSCLE (SHEATH) HERNIA MULTIPLE SITE 8,450.00 5,915.00 2,535.00
M62.85 MUSCLE (SHEATH) HERNIA PELVIC REGION AND THIGH 8,450.00 5,915.00 2,535.00
M62.86 MUSCLE (SHEATH) HERNIA LOWER LEG 8,450.00 5,915.00 2,535.00
M62.88 MUSCLE (SHEATH) HERNIA OTHER 8,450.00 5,915.00 2,535.00
M62.89 MUSCLE (SHEATH) HERNIA SITE UNSPECIFIED 8,450.00 5,915.00 2,535.00
M62.9 DISORDER OF MUSCLE, UNSPECIFIED 8,450.00 5,915.00 2,535.00
M62.90 DISORDER OF MUSCLE, UNSPECIFIED MULTIPLE SITE 8,450.00 5,915.00 2,535.00
M62.91 DISORDER OF MUSCLE, UNSPECIFIED SHOULDER REGION 8,450.00 5,915.00 2,535.00
DISORDER OF MUSCLE, UNSPECIFIED PELVIC REGION AND
M62.95 8,450.00 5,915.00 2,535.00
THIGH
M62.96 DISORDER OF MUSCLE, UNSPECIFIED LOWER LEG 8,450.00 5,915.00 2,535.00
M62.97 DISORDER OF MUSCLE, UNSPECIFIED ANKLE AND FOOT 8,450.00 5,915.00 2,535.00
M62.98 DISORDER OF MUSCLE, UNSPECIFIED OTHER 8,450.00 5,915.00 2,535.00
M62.99 DISORDER OF MUSCLE, UNSPECIFIED SITE UNSPECIFIED 8,450.00 5,915.00 2,535.00
M65.0 ABSCESS OF TENDON SHEATH 8,450.00 5,915.00 2,535.00
M65.1 OTHER INFECTIVE TENOSYNOVITIS 8,450.00 5,915.00 2,535.00
M65.13 OTHER INFECTIVE (TENO)SYNOVITIS FOREARM 8,450.00 5,915.00 2,535.00
M65.2 CALCIFIC TENDINITIS 8,450.00 5,915.00 2,535.00
M65.20 CALCIFIC TENDINITIS MULTIPLE SITE 8,450.00 5,915.00 2,535.00
M65.22 CALCIFIC TENDINITIS UPPER ARM 8,450.00 5,915.00 2,535.00
M65.25 CALCIFIC TENDINITIS PELVIC REGION AND THIGH 8,450.00 5,915.00 2,535.00
M65.29 CALCIFIC TENDINITIS SITE UNSPECIFIED 8,450.00 5,915.00 2,535.00
M65.3 TRIGGER FINGER;NODULAR TENDINOUS DISEASE 8,450.00 5,915.00 2,535.00
M65.4 RADIAL STYLOID TENOSYNOVITIS [DE QUERVAIN] 8,450.00 5,915.00 2,535.00
M65.8 OTHER SYNOVITIS AND TENOSYNOVITIS 8,450.00 5,915.00 2,535.00
M65.80 OTHER SYNOVITIS AND TENOSYNOVITIS MULTIPLE SITE 8,450.00 5,915.00 2,535.00
M65.84 OTHER SYNOVITIS AND TENOSYNOVITIS HAND 8,450.00 5,915.00 2,535.00
M65.86 OTHER SYNOVITIS AND TENOSYNOVITIS LOWER LEG 8,450.00 5,915.00 2,535.00
M65.87 OTHER SYNOVITIS AND TENOSYNOVITIS ANKLE AND FOOT 8,450.00 5,915.00 2,535.00
M65.89 OTHER SYNOVITIS AND TENOSYNOVITIS SITE UNSPECIFIED 8,450.00 5,915.00 2,535.00
M65.9 SYNOVITIS AND TENOSYNOVITIS, UNSPECIFIED 8,450.00 5,915.00 2,535.00
SYNOVITIS AND TENOSYNOVITIS, UNSPECIFIED MULTIPLE
M65.90 8,450.00 5,915.00 2,535.00
SITE
SYNOVITIS AND TENOSYNOVITIS, UNSPECIFIED SHOULDER
M65.91 8,450.00 5,915.00 2,535.00
REGION
M65.92 SYNOVITIS AND TENOSYNOVITIS, UNSPECIFIED UPPER ARM 8,450.00 5,915.00 2,535.00
M65.93 SYNOVITIS AND TENOSYNOVITIS, UNSPECIFIED FOREARM 8,450.00 5,915.00 2,535.00
M65.94 SYNOVITIS AND TENOSYNOVITIS, UNSPECIFIED HAND 8,450.00 5,915.00 2,535.00

SYNOVITIS AND TENOSYNOVITIS, UNSPECIFIED PELVIC
M65.95 8,450.00 5,915.00 2,535.00
REGION AND THIGH
M65.96 SYNOVITIS AND TENOSYNOVITIS, UNSPECIFIED LOWER LEG 8,450.00 5,915.00 2,535.00
SYNOVITIS AND TENOSYNOVITIS, UNSPECIFIED ANKLE AND
M65.97 8,450.00 5,915.00 2,535.00
FOOT
SYNOVITIS AND TENOSYNOVITIS, UNSPECIFIED SITE
M65.99 8,450.00 5,915.00 2,535.00
UNSPECIFIED
M66.0 RUPTURE OF POPLITEAL CYST 8,450.00 5,915.00 2,535.00
M66.4 SPONTANEOUS RUPTURE OF OTHER TENDONS 8,450.00 5,915.00 2,535.00
SPONTANEOUS RUPTURE OF UNSPECIFIED TENDON;
M66.5 RUPTURE AT MUSCULOTENDINOUS JUNCTION, 8,450.00 5,915.00 2,535.00
NONTRAUMATIC
M67.0 SHORT ACHILLES TENDON (ACQUIRED) 8,450.00 5,915.00 2,535.00
M67.1 OTHER CONTRACTURE OF TENDON (SHEATH) 8,450.00 5,915.00 2,535.00
M67.2 SYNOVIAL HYPERTROPHY, NOT ELSEWHERE CLASSIFIED 8,450.00 5,915.00 2,535.00
M67.3 TRANSIENT SYNOVITIS; TOXIC SYNOVITIS 8,450.00 5,915.00 2,535.00
M67.4 GANGLION; GANGLION OF JOINT OR TENDON (SHEATH) 8,450.00 5,915.00 2,535.00
M67.8 OTHER SPECIFIED DISORDERS OF SYNOVIUM AND TENDON 8,450.00 5,915.00 2,535.00
M67.9 DISORDER OF SYNOVIUM AND TENDON, UNSPECIFIED 8,450.00 5,915.00 2,535.00
M70.0 CHRONIC CREPITANT SYNOVITIS OF HAND AND WRIST 8,450.00 5,915.00 2,535.00
Page 74 of 126
First Case Rate

M70.1 BURSITIS OF HAND 8,450.00 5,915.00 2,535.00
M70.2 OLECRANON BURSITIS 8,450.00 5,915.00 2,535.00
M70.3 OTHER BURSITIS OF ELBOW 8,450.00 5,915.00 2,535.00
M70.4 PREPATELLAR BURSITIS 8,450.00 5,915.00 2,535.00
M70.5 OTHER BURSITIS OF KNEE 8,450.00 5,915.00 2,535.00
TROCHANTERIC BURSITIS; TROCHANTERIC TENDINITIS
M70.6 8,450.00 5,915.00 2,535.00
SHOULDER REGION
M70.7 OTHER BURSITIS OF HIP; ISCHIAL BURSITIS 8,450.00 5,915.00 2,535.00
OTHER SOFT TISSUE DISORDERS RELATED TO USE,
M70.8 8,450.00 5,915.00 2,535.00
OVERUSE AND PRESSURE
UNSPECIFIED SOFT TISSUE DISORDER RELATED TO USE,
M70.9 8,450.00 5,915.00 2,535.00
OVERUSE AND PRESSURE
M71.1 OTHER INFECTIVE BURSITIS 8,450.00 5,915.00 2,535.00
M71.2 SYNOVIAL CYST OF POPLITEAL SPACE [BAKER] 8,450.00 5,915.00 2,535.00
M71.3 OTHER BURSAL CYST; SYNOVIAL CYST NOS 8,450.00 5,915.00 2,535.00
OTHER BURSAL CYST; SYNOVIAL CYST NOS SHOULDER
M71.31 8,450.00 5,915.00 2,535.00
REGION
M71.5 OTHER BURSITIS, NOT ELSEWHERE CLASSIFIED 8,450.00 5,915.00 2,535.00
OTHER BURSITIS, NOT ELSEWHERE CLASSIFIED SHOULDER
M71.51 8,450.00 5,915.00 2,535.00
REGION
M71.8 OTHER SPECIFIED BURSOPATHIES 8,450.00 5,915.00 2,535.00
M71.9 BURSOPATHY, UNSPECIFIED 8,450.00 5,915.00 2,535.00
M71.91 BURSOPATHY, UNSPECIFIED SHOULDER REGION 8,450.00 5,915.00 2,535.00
M71.99 BURSOPATHY, UNSPECIFIED SITE UNSPECIFIED 8,450.00 5,915.00 2,535.00
M72.0 PALMAR FASCIAL FIBROMATOSIS [DUPUYTREN] 8,450.00 5,915.00 2,535.00
M72.2 PLANTAR FASCIAL FIBROMATOSIS; PLANTAR FASCIITIS 8,450.00 5,915.00 2,535.00
M72.5 FASCIITIS, NOT ELSEWHERE CLASSIFIED, 8,450.00 5,915.00 2,535.00
OTHER FIBROBLASTIC DISORDERS; ABSCESS OF FASCIA
M72.88 8,450.00 5,915.00 2,535.00
OTHER
FIBROBLASTIC DISORDER, UNSPECIFIED; FASCIITIS NOS;
M72.9 8,450.00 5,915.00 2,535.00
FIBROMATOSIS NOS
M72.98 8,450.00 5,915.00 2,535.00
FIBROMATOSIS NOS OTHER
M72.99 8,450.00 5,915.00 2,535.00
FIBROMATOSIS NOS SITE UNSPECIFIED
ADHESIVE CAPSULITIS OF SHOULDER; FROZEN SHOULDER;
M75.0 8,450.00 5,915.00 2,535.00
PERIARTHRITIS OF SHOULDER
ROTATOR CUFF SYNDROME; ROTATOR CUFF OR
SUPRASPINATUS TEAR OR RUPTURE
M75.1 8,450.00 5,915.00 2,535.00
COMPLETE)(INCOMPLETE), NOT SPECIFIED
AS TRAUMATIC; SUPRASPINATUS SYNDROME
M75.2 BICIPITAL TENDINITIS 8,450.00 5,915.00 2,535.00
CALCIFIC TENDINITIS OF SHOULDER; CALCIFIED BURSA OF
M75.3 8,450.00 5,915.00 2,535.00
SHOULDER
M75.4 IMPINGEMENT SYNDROME OF SHOULDER 8,450.00 5,915.00 2,535.00
M75.5 BURSITIS OF SHOULDER 8,450.00 5,915.00 2,535.00
M75.8 OTHER SHOULDER LESIONS 8,450.00 5,915.00 2,535.00
M75.9 SHOULDER LESION, UNSPECIFIED 8,450.00 5,915.00 2,535.00
M76 ENTHESOPATHIES OF LOWER LIMB, EXCLUDING FOOT 8,450.00 5,915.00 2,535.00
M76.0 GLUTEAL TENDINITIS 8,450.00 5,915.00 2,535.00
M76.1 PSOAS TENDINITIS 8,450.00 5,915.00 2,535.00
M76.3 ILIOTIBIAL BAND SYNDROME 8,450.00 5,915.00 2,535.00
M76.4 TIBIAL COLLATERAL BURSITIS [PELLEGRINI-STIEDA] 8,450.00 5,915.00 2,535.00
M76.5 PATELLAR TENDINITIS 8,450.00 5,915.00 2,535.00
M76.6 ACHILLES TENDINITIS; ACHILLES BURSITIS 8,450.00 5,915.00 2,535.00
M76.7 PERONEAL TENDINITIS 8,450.00 5,915.00 2,535.00
OTHER ENTHESOPATHIES OF LOWER LIMB, EXCLUDING
M76.8 FOOT; ANTERIOR TIBIAL SYNDROME; POSTERIOR TIBIAL 8,450.00 5,915.00 2,535.00
TENDINITIS
M76.9 ENTHESOPATHY OF LOWER LIMB, UNSPECIFIED 8,450.00 5,915.00 2,535.00
M77.0 MEDIAL EPICONDYLITIS 8,450.00 5,915.00 2,535.00
M77.1 LATERAL EPICONDYLITIS; TENNIS ELBOW 8,450.00 5,915.00 2,535.00
M77.3 CALCANEAL SPUR 8,450.00 5,915.00 2,535.00
M77.5 OTHER ENTHESOPATHY OF FOOT 8,450.00 5,915.00 2,535.00
M77.8 OTHER ENTHESOPATHIES, NOT ELSEWHERE CLASSIFIED 8,450.00 5,915.00 2,535.00
ENTHESOPATHY, UNSPECIFIED; BONE SPUR NOS;

M77.9 8,450.00 5,915.00 2,535.00
CAPSULITIS NOS; PERIARTHRITIS NOS; TENDINITIS NOS
M79.00 RHEUMATISM, UNSPECIFIED MULTIPLE SITE 7,670.00 5,369.00 2,301.00
M79.01 RHEUMATISM, UNSPECIFIED SHOULDER REGION 7,670.00 5,369.00 2,301.00
M79.02 RHEUMATISM, UNSPECIFIED UPPER ARM 7,670.00 5,369.00 2,301.00
M79.05 RHEUMATISM, UNSPECIFIED PELVIC REGION AND THIGH 7,670.00 5,369.00 2,301.00
M79.07 RHEUMATISM, UNSPECIFIED ANKLE AND FOOT 7,670.00 5,369.00 2,301.00
M79.08 RHEUMATISM, UNSPECIFIED OTHER 7,670.00 5,369.00 2,301.00
M79.09 RHEUMATISM, UNSPECIFIED SITE UNSPECIFIED 7,670.00 5,369.00 2,301.00
M79.10 MYALGIA MULTIPLE SITE 7,670.00 5,369.00 2,301.00
M79.11 MYALGIA SHOULDER REGION 7,670.00 5,369.00 2,301.00
M79.12 MYALGIA UPPER ARM 7,670.00 5,369.00 2,301.00
M79.15 MYALGIA PELVIC REGION AND THIGH 7,670.00 5,369.00 2,301.00
Page 75 of 126
First Case Rate

M79.16 MYALGIA LOWER LEG 7,670.00 5,369.00 2,301.00
M79.18 MYALGIA OTHER 7,670.00 5,369.00 2,301.00
M79.19 MYALGIA SITE UNSPECIFIED 7,670.00 5,369.00 2,301.00
M79.20 NEURALGIA AND NEURITIS, UNSPECIFIED MULTIPLE SITE 7,670.00 5,369.00 2,301.00
NEURALGIA AND NEURITIS, UNSPECIFIED SHOULDER
M79.21 7,670.00 5,369.00 2,301.00
REGION
M79.22 NEURALGIA AND NEURITIS, UNSPECIFIED UPPER ARM 7,670.00 5,369.00 2,301.00
NEURALGIA AND NEURITIS, UNSPECIFIED PELVIC REGION
M79.25 7,670.00 5,369.00 2,301.00
AND THIGH
M79.28 NEURALGIA AND NEURITIS, UNSPECIFIED OTHER 7,670.00 5,369.00 2,301.00
NEURALGIA AND NEURITIS, UNSPECIFIED SITE
M79.29 7,670.00 5,369.00 2,301.00
UNSPECIFIED
M79.39 PANNICULITIS, UNSPECIFIED SITE UNSPECIFIED 7,670.00 5,369.00 2,301.00
M79.80 OTHER SPECIFIED SOFT TISSUE DISORDERS MULTIPLE SITE 8,450.00 5,915.00 2,535.00
OTHER SPECIFIED SOFT TISSUE DISORDERS SHOULDER
M79.81 8,450.00 5,915.00 2,535.00
REGION
M79.82 OTHER SPECIFIED SOFT TISSUE DISORDERS UPPER ARM 8,450.00 5,915.00 2,535.00
M79.84 OTHER SPECIFIED SOFT TISSUE DISORDERS HAND 8,450.00 5,915.00 2,535.00
OTHER SPECIFIED SOFT TISSUE DISORDERS PELVIC REGION
M79.85 8,450.00 5,915.00 2,535.00
AND THIGH
M79.86 OTHER SPECIFIED SOFT TISSUE DISORDERS LOWER LEG 8,450.00 5,915.00 2,535.00
OTHER SPECIFIED SOFT TISSUE DISORDERS ANKLE AND
M79.87 8,450.00 5,915.00 2,535.00
FOOT
M79.88 OTHER SPECIFIED SOFT TISSUE DISORDERS OTHER 8,450.00 5,915.00 2,535.00
OTHER SPECIFIED SOFT TISSUE DISORDERS SITE
M79.89 8,450.00 5,915.00 2,535.00
UNSPECIFIED
M79.91 SOFT TISSUE DISORDER, UNSPECIFIED SHOULDER REGION 8,450.00 5,915.00 2,535.00
SOFT TISSUE DISORDER, UNSPECIFIED PELVIC REGION AND
M79.95 8,450.00 5,915.00 2,535.00
THIGH
M79.98 SOFT TISSUE DISORDER, UNSPECIFIED OTHER 8,450.00 5,915.00 2,535.00
M79.99 SOFT TISSUE DISORDER, UNSPECIFIED SITE UNSPECIFIED 8,450.00 5,915.00 2,535.00
POSTMENOPAUSAL OSTEOPOROSIS WITH PATHOLOGICAL
M80.0 10,270.00 7,189.00 3,081.00
FRACTURE
POSTOOPHORECTOMY OSTEOPOROSIS WITH
M80.1 10,270.00 7,189.00 3,081.00
PATHOLOGICAL FRACTURE
POSTSURGICAL MALABSORPTION OSTEOPOROSIS WITH
M80.3 10,270.00 7,189.00 3,081.00
PATHOLOGICAL FRACTURE
M81.0 POSTMENOPAUSAL OSTEOPOROSIS 10,270.00 7,189.00 3,081.00
M81.08 POSTMENOPAUSAL OSTEOPOROSIS OTHER 10,270.00 7,189.00 3,081.00
M81.1 POSTOOPHORECTOMY OSTEOPOROSIS 10,270.00 7,189.00 3,081.00
M81.4 DRUG-INDUCED OSTEOPOROSIS 10,270.00 7,189.00 3,081.00
M81.40 DRUG-INDUCED OSTEOPOROSIS MULTIPLE SITE 10,270.00 7,189.00 3,081.00
M81.55 IDIOPATHIC OSTEOPOROSIS PELVIC REGION AND THIGH 10,270.00 7,189.00 3,081.00
M81.58 IDIOPATHIC OSTEOPOROSIS OTHER 10,270.00 7,189.00 3,081.00
M81.6 LOCALIZED OSTEOPOROSIS [LEQUESNE] 10,270.00 7,189.00 3,081.00
M81.8 OTHER OSTEOPOROSIS; SENILE OSTEOPOROSIS 10,270.00 7,189.00 3,081.00
M81.88 OTHER OSTEOPOROSIS; SENILE OSTEOPOROSIS OTHER 10,270.00 7,189.00 3,081.00
OTHER OSTEOPOROSIS; SENILE OSTEOPOROSIS SITE
M81.89 10,270.00 7,189.00 3,081.00
UNSPECIFIED
M81.9 OSTEOPOROSIS, UNSPECIFIED 10,270.00 7,189.00 3,081.00
M81.95 OSTEOPOROSIS, UNSPECIFIED PELVIC REGION AND THIGH 10,270.00 7,189.00 3,081.00
M81.98 OSTEOPOROSIS, UNSPECIFIED OTHER 10,270.00 7,189.00 3,081.00
ADULT OSTEOMALACIA DUE TO MALABSORPTION;
M83.2 POSTSURGICAL MALABSORPTION OSTEOMALACIA IN 10,270.00 7,189.00 3,081.00
ADULTS
M83.4 ALUMINIUM BONE DISEASE 10,270.00 7,189.00 3,081.00
M83.8 OTHER ADULT OSTEOMALACIA 10,270.00 7,189.00 3,081.00
M83.87 OTHER ADULT OSTEOMALACIA ANKLE AND FOOT 10,270.00 7,189.00 3,081.00
M83.89 OTHER ADULT OSTEOMALACIA SITE UNSPECIFIED 10,270.00 7,189.00 3,081.00
M83.9 ADULT OSTEOMALACIA, UNSPECIFIED 10,270.00 7,189.00 3,081.00
M83.99 ADULT OSTEOMALACIA, UNSPECIFIED SITE UNSPECIFIED 10,270.00 7,189.00 3,081.00
M85.0 FIBROUS DYSPLASIA (MONOSTOTIC) 10,270.00 7,189.00 3,081.00
M85.1 SKELETAL FLUOROSIS MULTIPLE SITE 10,270.00 7,189.00 3,081.00
M85.2 HYPEROSTOSIS OF SKULL 10,270.00 7,189.00 3,081.00
M85.5 ANEURYSMAL BONE CYST 10,270.00 7,189.00 3,081.00
M85.55 ANEURYSMAL BONE CYST PELVIC REGION AND THIGH 10,270.00 7,189.00 3,081.00
M85.6 OTHER CYST OF BONE 10,270.00 7,189.00 3,081.00
M85.63 OTHER CYST OF BONE FOREARM 10,270.00 7,189.00 3,081.00
M85.65 OTHER CYST OF BONE PELVIC REGION AND THIGH 10,270.00 7,189.00 3,081.00
Page 76 of 126
First Case Rate

OTHER SPECIFIED DISORDERS OF BONE DENSITY AND
M85.8 10,270.00 7,189.00 3,081.00
STRUCTURE; HYPEROSTOSIS OF BONES, EXCEPT SKULL
OTHER SPECIFIED DISORDERS OF BONE DENSITY AND
M85.88 STRUCTURE; HYPEROSTOSIS OF BONES, EXCEPT SKULL 10,270.00 7,189.00 3,081.00
OTHER
M86.0 ACUTE HAEMATOGENOUS OSTEOMYELITIS 16,900.00 11,830.00 5,070.00
M86.1 OTHER ACUTE OSTEOMYELITIS 16,900.00 11,830.00 5,070.00
M86.15 OTHER ACUTE OSTEOMYELITIS PELVIC REGION AND THIGH 16,900.00 11,830.00 5,070.00
M86.17 OTHER ACUTE OSTEOMYELITIS ANKLE AND FOOT 16,900.00 11,830.00 5,070.00
M86.19 OTHER ACUTE OSTEOMYELITIS SITE UNSPECIFIED 16,900.00 11,830.00 5,070.00
M86.2 SUBACUTE OSTEOMYELITIS 16,900.00 11,830.00 5,070.00
M86.29 SUBACUTE OSTEOMYELITIS SITE UNSPECIFIED 16,900.00 11,830.00 5,070.00
M86.4 CHRONIC OSTEOMYELITIS WITH DRAINING SINUS 16,900.00 11,830.00 5,070.00
M86.5 OTHER CHRONIC HAEMATOGENOUS OSTEOMYELITIS 16,900.00 11,830.00 5,070.00
OTHER CHRONIC HAEMATOGENOUS OSTEOMYELITIS
M86.50 16,900.00 11,830.00 5,070.00
MULTIPLE SITE
M86.6 OTHER CHRONIC OSTEOMYELITIS 16,900.00 11,830.00 5,070.00
M86.60 OTHER CHRONIC OSTEOMYELITIS MULTIPLE SITE 16,900.00 11,830.00 5,070.00
M86.61 OTHER CHRONIC OSTEOMYELITIS SHOULDER REGION 16,900.00 11,830.00 5,070.00
M86.62 OTHER CHRONIC OSTEOMYELITIS UPPER ARM 16,900.00 11,830.00 5,070.00
M86.63 OTHER CHRONIC OSTEOMYELITIS FOREARM 16,900.00 11,830.00 5,070.00
OTHER CHRONIC OSTEOMYELITIS PELVIC REGION AND
M86.65 16,900.00 11,830.00 5,070.00
THIGH
M86.66 OTHER CHRONIC OSTEOMYELITIS LOWER LEG 16,900.00 11,830.00 5,070.00
M86.67 OTHER CHRONIC OSTEOMYELITIS ANKLE AND FOOT 16,900.00 11,830.00 5,070.00
M86.68 OTHER CHRONIC OSTEOMYELITIS OTHER 16,900.00 11,830.00 5,070.00
M86.69 OTHER CHRONIC OSTEOMYELITIS SITE UNSPECIFIED 16,900.00 11,830.00 5,070.00
M86.8 OTHER OSTEOMYELITIS; BRODIE'S ABSCESS 16,900.00 11,830.00 5,070.00
OTHER OSTEOMYELITIS; BRODIE'S ABSCESS MULTIPLE
M86.80 16,900.00 11,830.00 5,070.00
SITE
OTHER OSTEOMYELITIS; BRODIE'S ABSCESS SHOULDER
M86.81 16,900.00 11,830.00 5,070.00
REGION
M86.88 OTHER OSTEOMYELITIS; BRODIE'S ABSCESS OTHER 16,900.00 11,830.00 5,070.00
OSTEOMYELITIS, UNSPECIFIED; INFECTION OF BONE NOS;
M86.9 16,900.00 11,830.00 5,070.00
PERIOSTITIS WITHOUT MENTION OF OSTEOMYELITIS
M86.90 PERIOSTITIS WITHOUT MENTION OF OSTEOMYELITIS 16,900.00 11,830.00 5,070.00
MULTIPLE SITE
SHOULDER REGION
UPPER ARM
HAND
LOWER LEG
ANKLE AND FOOT
OTHER
M86.99 PERIOSTITIS WITHOUT MENTION OF OSTEOMYELITIS SITE 16,900.00 11,830.00 5,070.00
UNSPECIFIED
IDIOPATHIC ASEPTIC NECROSIS OF BONE PELVIC REGION
M87.05 16,900.00 11,830.00 5,070.00
AND THIGH
M87.2 OSTEONECROSIS DUE TO PREVIOUS TRAUMA 16,900.00 11,830.00 5,070.00
M87.8 OTHER OSTEONECROSIS 16,900.00 11,830.00 5,070.00
M87.85 OTHER OSTEONECROSIS PELVIC REGION AND THIGH 16,900.00 11,830.00 5,070.00
M87.86 OTHER OSTEONECROSIS LOWER LEG 16,900.00 11,830.00 5,070.00
M87.9 OSTEONECROSIS, UNSPECIFIED 16,900.00 11,830.00 5,070.00
M87.90 OSTEONECROSIS, UNSPECIFIED MULTIPLE SITE 16,900.00 11,830.00 5,070.00
M87.91 OSTEONECROSIS, UNSPECIFIED SHOULDER REGION 16,900.00 11,830.00 5,070.00
M87.95 OSTEONECROSIS, UNSPECIFIED PELVIC REGION AND THIGH 16,900.00 11,830.00 5,070.00
M87.99 OSTEONECROSIS, UNSPECIFIED SITE UNSPECIFIED 16,900.00 11,830.00 5,070.00
M88.0 PAGET'S DISEASE OF SKULL 16,900.00 11,830.00 5,070.00
M88.9 PAGET'S DISEASE OF BONE, UNSPECIFIED 16,900.00 11,830.00 5,070.00
ALGONEURODYSTROPHY; SHOULDER-HAND SYNDROME;
M89.0 11,440.00 8,008.00 3,432.00
SUDECK'S ATROPHY; SYMPATHETIC REFLEX DYSTROPHY
Page 77 of 126
First Case Rate

ALGONEURODYSTROPHY; SHOULDER-HAND SYNDROME;
M89.01 SUDECK'S ATROPHY; SYMPATHETIC REFLEX DYSTROPHY 11,440.00 8,008.00 3,432.00
SHOULDER REGION
M89.2 OTHER DISORDERS OF BONE DEVELOPMENT AND GROWTH 11,440.00 8,008.00 3,432.00
M89.38 HYPERTROPHY OF BONE OTHER 10,270.00 7,189.00 3,081.00
OTHER HYPERTROPHIC OSTEOARTHROPATHY; MARIE-
M89.4 11,440.00 8,008.00 3,432.00
BAMBERGER DISEASE; PACHYDERMOPERIOSTOSIS
OTHER HYPERTROPHIC OSTEOARTHROPATHY; MARIE-

M89.48 11,440.00 8,008.00 3,432.00
BAMBERGER DISEASE; PACHYDERMOPERIOSTOSIS OTHER
M89.5 OSTEOLYSIS 11,440.00 8,008.00 3,432.00
M89.54 OSTEOLYSIS HAND 11,440.00 8,008.00 3,432.00
M89.6 OSTEOPATHY AFTER POLIOMYELITIS 11,440.00 8,008.00 3,432.00
OTHER SPECIFIED DISORDERS OF BONE; INFANTILE
M89.8 CORTICAL HYPEROSTOSES; POST-TRAUMATIC 11,440.00 8,008.00 3,432.00
SUBPERIOSTEAL OSSIFICATION
CORTICAL HYPEROSTOSES; POST-TRAUMATIC
M89.85 11,440.00 8,008.00 3,432.00
SUBPERIOSTEAL OSSIFICATION PELVIC REGION AND
THIGH
SUBPERIOSTEAL OSSIFICATION LOWER LEG
SUBPERIOSTEAL OSSIFICATION ANKLE AND FOOT
SUBPERIOSTEAL OSSIFICATION OTHER
SUBPERIOSTEAL OSSIFICATION SITE UNSPECIFIED
DISORDER OF BONE, UNSPECIFIED PELVIC REGION AND
M89.95 11,440.00 8,008.00 3,432.00
THIGH
M89.98 DISORDER OF BONE, UNSPECIFIED OTHER 11,440.00 8,008.00 3,432.00
M89.99 DISORDER OF BONE, UNSPECIFIED SITE UNSPECIFIED 11,440.00 8,008.00 3,432.00
JUVENILE OSTEOCHONDROSIS OF HEAD OF FEMUR [LEGG-
M91.1 11,440.00 8,008.00 3,432.00
CALVÉ-PERTHES]
OTHER JUVENILE OSTEOCHONDROSIS OF HIP AND PELVIS;
M91.8 JUVENILE OSTEOCHONDROSIS AFTER REDUCTION OF 11,440.00 8,008.00 3,432.00
CONGENITAL DISLOCATION OF HIP
M94.0 CHONDROCOSTAL JUNCTION SYNDROME [TIETZE] 11,440.00 8,008.00 3,432.00
M94.8 OTHER SPECIFIED DISORDERS OF CARTILAGE 11,440.00 8,008.00 3,432.00
M96.8 OTHER POSTPROCEDURAL MUSCULOSKELETAL DISORDERS 7,670.00 5,369.00 2,301.00
M99.0 SEGMENTAL AND SOMATIC DYSFUNCTION, RIB CAGE 10,140.00 7,098.00 3,042.00
M99.1 SUBLUXATION COMPLEX (VERTEBRAL) 10,140.00 7,098.00 3,042.00
M99.3 OSSEOUS STENOSIS OF NEURAL CANAL 10,140.00 7,098.00 3,042.00
M99.5 INTERVERTEBRAL DISC STENOSIS OF NEURAL CANAL 10,140.00 7,098.00 3,042.00
CONNECTIVE TISSUE AND DISC STENOSIS OF
M99.7 10,140.00 7,098.00 3,042.00
INTERVERTEBRAL FORAMINA
M99.8 OTHER BIOMECHANICAL LESIONS 11,440.00 8,008.00 3,432.00
M99.9 BIOMECHANICAL LESION, UNSPECIFIED 11,440.00 8,008.00 3,432.00
ACUTE NEPHRITIC SYNDROME INCLUDING ACUTE
GLOMERULAR DISEASE, ACUTE GLOMERULONEPHRITIS,
N00.0 13,000.00 9,100.00 3,900.00
ACUTE NEPHRITIS, ACUTE RENAL DISEASE NOS, WITH
MINOR GLOMERULAR ABNORMALITY

ACUTE NEPHRITIS, ACUTE RENAL DISEASE NOS, WITH
N00.1 13,000.00 9,100.00 3,900.00
FOCAL AND SEGMENTAL GLOMERULAR LESIONS (WITH
FOCAL AND SEGMENTAL HYALINOSIS; FOCAL AND
SEGMENTAL SCLEROSIS) & FOCAL GLOM

N00.2 13,000.00 9,100.00 3,900.00
ACUTE NEPHRITIS, ACUTE RENAL DISEASE NOS WITH
DIFFUSE MEMBRANOUS GLOMERULONEPHRITIS
N00.3 ACUTE NEPHRITIS, ACUTE RENAL DISEASE NOS WITH 13,000.00 9,100.00 3,900.00
DIFFUSE MESANGIAL PROLIFERATIVE
GLOMERULONEPHRITIS
DIFFUSE ENDOCAPILLARY PROLIFERATIVE
GLOMERULONEPHRITIS
Page 78 of 126
First Case Rate

N00.5 13,000.00 9,100.00 3,900.00
DIFFUSE MESANGIOCAPILLARY GLOMERULONEPHRITIS
(MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS,
TYPES 1 AND 3, OR NOS)

DIFFUSE CRESCENTIC GLOMERULONEPHRITIS
(EXTRACPILLARY GLOMERULONEPHRITIS)

N00.8 13,000.00 9,100.00 3,900.00
OTHER (PROLIFERATIVE GLOMERULONEPHRITIS NOS)
N00.9 13,000.00 9,100.00 3,900.00
ACUTE NEPHRITIS, ACUTE RENAL DISEASE NOS,
UNSPECIFIED RENAL BIOPSY
RAPIDLY PROGRESSIVE NEPHRITIC SYNDROME; RAPIDLY
PROGRESSIVE GLOMERULAR DISEASE; RAPIDLY
N01.0 PROGRESSIVE GLOMERULONEPHRITIS; RAPIDLY 13,000.00 9,100.00 3,900.00
PROGRESSIVE NEPHRITIS, MINOR GLOMERULAR
ABNORMALITY
PROGRESSIVE NEPHRITIS, FOCAL AND SEGMENTAL
GLOMERULAR LESIONS
PROGRESSIVE NEPHRITIS, DIFFUSE MESANGIAL
PROLIFERATIVE GLOMERULONEPHRITIS
PROGRESSIVE NEPHRITIS, DIFFUSE MESANGIOCAPILLARY
GLOMERULONEPHRITIS
N01.8 13,000.00 9,100.00 3,900.00
PROGRESSIVE GLOMERULONEPHRITIS; RAPIDLY
PROGRESSIVE NEPHRITIS, OTHER
N01.9 13,000.00 9,100.00 3,900.00
PROGRESSIVE GLOMERULONEPHRITIS; RAPIDLY
PROGRESSIVE NEPHRITIS, UNSPECIFIED
RECURRENT AND PERSISTENT HAEMATURIA INCLUDING
BENIGN FAMILIAL HAEMATURIA; BENIGN FAMILIAL
N02.0 HAEMATURIA OF CHILDHOOD; HAEMATURIA WITH 13,000.00 9,100.00 3,900.00
MORPHOLOGICAL LESION SPECIFIED WITH MINOR
GLOMERULAR ABNORMALITY

MORPHOLOGICAL LESION SPECIFIED WITH FOCAL AND
SEGMENTAL GLOMERULAR LESIONS

MORPHOLOGICAL LESION SPECIFIED WITH DIFFUSE
MEMBRANOUS GLOMERULONEPHRITIS

MORPHOLOGICAL LESION SPECIFIED WITH DIFFUSE
MESANGIOCAPILLARY GLOMERULONEPHRITIS

MORPHOLOGICAL LESION SPECIFIED WITH OTHER
(PROLIFERATIVE GLOMERULONEPHRITIS NOS)
Page 79 of 126
First Case Rate

MORPHOLOGICAL LESION SPECIFIED WITH UNSPECIFIED
RENAL BIOPSY
CHRONIC NEPHRITIC SYNDROME INCLUDING CHRONIC
GLOMERULAR DISEASE, CHRONIC GLOMERULONEPHRITIS,
N03.0 13,000.00 9,100.00 3,900.00
CHRONIC NEPHRITIS, CHRONIC RENAL DISEASE NOS, WITH
MINOR GLOMERULAR ABNORMALITY

N03.1 13,000.00 9,100.00 3,900.00
FOCAL AND SEGMENTAL GLOMERULAR LESIONS

N03.2 13,000.00 9,100.00 3,900.00
CHRONIC NEPHRITIS, CHRONIC RENAL DISEASE NOS,
WITHDIFFUSE MEMBRANOUS GLOMERULONEPHRITIS

N03.3 CHRONIC NEPHRITIS, CHRONIC RENAL DISEASE NOS, WITH 13,000.00 9,100.00 3,900.00
DIFFUSE MESANGIAL PROLIFERATIVE
GLOMERULONEPHRITIS

N03.4 CHRONIC NEPHRITIS, CHRONIC RENAL DISEASE NOS, WITH 13,000.00 9,100.00 3,900.00
DIFFUSE ENDOCAPILLARY PROLIFERATIVE
GLOMERULONEPHRITIS

N03.5 13,000.00 9,100.00 3,900.00
DIFFUSE MESANGIOCAPILLARY GLOMERULONEPHRITIS

N03.7 13,000.00 9,100.00 3,900.00
DIFFUSE CRESCENTIC GLOMERULONEPHRITIS

N03.8 13,000.00 9,100.00 3,900.00
OTHER (PROLIFERATIVE GLOMERULONEPHRITIS NOS)

N03.9 13,000.00 9,100.00 3,900.00
UNSPECIFIED RENAL BIOPSY
NEPHROTIC SYNDROME: MINOR GLOMERULAR
N04.0 13,000.00 9,100.00 3,900.00
ABNORMALITY; MINIMAL CHANGE LESION
NEPHROTIC SYNDROME: FOCAL AND SEGMENTAL
GLOMERULAR LESIONS; FOCAL AND SEGMENTAL
N04.1 13,000.00 9,100.00 3,900.00
HYALINOSIS; FOCAL AND SEGMENTAL SCLEROSIS; FOCAL
GLOMERULONEPHRITIS
NEPHROTIC SYNDROME: DIFFUSE MEMBRANOUS
N04.2 13,000.00 9,100.00 3,900.00
GLOMERULONEPHRITIS
NEPHROTIC SYNDROME: DIFFUSE MESANGIAL
N04.3 13,000.00 9,100.00 3,900.00
NEPHROTIC SYNDROME: DIFFUSE ENDOCAPILLARY
N04.4 13,000.00 9,100.00 3,900.00
NEPHROTIC SYNDROME: DIFFUSE MESANGIOCAPILLARY
N04.5 GLOMERULONEPHRITIS; MEMBRANOPROLIFERATIVE 13,000.00 9,100.00 3,900.00
GLOMERULONEPHRITIS, TYPES 1 AND 3, OR NOS
NEPHROTIC SYNDROME: DIFFUSE CRESCENTIC
N04.7 GLOMERULONEPHRITIS; EXTRACAPILLARY 13,000.00 9,100.00 3,900.00
GLOMERULONEPHRITIS
N04.8 NEPHROTIC SYNDROME: OTHER 13,000.00 9,100.00 3,900.00
N04.9 NEPHROTIC SYNDROME:UNSPECIFIED 13,000.00 9,100.00 3,900.00
UNSPECIFIED NEPHRITIC SYNDROME INCLUDING
GLOMERULAR DISEASE, GLOMERULONEPHRITIS,
N05.0 13,000.00 9,100.00 3,900.00
NEPHRITIS NOS WITH MINOR GLOMERULAR
ABNORMALITY, MINIMAL CHANGE LESION
NEPHRITIS NOS WITH FOCAL AND SEGMENTAL
N05.1 13,000.00 9,100.00 3,900.00
GLOMERULAR LESIONS (WITH FOCAL AND SEGMENTAL
HYALINOSIS; FOCAL AND SEGMENTAL SCLEROSIS) & FOCAL
GLOMERULONEPHRITIS
Page 80 of 126
First Case Rate

N05.2 13,000.00 9,100.00 3,900.00
NEPHRITIS NOS WITH DIFFUSE MEMBRANOUS
GLOMERULONEPHRITIS
N05.3 13,000.00 9,100.00 3,900.00
NEPHRITIS NOS WITH DIFFUSE MESANGIAL
N05.4 13,000.00 9,100.00 3,900.00
NEPHRITIS NOS WITH DIFFUSE ENDOCAPILLARY
N05.5 NEPHRITIS NOS WITH DIFFUSE MESANGIOCAPILLARY 13,000.00 9,100.00 3,900.00
GLOMERULONEPHRITIS, MEMBRANOPROLIFERATIVE
N05.6 NEPHRITIS NOS WITH DENSE DEPOSIT DISEASE 13,000.00 9,100.00 3,900.00
MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS, TYPE
2
N05.7 NEPHRITIS NOS WITH DIFFUSE CRESCENTIC 13,000.00 9,100.00 3,900.00
GLOMERULONEPHRITIS, EXTRACAPILLARY
GLOMERULONEPHRITIS
N05.8 13,000.00 9,100.00 3,900.00
NEPHRITIS NOS WITH OTHER
N05.9 GLOMERULAR DISEASE, GLOMERULONEPHRITIS, 13,000.00 9,100.00 3,900.00
NEPHRITIS NOS WITH UNSPECIFIED RENAL BIOPSY
ISOLATED PROTEINURIA WITH SPECIFIED
N06.0 MORPHOLOGICAL LESION WITH MORPHOLOGICAL LESION 13,000.00 9,100.00 3,900.00
SPECIFIED WITH MINOR GLOMERULAR ABNORMALITY
N06.8 MORPHOLOGICAL LESION WITH OTHER 13,000.00 9,100.00 3,900.00
N06.9 MORPHOLOGICAL LESION WITH UNSPECIFIED RENAL 13,000.00 9,100.00 3,900.00
BIOPSY
HEREDITARY NEPHROPATHY, NOT ELSEWHERE CLASSIFIED
N07.0 13,000.00 9,100.00 3,900.00
WITH MINOR GLOMERULAR ABNORMALITY

WITH FOCAL AND SEGMENTAL GLOMERULAR LESIONS
N07.1 13,000.00 9,100.00 3,900.00
(WITH FOCAL AND SEGMENTAL HYALINOSIS; FOCAL AND
SEGMENTAL SCLEROSIS) & FOCAL GLOMERULONEPHRITIS

N07.2 13,000.00 9,100.00 3,900.00
WITH DIFFUSE MEMBRANOUS GLOMERULONEPHRITIS
N07.3 WITH DIFFUSE MESANGIAL PROLIFERATIVE 13,000.00 9,100.00 3,900.00
GLOMERULONEPHRITIS
WITH DIFFUSE MESANGIOCAPILLARY
N07.5 13,000.00 9,100.00 3,900.00
GLOMERULONEPHRITIS, MEMBRANOPROLIFERATIVE
N07.9 13,000.00 9,100.00 3,900.00
WITH UNSPECIFIED RENAL BIOPSY
ACUTE TUBULO-INTERSTITIAL NEPHRITIS;
N10 PYELONEPHRITIS; ACUTE INFECTIOUS INTERSTITIAL 13,000.00 9,100.00 3,900.00
NEPHRITIS; ACUTE PYELITIS; ACUTE PYELONEPHRITIS
NONOBSTRUCTIVE REFLUX-ASSOCIATED CHRONIC
N11.0 PYELONEPHRITIS; CHRONIC PYELONEPHRITIS ASSOCIATED 14,170.00 9,919.00 4,251.00
WITH VESICOURETERAL REFLUX
CHRONIC OBSTRUCTIVE PYELONEPHRITIS; CHRONIC
PYELONEPHRITIS ASSOCIATED WITH ANOMALY OF
[PELVIURETERIC JUNCTION, PYELOURETERIC JUNCTION,
N11.1 14,170.00 9,919.00 4,251.00
URETER]; CHRONIC PYELONEPHRITIS ASSOCIATED WITH
KINKING OF [PELVIURETERIC JUNCTION, PYELOURETERIC
JUNCTION, URETER]; CHR
OTHER CHRONIC TUBULO-INTERSTITIAL NEPHRITIS;
N11.8 14,170.00 9,919.00 4,251.00
NONOBSTRUCTIVE CHRONIC PYELONEPHRITIS NOS
Page 81 of 126
First Case Rate

CHRONIC TUBULO-INTERSTITIAL NEPHRITIS,
N11.9 UNSPECIFIED; CHRONIC INTERSTITIAL NEPHRITIS NOS; 13,000.00 9,100.00 3,900.00
CHRONIC PYELITIS NOS; CHRONIC PYELONEPHRITIS NOS
TUBULO-INTERSTITIAL NEPHRITIS, NOT SPECIFIED AS
N12 ACUTE OR CHRONIC; INTERSTITIAL NEPHRITIS NOS; 13,000.00 9,100.00 3,900.00
PYELITIS NOS; PYELONEPHRITIS NOS
HYDRONEPHROSIS WITH URETEROPELVIC JUNCTION
N13.0 12,610.00 8,827.00 3,783.00
OBSTRUCTION
HYDRONEPHROSIS WITH URETERAL STRICTURE, NOT
N13.1 12,610.00 8,827.00 3,783.00
HYDRONEPHROSIS WITH RENAL AND URETERAL
N13.2 12,610.00 8,827.00 3,783.00
CALCULOUS OBSTRUCTION
N13.3 OTHER AND UNSPECIFIED HYDRONEPHROSIS 12,610.00 8,827.00 3,783.00
N13.4 HYDROURETER 12,610.00 8,827.00 3,783.00
KINKING AND STRICTURE OF URETER WITHOUT
N13.5 12,610.00 8,827.00 3,783.00
HYDRONEPHROSIS
PYONEPHROSIS; CONDITIONS IN N13.0-N13.5 WITH
N13.6 12,610.00 8,827.00 3,783.00
INFECTION; OBSTRUCTIVE UROPATHY WITH INFECTION
VESICOURETERAL-REFLUX-ASSOCIATED UROPATHY;
N13.7 VESICOURETERAL REFLUX NOS; VESICOURETERAL REFLUX 12,610.00 8,827.00 3,783.00
WITH SCARRING
N13.8 OTHER OBSTRUCTIVE AND REFLUX UROPATHY 12,610.00 8,827.00 3,783.00
OBSTRUCTIVE AND REFLUX UROPATHY, UNSPECIFIED;
N13.9 12,610.00 8,827.00 3,783.00
URINARY TRACT OBSTRUCTION NOS
N14.0 ANALGESIC NEPHROPATHY 13,000.00 9,100.00 3,900.00
NEPHROPATHY INDUCED BY OTHER DRUGS, MEDICAMENTS
N14.1 13,000.00 9,100.00 3,900.00
AND BIOLOGICAL SUBSTANCES
NEPHROPATHY INDUCED BY UNSPECIFIED DRUG,
N14.2 13,000.00 9,100.00 3,900.00
MEDICAMENT OR BIOLOGICAL SUBSTANCE
N14.4 TOXIC NEPHROPATHY, NOT ELSEWHERE CLASSIFIED 13,000.00 9,100.00 3,900.00
N15.0 BALKAN NEPHROPATHY; BALKAN ENDEMIC NEPHROPATHY 13,000.00 9,100.00 3,900.00
N15.1 RENAL AND PERINEPHRIC ABSCESS 18,070.00 12,649.00 5,421.00
N15.8 OTHER SPECIFIED RENAL TUBULO-INTERSTITIAL DISEASES 13,000.00 9,100.00 3,900.00
RENAL TUBULO-INTERSTITIAL DISEASE, UNSPECIFIED;
N15.9 13,000.00 9,100.00 3,900.00
INFECTION OF KIDNEY NOS
ACUTE RENAL FAILURE WITH TUBULAR NECROSIS;
N17.0 TUBULAR NECROSIS NOS; ACUTE TUBULAR NECROSIS ; 25,090.00 17,563.00 7,527.00
RENAL TUBULAR NECROSIS
ACUTE RENAL FAILURE WITH ACUTE CORTICAL NECROSIS;
N17.1 CORTICAL NECROSIS NOS; ACUTE CORTICAL NECROSIS ; 25,090.00 17,563.00 7,527.00
RENAL CORTICAL NECROSIS
ACUTE RENAL FAILURE WITH MEDULLARY NECROSIS;
MEDULLARY PAPILLARY NECROSIS, NOS; ACUTE
N17.2 25,090.00 17,563.00 7,527.00
MEDULLARY PAPILLARY NECROSIS; RENAL MEDULLARY
PAPILLARY NECROSIS
N17.8 OTHER ACUTE RENAL FAILURE 25,090.00 17,563.00 7,527.00
N17.9 ACUTE RENAL FAILURE, UNSPECIFIED; 25,090.00 17,563.00 7,527.00
CHRONIC KIDNEY DISEASE, STAGE 5; CHRONIC URAEMIA;
END STAGE KIDNEY DISEASE: IN ALLOGRAFT FAILURE, NOS,
ON DIALYSIS, WITHOUT DIALYSIS OR TRANSPLANT; RENAL
N18.5 18,850.00 13,195.00 5,655.00
RETINITIS+(H32.8*); URAEMIC: APOPLEXIA+(I68.8*),
DEMENTIA+(F02.8*), NEUROPATHY+(G63.8*),
PARALYSIS+(G99.8*), PERICARDITIS+(I32.8*)
N18.9 CHRONIC KIDNEY DISEASE, UNSPECIFIED 18,850.00 13,195.00 5,655.00
UNSPECIFIED KIDNEY FAILURE; RENAL INSUFFICIENCY
N19 18,850.00 13,195.00 5,655.00
NOS
CALCULUS OF KIDNEY; NEPHROLITHIASIS NOS; RENAL
N20.0 CALCULUS OR STONE; STAGHORN CALCULUS; STONE IN 5,200.00 3,640.00 1,560.00
KIDNEY
N20.1 CALCULUS OF URETER; URETERIC STONE 5,200.00 3,640.00 1,560.00
N20.2 CALCULUS OF KIDNEY WITH CALCULUS OF URETER 5,200.00 3,640.00 1,560.00
URINARY CALCULUS, UNSPECIFIED; CALCULOUS
N20.9 5,200.00 3,640.00 1,560.00
PYELONEPHRITIS
RENAL OSTEODYSTROPHY; AZOTAEMIC OSTEODYSTROPHY;
N25.0 PHOSPHATE-LOSING TUBULAR DISORDERS; RENAL 12,350.00 8,645.00 3,705.00
RICKETS; RENAL SHORT STATURE
N25.1 NEPHROGENIC DIABETES INSIPIDUS 13,130.00 9,191.00 3,939.00
OTHER DISORDERS RESULTING FROM IMPAIRED RENAL
TUBULAR FUNCTION; LIGHTWOOD-ALBRIGHT SYNDROME;
N25.8 12,350.00 8,645.00 3,705.00
RENAL TUBULAR ACIDOSIS NOS; SECONDARY
HYPERPARATHYROIDISM OF RENAL ORIGIN
DISORDER RESULTING FROM IMPAIRED RENAL TUBULAR
N25.9 12,350.00 8,645.00 3,705.00
FUNCTION, UNSPECIFIED
UNSPECIFIED CONTRACTED KIDNEY; ATROPHY OF KIDNEY
N26 14,690.00 10,283.00 4,407.00
(TERMINAL); RENAL SCLEROSIS NOS
N27.0 SMALL KIDNEY, UNILATERAL 14,690.00 10,283.00 4,407.00
N27.1 SMALL KIDNEY, BILATERAL 14,690.00 10,283.00 4,407.00
Page 82 of 126
First Case Rate

N27.9 SMALL KIDNEY, UNSPECIFIED 14,690.00 10,283.00 4,407.00
ISCHAEMIA AND INFARCTION OF KIDNEY; EMBOLISM OF
RENAL ARTERY; OBSTRUCTION OF RENAL ARTERY;
N28.0 12,480.00 8,736.00 3,744.00
OCCLUSION OF RENAL ARTERY; THROMBOSIS OF RENAL
ARTERY; RENAL INFARCT
CYST OF KIDNEY, ACQUIRED; MULTIPLE CYST OF KIDNEY,
N28.1 12,350.00 8,645.00 3,705.00
ACQUIRED; SOLITARY CYST OF KIDNEY, ACQUIRED
OTHER SPECIFIED DISORDERS OF KIDNEY AND URETER;

HYPERTROPHY OF KIDNEY, MEGALOURETER,
N28.8 14,690.00 10,283.00 4,407.00
NEPHROPTOSIS, PYELITIS CYSTICA, PYELOURETERITIS
CYSTICA, URETERITIS CYSTICA, URETEROCELE
DISORDER OF KIDNEY AND URETER, UNSPECIFIED;
N28.9 14,690.00 10,283.00 4,407.00
NEPHROPATHY NOS; RENAL DISEASE NOS
OTHER DISORDERS OF KIDNEY AND URETER IN OTHER
N29.8* 14,690.00 10,283.00 4,407.00
N30.0 ACUTE CYSTITIS 9,750.00 6,825.00 2,925.00
N30.1 CHRONIC INTERSTITIAL CYSTITIS 9,750.00 6,825.00 2,925.00
N30.2 OTHER CHRONIC CYSTITIS 9,750.00 6,825.00 2,925.00
N30.3 TRIGONITIS; URETHROTRIGONITIS 9,750.00 6,825.00 2,925.00
N30.4 IRRADIATION CYSTITIS 5,200.00 3,640.00 1,560.00
N30.8 OTHER CYSTITIS; ABSCESS OF BLADDER 18,070.00 12,649.00 5,421.00
N30.9 CYSTITIS, UNSPECIFIED 9,750.00 6,825.00 2,925.00
UNINHIBITED NEUROPATHIC BLADDER, NOT ELSEWHERE
N31.0 11,700.00 8,190.00 3,510.00
CLASSIFIED
REFLEX NEUROPATHIC BLADDER, NOT ELSEWHERE
N31.1 11,700.00 8,190.00 3,510.00
CLASSIFIED
FLACCID NEUROPATHIC BLADDER, NOT ELSEWHERE
CLASSIFIED; ATONIC MOTOR NEUROPATHIC BLADDER;
N31.2 SENSORY ATONIC MOTOR NEUROPATHIC BLADDER; 11,700.00 8,190.00 3,510.00
AUTONOMOUS NEUROPATHIC BLADDER ; NONREFLEX
NEUROPATHIC BLADDER
N31.8 OTHER NEUROMUSCULAR DYSFUNCTION OF BLADDER 11,700.00 8,190.00 3,510.00
NEUROMUSCULAR DYSFUNCTION OF BLADDER,

N31.9 11,700.00 8,190.00 3,510.00
UNSPECIFIED; NEUROGENIC BLADDER DYSFUNCTION NOS
N32.9 BLADDER DISORDER, UNSPECIFIED 11,700.00 8,190.00 3,510.00
URETHRAL ABSCESS; ABSCESS OF COWPER'S GLAND;
N34.0 ABSCESS OF LITTRé'S GLAND; PERIURETHRAL ABSCESS ; 18,070.00 12,649.00 5,421.00
ABSCESS OF URETHRAL GLAND
N39.0 URINARY TRACT INFECTION, SITE NOT SPECIFIED 9,750.00 6,825.00 2,925.00
N39.1 PERSISTENT PROTEINURIA, UNSPECIFIED 13,000.00 9,100.00 3,900.00
N39.2 ORTHOSTATIC PROTEINURIA, UNSPECIFIED 13,000.00 9,100.00 3,900.00
N39.3 STRESS INCONTINENCE 11,700.00 8,190.00 3,510.00
OTHER SPECIFIED URINARY INCONTINENCE; OVERFLOW
N39.4 INCONTINENCE, REFLEX INCONTINENCE, URGE 11,700.00 8,190.00 3,510.00
INCONTINENCE
HYPERPLASIA OF PROSTATE; ADENOFIBROMATOUS
HYPERTROPHY OF PROSTATE; ADENOMA (BENIGN)OF
PROSTATE ; ENLARGEMENT OF PROSTATE (BENIGN);
N40 11,960.00 8,372.00 3,588.00
FIBROADENOMA OF PROSTATE; FIBROMA OF PROSTATE;
HYPERTROPHY OF PROSTATE (BENIGN); MYOMA OF
PROSTATE; MEDIAN BAR (PROSTATE),
N41.0 ACUTE PROSTATITIS 11,960.00 8,372.00 3,588.00
N41.1 CHRONIC PROSTATITIS 11,960.00 8,372.00 3,588.00
N41.2 ABSCESS OF PROSTATE 11,960.00 8,372.00 3,588.00
N41.3 PROSTATOCYSTITIS 11,960.00 8,372.00 3,588.00
N41.8 OTHER INFLAMMATORY DISEASES OF PROSTATE 11,960.00 8,372.00 3,588.00
INFLAMMATORY DISEASE OF PROSTATE, UNSPECIFIED;
N41.9 11,960.00 8,372.00 3,588.00
PROSTATITIS NOS
N42.0 CALCULUS OF PROSTATE; PROSTATIC STONE 11,960.00 8,372.00 3,588.00
N42.1 CONGESTION AND HAEMORRHAGE OF PROSTATE 11,960.00 8,372.00 3,588.00
N42.2 ATROPHY OF PROSTATE 11,960.00 8,372.00 3,588.00
N42.8 OTHER SPECIFIED DISORDERS OF PROSTATE 11,960.00 8,372.00 3,588.00
N42.9 DISORDER OF PROSTATE, UNSPECIFIED 11,960.00 8,372.00 3,588.00
ORCHITIS, EPIDIDYMITIS AND EPIDIDYMO-ORCHITIS WITH
N45.0 10,270.00 7,189.00 3,081.00
ABSCESS; ABSCESS OF EPIDIDYMIS OR TESTIS
ORCHITIS, EPIDIDYMITIS AND EPIDIDYMO-ORCHITIS
N45.9 10,270.00 7,189.00 3,081.00
WITHOUT ABSCESS; EPIDIDYMITIS NOS; ORCHITIS NOS
REDUNDANT PREPUCE, PHIMOSIS AND PARAPHIMOSIS;

N47 8,320.00 5,824.00 2,496.00
ADHERENT PREPUCE; TIGHT FORESKIN
LEUKOPLAKIA OF PENIS; BALANITIS XEROTICA
N48.0 11,700.00 8,190.00 3,510.00
OBLITERANS; KRAUROSIS OF PENIS
N48.1 BALANOPOSTHITIS; BALANITIS 11,700.00 8,190.00 3,510.00
Page 83 of 126
First Case Rate

OTHER INFLAMMATORY DISORDERS OF PENIS; ABSCESS OF
CORPUS CAVERNOSUM AND PENIS; BOIL OF CORPUS
CAVERNOSUM AND PENIS; CARBUNCLE OF CORPUS
N48.2 11,700.00 8,190.00 3,510.00
CAVERNOSUM AND PENIS; CELLULITIS OF CORPUS
CAVERNOSUM AND PENIS; CAVERNITIS (PENIS) OF CORPUS
CAVERNOSUM AND PENIS
N48.5 ULCER OF PENIS 11,700.00 8,190.00 3,510.00
INDURATIO PENIS PLASTICA; PEYRONIE'S DISEASE; PLASTIC
N48.6 11,700.00 8,190.00 3,510.00
INDURATION OF PENIS
OTHER SPECIFIED DISORDERS OF PENIS; ATROPHYOF
CORPUS CAVERNOSUM AND PENIS ; HYPERTROPHY OF
N48.8 8,320.00 5,824.00 2,496.00
CORPUS CAVERNOSUM AND PENIS ; THROMBOSIS OF
CORPUS CAVERNOSUM AND PENIS
INFLAMMATORY DISORDERS OF SEMINAL VESICLE;
N49.0 11,700.00 8,190.00 3,510.00
VESICULITIS NOS
INFLAMMATORY DISORDERS OF SPERMATIC CORD, TUNICA
N49.1 11,700.00 8,190.00 3,510.00
VAGINALIS AND VAS DEFERENS; VASITIS
N49.2 INFLAMMATORY DISORDERS OF SCROTUM 11,700.00 8,190.00 3,510.00
INFLAMMATORY DISORDERS OF OTHER SPECIFIED MALE
N49.8 GENITAL ORGANS; INFLAMMATION OF MULTIPLE SITES IN 11,700.00 8,190.00 3,510.00
MALE GENITAL ORGANS
INFLAMMATORY DISORDER OF UNSPECIFIED MALE
GENITAL ORGAN; ABSCESS OF UNSPECIFIED MALE GENITAL
N49.9 ORGAN; BOIL OF UNSPECIFIED MALE GENITAL ORGAN; 11,700.00 8,190.00 3,510.00
CARBUNCLE OF UNSPECIFIED MALE GENITAL ORGAN;
CELLULITIS OF UNSPECIFIED MALE GENITAL ORGAN
N50.0 ATROPHY OF TESTIS 8,320.00 5,824.00 2,496.00
VASCULAR DISORDERS OF MALE GENITAL ORGANS;
HAEMATOCELE OF MALE GENITAL ORGANS NOS;
N50.1 8,320.00 5,824.00 2,496.00
HAEMORRHAGE OF MALE GENITAL ORGANS;, THROMBOSIS
OF MALE GENITAL ORGANS
OTHER SPECIFIED DISORDERS OF MALE GENITAL ORGANS;
ATROPHY OF SCROTUM, SEMINAL VESICLE, SPERMATIC
CORD, TESTIS [EXCEPT ATROPHY], TUNICA VAGINALIS AND
N50.8 8,320.00 5,824.00 2,496.00
VAS DEFERENS; HYPERTROPHY OF SCROTUM, SEMINAL
VESICLE, SPERMATIC CORD, TESTIS [EXCEPT ATROPHY],
TUNICA VAG
INFLAMMATORY DISORDERS OF BREAST; ACUTE ABSCESS
OF NON PUERPERAL AREOLA; ACUTE ABSCESS
NONPUERPERAL BREAST; CHRONIC ABSCESS OF
N61 10,270.00 7,189.00 3,081.00
NONPUERPERAL AREOLA; CHRONIC ABSCESS OF
NONPUERPERAL BREAST; CARBUNCLE OF BREAST; ACUTE
MASTITIS NONPUERPERAL, NOS; ACUTE INF
N70.0 ACUTE SALPINGITIS AND OOPHORITIS 11,700.00 8,190.00 3,510.00
N70.1 CHRONIC SALPINGITIS AND OOPHORITIS; HYDROSALPINX 11,700.00 8,190.00 3,510.00
N70.9 SALPINGITIS AND OOPHORITIS, UNSPECIFIED 11,700.00 8,190.00 3,510.00
N71.0 ACUTE INFLAMMATORY DISEASE OF UTERUS 11,700.00 8,190.00 3,510.00
N71.1 CHRONIC INFLAMMATORY DISEASE OF UTERUS 11,700.00 8,190.00 3,510.00
N71.9 INFLAMMATORY DISEASE OF UTERUS, UNSPECIFIED 11,700.00 8,190.00 3,510.00
INFLAMMATORY DISEASE OF CERVIX UTERI; CERVICITIS
WITH OR WITHOUT EROSION OR ECTROPION;
N72 ENDOCERVICITIS WITH OR WITHOUT EROSION OR 11,700.00 8,190.00 3,510.00
ECTROPION; EXOCERVICITIS WITH OR WITHOUT EROSION
OR ECTROPION
ACUTE PARAMETRITIS AND PELVIC CELLULITIS; ACUTE
N73.0 ABCESS OF BROAD LIGAMENT; ACUTE ABSCESS OF 11,700.00 8,190.00 3,510.00
PARAMETRIUM; ACUTE PELVIC CELLULITIS, FEMALE
N73.1 CHRONIC PARAMETRITIS AND PELVIC CELLULITIS 11,700.00 8,190.00 3,510.00
N73.2 UNSPECIFIED PARAMETRITIS AND PELVIC CELLULITIS 11,700.00 8,190.00 3,510.00
N73.3 FEMALE ACUTE PELVIC PERITONITIS 11,700.00 8,190.00 3,510.00
N73.4 FEMALE CHRONIC PELVIC PERITONITIS 11,700.00 8,190.00 3,510.00
N73.5 FEMALE PELVIC PERITONITIS, UNSPECIFIED 11,700.00 8,190.00 3,510.00
N73.6 FEMALE PELVIC PERITONEAL ADHESIONS 11,700.00 8,190.00 3,510.00
OTHER SPECIFIED FEMALE PELVIC INFLAMMATORY
N73.8 11,700.00 8,190.00 3,510.00
DISEASES
FEMALE PELVIC INFLAMMATORY DISEASE, UNSPECIFIED;
N73.9 11,700.00 8,190.00 3,510.00
FEMALE PELVIC INFECTION OR INFLAMMATION NOS
FEMALE PELVIC INFLAMMATORY DISORDERS IN OTHER
N74.8* 11,700.00 8,190.00 3,510.00
N80.0 ENDOMETRIOSIS OF UTERUS; ADENOMYOSIS 10,010.00 7,007.00 3,003.00
N80.1 ENDOMETRIOSIS OF OVARY 10,010.00 7,007.00 3,003.00
N80.2 ENDOMETRIOSIS OF FALLOPIAN TUBE 10,010.00 7,007.00 3,003.00
N80.3 ENDOMETRIOSIS OF PELVIC PERITONEUM 10,010.00 7,007.00 3,003.00
N80.4 ENDOMETRIOSIS OF RECTOVAGINAL SEPTUM AND VAGINA 10,010.00 7,007.00 3,003.00
N80.5 ENDOMETRIOSIS OF INTESTINE 10,010.00 7,007.00 3,003.00
N80.8 OTHER ENDOMETRIOSIS 10,010.00 7,007.00 3,003.00
Page 84 of 126
First Case Rate

N80.9 ENDOMETRIOSIS, UNSPECIFIED 10,010.00 7,007.00 3,003.00
N82.0 VESICOVAGINAL FISTULA 10,140.00 7,098.00 3,042.00
FOLLICULAR CYST OF OVARY; CYST OF GRAAFIAN FOLLICLE;
N83.0 10,140.00 7,098.00 3,042.00
HAEMORRHAGIC FOLLICULAR CYST OF OVARY
CORPUS LUTEUM CYST; HAEMORRHAGIC CORPUS LUTEUM
N83.1 10,140.00 7,098.00 3,042.00
CYST
OTHER AND UNSPECIFIED OVARIAN CYSTS; RETENTION OF
N83.2 10,270.00 7,189.00 3,081.00
OVARY; SIMPLE CYST OF OVARY
N83.3 ACQUIRED ATROPHY OF OVARY AND FALLOPIAN TUBE 10,140.00 7,098.00 3,042.00
N83.6 HAEMATOSALPINX 10,140.00 7,098.00 3,042.00
N83.7 HAEMATOMA OF BROAD LIGAMENT 10,140.00 7,098.00 3,042.00
OTHER NONINFLAMMATORY DISORDERS OF OVARY,
N83.8 FALLOPIAN TUBE AND BROAD LIGAMENT; BROAD 11,050.00 7,735.00 3,315.00
LIGAMENT LACERATION SYNDROME [ALLEN-MASTERS]
NONINFLAMMATORY DISORDER OF OVARY, FALLOPIAN

N83.9 11,050.00 7,735.00 3,315.00
TUBE AND BROAD LIGAMENT, UNSPECIFIED
POLYP OF CORPUS UTERI; POLYP OF ENDOMETRIUM; POLYP
N84.0 6,760.00 4,732.00 2,028.00
OF UTERUS NOS
N84.1 POLYP OF CERVIX UTERI; MUCOUS POLYP OF CERVIX 6,760.00 4,732.00 2,028.00
N84.2 POLYP OF VAGINA 6,760.00 4,732.00 2,028.00
N84.3 POLYP OF VULVA; POLYP OF LABIA 6,760.00 4,732.00 2,028.00
N84.8 POLYP OF OTHER PARTS OF FEMALE GENITAL TRACT 6,760.00 4,732.00 2,028.00
N84.9 POLYP OF FEMALE GENITAL TRACT, UNSPECIFIED 6,760.00 4,732.00 2,028.00
HAEMATOMETRA; HAEMATOSALPINX WITH
N85.7 10,140.00 7,098.00 3,042.00
HAEMATOMETRA
OTHER SPECIFIED NONINFLAMMATORY DISORDERS OF
N85.8 UTERUS; ATROPHY OF UTERUS, ACQUIRED; FIBROSIS OF 11,050.00 7,735.00 3,315.00
UTERUS NOS
NONINFLAMMATORY DISORDER OF UTERUS, UNSPECIFIED;
N85.9 11,050.00 7,735.00 3,315.00
DISORDER OF UTERUS NOS
HAEMATOCOLPOS; HAEMATOCOLPOS WITH
N89.7 10,140.00 7,098.00 3,042.00
HAEMATOMETRA OR HAEMATOSALPINX
PRIMARY AMENORRHOEA; FAILURE TO START
N91.0 8,580.00 6,006.00 2,574.00
MENSTRUATION AT PUBERTY.
SECONDARY AMENORRHOEA; ABSENCE OF MENSTRUATION
N91.1 8,580.00 6,006.00 2,574.00
IN A WOMAN WHO HAD PREVIOUSLY MENSTRUATED.
AMENORRHOEA, UNSPECIFIED; ABSENCE OF
N91.2 8,580.00 6,006.00 2,574.00
MENSTRUATION NOS
OLIGOMENORRHOEA, UNSPECIFIED; HYPOMENORRHOEA
N91.5 8,580.00 6,006.00 2,574.00
NOS
EXCESSIVE AND FREQUENT MENSTRUATION WITH
N92.0 REGULAR CYCLE; HEAVY PERIODS NOS; MENORRHAGIA 8,580.00 6,006.00 2,574.00
NOS; POLYMENORRHOEA
EXCESSIVE AND FREQUENT MENSTRUATION WITH
IRREGULAR CYCLE; IRREGULAR INTERMENSTRUAL
N92.1 BLEEDING; IRREGULAR, SHORTENED INTERVALS BETWEEN 8,580.00 6,006.00 2,574.00
MENSTRUAL BLEEDING; MENOMETRORRHAGIA;
METRORRHAGIA
EXCESSIVE MENSTRUATION AT PUBERTY; EXCESSIVE
N92.2 BLEEDING ASSOCIATED WITH ONSET OF MENSTRUAL 8,580.00 6,006.00 2,574.00
PERIODS; PUBERTAL MENORRHAGIA; PUBERTY BLEEDING
OVULATION BLEEDING; REGULAR INTERMENSTRUAL
N92.3 8,580.00 6,006.00 2,574.00
BLEEDING
EXCESSIVE BLEEDING IN THE PREMENOPAUSAL PERIOD;
CLIMATERIC MENORRHAGIA OR METRORRHAGIA;
N92.4 MENOPAUSAL MENORRHAGIA OR METRORRHAGIA; 8,580.00 6,006.00 2,574.00
PRECLIMATERIC MENORRHAGIA OR METRORRHAGIA;
PREMENOPAUSAL MENORRHAGIA OR METRORRHAGIA
N92.5 OTHER SPECIFIED IRREGULAR MENSTRUATION 8,580.00 6,006.00 2,574.00
IRREGULAR MENSTRUATION, UNSPECIFIED; IRREGULAR
N92.6 8,580.00 6,006.00 2,574.00
BLEEDING NOS; IRREGULAR PERIODS NOS
N93.0 POSTCOITAL AND CONTACT BLEEDING 8,580.00 6,006.00 2,574.00
OTHER SPECIFIED ABNORMAL UTERINE AND VAGINAL
N93.8 BLEEDING; DYSFUNCTIONAL OR FUNCTIONAL UTERINE OR 8,580.00 6,006.00 2,574.00
VAGINAL BLEEDING NOS
ABNORMAL UTERINE AND VAGINAL BLEEDING,
N93.9 8,580.00 6,006.00 2,574.00
UNSPECIFIED
N94.0 MITTELSCHMERZ 6,240.00 4,368.00 1,872.00
N94.1 DYSPAREUNIA 6,240.00 4,368.00 1,872.00
N94.2 VAGINISMUS 6,240.00 4,368.00 1,872.00
N94.3 PREMENSTRUAL TENSION SYNDROME 6,240.00 4,368.00 1,872.00
N94.4 PRIMARY DYSMENORRHOEA 6,240.00 4,368.00 1,872.00
N94.5 SECONDARY DYSMENORRHOEA 6,240.00 4,368.00 1,872.00
N94.6 DYSMENORRHOEA, UNSPECIFIED 6,240.00 4,368.00 1,872.00
Page 85 of 126
First Case Rate

OTHER SPECIFIED CONDITIONS ASSOCIATED WITH FEMALE
N94.8 8,580.00 6,006.00 2,574.00
GENITAL ORGANS AND MENSTRUAL CYCLE
UNSPECIFIED CONDITION ASSOCIATED WITH FEMALE
N94.9 8,580.00 6,006.00 2,574.00
GENITAL ORGANS AND MENSTRUAL CYCLE
N95.0 POSTMENOPAUSAL BLEEDING 7,800.00 5,460.00 2,340.00
N99.0 POSTPROCEDURAL RENAL FAILURE 13,390.00 9,373.00 4,017.00
POSTPROCEDURAL URETHRAL STRICTURE;
N99.1 13,390.00 9,373.00 4,017.00
POSTCATHETERIZATION URETHRAL STRICTURE
N99.4 POSTPROCEDURAL PELVIC PERITONEAL ADHESIONS 13,390.00 9,373.00 4,017.00
OTHER POSTPROCEDURAL DISORDERS OF GENITOURINARY
N99.8 13,390.00 9,373.00 4,017.00
SYSTEM; RESIDUAL OVARY SYNDROME
POSTPROCEDURAL DISORDER OF GENITOURINARY SYSTEM,
N99.9 13,390.00 9,373.00 4,017.00
UNSPECIFIED
O00.0 ABDOMINAL PREGNANCY 10,140.00 7,098.00 3,042.00
TUBAL PREGNANCY; FALLOPIAN PREGNANCY; RUPTURE OF
O00.1 10,140.00 7,098.00 3,042.00
FALLOPIAN TUBE DUE TO PREGNANCY
O00.2 OVARIAN PREGNANCY 10,140.00 7,098.00 3,042.00
OTHER ECTOPIC PREGNANCY; CERVICAL PREGNANCY;
O00.8 CORNUAL PREGNANCY; INTRALIGAMENTOUS PREGNANCY; 10,140.00 7,098.00 3,042.00
MURAL PREGNANCY
O00.9 ECTOPIC PREGNANCY, UNSPECIFIED 10,140.00 7,098.00 3,042.00
CLASSICAL HYDATIDIFORM MOLE; COMPLETE
O01.0 8,580.00 6,006.00 2,574.00
HYDATIDIFORM MOLE
O01.1 INCOMPLETE AND PARTIAL HYDATIDIFORM MOLE 8,580.00 6,006.00 2,574.00
HYDATIDIFORM MOLE, UNSPECIFIED; TROPHOBLASTIC
O01.9 8,580.00 6,006.00 2,574.00
DISEASE NOS; VESICULAR MOLE NOS
BLIGHTED OVUM AND NONHYDATIDIFORM MOLE;
O02.0 CARNEOUS MOLE; FLESHY MOLE; INTRAUTERINE MOLE 6,500.00 4,550.00 1,950.00
NOS; PATHOLOGICAL OVUM
MISSED ABORTION; EARLY FETAL DEATH WITH RETENTION
O02.1 6,500.00 4,550.00 1,950.00
OF DEAD FETUS
O02.8 OTHER SPECIFIED ABNORMAL PRODUCTS OF CONCEPTION 6,500.00 4,550.00 1,950.00
O02.9 ABNORMAL PRODUCT OF CONCEPTION, UNSPECIFIED 6,500.00 4,550.00 1,950.00
SPONTANEOUS ABORTION, INCOMPLETE, COMPLICATED BY
GENITAL TRACT AND PELVIC INFECTION WITH GENITAL
TRACT AND PELVIC INFECTION FOLLOWING ABORTION AND
O03.0 8,970.00 6,279.00 2,691.00
ECTOPIC AND MOLAR PREGNANCY; ENDOMETRITIS;
OOPHORITIS; PARAMETRITIS; PELVIC PERITONITIS;
SALPINGITIS; SALPIN
SPONTANEOUS ABORTION, INCOMPLETE, COMPLICATED

DELAYED OR EXCESSIVE HAEMORRHAGE WITH DELAYED
OR EXCESSIVE HAEMORRHAGE FOLLOWING ABORTION
O03.1 8,970.00 6,279.00 2,691.00
AND ECTOPIC AND MOLAR PREGNANCY;
AFIBRINOGENAEMIA; DEFIBRINATION SYNDROME;
INTRAVASCULAR COAGULATION
SPONTANEOUS ABORTION, INCOMPLETE, COMPLICATED BY
EMBOLISM WITH EMBOLISM NOS OR AIR EMBOLISM OR
AMNIOTIC FLUID EMBOLISM OR BLOOD-CLOT EMBOLISM
O03.2 8,970.00 6,279.00 2,691.00
OR PULMONARY EMBOLISM OR PYAEMIC EMBOLISM OR
SEPTIC OR SEPTICOPYAEMIC EMBOLISM OR SOAP
EMBOLISM
SPONTANEOUS ABORTION, INCOMPLETE, WITH OTHER AND
UNSPECIFIED COMPLICATIONS WITH SHOCK FOLLOWING
ABORTION AND ECTOPIC AND MOLAR PREGNANCY;
O03.3 8,970.00 6,279.00 2,691.00
CIRCULATORY COLLAPASE; POSTOPERATIVE SHOCK; RENAL
FAILURE FOLLOWING ABORTION AND ECTOPIC AND MOLAR
PREGNANCY; OLIGURI
SPONTANEOUS ABORTION, INCOMPLETE, WITHOUT
O03.4 6,500.00 4,550.00 1,950.00
COMPLICATION
SPONTANEOUS ABORTION, COMPLETE, COMPLICATED BY
GENITAL TRACT AND PELVIC INFECTION WITH GENITAL
TRACT AND PELVIC INFECTION FOLLOWING ABORTION AND
O03.5 8,970.00 6,279.00 2,691.00
ECTOPIC AND MOLAR PREGNANCY; ENDOMETRITIS;
OOPHORITIS; PARAMETRITIS; PELVIC PERITONITIS;
SALPINGITIS; SALPINGO
SPONTANEOUS ABORTION, COMPLETE OR UNSPECIFIED,

COMPLICATED DELAYED OR EXCESSIVE HAEMORRHAGE
WITH DELAYED OR EXCESSIVE HAEMORRHAGE
O03.6 8,970.00 6,279.00 2,691.00
FOLLOWING ABORTION AND ECTOPIC AND MOLAR
PREGNANCY; AFIBRINOGENAEMIA; DEFIBRINATION
SYNDROME; INTRAVASCULAR COAGULATION
Page 86 of 126
First Case Rate

WITH OTHER COMPLICATED BY EMBOLISM WITH
EMBOLISM FOLLOWING ABORTION AND ECTOPIC AND
O03.7 8,970.00 6,279.00 2,691.00
MOLAR PREGNANCY; EMBOLISM NOS; AIR EMBOLISM;
AMNIOTIC FLUID EMBOLISM; BLOOD-CLOT EMBOLISM;
PULMONARY EMBOLISM; PYAEMIC EMBO

WITH OTHER AND UNSPECIFIED COMPLICATIONS WITH
SHOCK FOLLOWING ABORTION AND ECTOPIC AND MOLAR
O03.8 8,970.00 6,279.00 2,691.00
PREGNANCY; CIRCULATORY COLLAPASE; POSTOPERATIVE
SHOCK; RENAL FAILURE FOLLOWING ABORTION AND
ECTOPIC AND MOLAR PREG
O03.9 6,500.00 4,550.00 1,950.00
WITHOUT COMPLICATION
OTHER ABORTION, INCOMPLETE, COMPLICATED BY
GENITAL TRACT AND PELVIC INFECTION WITH
ENDOMETRITIS AND/OR OOPHORITIS AND/OR
O05.0 8,970.00 6,279.00 2,691.00
PARAMETRITIS AND/OR PELVIC PERITONITIS AND/OR
SALPINGITIS AND/OR SALPINGO-OOPHORITIS AND/OR
SEPSIS AND/OR SEPTIC SHOCK AND/OR SEPTICAE
OTHER ABORTION, INCOMPLETE, COMPLICATED DELAYED
OR EXCESSIVE HAEMORRHAGE WITH DELAYED OR
EXCESSIVE HAEMORRHAGE FOLLOWING ABORTION AND
O05.1 8,970.00 6,279.00 2,691.00
ECTOPIC AND MOLAR PREGNANCY; AFIBRINOGENAEMIA;
DEFIBRINATION SYNDROME; INTRAVASCULAR
COAGULATION
O05.4 OTHER ABORTION, INCOMPLETE, WITHOUT COMPLICATION 6,500.00 4,550.00 1,950.00
OTHER ABORTION, COMPLETE, WITH OTHER AND

O05.8 8,970.00 6,279.00 2,691.00
PREGNANCY; OLIGURIA ACUTE
OTHER ABORTION, COMPLETE OR UNSPECIFIED, WITHOUT
O05.9 6,500.00 4,550.00 1,950.00
COMPLICATION
UNSPECIFIED ABORTION OR INDUCED ABORTION NOS,
INCOMPLETE, COMPLICATED BY GENITAL TRACT AND
PELVIC INFECTION WITH ENDOMETRITIS AND/OR
O06.0 8,970.00 6,279.00 2,691.00
OOPHORITIS AND/OR PARAMETRITIS AND/OR PELVIC
PERITONITIS AND/OR SALPINGITIS AND/OR SALPINGO-
OOPHORITIS AND/OR SEPSIS AND/
INCOMPLETE, COMPLICATED DELAYED OR EXCESSIVE
O06.1 HAEMORRHAGE WITH AFIBRINOGENAEMIA OR 8,970.00 6,279.00 2,691.00
DEFIBRINATION SYNDROME OR INTRAVASCULAR
COAGULATION
INCOMPLETE, COMPLICATED BY EMBOLISM OR EMBOLISM
NOS WITH AIR EMBOLISM OR AMNIOTIC FLUID EMBOLISM
O06.2 8,970.00 6,279.00 2,691.00
OR BLOOD-CLOT EMBOLISM OR PULMONARY EMBOLISM OR
PYAEMIC EMBOLISM OR SEPTIC OR SEPTICOPYAEMIC
EMBOLISM OR SOAP E
INCOMPLETE, WITH OTHER AND UNSPECIFIED
COMPLICATIONS WITH SHOCK FOLLOWING ABORTION AND
O06.3 8,970.00 6,279.00 2,691.00
ECTOPIC AND MOLAR PREGNANCY; CIRCULATORY
COLLAPASE; POSTOPERATIVE SHOCK; RENAL FAILURE
FOLLOWING ABORTION AND ECTOPIC AND
O06.4 6,500.00 4,550.00 1,950.00
INCOMPLETE, WITHOUT COMPLICATION
COMPLETE, OR UNSPECIFIED, COMPLICATED BY GENITAL
TRACT AND PELVIC INFECTION OR ENDOMETRITIS AND/OR
O06.5 8,970.00 6,279.00 2,691.00
OOPHORITIS AND/OR PARAMETRITIS AND/OR PELVIC
PERITONITIS AND/OR SALPINGITIS AND/OR SALPINGO-
OOPHORITIS AND/OR
COMPLETE, COMPLICATED BY DELAYED OR EXCESSIVE
O06.6 HAEMORRHAGE OR AFIBRINOGENAEMIA OR 8,970.00 6,279.00 2,691.00
DEFIBRINATION SYNDROME OR INTRAVASCULAR
COAGULATION
Page 87 of 126
First Case Rate

COMPLETE, COMPLICATED BY EMBOLISM OR EMBOLISM
NOS OR AIR EMBOLISM OR AMNIOTIC FLUID EMBOLISM OR
O06.7 8,970.00 6,279.00 2,691.00
BLOOD-CLOT EMBOLISM OR PULMONARY EMBOLISM OR
PYAEMIC EMBOLISM OR SEPTIC OR SEPTICOPYAEMIC
EMBOLISM OR SOAP EMBOLI

COMPLETE, WITH OTHER AND UNSPECIFIED
COMPLICATIONS WITH SHOCK FOLLOWING ABORTION AND
O06.8 8,970.00 6,279.00 2,691.00
ECTOPIC AND MOLAR PREGNANCY; CIRCULATORY
COLLAPASE; POSTOPERATIVE SHOCK; RENAL FAILURE
FOLLOWING ABORTION AND ECTOPIC AND M

O06.9 6,500.00 4,550.00 1,950.00
COMPLETE OR UNSPECIFIED, WITHOUT COMPLICATION
FAILED MEDICAL ABORTION, COMPLICATED BY GENITAL

TRACT AND PELVIC INFECTION WITH ENDOMETRITIS;
O07.0 OOPHORITIS; PARAMETRITIS; PARAMETRITIS; PELVIC 6,500.00 4,550.00 1,950.00
PERITONITIS; SALPINGITIS; SALPINGO-OOPHORITIS;
SEPSIS; SEPTIC SHOCK; SEPTICAEMIA
FAILED MEDICAL ABORTION COMPLICATED BY DELAYED OR

EXCESSIVE HAEMORRHAGE; AFIBRINOGENAEMIA WITH
DELAYED OR EXCESSIVE HAEMORRHAGE FOLLOWING
O07.1 8,970.00 6,279.00 2,691.00
FAILED MEDICAL ABORTION WITH OTHER AND

O07.3 6,500.00 4,550.00 1,950.00
PREGNANCY; OLIGURIA ACUTE RE
FAILED MEDICAL ABORTION WITHOUT COMPLICATION;
O07.4 6,500.00 4,550.00 1,950.00
FAILED MEDICAL ABORTION NOS
OTHER AND UNSPECIFIED FAILED ATTEMPTED ABORTION
COMPLICATED BY GENITAL TRACT AND PELVIC INFECTION
O07.5 WITH ENDOMETRITIS; OOPHORITIS; PARAMETRITIS; 8,970.00 6,279.00 2,691.00
PELVIC PERITONITIS; SALPINGITIS; SALPINGO-OOPHORITIS;
SEPSI; SEPTIC SHOCK; SEPTICAEMIA

COMPLICATED BY DELAYED OR EXCESSIVE HAEMORRHAGE
WITH DELAYED OR EXCESSIVE HAEMORRHAGE
O07.6 8,970.00 6,279.00 2,691.00
FOLLOWING ABORTION AND ECTOPIC AND MOLAR
PREGNANCY; AFIBRINOGENAEMIA; DEFIBRINATION
SYNDROME; INTRAVASCULAR COAGULATION

WITH OTHER AND UNSPECIFIED COMPLICATIONS WITH
WITH SHOCK FOLLOWING ABORTION AND ECTOPIC AND
O07.8 6,500.00 4,550.00 1,950.00
MOLAR PREGNANCY; CIRCULATORY COLLAPASE;
POSTOPERATIVE SHOCK; RENAL FAILURE FOLLOWING
ABORTION AND ECTOPIC AND MOLA
O07.9 WITHOUT COMPLICATION; FAILED ATTEMPTED ABORTION 6,500.00 4,550.00 1,950.00
NOS
GENITAL TRACT AND PELVIC INFECTION FOLLOWING
O08.0 ENDOMETRITIS; OOPHORITIS; PARAMETRITIS; PELVIC 11,700.00 8,190.00 3,510.00
PERITONITIS; SALPINGITIS; SALPINGO-OOPHORITIS;
SEPSIS; SEPTIC SHOCK; SEPTICAEMIA
DELAYED OR EXCESSIVE HAEMORRHAGE FOLLOWING
O08.1 9,100.00 6,370.00 2,730.00
EMBOLISM FOLLOWING ABORTION AND ECTOPIC AND
MOLAR PREGNANCY; EMBOLISM NOS; AIR EMBOLISM;
O08.2 AMNIOTIC FLUID EMBOLISM; BLOOD-CLOT EMBOLISM; 12,090.00 8,463.00 3,627.00
PULMONARY EMBOLISM; PYAEMIC EMBOLISM; SEPTIC OR
SEPTICOPYAEMIC EMBOLISM; SOAP EMBOLISM
SHOCK FOLLOWING ABORTION AND ECTOPIC AND MOLAR
O08.3 PREGNANCY; CIRCULATORY COLLAPASE; POSTOPERATIVE 8,970.00 6,279.00 2,691.00
SHOCK
Page 88 of 126
First Case Rate

RENAL FAILURE FOLLOWING ABORTION AND ECTOPIC AND
MOLAR PREGNANCY; OLIGURIA ACUTE RENAL FAILURE;
O08.4 25,090.00 17,563.00 7,527.00
OLIGURIA RENAL SHUTDOWN; OLIGURIA RENAL TUBULAR
NECROSIS; OLIGURIA URAEMIA
METABOLIC DISORDERS FOLLOWING ABORTION AND
O08.5 12,090.00 8,463.00 3,627.00
ECTOPIC AND MOLAR PREGNANCY
OTHER COMPLICATIONS FOLLOWING ABORTION AND
O08.8 ECTOPIC AND MOLAR PREGNANCY; CARDIAC ARREST; 8,970.00 6,279.00 2,691.00
URINARY TRACT INFECTION
COMPLICATION FOLLOWING ABORTION AND ECTOPIC AND
O08.9 12,090.00 8,463.00 3,627.00
MOLAR PREGNANCY, UNSPECIFIED
PRE-EXISTING ESSENTIAL HYPERTENSION COMPLICATING
O10.0 8,840.00 6,188.00 2,652.00
PREGNANCY CHILD BIRTH AND THE PUERPERIUM
PRE-EXISTING HYPERTENSIVE HEART DISEASE
O10.1 COMPLICATING PREGNANCY, CHILDBIRTH AND THE 8,840.00 6,188.00 2,652.00
PUERPERIUM
PRE-EXISTING HYPERTENSIVE RENAL DISEASE
O10.2 COMPLICATING PREGNANCY CHILDBIRTH AND THE 8,840.00 6,188.00 2,652.00
PUERPERIUM
PRE-EXISTING HYPERTENSIVE HEART AND RENAL DISEASE
PUERPERIUM
PRE-EXISTING SECONDARY HYPERTENSION COMPLICATING
O10.4 8,840.00 6,188.00 2,652.00
PREGNANCY, CHILDBIRTH AND THE PUERPERIUM
UNSPECIFIED PRE-EXISTING HYPERTENSION
PUERPERIUM
PRE-EXISTING HYPERTENSIVE DISORDER WITH
O11 8,840.00 6,188.00 2,652.00
SUPERIMPOSED PROTEINURIA
O12.1 GESTATIONAL PROTEINURIA 8,840.00 6,188.00 2,652.00
O12.2 GESTATIONAL OEDEMA WITH PROTEINURIA 8,840.00 6,188.00 2,652.00
GESTATIONAL [PREGNANCY-INDUCED] HYPERTENSION
O13 WIHTOUT SIGNIFICANT PROTEINURIA; GESTATIONAL 8,840.00 6,188.00 2,652.00
HYPERTENSION NOS; MILD PRE-ECLAMPSIA
O14.0 MODERATE PRE-ECLAMPSIA 8,840.00 6,188.00 2,652.00
O14.1 SEVERE PRE-ECLAMPSIA 8,840.00 6,188.00 2,652.00
O14.9 PRE-ECLAMPSIA, UNSPECIFIED 8,840.00 6,188.00 2,652.00
O15.0 ECLAMPSIA IN PREGNANCY 8,840.00 6,188.00 2,652.00
O15.1 ECLAMPSIA IN LABOUR 8,840.00 6,188.00 2,652.00
O15.2 ECLAMPSIA IN THE PUERPERIUM 8,840.00 6,188.00 2,652.00
ECLAMPSIA, UNSPECIFIED AS TO TIME PERIOD; ECLAMPSIA
O15.9 8,840.00 6,188.00 2,652.00
NOS
O16 UNSPECIFIED MATERNAL HYPERTENSION 8,840.00 6,188.00 2,652.00
THREATENED ABORTION; HAEMORRHAGE SPECIFIED AS
O20.0 8,840.00 6,188.00 2,652.00
DUE TO THREATENED ABORTION
O20.8 OTHER HAEMORRHAGE IN EARLY PREGNANCY 8,840.00 6,188.00 2,652.00
O20.9 HAEMORRHAGE IN EARLY PREGNANCY, UNSPECIFIED 8,840.00 6,188.00 2,652.00
MILD HYPEREMESIS GRAVIDARUM; HYPEREMESIS
O21.0 GRAVIDARUM, MILD OR UNSPECIFIED, STARTING BEFORE 8,840.00 6,188.00 2,652.00
THE END OF THE 22ND WEEK OF GESTATION
HYPEREMESIS GRAVIDARUM WITH METABOLIC
DISTURBANCE; HYPEREMESIS GRAVIDARUM, STARTING
O21.1 BEFORE THE END OF THE 22ND WEEK OF GESTATION, WITH 8,840.00 6,188.00 2,652.00
METABOLIC DISTURBANCE SUCH AS CARBOHYDRATE
DEPLETION, DEHYDRATION, ELCTROLYTE IMBALANCE
LATE VOMITING OF PREGNANCY; EXCESSIVE VOMITING

O21.2 8,840.00 6,188.00 2,652.00
STARTING AFTER 22 COMPLETED WEEKS OF GESTATION
OTHER VOMITING COMPLICATING PREGNANCY; VOMITING
O21.8 DUE TO DISEASE CLASSIFIED ELSEWHERE, COMPLICATING 8,840.00 6,188.00 2,652.00
PREGNANCY
O21.9 VOMITING OF PREGNANCY, UNSPECIFIED 8,840.00 6,188.00 2,652.00
DEEP PHLEBOTHROMBOSIS IN PREGNANCY; DEEP-VEIN
O22.3 8,840.00 6,188.00 2,652.00
THROMBOSIS, ANTEPARTUM
CEREBRAL VENOUS THROMBOSIS IN PREGNANCY;
O22.5 8,840.00 6,188.00 2,652.00
CEREBROVENOUS SINUS THROMBOSIS IN PREGNANCY
VENOUS COMPLICATION IN PREGNANCY, UNSPECIFIED;

O22.9 GESTATIONAL PHLEBITIS NOS; GESTATIONAL 8,840.00 6,188.00 2,652.00
PHLEBOPATHY NOS; GESTATIONAL THROMBOSIS NOS
O23.0 INFECTIONS OF KIDNEY IN PREGNANCY 8,840.00 6,188.00 2,652.00
O23.1 INFECTIONS OF BLADDER IN PREGNANCY 5,200.00 3,640.00 1,560.00
O23.2 INFECTIONS OF URETHRA IN PREGNANCY 5,200.00 3,640.00 1,560.00
INFECTIONS OF OTHER PARTS OF URINARY TRACT IN
O23.3 8,840.00 6,188.00 2,652.00
PREGNANCY
UNSPECIFIED INFECTION OF URINARY TRACT IN
O23.4 5,200.00 3,640.00 1,560.00
PREGNANCY
Page 89 of 126
First Case Rate

O23.5 INFECTIONS OF THE GENITAL TRACT IN PREGNANCY 5,200.00 3,640.00 1,560.00
OTHER AND UNSPECIFIED GENITOURINARY TRACT
O23.9 INFECTION IN PREGNANCY; GENITOURINARY TRACT 5,200.00 3,640.00 1,560.00
INFECTION IN PREGNANCY NOS
O24.0 PRE-EXISTING DIABETES MELLITUS, INSULIN-DEPENDENT 8,840.00 6,188.00 2,652.00
PRE-EXISTING DIABETES MELLITUS, NON-INSULIN-
O24.1 8,840.00 6,188.00 2,652.00
DEPENDENT
PRE-EXISTING MALNUTRITION-RELATED DIABETES
O24.2 8,840.00 6,188.00 2,652.00
MELLITUS
O24.3 PRE-EXISTING DIABETES MELLITUS, UNSPECIFIED 8,840.00 6,188.00 2,652.00
DIABETES MELLITUS ARISING IN PREGNANCY;
O24.4 8,840.00 6,188.00 2,652.00
GESTATIONAL DIABETES MELLITUS NOS
O24.9 DIABETES MELLITUS IN PREGNANCY, UNSPECIFIED 8,840.00 6,188.00 2,652.00
O26.2 PREGNANCY CARE OF HABITUAL ABORTER 8,840.00 6,188.00 2,652.00
RETAINED IN TRAUTERINE CONTRACEPTIVE DEVICE IN
O26.3 8,840.00 6,188.00 2,652.00
PREGNANCY
O26.4 HERPES GESTATIONIS 8,840.00 6,188.00 2,652.00
MATERNAL HYPOTENSION SYNDROME; SUPINE
O26.5 8,840.00 6,188.00 2,652.00
HYPOTENSIVE SYNDROME
LIVER DISORDERS IN PREGNANCY, CHILDBIRTH AND THE
O26.6 8,840.00 6,188.00 2,652.00
PUERPERIUM
SUBLUXATION OF SYMPHYSIS (PUBIS) IN PREGNANCY
O26.7 8,840.00 6,188.00 2,652.00
CHILDBIRTH AND THE PUERPERIUM
OTHER SPECIFIED PREGNANCY-RELATED CONDITIONS;
EXHAUSTION AND FATIGUE PREGNANCY-RELATED;
O26.8 8,840.00 6,188.00 2,652.00
PERIPHERAL NEURITIS PREGNANCY-RELATED; RENAL
DISEASE PREGNANCY-RELATED
O26.9 PREGNANCY-RELATEDCONDITION, UNSPECIFIED 8,840.00 6,188.00 2,652.00
ABNORMAL HAEMATOLOGICAL FINDING ON ANTENATAL
O28.0 8,840.00 6,188.00 2,652.00
SCREENING OF MOTHER
ABNORMAL ULTRASONIC FINDING ON ANTENATAL
O28.3 8,840.00 6,188.00 2,652.00
SCREENING OF MOTHER
ABNORMAL CHROMOSOMAL AND GENETIC FINDING ON
O28.5 8,840.00 6,188.00 2,652.00
ANTENATAL SCREENING OF MOTHER
OTHER ABNORMAL FINDINGS ON ANTENATAL SCREENING
O28.8 8,840.00 6,188.00 2,652.00
OF MOTHER
ABNORMAL FINDING ON ANTENATAL SCREENING OF
O28.9 8,840.00 6,188.00 2,652.00
MOTHER, UNSPECIFIED
OTHER COMPLICATIONS OF ANAESTHESIA DURING
O29.8 8,840.00 6,188.00 2,652.00
PREGNANCY
O30.0 TWIN PREGNANCY 8,840.00 6,188.00 2,652.00
O30.1 TRIPLET PREGNANCY 8,840.00 6,188.00 2,652.00
O30.8 OTHER MULTIPLE GESTATION 8,840.00 6,188.00 2,652.00
MULTIPLE GESTATION, UNSPECIFIED; MULTIPLE
O30.9 8,840.00 6,188.00 2,652.00
PREGNANCY NOS
O31.0 PAPYRACEOUS FETUS; FETUS COMPRESSUS 8,840.00 6,188.00 2,652.00
CONTINUING PREGNANCY AFTER ABORTION OF ONE FETUS
O31.1 8,840.00 6,188.00 2,652.00
OR MORE
CONTINUING PREGNANCY AFTER INTRAUTERINE DEATH OF
O31.2 8,840.00 6,188.00 2,652.00
ONE FETUS OR MORE
OTHER COMPLICATIONS SPECIFIC TO MULTIPLE
O31.8 8,840.00 6,188.00 2,652.00
GESTATION
O32.0 MATERNAL CARE FOR UNSTABLE LIE 8,840.00 6,188.00 2,652.00
O32.1 MATERNAL CARE FOR BREECH PRESENTATION 8,840.00 6,188.00 2,652.00
MATERNAL CARE FOR TRANSVERSE AND OBLIQUE LIE;
O32.2 8,840.00 6,188.00 2,652.00
OBLIQUE PRESENTATION; TRANSVERSE PRESENTATION
MATERNAL CARE FOR FACE, BROW AND CHIN
O32.3 8,840.00 6,188.00 2,652.00
PRESENTATION
MATERNAL CARE FOR HIGH HEAD AT TERM; FAILURE OF
O32.4 8,840.00 6,188.00 2,652.00
HEAD TO ENTER PELVIC BRIM
MATERNAL CARE FOR MULTIPLE GESTATION WITH
O32.5 8,840.00 6,188.00 2,652.00
MALPRESENTATION OF ONE FETUS OR MORE
O32.6 MATERNAL CARE FOR COMPOUND PRESENTATION 8,840.00 6,188.00 2,652.00
MATERNAL CARE FOR OTHER MALPRESENTATION OF
O32.8 8,840.00 6,188.00 2,652.00
FETUS
MATERNAL CARE FOR MALPRESENTATION OF FETUS,
O32.9 8,840.00 6,188.00 2,652.00
UNSPECIFIED
MATERNAL CARE FOR DISPROPORTION DUE TO DEFORMITY
O33.0 OF MATERNAL PELVIC BONES; PELVIC DEFORMITY CAUSING 8,840.00 6,188.00 2,652.00
DISPROPORTION NOS
MATERNAL CARE FOR DISPROPORTION DUE TO GENERALLY
O33.1 CONTRACTED PELVIS; CONTRACTED PELVIS NOS CAUSING 8,840.00 6,188.00 2,652.00
DISPROPORTION
MATERNAL CARE FOR DISPROPORTION DUE TO INLET
O33.2 CONTRACTION OF PELVIS; INLET CONTRACTION (PELVIS) 8,840.00 6,188.00 2,652.00
CAUSING DISPROPORTION
Page 90 of 126
First Case Rate

MATERNAL CARE FOR DISPROPORTION DUE TO OUTLET
CONTRACTION OF PELVIS; MID-CAVITY CONTRACTION
O33.3 8,840.00 6,188.00 2,652.00
PELVIS CAUSING DISPROPORTION; OUTLET CONTRACTION
PELVIS CAUSING DISPROPORTION
MATERNAL CARE FOR DISPROPORTION OF MIXED
O33.4 8,840.00 6,188.00 2,652.00
MATERNAL AND FETAL ORIGIN
MATERNAL CARE FOR DISPROPORTION DUE TO UNUSUALLY
O33.5 LARGE FETUS; DISPROPORTION OF FETAL ORIGIN WITH 8,840.00 6,188.00 2,652.00
NORMALLY FORMED FETUS; FETAL DISPROPORTION NOS
MATERNAL CARE FOR DISPROPORTION DUE TO
O33.6 8,840.00 6,188.00 2,652.00
HYDROCEPHALIC FETUS
MATERNAL CARE FOR DISPROPORTION DUE TO OTHER
FETAL DEFORMITIES; CONJOINED TWINS; FETAL ASCITES
CAUSING DISPROPORTION; FETAL HYDROPS CAUSING
O33.7 8,840.00 6,188.00 2,652.00
DISPROPORTION; FETAL MEANINGOMYELOCELE CAUSING
DISPROPORTION; FETAL TUMOUR CAUSING
DISPROPORTION
MATERNAL CARE FOR DISPROPORTION, UNSPECIFIED;
O33.9 CEPHALOPELVIC DISPROPORTION NOS; FETOPELVIC 8,840.00 6,188.00 2,652.00
DISPROPORTION NOS
MATERNAL CARE FOR CONGENITAL MALFORMATION OF
O34.0 UTERUS; MATERNAL CARE FOR DOUBLE UTERUS; 8,840.00 6,188.00 2,652.00
MATERNAL CARE FOR UTERUS BICORNIS
MATERNAL CARE FOR TUMOUR OF CORPUS UTERI;
O34.1 MATERNAL FOR POLYP OF CORPUS UTERI; MATERNAL CARE 8,840.00 6,188.00 2,652.00
FOR UTERINE FIBROID
MATERNAL CARE DUE TO UTERINE SCAR FROM PREVIOUS
O34.2 8,840.00 6,188.00 2,652.00
SURGERY; MATERNAL CARE FOR SCAR FROM PREVIOUS
MATERNAL CARE FOR CERVICAL INCOMPETENCE;
MATERNAL CARE FOR CERCLAGE WITH OR WITHOUT
O34.3 MENTION OF CERVICAL INCOMPETENCE; MATERNAL CARE 8,840.00 6,188.00 2,652.00
FOR SHIRODKAR SUTURE WITH OR WITHOUT MENTION OF
CERVICAL INCOMPETENCE
MATERNAL CARE FOR OTHER ABNORMALITIES OF CERVIX;
MATERNAL CARE FOR POLYP OF CERVIX; MATERNAL CARE
O34.4 FOR PREVIOUS SURGERY TO CERVIX; MATERNAL CARE FOR 8,840.00 6,188.00 2,652.00
STRICTURE OR STENOSIS OF CERVIX; MATERNAL CARE FOR
TUMOUR OF CERVIX
MATERNAL CARE FOR OTHER ABNORMALITIES OF GRAVID
UTERUS; MATERNAL CARE FOR INCARCERATIION OF
O34.5 GRAVID UTERUS; MATERNAL CARE FOR PROLAPSE OF 8,840.00 6,188.00 2,652.00
GRAVID UTERUS; MATERNAL CARE FOR RETROVERSION OF
GRAVID UTERUS
MATERNAL CARE FOR ABNORMALITY OF VAGINA;
MATERNAL CARE FOR PREVIOUS SURGERY TO VAGINA;
MATERNAL CARE FOR SEPTATE VAGINA; MATERNAL CARE
O34.6 8,840.00 6,188.00 2,652.00
FOR ACQUIRED STENOSIS OF VAGINA; MATERNAL CARE
FOR CONGENITAL STENOSIS OF VAGINA; MATERNAL CARE
FOR TUMOUR OF VAGINA
MATERNAL CARE FOR ABNORMALITY OF VULVA AND

PERINEUM; MATERNAL CARE FOR FIBROSIS OF PERINEUM;
O34.7 MATERNAL CARE FOR PREVIOUS SURGERY TO PERINEUM 8,840.00 6,188.00 2,652.00
OR VULVA; MATERNAL CARE FOR RIGID PERINEUM;
MATERNAL CARE FOR TUMOUR OF VULVA
MATERNAL CARE FOR OTHER ABNORMALITIES OF PELVIC

ORGANS; MATERNAL CARE FOR CYSTOCELE; MATERNAL
O34.8 CARE FOR PREVIOUS PELVIC FLOOR REPAIR; MATERNAL 8,840.00 6,188.00 2,652.00
CARE FOR PENDULOUS ABDOMEN; MATERNAL CARE FOR
RECTOCELE; MATERNAL CARE FOR RIGID PELVIC FLOOR
MATERNAL CARE FOR ABNORMALITY OF PELVIC ORGAN,
O34.9 8,840.00 6,188.00 2,652.00
UNSPECIFIED
MATERNAL CARE FOR (SUSPECTED) CENTRAL NERVOUS
SYSTEM MALFORMATION IN FETUS; MATERNAL CARE FOR
O35.0 8,840.00 6,188.00 2,652.00
SUSPECTED FETAL ANENCEPHALY; MATERNAL CARE FOR
SUSPECTED FETAL SPINA BIFIDA
MATERNAL CARE FOR (SUSPECTED) HEREDITARY DISEASE
O35.2 8,840.00 6,188.00 2,652.00
IN FETUS
MATERNAL CARE FOR (SUSPECTED) DAMAGE TO FETUS
FROM VIRAL DISEASE IN MOTHER; MATERNAL CARE FOR
O35.3 SUSPECTED DAMAGE TO FETUS FROM MATERNAL 8,840.00 6,188.00 2,652.00
CYTOMEGALOVIRUS INFECTION; MATERNAL CARE FOR
SUSPECTED DAMAGE TO FETUS FROM MATERNAL RUBELLA
Page 91 of 126
First Case Rate

MATERNAL CARE FOR (SUSPECTED) DAMAGE TO FETUS BY
O35.5 DRUGS; MATERNAL CARE FOR SUSPECTED DAMAGE TO 8,840.00 6,188.00 2,652.00
FETUS FROM DRUG ADDICTION
MATERNAL CARE FOR OTHER (SUSPECTED) FETAL
ABNORMALITY AND DAMAGE; MATERNAL CARE FOR
O35.8 SUSPECTED DAMAGE TO FETUS FROM MATERNAL 8,840.00 6,188.00 2,652.00
LISTERIOSIS; MATERNAL CARE FOR SUSPECTED DAMAGE
TO FETUS FROM MATERNAL TOXOPLASMOSIS
MATERNAL CARE FOR (SUSPECTED) FETAL ABNORMALITY
O35.9 8,840.00 6,188.00 2,652.00
AND DAMAGE, UNSPECIFIED
MATERNAL CARE FOR RHESUS ISOIMMUNIZATION; ANTI-D
O36.0 [RH] ANTIBODIES; RH INCOMPATIBILITY (WITH HYDROPS 8,840.00 6,188.00 2,652.00
FETALIS)
MATERNAL CARE FOR OTHER ISOIMMUNIZATION; ABO
O36.1 ISOIMMUNIZATION; ISOIMMUNIZATION NOS (WITH 8,840.00 6,188.00 2,652.00
HYDROPS FETALIS)
MATERNAL CARE FOR HYDROPS FETALIS; HYDROPS
O36.2 FETALIS NOS; HYDROPS FETALIS NOT ASSOCIATED WITH 8,840.00 6,188.00 2,652.00
ISOIMMUNIZATION
O36.3 MATERNAL CARE FOR SIGNS OF FETAL HYPOXIA 8,840.00 6,188.00 2,652.00
O36.4 MATERNAL CARE FOR INTRAUTERINE DEATH 8,840.00 6,188.00 2,652.00
MATERNAL CARE FOR POOR FETAL GROWTH; MATERNAL
CARE FOR KNOWN OR SUSPECTED LIGHT-FOR-DATES;
O36.5 MATERNAL CARE FOR KNOWN OR SUSPECTED PLACENTAL 8,840.00 6,188.00 2,652.00
INSUFFICIENCY; MATERNAL CARE FOR KNOWN OR
SUSPECTED SMALL-FOR-DATES
MATERNAL CARE FOR EXCESSIVE FETAL GROWTH;
O36.6 MATERNAL CARE FOR KNOWN OR SUSPECTED LARGE-FOR- 8,840.00 6,188.00 2,652.00
DATES
MATERNAL CARE FOR VIABLE FETUS IN ABDOMINAL
O36.7 10,140.00 7,098.00 3,042.00
PREGNANCY
O36.8 MATERNAL CARE FOR OTHER SPECIFIED FETAL PROBLEMS 8,840.00 6,188.00 2,652.00
O36.9 MATERNAL CARE FOR FETAL PROBLEM, UNSPECIFIED 8,840.00 6,188.00 2,652.00
O40 POLYHYDRAMNIOS; HYDRAMNIOS 8,840.00 6,188.00 2,652.00
OLIGOHYDRAMNIOS; OLIGOHYDRAMNIOS WITHOUT
O41.0 8,840.00 6,188.00 2,652.00
MENTION OF RUPTURE OF MEMBRANE
INFECTION OF AMNIOTIC SAC AND MEMBRANES;
O41.1 AMNIONITIS; CHORIOAMNIONITIS; MEMBRANITIS; 8,840.00 6,188.00 2,652.00
PLACENTITIS
OTHER SPECIFIED DISORDERS OF AMNIOTIC FLUID AND
O41.8 8,840.00 6,188.00 2,652.00
MEMBRANES
DISORDER OF AMNIOTIC FLUID AND MEMBRANES,
O41.9 8,840.00 6,188.00 2,652.00
UNSPECIFIED; PREMATURE RUPTURE OF MEMBRANES
PREMATURE RUPTURE OF MEMBRANES ON SET OF LABOUR
O42.0 8,840.00 6,188.00 2,652.00
WITHIN 24 HOURS
PREMATURE RUPTURE OF MEMBRANES ON SET OF LABOUR
O42.1 8,840.00 6,188.00 2,652.00
AFTER 24 HOURS
PREMATURE RUPTURE OF MEMBRANES, LABOUR DELAYED
O42.2 8,840.00 6,188.00 2,652.00
BY THERAPY
O42.9 PREMATURE RUPTURE OF MEMBRANES, UNSPECIFIED 8,840.00 6,188.00 2,652.00
PLACENTAL TRANSFUSION SYNDROMES; FETOMATERNAL
O43.0 TRANSFUSION; MATERNOFETAL TRANSFUSION; TWIN-TO- 8,840.00 6,188.00 2,652.00
TWIN TRANSFUSION
MALFORMATION OF PLACENTA; ABNORMAL PLACENTA
O43.1 8,840.00 6,188.00 2,652.00
NOS; CIRCUMVALLATE PLACENTA
OTHER PLACENTAL DISORDERS; PLACENTAL
O43.8 8,840.00 6,188.00 2,652.00
DYSFUNCTION; PLACENTAL INFARCTION
O43.9 PLACENTAL DISORDER, UNSPECIFIED 8,840.00 6,188.00 2,652.00
PLACENTA PRAEVIA SPECIFIED AS WITHOUT
O44.0 HAEMORRHAGE; LOW IMPLANTATION OF PLACENTA, NOS 8,840.00 6,188.00 2,652.00
OR WITH HAEMORRHAGE
PLACENTA PRAEVIA WITH HAEMORRHAGE; LOW
IMPLANTATION OF PLACENTA, NOS OR WITH
HAEMORRHAGE; PLACENTA PRAEVIA, MARGINAL NOS OR
O44.1 8,840.00 6,188.00 2,652.00
WITH HAEMORRHAGE; PLACENTA PRAEVIA, PARTIAL NOS
OR WITH HAEMORRHAGE; PLACENTA PRAEVIA, TOTAL NOS
OR WITH HAEMORRHAGE
PREMATURE SEPARATION OF PLACENTA WITH
COAGULATION DEFECT; ABRUPTIO PLACENTAE WITH
(EXCESSIVE) HAEMORRHAGE ASSOCIATED WITH
O45.0 AFIBRINOGENAEMIA; ABRUPTIO PLACENTAE WITH 8,840.00 6,188.00 2,652.00
(EXCESSIVE) HAEMORRHAGE ASSOCIATED WITH
DISSEMINATED INTRAVASCULAR COAGULATION;
ABRUPTIO
O45.8 OTHER PREMATURE SEPARATION OF PLACENTA 8,840.00 6,188.00 2,652.00
PREMATURE SEPARATION OF PLACENTA, UNSPECIFIED;
O45.9 8,840.00 6,188.00 2,652.00
ABRUPTIO PLACENTA NOS
Page 92 of 126
First Case Rate

ANTEPARTUM HAEMORRHAGE WITH COAGULATION
DEFECT; ANTEPARTUM HAEMORRHAGE (EXCESSIVE)
ASSOCIATED WITH AFIBRINOGENAEMIA; ANTEPARTUM
O46.0 8,840.00 6,188.00 2,652.00
HAEMORRHAGE (EXCESSIVE) ASSOCIATED WITH
DISSEMINATED INTRAVASCULAR COAGULATION;
ANTEPARTUM HAEMORRHAGE (EXCESSIVE) ASSOCIATED W
O46.8 OTHER ANTEPARTUM HAEMORRHAGE 8,840.00 6,188.00 2,652.00
O46.9 ANTEPARTUM HAEMORRHAGE, UNSPECIFIED 8,840.00 6,188.00 2,652.00
FALSE LABOUR BEFORE 37 COMPLETED WEEKS OF
O47.0 8,840.00 6,188.00 2,652.00
GESTATION
FALSE LABOUR AT OR AFTER 37 COMPLETED WEEKS OF
O47.1 8,840.00 6,188.00 2,652.00
GESTATION
O47.9 FALSE LABOUR, UNSPECIFIED 8,840.00 6,188.00 2,652.00
O48 PROLONGED PREGNANCY; POST-DATES; POST-TERM 8,840.00 6,188.00 2,652.00
O60.0 PRETERM LABOR, NOT RESULTING TO DELIVERY 8,840.00 6,188.00 2,652.00
OTHER INTRAPARTUM HAEMORRHAGE; EXCESSIVE
O67.8 12,090.00 8,463.00 3,627.00
INTRAPARTUM HAEMORRHAGE
O71.0 RUPTURE OF UTERUS BEFORE ON SET OF LABOUR 12,090.00 8,463.00 3,627.00
RUPTURE OF UTERUS DURING LABOUR; RUPTURE OF
O71.1 UTERUS NOT STATED AS OCCURING BEFORE ONSET OF 12,090.00 8,463.00 3,627.00
LABOUR
O71.2 POST PARTUM INVERSION OF UTERUS 12,090.00 8,463.00 3,627.00
OBSTETRIC LACERATION OF CERVIX; ANNULAR
O71.3 12,090.00 8,463.00 3,627.00
DETACHMENT OF CERVIX
OTHER OBSTETRIC INJURY TO PELVIC ORGANS; OBSTETRIC
O71.5 12,090.00 8,463.00 3,627.00
INJURY TO BLADDER; OBSTETRIC INJURY TO URETHRA
OBSTETRIC HAEMATOMA OF PELVIS; OBSTETRIC

O71.7 HAEMATOMA OF PERINEUM; OBSTETRIC HAEMATOMA OF 12,090.00 8,463.00 3,627.00
VAGINA; OBSTETRIC HAEMATOMA OF VULVA
O71.8 OTHER SPECIFIED OBSTETRIC TRAUMA 12,090.00 8,463.00 3,627.00
O71.9 OBSTETRIC TRAUMA, UNSPECIFIED 12,090.00 8,463.00 3,627.00
THIRD-STAGE HAEMORRHAGE; HAEMORRHAGE
O72.0 ASSOCIATED WITH RETAINED, TRAPPED OR ADHERENT 9,100.00 6,370.00 2,730.00
PLACENTA; RETAINED PLACENTA NOS
OTHER IMMEDIATE POSTPARTUM HAEMORRHAGE;
O72.1 HAEMORRHAGE FOLLOWING DELIVERY OF PLACENTA; 9,100.00 6,370.00 2,730.00
POSTPARTUM ATOMIC HAEMORRHAGE NOS
DELAYED AND SECONDARY POSTPARTUM HAEMORRHAGE;

HAEMORRHAGE ASSOCIATED WITH RETAINED PORTIONS
O72.2 9,100.00 6,370.00 2,730.00
OF PLACENTA OR MEMBRANES; RETAINED PRODUCTS OF
CONCEPCION NOS, FOLLOWING DELIVERY
POSTPARTUM COAGULATION DEFECTS;
O72.3 AFIBRINOGENAEMIA POSTPARTUM; FIBRINOLYSIS 9,100.00 6,370.00 2,730.00
POSTPARTUM
RETAINED PLACENTA WITHOUT HAEMORRHAGE;
O73.0 9,100.00 6,370.00 2,730.00
PLACENTA ACCRETA WITHOUT HAEMORRHAGE
RETAINED PORTIONS OF PLACENTA AND MEMBRANES
WITHOUT HAEMORRHAGE; RETAINED PRODUCTS OF
O73.1 9,100.00 6,370.00 2,730.00
CONCEPTION FOLLOWING DELIVERY, WITHOUT
HAEMORRHAGE
ASPIRATION PNEUMONITIS DUE TO ANAESTHESIA DURING
LABOUR AND DELIVERY; INHALATION OF STOMACH
CONTENTS OR SECRETIONS NOS DUE TO ANAESTHESIA
O74.0 12,090.00 8,463.00 3,627.00
DURING LABOUR AND DELIVERY; MENDELSON'S
SYNDROME DUE TO ANAESTHESIA DURING LABOUR AND
DELIVERY
CARDIAC COMPLICATIONS OF ANAESTHESIA DURING
LABOUR AND DELIVERY; CARDIAC ARREST DUE TO
O74.2 ANAESTHESIA DURING LABOUR AND DELIVERY; CARDIAC 12,090.00 8,463.00 3,627.00
FAILURE DUE TO ANAESTHESIA DURING LABOUR AND
DELIVERY
OTHER COMPLICATIONS OF ANAESTHESIA DURING LABOUR
O74.8 12,090.00 8,463.00 3,627.00
AND DELIVERY
SHOCK DURING OR FOLLOWING LABOUR AND DELIVERY;
O75.1 12,090.00 8,463.00 3,627.00
OBSTETIC SHOCK
OTHER SPECIFIED COMPLICATIONS OF LABOUR AND
O75.8 12,090.00 8,463.00 3,627.00
DELIVERY
O75.9 COMPLICATION OF LABOUR AND DELIVERY, UNSPECIFIED 12,090.00 8,463.00 3,627.00
PUERPERAL SEPSIS; PUERPERAL ENDOMETRITIS;
O85 PUERPERAL FEVER; PUERPERAL PERITONITIS; 13,780.00 9,646.00 4,134.00
PUERPERAL SEPTICAEMIA
INFECTION OF OBSTETRIC SURGICAL WOUND; INFECTED
O86.0 CAESAREAN SECTION WOUND FOLLOWING DELIVERY; 13,780.00 9,646.00 4,134.00
INFECTED PERINEAL REPAIR FOLLOWING DELIVERY
Page 93 of 126
First Case Rate

OTHER INFECTION OF GENITAL TRACT FOLLOWING
O86.1 DELIVERY; CERVICITIS FOLLOWING DELIVERY; VAGINITIS 13,780.00 9,646.00 4,134.00
FOLLOWING DELIVERY
O86.2 URINARY TRACT INFECTION FOLLOWING DELIVERY 13,780.00 9,646.00 4,134.00
OTHER GENITOURINARY TRACT INFECTIONS FOLLOWING
O86.3 DELIVERY; PUERPERAL GENITOURINARY TRACT INFECTION 13,780.00 9,646.00 4,134.00
NOS
PYREXIA OF UNKNOWN ORIGIN FOLLOWING DELIVERY;
O86.4 13,780.00 9,646.00 4,134.00
PUERPERAL INFECTION NOS; PUERPERAL PYREXIA NOS
O86.8 OTHER SPECIFIED PUERPERA LINFECTIONS 13,780.00 9,646.00 4,134.00
O87.0 SUPERFICIAL THROMBOPHLEBITIS IN THE PUERPERIUM 13,780.00 9,646.00 4,134.00
DEEP PHLEBOTHROMBOSIS IN THE PUERPERIUM; DEEP-
O87.1 VEIN THROMBOSIS, POSTPARTUM; PELVIC 13,780.00 9,646.00 4,134.00
THROMBOPHLEBITIS, POSTPARTUM
O87.2 HAEMORRHOIDS IN THE PUERPERIUM 13,780.00 9,646.00 4,134.00
OTHER VENOUS COMPLICATIONS IN THE PUERPERIUM;
O87.8 13,780.00 9,646.00 4,134.00
GENITAL VARICES IN THE PUERPERIUM
VENOUS COMPLICATION IN THE PUERPERIUM,

O87.9 UNSPECIFIED; PUERPERAL PHLEBITIS NOS; PUERPERAL 12,090.00 8,463.00 3,627.00
PHLEBOPATHY NOS; PUERPERAL THROMBOSIS NOS
O88.1 AMNIOTIC FLUID EMBOLISM 13,780.00 9,646.00 4,134.00
OBSTETRIC BLOOD-CLOT EMBOLISM; OBSTETRIC
O88.2 PULMONARY EMBOLISM NOS; PUERPERAL PULMONARY 13,780.00 9,646.00 4,134.00
EMBOLISM NOS
PULMONARY COMPLICATIONS OF ANAESTHESIA DURING
THE PUERPERIUM; ASPIRATION PNEUMONITIS DUE TO
ANAESTHESIA DURING THE PUERPERIUM; INHALATION OF
O89.0 STOMACH 13,780.00 9,646.00 4,134.00
CONTENTS OR SECRETIONS NOS DUE TO ANAESTHESIA
DURING THE PUERPERIUM
MENDELSON'S SYNDROME DUE TO ANAEST
CARDIAC COMPLICATIONS OF ANAESTHESIA DURING THE
PUERPERIUM; CARDIAC ARREST DUE TO ANAESTHESIA
O89.1 13,780.00 9,646.00 4,134.00
DURING THE PUERPERIUM; CARDIAC FAILURE DUE TO
ANAESTHESIA DURING THE PUERPERIUM
CENTRAL NERVOUS SYSTEM COMPLICATIONS OF

O89.2 ANAESTHESIA DURING THE PUERPERIUM; CEREBRAL 13,780.00 9,646.00 4,134.00
ANOXIA DUE TO ANAESTHESIA DURING THE PUERPERIUM
SPINAL AND EPIDURAL ANAESTHESIA-INDUCED HEADACHE
O89.4 13,780.00 9,646.00 4,134.00
DURING THE PUERPERIUM
OTHER COMPLICATIONS OF ANAESTHESIA DURING THE
O89.8 13,780.00 9,646.00 4,134.00
PUERPERIUM
COMPLICATION OF ANAESTHESIA DURING THE
O89.9 13,780.00 9,646.00 4,134.00
PUERPERIUM, UNSPECIFIED
O90.0 DISRUPTION OF CAESAREAN SECTION WOUND 13,780.00 9,646.00 4,134.00
DISRUPTION OF PERINEAL OBSTETRIC WOUND;
DISRUPTION OF WOUND OF EPISIOTOMY; DISRUPTION OF
O90.1 13,780.00 9,646.00 4,134.00
WOUND OF PERINEAL LACERATION; SECONDARY PERINEAL
TEAR
O90.2 HAEMATOMA OF OBSTETRIC WOUND 13,780.00 9,646.00 4,134.00
O90.3 CARDIOMYOPATHY IN THE PUERPERIUM 13,780.00 9,646.00 4,134.00
POSTPARTUM ACUTE RENAL FAILURE; HEPATORENAL
O90.4 13,780.00 9,646.00 4,134.00
SYNDROME FOLLOWING LABOUR AND DELIVERY
O90.5 POSTPARTUM THYROIDITIS 13,780.00 9,646.00 4,134.00
OTHER COMPLICATIONS OF THE PUERPERIUM, NOT
O90.8 13,780.00 9,646.00 4,134.00
O90.9 COMPLICATION OF THE PUERPERIUM, UNSPECIFIED 13,780.00 9,646.00 4,134.00
INFECTION OF NIPPLE ASSOCIATED WITH CHILDBIRTH;
O91.0 GESTATIONAL ABSCESS OF NIPPLE; PUERPERAL ABSCESS OF 10,270.00 7,189.00 3,081.00
NIPPLE
ABSCESS OF BREAST ASSOCIATED WITH CHILDBIRTH;
MAMMARY ABSCESS GESTATIONAL OR PUERPERAL;
O91.1 10,270.00 7,189.00 3,081.00
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;
O91.2 10,270.00 7,189.00 3,081.00
INTERSTITIAL MASTITIS GESTATIONAL OR PUERPERAL;
PARENCHYMATOUS MASTITIS GESTATIONAL OR
PUERPERAL
O92.0 RETRACTED NIPPLE ASSOCIATED WITH CHILDBIRTH 10,270.00 7,189.00 3,081.00
CRACKED NIPPLE ASSOCIATED WITH CHILDBIRTH; FISSURE
O92.1 10,270.00 7,189.00 3,081.00
OF NIPPLE, GESTATIONAL OR PUERPERAL
TUBERCULOSIS COMPLICATING PREGNANCY, CHILDBIRTH
O98.0 8,840.00 6,188.00 2,652.00
AND THE PUERPERIUM
Page 94 of 126
First Case Rate

SYPHILIS COMPLICATING PREGNANCY, CHILDBIRTH AND
O98.1 8,840.00 6,188.00 2,652.00
THE PUERPERIUM
GONORRHOEACOMPLICATINGPREGNANCYCHILDBIRTHAND
O98.2 8,840.00 6,188.00 2,652.00
THEPUERPERIUM
OTHER INFECTIONS WITH APREDOMINANTLY SEXUAL
O98.3 MODE OF TRANSMISSION COMPLICATING PREGNANCY, 8,840.00 6,188.00 2,652.00
VIRAL HEPATITIS COMPLICATING PREGNANCY,
O98.4 8,840.00 6,188.00 2,652.00
OTHER VIRAL DISEASES COMPLICATING PREGNANCY,
O98.5 8,840.00 6,188.00 2,652.00
PROTOZOAL DISEASES COMPLICATING PREGNANCY,
O98.6 8,840.00 6,188.00 2,652.00
OTHER MATERNAL INFECTIOUS AND PARASITIC DISEASES
PUERPERIUM
UNSPECIFIED MATERNAL INFECTIOUS OR PARASITIC
O98.9 DISEASE COMPLICATING PREGNANCY, CHILDBIRTH AND 8,840.00 6,188.00 2,652.00
THE PUERPERIUM
ANAEMIA COMPLICATING PREGNANCY, CHILDBIRTH AND
O99.0 8,840.00 6,188.00 2,652.00
THE PUERPERIUM
OTHER DISEASES OF THE BLOOD AND BLOOD-FORMING
ORGANS AND CERTAIN DISORDERS INVOLVING THE
O99.1 8,840.00 6,188.00 2,652.00
IMMUNE MECHANISM COMPLICATING PREGNANCY,
ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES
PUERPERIUM
MENTAL DISORDERS AND DISEASES OF THE NERVOUS
O99.3 SYSTEM COMPLICATING PREGNANCY, CHILDBIRTH AND 8,840.00 6,188.00 2,652.00
THE PUERPERIUM
DISEASES OF THE CIRCULATORY SYSTEM COMPLICATING
O99.4 8,840.00 6,188.00 2,652.00
DISEASES OF THE RESPIRATORY SYSTEM COMPLICATING

O99.5 8,840.00 6,188.00 2,652.00
DISEASES OF THE DIGESTIVE SYSTEM COMPLICATING

O99.6 8,840.00 6,188.00 2,652.00
DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE
PUERPERIUM
OTHER SPECIFIED DISEASES AND CONDITIONS
PUERPERIUM
FETUS AND NEWBORN AFFECTED BY MATERNAL
P00.0 10,010.00 7,007.00 3,003.00
HYPERTENSIVE DISORDERS
FETUS AND NEWBORN AFFECTED BY MATERNAL RENAL
P00.1 10,010.00 7,007.00 3,003.00
AND URINARY TRACT DISEASES
P00.2 10,010.00 7,007.00 3,003.00
INFECTIOUS AND PARASITIC DISEASES
FETUS AND NEWBORN AFFECTED BY OTHER MATERNAL
P00.3 10,010.00 7,007.00 3,003.00
CIRCULATORY AND RESPIRATORY DISEASES
P00.4 10,010.00 7,007.00 3,003.00
NUTRITIONAL DISORDERS
P00.5 FETUS AND NEWBORN AFFECTED BY MATERNAL INJURY 10,010.00 7,007.00 3,003.00
FETUS AND NEWBORN AFFECTED BY SURGICAL
P00.6 10,010.00 7,007.00 3,003.00
PROCEDURE ON MOTHER
FETUS AND NEWBORN AFFECTED BY OTHER MEDICAL
P00.7 10,010.00 7,007.00 3,003.00
PROCEDURES ON MOTHER, NOT ELSEWHERE CLASSIFIED
P00.8 10,010.00 7,007.00 3,003.00
CONDITIONS
FETUS AND NEWBORN AFFECTED BY UNSPECIFIED
P00.9 10,010.00 7,007.00 3,003.00
MATERNAL CONDITION
P01.0 FETUS AND NEWBORN AFFECTED BY INCOMPETENT CERVIX 10,010.00 7,007.00 3,003.00
FETUS AND NEWBORN AFFECTED BY PREMATURE RUPTURE
P01.1 10,010.00 7,007.00 3,003.00
OF MEMBRANES
P01.2 FETUS AND NEWBORN AFFECTED BY OLIGOHYDRAMNIOS 10,010.00 7,007.00 3,003.00
FETUS AND NEWBORN AFFECTED BY POLYHYDRAMNIOS;
P01.3 10,010.00 7,007.00 3,003.00
HYDRAMNIOS
FETUS AND NEWBORN AFFECTED BY ECTOPIC PREGNANCY;
P01.4 10,010.00 7,007.00 3,003.00
ABDOMINAL PREGNANCY
FETUS AND NEWBORN AFFECTED BY MULTIPLE
P01.5 10,010.00 7,007.00 3,003.00
PREGNANCY; TRIPLET PREGNANCE; TWIN PREGNANCY
Page 95 of 126
First Case Rate

P01.6 FETUS AND NEWBORN AFFECTED BY MATERNAL DEATH 10,010.00 7,007.00 3,003.00
FETUS AND NEWBORN AFFECTED BY MALPRESENTATION

BEFORE LABOUR; BREECH PRESENTATION BEFORE LABOR;
P01.7 EXTERNAL VERSION BEFORE LABOUR; FACE 10,010.00 7,007.00 3,003.00
PRESENTATION BEFORE LABOUR; TRANSVERSE LIE BEFORE
LABOUR; UNSTABLE LIE BEFORE LABOUR
P01.8 COMPLICATIONS OF PREGNANCY; SPONTANEOUS 10,010.00 7,007.00 3,003.00
ABORTION, FETUS
P01.9 10,010.00 7,007.00 3,003.00
COMPLICATION OF PREGNANCY, UNSPECIFIED
P02.0 FETUS AND NEWBORN AFFECTED BY PLACENTA PRAEVIA 10,010.00 7,007.00 3,003.00
FETUS AND NEWBORN AFFECTED BY OTHER FORMS OF

PLACENTAL SEPARATION AND HAEMORRHAGE; ABRUPTIO
PLACENTAE; ACCIDENTAL HAEMORRHAGE; ANTEPARTUM
P02.1 10,010.00 7,007.00 3,003.00
HAEMORRHAGE; DAMAGE TO PLACENTA FROM
AMNIOCENTESIS, CAESARIAN SECTION OR SURGICAL
INDUCTION; MATERNAL BLOOD LOSS; PRE
FETUS AND NEWBORN AFFECTED BY OTHER AND

UNSPECIFIED MORPHOLOGICAL AND FUNCTIONAL
P02.2 10,010.00 7,007.00 3,003.00
ABNORMALITIES OF PLACENTA; PLACENTAL DYSFUNCTION;
PLACENTAL INFARCTION; PLACENTAL INSUFFICIENCY
FETUS AND NEWBORN AFFECTED BY PLACENTAL
TRANSFUSION SYNDROMES; PLACENTAL AND CORD
P02.3 10,010.00 7,007.00 3,003.00
ABNORMALITIES RESULTING IN TWIN-TO-TWIN OR OTHER
TRANSPLACENTAL TRANSFUSION
P02.4 FETUS AND NEWBORN AFFECTED BY PROLAPSED CORD 10,010.00 7,007.00 3,003.00
FETUS AND NEWBORN AFFECTED BY OTHER COMPRESSION

P02.5 OF UMBILICAL CORD; CORD (TIGHTLY) AROUND NECK; 10,010.00 7,007.00 3,003.00
ENTANGLEMENT OF CORD; KNOT IN CORD
FETUS AND NEWBORN AFFECTED BY OTHER AND
P02.6 UNSPECIFIED CONDITIONS OF UMBILICAL CORD; SHORT 10,010.00 7,007.00 3,003.00
CORD; VASA PRAEVIA
FETUS AND NEWBORN AFFECTED BY CHORIOAMNIONITIS;
P02.7 10,010.00 7,007.00 3,003.00
AMNIONITIS; MEMBRANITIS; PLACENTITIS
FETUS AND NEWBORN AFFECTED BY OTHER
P02.8 10,010.00 7,007.00 3,003.00
ABNORMALITIES OF MEMBRANES
FETUS AND NEWBORN AFFECTED BY ABNORMALITY OF
P02.9 10,010.00 7,007.00 3,003.00
MEMBRANES, UNSPECIFIED
FETUS AND NEWBORN AFFECTED BY BREECH DELIVERY
P03.0 10,010.00 7,007.00 3,003.00
AND EXTRACTION
FETUS AND NEWBORN AFFECTED BY OTHER
MALPRESENTATION, MALPOSITION AND DISPROPORTION
P03.1 10,010.00 7,007.00 3,003.00
DURING LABOUR AND DELIVERY; CONTRACTED PELVIS;
PERSISTENT OCCIPITOPOSTERIOR; TRANSVERSE LIE
P03.2 FETUS AND NEWBORN AFFECTED BY FORCEPS DELIVERY 10,010.00 7,007.00 3,003.00
FETUS AND NEWBORN AFFECTED BY DELIVERY BY VACUUM
P03.3 10,010.00 7,007.00 3,003.00
EXTRACTOR [VENTOUSE]
P03.4 FETUS AND NEWBORN AFFECTED BY CAESAREAN DELIVERY 10,010.00 7,007.00 3,003.00
FETUS AND NEWBORN AFFECTED BY PRECIPITATE
P03.5 10,010.00 7,007.00 3,003.00
DELIVERY
FETUS AND NEWBORN AFFECTED BY ABNORMAL UTERINE
P03.6 10,010.00 7,007.00 3,003.00
CONTRACTIONS
FETUS AND NEWBORN AFFECTED BY OTHER SPECIFIED
P03.8 10,010.00 7,007.00 3,003.00
COMPLICATIONS OF LABOUR AND DELIVERY
FETUS AND NEWBORN AFFECTED BY COMPLICATION OF
P03.9 10,010.00 7,007.00 3,003.00
LABOUR AND DELIVERY, UNSPECIFIED
P04.0 ANAESTHESIA AND ANALGESIA IN PREGNANCY, LABOUR 10,010.00 7,007.00 3,003.00
AND DELIVERY
P04.1 MEDICATION; CANCER CHEMOTHERAPY; CYTOTOXIC 10,010.00 7,007.00 3,003.00
DRUGS
FETUS AND NEWBORN AFFECTED BY MATERNAL USE OF
P04.2 10,010.00 7,007.00 3,003.00
TOBACCO
P04.3 10,010.00 7,007.00 3,003.00
ALCOHOL
P04.5 10,010.00 7,007.00 3,003.00
NUTRITIONAL CHEMICAL SUBSTANCES
P04.8 10,010.00 7,007.00 3,003.00
NOXIOUS INFLUENCES
Page 96 of 126
First Case Rate

P05.0 LIGHT FOR GESTATIONAL AGE 21,970.00 15,379.00 6,591.00
P05.1 SMALL FOR GESTATIONAL AGE 21,970.00 15,379.00 6,591.00
FETAL MALNUTRITION WITHOUT MENTION OF LIGHT OR
P05.2 21,970.00 15,379.00 6,591.00
SMALL FOR GESTATIONAL AGE
P05.9 SLOW FETAL GROWTH, UNSPECIFIED 21,970.00 15,379.00 6,591.00
EXTREMELY LOW BIRTH WEIGHT; BIRTH WEIGHT 999 G OR
P07.0 21,970.00 15,379.00 6,591.00
LESS.
P07.1 OTHER LOW BIRTH WEIGHT; BIRTH WEIGHT 1000-2499 G. 21,970.00 15,379.00 6,591.00
EXTREME IMMATURITY; LESS THAN 28 COMPLETED WEEKS

P07.2 21,970.00 15,379.00 6,591.00
(LESS THAN 196 COMPLETED DAYS) OF GESTATION.
OTHER PRETERM INFANTS; 28 COMPLETED WEEKS OR
MORE BUT LESS THAN 37 COMPLETED WEEKS (196
P07.3 21,970.00 15,379.00 6,591.00
COMPLETED DAYS BUT LESS THAN 259 COMPLETED DAYS)
OF GESTATION; PREMATURITY NOS
EXCEPTIONALLY LARGE BABY; USUALLY IMPLIES A BIRTH
P08.0 9,100.00 6,370.00 2,730.00
WEIGHT OF 4500 G OR MORE.
OTHER HEAVY FOR GESTATIONAL AGE INFANTS; OTHER
P08.1 FETUS OR INFANT HEAVY- OR LARGE-FOR-DATES 9,100.00 6,370.00 2,730.00
REGARDLESS OF PERIOD OF GESTATION.
POST-TERM INFANT, NOT HEAVY FOR GESTATIONAL AGE;
FETUS OR INFANT WITH GESTATION PERIOD OF 42
P08.2 COMPLETED WEEKS OR MORE (294 DAYS OR 9,750.00 6,825.00 2,925.00
MORE), NOT HEAVY- OR LARGE-FOR-DATES;
POSTMATURITY NOS
SUBDURAL HAEMORRHAGE DUE TO BIRTH INJURY;
P10.0 SUBDURAL HAEMATOMA (LOCALIZED) DUE TO BIRTH 17,940.00 12,558.00 5,382.00
INJURY
P10.1 CEREBRAL HAEMORRHAGE DUE TO BIRTH INJURY 17,940.00 12,558.00 5,382.00
INTRAVENTRICULAR HAEMORRHAGE DUE TO BIRTH
P10.2 17,940.00 12,558.00 5,382.00
INJURY
P10.3 SUBARACHNOID HAEMORRHAGE DUE TO BIRTH INJURY 17,940.00 12,558.00 5,382.00
P10.4 TENTORIAL TEAR DUE TO BIRTH INJURY 17,940.00 12,558.00 5,382.00
UNSPECIFIED INTRACRANIAL LACERATION AND
P10.9 17,940.00 12,558.00 5,382.00
HAEMORRHAGE DUE TO BIRTH INJURY
P11.1 OTHER SPECIFIED BRAIN DAMAGE DUE TO BIRTH INJURY 17,940.00 12,558.00 5,382.00
P11.2 UNSPECIFIED BRAIN DAMAGE DUE TO BIRTH INJURY 17,940.00 12,558.00 5,382.00
BIRTH INJURY TO CENTRAL NERVOUS SYSTEM,
P11.9 17,940.00 12,558.00 5,382.00
UNSPECIFIED
P12.0 CEPHALHAEMATOMA DUE TO BIRTH INJURY 17,940.00 12,558.00 5,382.00
P12.3 BRUISING OF SCALP DUE TO BIRTH INJURY 17,940.00 12,558.00 5,382.00
P12.8 OTHER BIRTH INJURIES TO SCALP 17,940.00 12,558.00 5,382.00
P12.9 BIRTH INJURY TO SCALP, UNSPECIFIED 17,940.00 12,558.00 5,382.00
P13.2 BIRTH INJURY TO FEMUR 17,940.00 12,558.00 5,382.00
P13.4 FRACTURE OF CLAVICLE DUE TO BIRTH INJURY 17,940.00 12,558.00 5,382.00
P13.8 BIRTH INJURIES TO OTHER PARTS OF SKELETON 17,940.00 12,558.00 5,382.00
P13.9 BIRTH INJURY TO SKELETON, UNSPECIFIED 17,940.00 12,558.00 5,382.00
P14.0 ERB'S PARALYSIS DUE TO BIRTH INJURY 17,940.00 12,558.00 5,382.00
P14.3 OTHER BRACHIAL PLEXUS BIRTH INJURIES 17,940.00 12,558.00 5,382.00
BIRTH INJURY TO FACE; FACIAL CONGESTION DUE TO
P15.4 17,940.00 12,558.00 5,382.00
BIRTH INJURY
P15.5 BIRTH INJURY TO EXTERNAL GENITALIA 17,940.00 12,558.00 5,382.00
P15.8 OTHER SPECIFIED BIRTH INJURIES 17,940.00 12,558.00 5,382.00
P15.9 BIRTH INJURY, UNSPECIFIED 17,940.00 12,558.00 5,382.00
INTRAUTERINE HYPOXIA FIRST NOTED BEFORE ONSET OF
P20.0 14,170.00 9,919.00 4,251.00
LABOUR
INTRAUTERINE HYPOXIA FIRST NOTED DURING LABOUR
P20.1 14,170.00 9,919.00 4,251.00
AND DELIVERY
P20.9 INTRAUTERINE HYPOXIA, UNSPECIFIED 14,170.00 9,919.00 4,251.00
SEVERE BIRTH ASPHYXIA; PULSE LESS THAN 100 PER
MINUTE AT BIRTH AND FALLING OR STEADY, RESPIRATION
P21.0 ABSENT OR GASPING, COLOUR POOR, TONE ABSENT; 14,170.00 9,919.00 4,251.00
ASPHYXIA WITH 1-MINUTE APGAR SCORE 0-3; WHITE
ASPHYXIA
MILD AND MODERATE BIRTH ASPHYXIA; NORMAL
RESPIRATION NOT ESTABLISHED WITHIN ONE MINUTE,
BUT HEART RATE 100 OR ABOVE,
P21.1 14,170.00 9,919.00 4,251.00
SOME MUSCLE TONE PRESENT, SOME RESPONSE TO
STIMULATION; ASPHYXIA WITH 1-MINUTE APGAR SCORE 4-
7; BLUE ASPHYXIA
BIRTH ASPHYXIA, UNSPECIFIED; ANOXIA, NOS; ASPHYXIA,
P21.9 14,170.00 9,919.00 4,251.00
NOS; HYPOXIA, NOS
RESPIRATORY DISTRESS SYNDROME OF NEWBORN;
P22.0 14,170.00 9,919.00 4,251.00
HYALINE MEMBRANE DISEASE
P22.1 TRANSIENT TACHYPNOEA OF NEWBORN 14,170.00 9,919.00 4,251.00
P22.8 OTHER RESPIRATORY DISTRESS OF NEWBORN 14,170.00 9,919.00 4,251.00
P22.9 RESPIRATORY DISTRESS OF NEWBORN, UNSPECIFIED 14,170.00 9,919.00 4,251.00
P23.0 CONGENITAL PNEUMONIA DUE TO VIRAL AGENT 16,510.00 11,557.00 4,953.00
P23.1 CONGENITAL PNEUMONIA DUE TO CHLAMYDIA 16,510.00 11,557.00 4,953.00
Page 97 of 126
First Case Rate

P23.2 CONGENITAL PNEUMONIA DUE TO STAPHYLOCOCCUS 16,510.00 11,557.00 4,953.00
CONGENITAL PNEUMONIA DUE TO STREPTOCOCCUS,
P23.3 16,510.00 11,557.00 4,953.00
GROUP B
P23.4 CONGENITAL PNEUMONIA DUE TO ESCHERICHIA COLI 16,510.00 11,557.00 4,953.00
P23.5 CONGENITAL PNEUMONIA DUE TO PSEUDOMONAS 16,510.00 11,557.00 4,953.00
CONGENITAL PNEUMONIA DUE TO OTHER BACTERIAL
AGENTS; HAEMOPHILUS INFLUENZAE; KLEBSIELLA
P23.6 16,510.00 11,557.00 4,953.00
PNEUMONIA; MYCOPLASMA; STREPTOCOCCUS, EXCEPT
GROUP B
P23.9 CONGENITAL PNEUMONIA 16,510.00 11,557.00 4,953.00
P24.0 NEONATAL ASPIRATION OF MECONIUM 14,170.00 9,919.00 4,251.00
NEONATAL ASPIRATION OF AMNIOTIC FLUID AND
P24.1 14,170.00 9,919.00 4,251.00
MUCUS;ASPIRATION OF LIQUOR (AMNII)
P24.2 NEONATAL ASPIRATION OF BLOOD 14,170.00 9,919.00 4,251.00
NEONATAL ASPIRATION OF MILK AND REGURGITATED
P24.3 14,170.00 9,919.00 4,251.00
FOOD
P24.8 OTHER NEONATAL ASPIRATION SYNDROMES 14,170.00 9,919.00 4,251.00
NEONATAL ASPIRATION SYNDROME, UNSPECIFIED;
P24.9 14,170.00 9,919.00 4,251.00
NEONATAL ASPIRATION PNEUMONIA NOS
INTERSTITIAL EMPHYSEMA ORIGINATING IN THE
P25.0 14,170.00 9,919.00 4,251.00
PERINATAL PERIOD
P25.1 PNEUMOTHORAX ORIGINATING IN THE PERINATAL PERIOD 14,170.00 9,919.00 4,251.00
PNEUMOMEDIASTINUM ORIGINATING IN THE PERINATAL
P25.2 14,170.00 9,919.00 4,251.00
PERIOD
OTHER CONDITIONS RELATED TO INTERSTITIAL
P25.8 14,170.00 9,919.00 4,251.00
EMPHYSEMA ORIGINATING IN THE PERINATAL PERIOD
TRACHEOBRONCHIAL HAEMORRHAGE ORIGINATING IN
P26.0 14,170.00 9,919.00 4,251.00
THE PERINATAL PERIOD
MASSIVE PULMONARY HAEMORRHAGE ORIGINATING IN
P26.1 14,170.00 9,919.00 4,251.00
OTHER PULMONARY HAEMORRHAGES ORIGINATING IN
P26.8 14,170.00 9,919.00 4,251.00
UNSPECIFIED PULMONARY HAEMORRHAGE ORIGINATING
P26.9 14,170.00 9,919.00 4,251.00
IN THE PERINATAL PERIOD
P27.0 WILSON-MIKITY SYNDROME; PULMONARY DYSMATURITY 14,170.00 9,919.00 4,251.00
BRONCHOPULMONARY DYSPLASIA ORIGINATING IN THE
P27.1 14,170.00 9,919.00 4,251.00
PERINATAL PERIOD
OTHER CHRONIC RESPIRATORY DISEASES ORIGINATING IN
P27.8 THE PERINATAL PERIOD; CONGENITAL PULMONARY 14,170.00 9,919.00 4,251.00
FIBROSIS; VENTILATOR LUNG IN NEWBORN
UNSPECIFIED CHRONIC RESPIRATORY DISEASE
P27.9 14,170.00 9,919.00 4,251.00
ORIGINATING IN THE PERINATAL PERIOD
PRIMARY ATELECTASIS OF NEWBORN; PRIMARY FAILURE
TO EXPAND TERMINAL RESPIRATORY UNITS; PULMONARY
P28.0 14,170.00 9,919.00 4,251.00
HYPOPLASIA ASSOCIATED WITH SHORT GESTATION;
PULMONARY IMMATURITY NOS
OTHER AND UNSPECIFIED ATELECTASIS OF NEWBORN;
ATELECTASIS, NOS; ATELECTASIS, PARTIAL; ATELECTASIS,
P28.1 14,170.00 9,919.00 4,251.00
SECONDARY; RESORPTION ATELECTASIS WITHOUT
RESPIRATORY DISTRESS SYNDROME
P28.2 CYANOTIC ATTACKS OF NEWBORN 14,170.00 9,919.00 4,251.00
PRIMARY SLEEP APNOEA OF NEWBORN; LEEP APNOEA OF
P28.3 14,170.00 9,919.00 4,251.00
NEWBORN NOS
P28.4 OTHER APNOEA OF NEWBORN 14,170.00 9,919.00 4,251.00
P28.5 RESPIRATORY FAILURE OF NEWBORN 14,170.00 9,919.00 4,251.00
OTHER SPECIFIED RESPIRATORY CONDITIONS OF
P28.8 NEWBORN; CONGENITAL LARYNGEAL STRIDOR NOS; 14,170.00 9,919.00 4,251.00
SNUFFLES IN NEWBORN
P29.0 NEONATAL CARDIAC FAILURE 29,510.00 20,657.00 8,853.00
P29.1 NEONATAL CARDIAC DYSRHYTHMIA 29,510.00 20,657.00 8,853.00
P29.2 NEONATAL HYPERTENSION 29,510.00 20,657.00 8,853.00
PERSISTENT FETAL CIRCULATION; DELAYED CLOSURE OF
P29.3 DUCTUS ARTERIOSUS; PERSISTENT PULMONARY 14,170.00 9,919.00 4,251.00
HYPERTENSION OF NEWBORN
P29.4 TRANSIENT MYOCARDIAL ISCHAEMIA OF NEWBORN 29,510.00 20,657.00 8,853.00
OTHER CARDIOVASCULAR DISORDERS ORIGINATING IN
P29.8 29,510.00 20,657.00 8,853.00
CARDIOVASCULAR DISORDER ORIGINATING IN THE
P29.9 14,170.00 9,919.00 4,251.00
PERINATAL PERIOD, UNSPECIFIED
CONGENITAL RUBELLA SYNDROME; CONGENITAL RUBELLA
P35.0 16,510.00 11,557.00 4,953.00
PNEUMONITIS
P35.1 CONGENITAL CYTOMEGALOVIRUS INFECTION 16,510.00 11,557.00 4,953.00
P35.2 CONGENITAL HERPESVIRAL [HERPES SIMPLEX] INFECTION 16,510.00 11,557.00 4,953.00
P35.3 CONGENITAL VIRAL HEPATITIS 16,510.00 11,557.00 4,953.00
Page 98 of 126
First Case Rate

OTHER CONGENITAL VIRAL DISEASES; CONGENITAL
P35.8 16,510.00 11,557.00 4,953.00
VARICELLA [CHICKENPOX]
P35.9 CONGENITAL VIRAL DISEASE, UNSPECIFIED 16,510.00 11,557.00 4,953.00
P36.0 SEPSIS OF NEWBORN DUE TO STREPTOCOCCUS, GROUP B 15,210.00 10,647.00 4,563.00
SEPSIS OF NEWBORN DUE TO OTHER AND UNSPECIFIED
P36.1 15,210.00 10,647.00 4,563.00
STREPTOCOCCI
P36.2 SEPSIS OF NEWBORN DUE TO STAPHYLOCOCCUS AUREUS 15,210.00 10,647.00 4,563.00
SEPSIS OF NEWBORN DUE TO OTHER AND UNSPECIFIED
P36.3 15,210.00 10,647.00 4,563.00
STAPHYLOCOCCI
P36.4 SEPSIS OF NEWBORN DUE TO ESCHERICHIA COLI 15,210.00 10,647.00 4,563.00
P36.5 SEPSIS OF NEWBORN DUE TO ANAEROBES 15,210.00 10,647.00 4,563.00
P36.8 OTHER BACTERIAL SEPSIS OF NEWBORN 15,210.00 10,647.00 4,563.00
P37.0 CONGENITAL TUBERCULOSIS 16,510.00 11,557.00 4,953.00
CONGENITAL TOXOPLASMOSIS; HYDROCEPHALUS DUE TO
P37.1 16,510.00 11,557.00 4,953.00
CONGENITAL TOXOPLASMOSIS
P37.3 CONGENITAL FALCIPARUM MALARIA 16,510.00 11,557.00 4,953.00
P37.5 NEONATAL CANDIDIASIS 16,510.00 11,557.00 4,953.00
OTHER SPECIFIED CONGENITAL INFECTIOUS AND
P37.8 16,510.00 11,557.00 4,953.00
PARASITIC DISEASES
CONGENITAL INFECTIOUS AND PARASITIC DISEASE,
P37.9 16,510.00 11,557.00 4,953.00
UNSPECIFIED
OMPHALITIS OF NEWBORN WITH OR WITHOUT MILD
P38 16,510.00 11,557.00 4,953.00
HAEMORRHAGE
P39.0 NEONATAL INFECTIVE MASTITIS 16,510.00 11,557.00 4,953.00
NEONATAL CONJUNCTIVITIS AND DACRYOCYSTITIS;
P39.1 NEONATAL CHLAYDIAL CONJUNCTIVITIS; OPHTHALMIA 16,510.00 11,557.00 4,953.00
NEONATORUM NOS
INTRA-AMNIOTIC INFECTION OF FETUS, NOT ELSEWHERE
P39.2 16,510.00 11,557.00 4,953.00
CLASSIFIED
P39.3 NEONATAL URINARY TRACT INFECTION 16,510.00 11,557.00 4,953.00
P39.4 NEONATAL SKIN INFECTION; NEONATAL PYODERMA 16,510.00 11,557.00 4,953.00
OTHER SPECIFIED INFECTIONS SPECIFIC TO THE
P39.8 16,510.00 11,557.00 4,953.00
PERINATAL PERIOD
INFECTION SPECIFIC TO THE PERINATAL PERIOD,
P39.9 16,510.00 11,557.00 4,953.00
UNSPECIFIED
P50.0 FETAL BLOOD LOSS FROM VASA PRAEVIA 10,140.00 7,098.00 3,042.00
P50.1 FETAL BLOOD LOSS FROM RUPTURED CORD 10,140.00 7,098.00 3,042.00
P50.2 FETAL BLOOD LOSS FROM PLACENTA 10,140.00 7,098.00 3,042.00
FETAL BLOOD LOSS, UNSPECIFIED; FETAL HAEMORRHAGE
P50.9 10,140.00 7,098.00 3,042.00
NOS
P51.9 UMBILICAL HAEMORRHAGE OF NEWBORN, UNSPECIFIED 10,140.00 7,098.00 3,042.00
INTRAVENTRICULAR (NONTRAUMATIC) HAEMORRHAGE,
GRADE 1, OF FETUS AND NEWBORN; SUBEPENDYMAL
P52.0 33,280.00 23,296.00 9,984.00
HAEMORRHAGE (WITHOUT INTRAVENTRICULAR
EXTENSION)
INTRAVENTRICULAR (NONTRAUMATIC) HAEMORRHAGE,
P52.1 GRADE 2, OF FETUS AND NEWBORN; SUBEPENDYMAL 33,280.00 23,296.00 9,984.00
HAEMORRHAGE WITH INTRAVENTRICULAR EXTENSION
UNSPECIFIED INTRAVENTRICULAR (NONTRAUMATIC)

P52.3 33,280.00 23,296.00 9,984.00
HAEMORRHAGE OF FETUS AND NEWBORN
INTRACEREBRAL (NONTRAUMATIC) HAEMORRHAGE OF
P52.4 33,280.00 23,296.00 9,984.00
FETUS AND NEWBORN
SUBARACHNOID (NONTRAUMATIC) HAEMORRHAGE OF
P52.5 33,280.00 23,296.00 9,984.00
FETUS AND NEWBORN
CEREBELLAR (NONTRAUMATIC) AND POSTERIOR FOSSA
P52.6 33,280.00 23,296.00 9,984.00
HAEMORRHAGE OF FETUS AND NEWBORN
OTHER INTRACRANIAL (NONTRAUMATIC) HAEMORRHAGES
P52.8 33,280.00 23,296.00 9,984.00
OF FETUS AND NEWBORN
INTRACRANIAL (NONTRAUMATIC) HAEMORRHAGE OF
P52.9 33,280.00 23,296.00 9,984.00
FETUS AND NEWBORN, UNSPECIFIED
HAEMORRHAGIC DISEASE OF FETUS AND NEWBORN;
P53 10,140.00 7,098.00 3,042.00
VITAMIN K DEFICIENCY OF NEWBORN
P54.0 NEONATAL HAEMATEMESIS 10,140.00 7,098.00 3,042.00
P54.2 NEONATAL RECTAL HAEMORRHAGE 10,140.00 7,098.00 3,042.00
P54.3 OTHER NEONATAL GASTROINTESTINAL HAEMORRHAGE 10,140.00 7,098.00 3,042.00
P54.4 NEONATAL ADRENAL HAEMORRHAGE 10,140.00 7,098.00 3,042.00
NEONATAL CUTANEOUS HAEMORRHAGE; BRUISING IN
FETUS OR NEWBORN; ECCHYMOSES IN FETUS OR
P54.5 10,140.00 7,098.00 3,042.00
NEWBORN; PETECHIAE IN FETUS OR NEWBORN;
SUPERFICIAL HAEMATOMATA IN FETUS OR NEWBORN
P54.6 NEONATAL VAGINAL HAEMORRHAGE; PSEUDOMENSES 10,140.00 7,098.00 3,042.00

P54.8 OTHER SPECIFIED NEONATAL HAEMORRHAGES 10,140.00 7,098.00 3,042.00
P54.9 NEONATAL HAEMORRHAGE, UNSPECIFIED 10,140.00 7,098.00 3,042.00
P55.0 RH ISOIMMUNIZATION OF FETUS AND NEWBORN 10,140.00 7,098.00 3,042.00
P55.1 ABO ISOIMMUNIZATION OF FETUS AND NEWBORN 10,140.00 7,098.00 3,042.00
Page 99 of 126
First Case Rate

P55.8 OTHER HAEMOLYTIC DISEASES OF FETUS AND NEWBORN 10,140.00 7,098.00 3,042.00
HAEMOLYTIC DISEASE OF FETUS AND NEWBORN,
P55.9 10,140.00 7,098.00 3,042.00
UNSPECIFIED
P56.0 HYDROPS FETALIS DUE TO ISOIMMUNIZATION 9,620.00 6,734.00 2,886.00
HYDROPS FETALIS DUE TO OTHER AND UNSPECIFIED
P56.9 9,620.00 6,734.00 2,886.00
HAEMOLYTIC DISEASE
P57.0 KERNICTERUS DUE TO ISOIMMUNIZATION 9,620.00 6,734.00 2,886.00
P57.8 OTHER SPECIFIED KERNICTERUS 9,620.00 6,734.00 2,886.00
P57.9 KERNICTERUS, UNSPECIFIED 9,620.00 6,734.00 2,886.00
P58.1 NEONATAL JAUNDICE DUE TO BLEEDING 9,620.00 6,734.00 2,886.00
P58.2 NEONATAL JAUNDICE DUE TO INFECTION 9,620.00 6,734.00 2,886.00
P58.3 NEONATAL JAUNDICE DUE TO POLYCYTHAEMIA 9,620.00 6,734.00 2,886.00
NEONATAL JAUNDICE DUE TO DRUGS OR TOXINS
P58.4 9,620.00 6,734.00 2,886.00
TRANSMITTED FROM MOTHER OR GIVEN TO NEWBORN
NEONATAL JAUNDICE DUE TO OTHER SPECIFIED
P58.8 9,620.00 6,734.00 2,886.00
EXCESSIVE HAEMOLYSIS
NEONATAL JAUNDICE DUE TO EXCESSIVE HAEMOLYSIS,
P58.9 9,620.00 6,734.00 2,886.00
UNSPECIFIED
NEONATAL JAUNDICE ASSOCIATED WITH PRETERM
DELIVERY; HYPERBILIRUBINAEMIA OF PREMATURITY;
P59.0 9,620.00 6,734.00 2,886.00
JAUNDICE DUE TO DELAYED CONJUCATION ASSOCIATED
WITH PRETERM DELIVERY
P59.1 INSPISSATED BILE SYNDROME 9,620.00 6,734.00 2,886.00
NEONATAL JAUNDICE FROM OTHER AND UNSPECIFIED
P59.2 9,620.00 6,734.00 2,886.00
HEPATOCELLULAR DAMAGE
P59.3 NEONATAL JAUNDICE FROM BREAST MILK INHIBITOR 9,620.00 6,734.00 2,886.00
P59.8 NEONATAL JAUNDICE FROM OTHER SPECIFIED CAUSES 9,620.00 6,734.00 2,886.00
NEONATAL JAUNDICE, UNSPECIFIED; INTENSE
P59.9 PHYSIOLOGICAL JAUNDICE, NOS; PROLONGED 9,620.00 6,734.00 2,886.00
PHYSIOLOGICAL JAUNDICE, NOS
DISSEMINATED INTRAVASCULAR COAGULATION OF FETUS
P60 AND NEWBORN; DEFIBRINATION SYNDROME OF FETUS OR 41,600.00 29,120.00 12,480.00
NEWBORN
TRANSIENT NEONATAL THROMBOCYTOPENIA; NEONATAL
THROMBOCYTOPENIA DUE TO EXCHANGE TRANSFUSION;
P61.0 NEONATAL THROMBOCYTOPENIA DUE TO IDIOPHATIC 10,140.00 7,098.00 3,042.00
MATERNAL THROMBOCYTOPENIA; NEONATAL
THROMBOCYTOPENIA DUE TO ISOIMMUNIZATION
P61.1 POLYCYTHAEMIA NEONATORUM 10,140.00 7,098.00 3,042.00
P61.2 ANAEMIA OF PREMATURITY 19,760.00 13,832.00 5,928.00
P61.3 CONGENITAL ANAEMIA FROM FETAL BLOOD LOSS 19,760.00 13,832.00 5,928.00
OTHER CONGENITAL ANAEMIAS, NOT ELSEWHERE
P61.4 19,760.00 13,832.00 5,928.00
CLASSIFIED; CONGENITAL ANAEMIA NOS
P61.5 TRANSIENT NEONATAL NEUTROPENIA 10,140.00 7,098.00 3,042.00
OTHER TRANSIENT NEONATAL DISORDERS OF
P61.6 10,140.00 7,098.00 3,042.00
COAGULATION
OTHER SPECIFIED PERINATAL HAEMATOLOGICAL
P61.8 10,140.00 7,098.00 3,042.00
DISORDERS
P61.9 PERINATAL HAEMATOLOGICAL DISORDER, UNSPECIFIED 10,140.00 7,098.00 3,042.00
SYNDROME OF INFANT OF MOTHER WITH GESTATIONAL
P70.0 12,090.00 8,463.00 3,627.00
DIABETES
SYNDROME OF INFANT OF A DIABETIC MOTHER; MATERNAL
P70.1 DIABETES MELLITUS (PRE-EXISTING) AFFECTING FETUS OR 12,090.00 8,463.00 3,627.00
NEWBORN WITH HYPOGLYCAEMIA
P70.2 NEONATAL DIABETES MELLITUS 12,090.00 8,463.00 3,627.00
P70.3 IATROGENIC NEONATAL HYPOGLYCAEMIA 12,090.00 8,463.00 3,627.00
OTHER NEONATAL HYPOGLYCAEMIA; TRANSITORY
P70.4 12,090.00 8,463.00 3,627.00
NEONATAL HYPOGLYCAEMIA
TRANSITORY DISORDER OF CARBOHYDRATE METABOLISM
P70.9 12,090.00 8,463.00 3,627.00
OF FETUS AND NEWBORN, UNSPECIFIED
P71.0 COW'S MILK HYPOCALCAEMIA IN NEWBORN 12,090.00 8,463.00 3,627.00
P71.1 OTHER NEONATAL HYPOCALCAEMIA 12,090.00 8,463.00 3,627.00
NEONATAL TETANY WITHOUT CALCIUM OR MAGNESIUM
P71.3 12,090.00 8,463.00 3,627.00
DEFICIENCY; NEONATAL TETANY NOS
P71.4 TRANSITORY NEONATAL HYPOPARATHYROIDISM 12,090.00 8,463.00 3,627.00
TRANSITORY NEONATAL DISORDER OF CALCIUM AND
P71.9 12,090.00 8,463.00 3,627.00
MAGNESIUM METABOLISM, UNSPECIFIED
NEONATAL GOITRE, NOT ELSEWHERE CLASSIFIED;
P72.0 TRANSITORY CONGENITAL GOITRE WITH NORMAL 12,090.00 8,463.00 3,627.00
FUNCTION
TRANSITORY NEONATAL HYPERTHYROIDISM; NEONATAL
P72.1 12,090.00 8,463.00 3,627.00
THYROTOXICOSIS
Page 100 of 126

First Case Rate

OTHER TRANSITORY NEONATAL DISORDERS OF THYROID
P72.2 FUNCTION, NOT ELSEWHERE CLASSIFIED; TRANSITORY 12,090.00 8,463.00 3,627.00
NEONATAL HYPOTHYROIDISM
OTHER SPECIFIED TRANSITORY NEONATAL ENDOCRINE
P72.8 12,090.00 8,463.00 3,627.00
DISORDERS
TRANSITORY NEONATAL ENDOCRINE DISORDER,
P72.9 12,090.00 8,463.00 3,627.00
UNSPECIFIED
P74.0 LATE METABOLIC ACIDOSIS OF NEWBORN 12,090.00 8,463.00 3,627.00
P74.1 DEHYDRATION OF NEWBORN 12,090.00 8,463.00 3,627.00
P74.2 DISTURBANCES OF SODIUM BALANCE OF NEWBORN 12,090.00 8,463.00 3,627.00
OTHER TRANSITORY ELECTROLYTE DISTURBANCES OF
P74.4 12,090.00 8,463.00 3,627.00
NEWBORN
OTHER TRANSITORY METABOLIC DISTURBANCES OF
P74.8 12,090.00 8,463.00 3,627.00
NEWBORN
TRANSITORY METABOLIC DISTURBANCE OF NEWBORN,
P74.9 12,090.00 8,463.00 3,627.00
UNSPECIFIED
P76.0 MECONIUM PLUG SYNDROME 15,210.00 10,647.00 4,563.00
P76.1 TRANSITORY ILEUS OF NEWBORN 15,210.00 10,647.00 4,563.00
OTHER SPECIFIED INTESTINAL OBSTRUCTION OF
P76.8 15,210.00 10,647.00 4,563.00
NEWBORN
P76.9 INTESTINAL OBSTRUCTION OF NEWBORN, UNSPECIFIED 15,210.00 10,647.00 4,563.00
P77 NECROTIZING ENTEROCOLITIS OF FETUS AND NEWBORN 15,210.00 10,647.00 4,563.00

PERINATAL INTESTINAL PERFORATION; MECONIUM
P78.0 15,210.00 10,647.00 4,563.00
PERITONITIS
NEONATAL HAEMATEMESIS AND MELAENA DUE TO
P78.2 15,210.00 10,647.00 4,563.00
SWALLOWED MATERNAL BLOOD
NONINFECTIVE NEONATAL DIARRHOEA; NEONATAL
P78.3 15,210.00 10,647.00 4,563.00
DIARRHOEA NOS
OTHER SPECIFIED PERINATAL DIGESTIVE SYSTEM
P78.8 DISORDERS; CONGENITAL CIRRHOSIS OF LIVER; PEPTIC 15,210.00 10,647.00 4,563.00
ULCER OF NEWBORN
P78.9 PERINATAL DIGESTIVE SYSTEM DISORDER, UNSPECIFIED 15,210.00 10,647.00 4,563.00
P80.9 HYPOTHERMIA OF NEWBORN, UNSPECIFIED 12,090.00 8,463.00 3,627.00
P81.0 ENVIRONMENTAL HYPERTHERMIA OF NEWBORN 12,090.00 8,463.00 3,627.00
OTHER SPECIFIED DISTURBANCES OF TEMPERATURE
P81.8 12,090.00 8,463.00 3,627.00
REGULATION OF NEWBORN
DISTURBANCE OF TEMPERATURE REGULATION OF
P81.9 12,090.00 8,463.00 3,627.00
NEWBORN, UNSPECIFIED; FEVER OF NEWBORN NOS
P83.1 NEONATAL ERYTHEMA TOXICUM 12,090.00 8,463.00 3,627.00
HYDROPS FETALIS NOT DUE TO HAEMOLYTIC DISEASE;
P83.2 12,090.00 8,463.00 3,627.00
HYDROPS FETALIS NOS
BREAST ENGORGEMENT OF NEWBORN; NONINFECTIVE
P83.4 12,090.00 8,463.00 3,627.00
MASTITIS OF NEWBORN
OTHER SPECIFIED CONDITIONS OF INTEGUMENT SPECIFIC
P83.8 TO FETUS AND NEWBORN; BRONZE BABY SYNDROME; 12,090.00 8,463.00 3,627.00
NEONATAL SCLERODERMA; URTICARIA NEONATORUM
P90 CONVULSIONS OF NEWBORN 15,600.00 10,920.00 4,680.00
P91.0 NEONATAL CEREBRAL ISCHAEMIA 33,540.00 23,478.00 10,062.00
P91.1 ACQUIRED PERIVENTRICULAR CYSTS OF NEWBORN 15,600.00 10,920.00 4,680.00
P91.2 NEONATAL CEREBRAL LEUKOMALACIA 15,600.00 10,920.00 4,680.00
P91.3 NEONATAL CEREBRAL IRRITABILITY 15,600.00 10,920.00 4,680.00
P91.4 NEONATAL CEREBRAL DEPRESSION 15,600.00 10,920.00 4,680.00
P91.6 HYPOXIC ISCHEMIC ENCEPHALOPATHY OF NEWBORN 15,600.00 10,920.00 4,680.00
OTHER SPECIFIED DISTURBANCES OF CEREBRAL STATUS OF
P91.8 15,600.00 10,920.00 4,680.00
NEWBORN
DISTURBANCE OF CEREBRAL STATUS OF NEWBORN,
P91.9 15,600.00 10,920.00 4,680.00
UNSPECIFIED
P92.1 REGURGITATION AND RUMINATION IN NEWBORN 11,310.00 7,917.00 3,393.00
P92.2 SLOW FEEDING OF NEWBORN 11,310.00 7,917.00 3,393.00
P92.4 OVERFEEDING OF NEWBORN 11,310.00 7,917.00 3,393.00
P92.8 OTHER FEEDING PROBLEMS OF NEWBORN 11,310.00 7,917.00 3,393.00
P92.9 FEEDING PROBLEM OF NEWBORN, UNSPECIFIED 11,310.00 7,917.00 3,393.00
P94.0 TRANSIENT NEONATAL MYASTHENIA GRAVIS 15,080.00 10,556.00 4,524.00
P94.1 CONGENITAL HYPERTONIA 15,600.00 10,920.00 4,680.00
CONGENITAL HYPOTONIA; NONSPECIFIC FLOPPY BABY
P94.2 15,600.00 10,920.00 4,680.00
SYNDROME
P94.9 DISORDER OF MUSCLE TONE OF NEWBORN, UNSPECIFIED 15,600.00 10,920.00 4,680.00
P96.0 CONGENITAL RENAL FAILURE; URAEMIA OF NEWBORN 11,830.00 8,281.00 3,549.00

COMPLICATIONS OF INTRAUTERINE PROCEDURES, NOT
P96.5 15,600.00 10,920.00 4,680.00
OTHER SPECIFIED CONDITIONS ORIGINATING IN THE
P96.8 15,600.00 10,920.00 4,680.00
PERINATAL PERIOD
CONDITION ORIGINATING IN THE PERINATAL PERIOD,
P96.9 15,600.00 10,920.00 4,680.00
UNSPECIFIED; CONGENITAL DEBILITY NOS
ANENCEPHALY; ACEPHALY; ACRANIA; AMYELENCEPHALY;
Q00.0 16,900.00 11,830.00 5,070.00
HEMICEPHALY; HEMICEPHALY
Q01.0 FRONTAL ENCEPHALOCELE 16,900.00 11,830.00 5,070.00
Page 101 of 126

First Case Rate

Q01.1 NASOFRONTAL ENCEPHALOCELE 16,900.00 11,830.00 5,070.00
Q01.2 OCCIPITAL ENCEPHALOCELE 16,900.00 11,830.00 5,070.00
Q01.8 ENCEPHALOCELE OF OTHER SITES 16,900.00 11,830.00 5,070.00
MICROCEPHALY; HYDROMICROCEPHALY;
Q02 16,900.00 11,830.00 5,070.00
MICRENCEPHALON
MALFORMATIONS OF AQUEDUCT OF SYLVIUS; ANOMALY OF
AQUEDUCT OF SYLVIUS; OBSTRUCTION, CONGENITAL OF
Q03.0 16,900.00 11,830.00 5,070.00
AQUEDUCT OF SYLVIUS; STENOSIS OF AQUEDUCT OF
SYLVIUS
ATRESIA OF FORAMINA OF MAGENDIE AND LUSCHKA;
Q03.1 16,900.00 11,830.00 5,070.00
DANDY-WALKER SYNDROME
Q03.8 OTHER CONGENITAL HYDROCEPHALUS 16,900.00 11,830.00 5,070.00
Q03.9 CONGENITAL HYDROCEPHALUS, UNSPECIFIED 22,490.00 15,743.00 6,747.00
CONGENITAL MALFORMATIONS OF CORPUS CALLOSUM;
Q04.0 16,900.00 11,830.00 5,070.00
AGENESIS OF CORPUS CALLOSUM
Q04.2 HOLOPROSENCEPHALY 16,900.00 11,830.00 5,070.00
OTHER REDUCTION DEFORMITIES OF BRAIN; ABSENCE OF
PART OF BRAIN; AGENESIS OF PART OF BRAIN; APLASIA OF
Q04.3 PART OF BRAIN; HYPOPLASIA OF PART OF BRAIN ; AGYRIA; 16,900.00 11,830.00 5,070.00
HYDRANENCEPHALY; LISSENCEPHALY; MICROGYRIA;
PACHYGYRIA
Q04.4 SEPTO-OPTIC DYSPLASIA 16,900.00 11,830.00 5,070.00
CONGENITAL CEREBRAL CYSTS; PORENCEPHALY;
Q04.6 16,900.00 11,830.00 5,070.00
SCHIZENCEPHALY
OTHER SPECIFIED CONGENITAL MALFORMATIONS OF
Q04.8 16,900.00 11,830.00 5,070.00
BRAIN; MACROGYRIA
CONGENITAL MALFORMATION OF BRAIN, UNSPECIFIED;
CONGENITAL ANOMALY NOS OF BRAIN; CONGENITAL
Q04.9 DEFORMITY NOS OF BRAIN; CONGENITAL DISEASE OF 16,900.00 11,830.00 5,070.00
LESION NOS OF BRAIN; CONGENITAL MULTIPLE ANOMALIS
NOS OF BRAIN
THORACIC SPINA BIFIDA WITH HYDROCEPHALUS; DORSAL
Q05.1 SPINA BIFIDA WITH HYDROCEPHALUS; THORACOLUMBAR 16,900.00 11,830.00 5,070.00
SPINA BIFIDA WITH HYDROCEPHALUS
LUMBAR SPINA BIFIDA WITH HYDROCEPHALUS;
Q05.2 16,900.00 11,830.00 5,070.00
LUMBOSACRAL SPINA BIFIDA WITH HYDROCEPHALUS
Q05.4 UNSPECIFIED SPINA BIFIDA WITH HYDROCEPHALUS 16,900.00 11,830.00 5,070.00
THORACIC SPINA BIFIDA WITHOUT HYDROCEPHALUS;
Q05.6 DORSAL NOS SPINA BIFIDA; THORACOLUMBAR NOS SPINA 16,900.00 11,830.00 5,070.00
BIFIDA
LUMBAR SPINA BIFIDA WITHOUT HYDROCEPHALUS;
Q05.7 16,900.00 11,830.00 5,070.00
LUMBOSACRAL SPINA BIFIDA NOS
Q05.8 SACRAL SPINA BIFIDA WITHOUT HYDROCEPHALUS 16,900.00 11,830.00 5,070.00
Q05.9 SPINA BIFIDA, UNSPECIFIED 16,900.00 11,830.00 5,070.00
Q06.0 AMYELIA 16,900.00 11,830.00 5,070.00
Q06.2 DIASTEMATOMYELIA 16,900.00 11,830.00 5,070.00
Q06.4 HYDROMYELIA; HYDRORACHIS 16,900.00 11,830.00 5,070.00
Q06.8 16,900.00 11,830.00 5,070.00
SPINAL CORD
CONGENITAL MALFORMATION OF SPINAL CORD,
UNSPECIFIED; CONGENITAL ANOMALY NOS OF SPINAL
Q06.9 CORD OR MENINGES; CONGENITAL DEFORMITY NOS OF 16,900.00 11,830.00 5,070.00
SPINAL CORD OR MENINGES; CONGENITAL DISEASE OR
LESION NOS OF SPINAL CORD OR MENINGES
Q07.0 ARNOLD-CHIARI SYNDROME 16,900.00 11,830.00 5,070.00
CONGENITAL MALFORMATION OF NERVOUS SYSTEM,
UNSPECIFIED; CONGENITAL ANOMALY NOS OF NERVOUS
Q07.9 SYSTEM; CONGENITAL DEFORMITY NOS OF NERVOUS 16,900.00 11,830.00 5,070.00
SYSTEM; CONGENITAL DISEASE OR LESION NOS OF
NERVOUS SYSTEM
Q12.2 COLOBOMA OF LENS 5,590.00 3,913.00 1,677.00
Q12.4 SPHEROPHAKIA 5,590.00 3,913.00 1,677.00
OTHER CONGENITAL CORNEAL MALFORMATIONS;
Q13.4 CONGENITAL MALFORMATION OF CORNEA NOS; 5,590.00 3,913.00 1,677.00
MICROCORNEA; PETER'S ANOMALY
CONGENITAL MALFORMATION OF VITREOUS HUMOUR;
Q14.0 5,590.00 3,913.00 1,677.00
CONGENITAL VITREOUS OPACITY
CONGENITAL MALFORMATION OF RETINA; CONGENITAL
Q14.1 5,590.00 3,913.00 1,677.00
RETINAL ANEURYSM
CONGENITAL MALFORMATION OF POSTERIOR SEGMENT OF
Q14.9 5,590.00 3,913.00 1,677.00
EYE, UNSPECIFIED
CONGENITAL GLAUCOMA; BUPHTHALMOS; GLAUCOMA OF
NEWBORN; HYDROPHTHALMOS; KERATOGLOBUS,
Q15.0 CONGENITAL, WITH GLAUCOMA; MACROCORNEA WITH 5,590.00 3,913.00 1,677.00
GLAUCOMA; MACROPHTHALMOS IN CONGENITAL
GLAUCOMA; MEGALOCORNEA WITH GLAUCOMA
Q15.8 OTHER SPECIFIED CONGENITAL MALFORMATIONS OF EYE 5,590.00 3,913.00 1,677.00
Page 102 of 126

First Case Rate

CONGENITAL MALFORMATION OF EYE, UNSPECIFIED;
Q15.9 CONGENITAL ANOMALY NOS OF EYE; CONGENITAL 5,590.00 3,913.00 1,677.00
DEFORMITY NOS OF EYE
COMMON ARTERIAL TRUNK; PERSISTENT TRUNCUS
Q20.0 15,080.00 10,556.00 4,524.00
ARTERIOSUS
DOUBLE OUTLET RIGHT VENTRICLE; TAUSSIG-BING
Q20.1 15,080.00 10,556.00 4,524.00
SYNDROME
Q20.2 DOUBLE OUTLET LEFT VENTRICLE 15,080.00 10,556.00 4,524.00
DISCORDANT VENTRICULOARTERIAL CONNECTION;
Q20.3 DEXTROTRANSPOSITION OF AORTA; TRANSPOSITION OF 15,080.00 10,556.00 4,524.00
GREAT VESSELS (COMPLETE)
DOUBLE INLET VENTRICLE; COMMON VENTRICLE; COR
Q20.4 15,080.00 10,556.00 4,524.00
TRILOCULARE BIATRIATUM; SINGLE VENTRICLE
DISCORDANT ATRIOVENTRICULAR CONNECTION;
Q20.5 CORRECTED TRANSPOSITION; LAEVOTRANSPOSITION; 15,080.00 10,556.00 4,524.00
VENTRICULAR INVERSION
CONGENITAL MALFORMATION OF CARDIAC CHAMBERS AND
Q20.9 15,080.00 10,556.00 4,524.00
CONNECTIONS, UNSPECIFIED
Q21.0 VENTRICULAR SEPTAL DEFECT 15,080.00 10,556.00 4,524.00
ATRIAL SEPTAL DEFECT; CORONARY SINUS DEFECT;
PATENT OR PERSISTENT FORAMEN OVALE; PATENT OR
Q21.1 15,080.00 10,556.00 4,524.00
PERSISTENT OSTIUM SECUNDUM DEFECT (TYPE II); SINUS
VENOSUS DEFECT
ATRIOVENTRICULAR SEPTAL DEFECT; COMMON
Q21.2 ATRIOVENTRICULAR CANAL; ENDOCARDIAL CUSHION 15,080.00 10,556.00 4,524.00
DEFECT; OSTIUM PRIMUM ATRIAL SEPTAL DEFECT (TYPE I)
TETRALOGY OF FALLOT; VENTRICULAR SEPTAL DEFECT
WITH PULMONARY STENOSIS OR ATRESIA,
Q21.3 15,080.00 10,556.00 4,524.00
DEXTROPOSITION OF AORTA AND HYPERTROPHY OF RIGHT
VENTRICLE.
AORTOPULMONARY SEPTAL DEFECT; AORTIC SEPTAL
Q21.4 15,080.00 10,556.00 4,524.00
DEFECT; AORTOPULMONARY WINDOW
OTHER CONGENITAL MALFORMATIONS OF CARDIAC SEPTA;
Q21.8 15,080.00 10,556.00 4,524.00
EISENMENGER'S DEFECT; PENTALOGY OF FALLOT
CONGENITAL MALFORMATION OF CARDIAC SEPTUM,
Q21.9 15,080.00 10,556.00 4,524.00
UNSPECIFIED; SEPTAL (HEART) DEFECT NOS
Q22.0 PULMONARY VALVE ATRESIA 15,080.00 10,556.00 4,524.00
Q22.1 CONGENITAL PULMONARY VALVE STENOSIS 15,080.00 10,556.00 4,524.00
CONGENITAL PULMONARY VALVE INSUFFICIENCY;
Q22.2 15,080.00 10,556.00 4,524.00
CONGENITAL PULMONARY VALVE REGURGITATION
Q22.4 CONGENITAL TRICUSPID STENOSIS; TRICUSPID ATRESIA 15,080.00 10,556.00 4,524.00
Q22.5 EBSTEIN'S ANOMALY 15,080.00 10,556.00 4,524.00
Q22.6 HYPOPLASTIC RIGHT HEART SYNDROME 15,080.00 10,556.00 4,524.00
OTHER CONGENITAL MALFORMATIONS OF TRICUSPID
Q22.8 15,080.00 10,556.00 4,524.00
VALVE
CONGENITAL STENOSIS OF AORTIC VALVE; CONGENITAL
Q23.0 15,080.00 10,556.00 4,524.00
AORTIC ATRESIA; CONGENITAL AORTIC STENOSIS
CONGENITAL INSUFFICIENCY OF AORTIC VALVE; BICUSPID

Q23.1 15,080.00 10,556.00 4,524.00
AORTIC VALVE; CONGENITAL AORTIC INSUFFICIENCY
CONGENITAL MITRAL STENOSIS; CONGENITAL MITRAL
Q23.2 15,080.00 10,556.00 4,524.00
ATRESIA
Q23.3 CONGENITAL MITRAL INSUFFICIENCY 15,080.00 10,556.00 4,524.00
HYPOPLASTIC LEFT HEART SYNDROME; ATRESIA, OR
MARKED HYPOPLASIA OF AORTIC ORIFICE OR VALVE, WITH
HYPOPLASIA OF ASCENDING AORTA AND DEFECTIVE
Q23.4 15,080.00 10,556.00 4,524.00
DEVELOPMENT OF LEFT VENTRICLE (WITH MITRAL VALVE
STENOSIS OR
ATRESIA).
OTHER CONGENITAL MALFORMATIONS OF AORTIC AND
Q23.8 15,080.00 10,556.00 4,524.00
MITRAL VALVES
CONGENITAL MALFORMATION OF AORTIC AND MITRAL
Q23.9 15,080.00 10,556.00 4,524.00
VALVES, UNSPECIFIED
Q24.0 DEXTROCARDIA 15,080.00 10,556.00 4,524.00
Q24.2 COR TRIATRIATUM 15,080.00 10,556.00 4,524.00
Q24.3 PULMONARY INFUNDIBULAR STENOSIS 15,080.00 10,556.00 4,524.00
Q24.4 CONGENITAL SUBAORTIC STENOSIS 15,080.00 10,556.00 4,524.00
MALFORMATION OF CORONARY VESSELS; CONGENITAL
Q24.5 15,080.00 10,556.00 4,524.00
CORONARY (ARTERY) ANEURYSM
Q24.6 CONGENITAL HEART BLOCK 15,080.00 10,556.00 4,524.00
HEART; CONGENITAL DIVERTICULUM OF LEFT VENTRICLE;
Q24.8 CONGENITAL MALFORMATION OF MYOCARDIUM; 15,080.00 10,556.00 4,524.00
CONGENITAL MALFORMATION OF PERICARDIUM;
MALPOSITION OF HEART; UHL'S DISEASE
CONGENITAL MALFORMATION OF HEART, UNSPECIFIED;
Q24.9 CONGENITAL ANOMALY NOS OF HEART; CONGENITAL 15,080.00 10,556.00 4,524.00
DISEASE NOS OF HEART
Page 103 of 126

First Case Rate

PATENT DUCTUS ARTERIOSUS; PATENT DUCTUS BOTALLO;
Q25.0 15,080.00 10,556.00 4,524.00
PERSISTENT DUCTUS ARTERIOSUS
COARCTATION OF AORTA; PREDUCTAL COARCTATION OF
Q25.1 15,080.00 10,556.00 4,524.00
AORTA; POSTDUCTAL COARCTATION OF AORTA
Q25.2 ATRESIA OF AORTA 15,080.00 10,556.00 4,524.00
Q25.3 STENOSIS OF AORTA; SUPRAVALVULAR AORTIC STENOSIS 15,080.00 10,556.00 4,524.00
OTHER CONGENITAL MALFORMATIONS OF AORTA;

ABSENCE OF AORTA; APLASIA OF AORTA; CONGENITAL
ANEURYSM OF AORTA; CONGENITAL DILATATION OF
Q25.4 15,080.00 10,556.00 4,524.00
AORTA; ANEURYSM OF SINUS OF VALSALVA (RUPTURE);
DOUBLE AORTIC ARCH [VASCULAR RING OR AORTA];
HYPOPLASIA OF AORTA; PERSISTEN
Q25.5 ATRESIA OF PULMONARY ARTERY 15,080.00 10,556.00 4,524.00
Q25.6 STENOSIS OF PULMONARY ARTERY 15,080.00 10,556.00 4,524.00
OTHER CONGENITAL MALFORMATIONS OF PULMONARY
ARTERY; ABERRANT PULMONARY ARTERY; AGENESIS OF
PULMONARY ARTERY; ANEURYSM, CONGENITAL OF
Q25.7 15,080.00 10,556.00 4,524.00
PULMONARY ARTERY; ANOMALY OF PULMONARY ARTERY;
HYPOPLASIA OF PULMONARY ARTERY; PULMONARY
ARTERIOVENOUS ANEURYSM
OTHER CONGENITAL MALFORMATIONS OF GREAT
Q25.8 15,080.00 10,556.00 4,524.00
ARTERIES
CONGENITAL MALFORMATION OF GREAT ARTERIES,
Q25.9 15,080.00 10,556.00 4,524.00
UNSPECIFIED
CONGENITAL STENOSIS OF VENA CAVA; CONGENITAL
Q26.0 STENOSIS OF INFERIOR VENA CAVA; CONGENITAL 15,080.00 10,556.00 4,524.00
STENOSIS OFSUPERIOR VENA CAVA
Q26.2 TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION 15,080.00 10,556.00 4,524.00
ANOMALOUS PULMONARY VENOUS CONNECTION,
Q26.4 15,080.00 10,556.00 4,524.00
UNSPECIFIED
OTHER CONGENITAL MALFORMATIONS OF GREAT VEINS;
ABSENCE OF INFERIOR VENA CAVA ; ABSENCE OF
Q26.8 SUPERIOR VENA CAVA ; AZYGOS CONTINUATION OF 15,080.00 10,556.00 4,524.00
INFERIOR VENA CAVA; PERSISTENT LEFT POSTERIOR
CARDINAL VEIN; SCIMITAR SYNDROME
CONGENITAL MALFORMATION OF GREAT VEIN,
Q26.9 UNSPECIFIED; ANOMALY OF INFERIOR VENA CAVA NOS; 15,080.00 10,556.00 4,524.00
ANOMALY OF SUPERIOR VENA CAVA NOS
Q27.1 CONGENITAL RENAL ARTERY STENOSIS 15,600.00 10,920.00 4,680.00
PERIPHERAL ARTERIOVENOUS MALFORMATION;
Q27.3 15,600.00 10,920.00 4,680.00
ARTERIOVENOUS ANEURYSM
PERIPHERAL VASCULAR SYSTEM; ABERRANT SUBCLAVIAN
ARTERY; ABSENCE OF ARTERY OR VEIN NEC; ATRESIA OF
Q27.8 15,600.00 10,920.00 4,680.00
ARTERY OR VEIN NEC; CONGENITAL ANEURYSM
(PERIPHERAL); CONGENITAL STRICTURE, ARTERY;
CONGENITAL VARIX
CONGENITAL MALFORMATION OF PERIPHERAL VASCULAR

Q27.9 15,600.00 10,920.00 4,680.00
SYSTEM, UNSPECIFIED; ANOMALY OF ARTERY OR VEIN NOS
ARTERIOVENOUS MALFORMATION OF PRECEREBRAL
Q28.0 VESSELS; CONGENITAL ARTERIOVENOUS PRECEREBRAL 15,600.00 10,920.00 4,680.00
ANEURYSM (NONRUPTURED)
OTHER MALFORMATIONS OF PRECEREBRAL VESSELS;
CONGENITAL MALFORMATION OF PRECEREBRAL VESSELS
Q28.1 15,600.00 10,920.00 4,680.00
NOS; CONGENITAL PRECEREBRAL ANEURYSM
(NONRUPTURED)
ARTERIOVENOUS MALFORMATION OF CEREBRAL VESSELS;
ARTERIOVENOUS MALFORMATION OF BRAIN NOS;
Q28.2 15,600.00 10,920.00 4,680.00
CONGENITAL ARTERIOVENOUS CEREBRAL ANEURYSM
(NONRUPTURED)
OTHER MALFORMATIONS OF CEREBRAL VESSELS;

Q28.3 CONGENITAL CEREBRAL ANEURYSM, NONRUPTURED; 15,600.00 10,920.00 4,680.00
CONGENITAL MALFORMATION OF CEREBRAL VESSELS NOS
CHOANAL ATRESIA; ABSENCE OF ANTERIOR NARES;
ABSENCE OF POSTERIOR NARES; CONGENITAL STENOSIS OF
Q30.0 14,300.00 10,010.00 4,290.00
ANTERIOR NARES; CONGENITAL STENOSIS OF POSTERIOR
NARES
AGENESIS AND UNDERDEVELOPMENT OF NOSE;
Q30.1 14,300.00 10,010.00 4,290.00
CONGENITAL ABSENCE OF NOSE
Q30.2 FISSURED, NOTCHED AND CLEFT NOSE 14,300.00 10,010.00 4,290.00
Q31.3 LARYNGOCELE 14,300.00 10,010.00 4,290.00
Q31.5 CONGENITAL LARYNGOMALACIA 14,300.00 10,010.00 4,290.00
Page 104 of 126

First Case Rate

OTHER CONGENITAL MALFORMATIONS OF LARYNX;
ABSENCE OF CRICOID CARTILAGE, EPIGLOTTIS, GLOTTIS,
LARYNX OR THYROID CARTILAGE; AGENESIS OF CRICOID
Q31.8 14,300.00 10,010.00 4,290.00
CARTILAGE, EPIGLOTTIS, GLOTTIS, LARYNX OR THYROID
CARTILAGE; ATRESIA OF CRICOID CARTILAGE, EPIGLOTTIS,
GLOTTIS,
Q31.9 CONGENITAL MALFORMATION OF LARYNX, UNSPECIFIED 14,300.00 10,010.00 4,290.00

Q32.0 CONGENITAL TRACHEOMALACIA 28,210.00 19,747.00 8,463.00
OTHER CONGENITAL MALFORMATIONS OF BRONCHUS;
ABSENCE OF BRONCHUS; AGENESIS OF BRONCHUS;
Q32.4 ATRESIA OF BRONCHUS; CONGENITAL MALFORMATION 28,210.00 19,747.00 8,463.00
NOS OF BRONCHUS; DIVERTICULUM OF BRONCHUS;
CONGENITAL MALFORMATIONS OF LUNG] OF BRONCHUS
CONGENITAL CYSTIC LUNG; CONGENITAL HONEYCOMB
Q33.0 LUNG; CONGENITAL CYSTIC LUNG DISEASE; CONGENITAL 28,210.00 19,747.00 8,463.00
POLYCYSTIC LUNG DISEASE
Q33.2 SEQUESTRATION OF LUNG 28,210.00 19,747.00 8,463.00
Q33.3 AGENESIS OF LUNG; ABSENCE OF LUNG, LOBE 28,210.00 19,747.00 8,463.00
Q33.4 CONGENITAL BRONCHIECTASIS 28,210.00 19,747.00 8,463.00
Q33.6 HYPOPLASIA AND DYSPLASIA OF LUNG 28,210.00 19,747.00 8,463.00
Q34.1 CONGENITAL CYST OF MEDIASTINUM 28,210.00 19,747.00 8,463.00
Q34.8 28,210.00 19,747.00 8,463.00
RESPIRATORY SYSTEM; ATRESIA OF NASOPHARYNX
CONGENITAL MALFORMATION OF RESPIRATORY SYSTEM,
UNSPECIFIED; CONGENITAL ABSENCE OF RESPIRATORY
Q34.9 28,210.00 19,747.00 8,463.00
ORGAN ; CONGENITAL ANOMALY NOS OF RESPIRATORY
ORGAN
CLEFT HARD PALATE, BILATERAL; BILATERAL FISSURE OF
Q35.0 HARD PALATE; BILATERAL PALATOSCHISIS OF HARD 10,140.00 7,098.00 3,042.00
PALATE
Q35.1 CLEFT HARD PALATE 10,140.00 7,098.00 3,042.00
Q35.3 CLEFT SOFT PALATE 10,140.00 7,098.00 3,042.00
Q35.5 CLEFT HARD PALATE WITH CLEFT SOFT PALATE 10,140.00 7,098.00 3,042.00
Q35.7 CLEFT UVULA 10,140.00 7,098.00 3,042.00
Q35.8 CLEFT PALATE, UNSPECIFIED, BILATERAL 10,140.00 7,098.00 3,042.00
Q35.9 CLEFT PALATE, UNSPECIFIED 10,140.00 7,098.00 3,042.00
Q36.0 CLEFT LIP, BILATERAL 10,140.00 7,098.00 3,042.00
Q36.1 CLEFT LIP, MEDIAN 10,140.00 7,098.00 3,042.00
Q36.9 CLEFT LIP, UNILATERAL; CLEFT LIP NOS 10,140.00 7,098.00 3,042.00
Q37.0 CLEFT HARD PALATE WITH BILATERAL CLEFT LIP 10,140.00 7,098.00 3,042.00
CLEFT HARD PALATE WITH UNILATERAL CLEFT LIP; CLEFT
Q37.1 10,140.00 7,098.00 3,042.00
HARD PALATE WITH CLEFT LIP NOS
Q37.2 CLEFT SOFT PALATE WITH BILATERAL CLEFT LIP 10,140.00 7,098.00 3,042.00
CLEFT SOFT PALATE WITH UNILATERAL CLEFT LIP; CLEFT
Q37.3 10,140.00 7,098.00 3,042.00
SOFT PALATE WITH CLEFT LIP NOS
Q37.4 CLEFT HARD AND SOFT PALATE WITH BILATERAL CLEFT LIP 10,140.00 7,098.00 3,042.00
CLEFT HARD AND SOFT PALATE WITH UNILATERAL CLEFT

Q37.5 10,140.00 7,098.00 3,042.00
LIP; CLEFT HARD AND SOFT PALATE WITH CLEFT LIP NOS
Q37.8 UNSPECIFIED CLEFT PALATE WITH BILATERAL CLEFT LIP 10,140.00 7,098.00 3,042.00
UNSPECIFIED CLEFT PALATE WITH UNILATERAL CLEFT LIP;
Q37.9 10,140.00 7,098.00 3,042.00
CLEFT PALATE WITH CLEFT LIP NOS
Q38.2 MACROGLOSSIA 5,200.00 3,640.00 1,560.00
CONGENITAL MALFORMATIONS OF PALATE, NOT
ELSEWHERE CLASSIFIED; ABSENCE OF UVULA;
Q38.5 5,200.00 3,640.00 1,560.00
CONGENITAL MALFORMATION OF PALATE NOS; HIGH
ARCHED PALATE
OTHER CONGENITAL MALFORMATIONS OF MOUTH;
Q38.6 5,200.00 3,640.00 1,560.00
CONGENITAL MALFORMATION OF MOUTH NOS
OTHER CONGENITAL MALFORMATIONS OF PHARYNX;
Q38.8 5,200.00 3,640.00 1,560.00
CONGENITAL MALFORMATION OF PHARYNX NOS
ATRESIA OF OESOPHAGUS WITHOUT FISTULA; ATRESIA OF
Q39.0 14,690.00 10,283.00 4,407.00
OESOPHAGUS NOS
ATRESIA OF OESOPHAGUS WITH TRACHEO-OESOPHAGEAL
Q39.1 FISTULA; ATRESIA OF OESOPHAGUS WITH BRONCHO- 14,690.00 10,283.00 4,407.00
OESOPHAGEAL FISTULA
CONGENITAL TRACHEO-OESOPHAGEAL FISTULA WITHOUT
Q39.2 ATRESIA; CONGENITAL TRACHEO-OESOPHAGEAL FISTULA 14,690.00 10,283.00 4,407.00
NOS
Q39.6 DIVERTICULUM OF OESOPHAGUS; OESOPHAGEAL POUCH 14,690.00 10,283.00 4,407.00
CONGENITAL MALFORMATION OF OESOPHAGUS,
Q39.9 14,690.00 10,283.00 4,407.00
UNSPECIFIED
Page 105 of 126

First Case Rate

CONGENITAL HYPERTROPHIC PYLORIC STENOSIS;
CONGENITAL OR INFANTILE CONSTRICTION OF PYLORUS;
CONGENITAL OR INFANTILE HYPERTROPHY OF PYLORUS;
Q40.0 14,690.00 10,283.00 4,407.00
CONGENITAL OR INFANTILE SPASM OF PYLORUS;
CONGENITAL OR INFANTILE STENOSIS OF PYLORUS;
CONGENITAL OR INFANTILE STRIC
CONGENITAL HIATUS HERNIA; DISPLACEMENT OF CARDIA
Q40.1 14,690.00 10,283.00 4,407.00
THROUGH OESOPHAGEAL HIATUS
STOMACH; CONGENITAL DISPLACEMENT OF STOMACH;
Q40.2 CONGENITAL DIVERTICULUM OF STOMACH; CONGENITAL 14,690.00 10,283.00 4,407.00
HOURGLASS STOMACH; DUPLICATION OF STOMACH;
MEGALOGASTRIA; MICROGASTRIA
CONGENITAL MALFORMATION OF UPPER ALIMENTARY

TRACT, UNSPECIFIED; CONGENITAL ANOMALY NOS OF
Q40.9 14,690.00 10,283.00 4,407.00
UPPER ALIMENTARY TRACT; CONGENITAL DEFORMITY NOS
OF UPPER ALIMENTARY TRACT
CONGENITAL ABSENCE, ATRESIA AND STENOSIS OF
Q41.0 14,690.00 10,283.00 4,407.00
DUODENUM
Q41.1 JEJUNUM; APPLE PEEL SYNDROME; IMPERFORATE 14,690.00 10,283.00 4,407.00
JEJUNUM
Q41.2 CONGENITAL ABSENCE, ATRESIA AND STENOSIS OF ILEUM 14,690.00 10,283.00 4,407.00
CONGENITAL ABSENCE, ATRESIA AND STENOSIS OF SMALL
Q41.9 INTESTINE, PART UNSPECIFIED; CONGENITAL ABSENCE, 14,690.00 10,283.00 4,407.00
ATRESIA AND STENOSIS OF INTESTINE NOS
Q42.0 14,690.00 10,283.00 4,407.00
RECTUM WITH FISTULA
Q42.1 14,690.00 10,283.00 4,407.00
RECTUM WITHOUT FISTULA; IMPERFORATE RECTUM
CONGENITAL ABSENCE, ATRESIA AND STENOSIS OF ANUS
Q42.2 14,690.00 10,283.00 4,407.00
WITH FISTULA
CONGENITAL ABSENCE, ATRESIA AND STENOSIS OF ANUS
Q42.3 14,690.00 10,283.00 4,407.00
WITHOUT FISTULA; IMPERFORATE ANUS
CONGENITAL ABSENCE, ATRESIA AND STENOSIS OF LARGE
Q42.9 14,690.00 10,283.00 4,407.00
INTESTINE, PART UNSPECIFIED
MECKEL'S DIVERTICULUM; PERSISTENT
Q43.0 OMPHALOMESENTERIC DUCT; PERSISTENT VITELLINE 14,690.00 10,283.00 4,407.00
DUCT
HIRSCHSPRUNG'S DISEASE; AGANGLIONOSIS; CONGENITAL
Q43.1 14,690.00 10,283.00 4,407.00
(AGANGLIONIC) MEGACOLON
OTHER CONGENITAL FUNCTIONAL DISORDERS OF COLON;
Q43.2 14,690.00 10,283.00 4,407.00
CONGENITAL DILATATION OF COLON
CONGENITAL MALFORMATIONS OF INTESTINAL FIXATION;
CONGENITAL ANOMALOUS OMENTAL ADHESIONS [BANDS]
; CONGENITAL PERITONEAL ADHESIONS [BANDS];
Q43.3 14,690.00 10,283.00 4,407.00
JACKSON'S MEMBRANE; MALROTATION OF COLON;
FAILURE OF ROTATION OF CAECUM AND COLON;
INCOMPLETE ROTATION OF CAECUM A
Q43.4 DUPLICATION OF INTESTINE 14,690.00 10,283.00 4,407.00
Q43.5 ECTOPIC ANUS 14,690.00 10,283.00 4,407.00
Q43.6 CONGENITAL FISTULA OF RECTUM AND ANUS 14,690.00 10,283.00 4,407.00
Q43.7 PERSISTENT CLOACA; CLOACA NOS 14,690.00 10,283.00 4,407.00
INTESTINE; CONGENITAL BLIND LOOP SYNDROME;
CONGENITAL DIVERTICULITIS, COLON; CONGENITAL
Q43.8 DIVERTICULUM, INTESTINE; DOLICHOCOLON; 14,690.00 10,283.00 4,407.00
MEGALOAPPENDIX; MEGALODUODENUM;
MICROCOLON; TRANSPOSITION OF APPENDIX;
TRANSPOSITIO
Q43.9 CONGENITAL MALFORMATION OF INTESTINE, UNSPECIFIED 14,690.00 10,283.00 4,407.00
AGENESIS, APLASIA AND HYPOPLASIA OF GALLBLADDER;

Q44.0 14,690.00 10,283.00 4,407.00
CONGENITAL ABSENCE OF GALLBLADDER
OTHER CONGENITAL MALFORMATIONS OF GALLBLADDER;
Q44.1 CONGENITAL MALFORMATION OF GALLBLADDER NOS; 14,690.00 10,283.00 4,407.00
INTRAHEPATIC GALLBLADDER
Q44.2 ATRESIA OF BILE DUCTS 14,690.00 10,283.00 4,407.00
Q44.3 CONGENITAL STENOSIS AND STRICTURE OF BILE DUCTS 14,690.00 10,283.00 4,407.00
Q44.4 CHOLEDOCHAL CYST 14,690.00 10,283.00 4,407.00
OTHER CONGENITAL MALFORMATIONS OF BILE DUCTS;
ACCESSORY HEPATIC DUCT; CONGENITAL MALFORMATION
Q44.5 14,690.00 10,283.00 4,407.00
OF BILE DUCT NOS; BILIARY DUCT DUPLICATION; CYSTIC
DUCT DUPLICATION
Page 106 of 126

First Case Rate

Q44.6 CYSTIC DISEASE OF LIVER; FIBROCYSTIC DISEASE OF LIVER 14,690.00 10,283.00 4,407.00
OTHER CONGENITAL MALFORMATIONS OF LIVER;

ACCESSORY LIVER; ALAGILLE'S SYNDROME; CONGENITAL
Q44.7 14,690.00 10,283.00 4,407.00
ABSENCE OF LIVER; CONGENITAL HEPATOMEGALY;
CONGENITAL MALFORMATION OF LIVER NOS
AGENESIS, APLASIA AND HYPOPLASIA OF PANCREAS;
Q45.0 14,690.00 10,283.00 4,407.00
CONGENITAL ABSENCE OF PANCREAS
DIGESTIVE SYSTEM; ABSENCE OF ALIMENTARY TRACT NOS,
Q45.8 COMPLETE; ABSENCE OF ALIMENTARY TRACT NOS, 14,690.00 10,283.00 4,407.00
PARTIAL; DUPLICATION OF DIGESTIVE ORGANS NOS;
MALPOSITION, CONGENITAL OF DIGESTIVE ORGANS NOS
CONGENITAL MALFORMATION OF DIGESTIVE SYSTEM,
UNSPECIFIED; CONGENITAL ANOMALY NOS OF DIGESTIVE
Q45.9 14,690.00 10,283.00 4,407.00
SYSTEM ; CONGENITAL DEFORMITY NOS OF DIGESTIVE
SYSTEM
Q50.1 DEVELOPMENTAL OVARIAN CYST 12,090.00 8,463.00 3,627.00
OTHER CONGENITAL MALFORMATIONS OF OVARY;
Q50.3 ACCESSORY OVARY; CONGENITAL MALFORMATION OF 12,090.00 8,463.00 3,627.00
OVARY NOS; OVARIAN STREAK
Q50.4 EMBRYONIC CYST OF FALLOPIAN TUBE; FIMBRIAL CYST 12,090.00 8,463.00 3,627.00
EMBRYONIC CYST OF BROAD LIGAMENT; CYST

Q50.5 12,090.00 8,463.00 3,627.00
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
Q50.6 12,090.00 8,463.00 3,627.00
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
Q51.0 12,090.00 8,463.00 3,627.00
OF UTERUS
Q51.2 OTHER DOUBLING OF UTERUS' DOUBLING OF UTERUS NOS 10,140.00 7,098.00 3,042.00
Q51.3 BICORNATE UTERUS 10,140.00 7,098.00 3,042.00
OTHER CONGENITAL MALFORMATIONS OF UTERUS AND
Q51.8 10,140.00 7,098.00 3,042.00
CERVIX; HYPOPLASIA OF UTERUS AND CERVIX
CONGENITAL MALFORMATION OF UTERUS AND CERVIX,
Q51.9 12,090.00 8,463.00 3,627.00
UNSPECIFIED
Q52.1 DOUBLING OF VAGINA; SEPTATE VAGINA 10,140.00 7,098.00 3,042.00
Q52.2 CONGENITAL RECTOVAGINAL FISTULA 10,140.00 7,098.00 3,042.00
Q52.3 IMPERFORATE HYMEN 10,140.00 7,098.00 3,042.00
Q52.8 10,140.00 7,098.00 3,042.00
FEMALE GENITALIA
Q55.0 ABSENCE AND APLASIA OF TESTIS; MONORCHISM 8,320.00 5,824.00 2,496.00
Q55.1 HYPOPLASIA OF TESTIS AND SCROTUM; FUSION OF TESTES 8,320.00 5,824.00 2,496.00
OTHER CONGENITAL MALFORMATIONS OF TESTIS AND
SCROTUM; CONGENITAL MALFORMATION OF TESTIS OR
Q55.2 8,320.00 5,824.00 2,496.00
SCROTUM NOS; POLYORCHISM; RETRACTILE TESTIS; TESTIS
MIGRANS
OTHER CONGENITAL MALFORMATIONS OF VAS DEFERENS,
EPIDIDYMIS, SEMINAL VESICLES AND PROSTATE; ABSENCE
OR APLASIA OF PROSTATE; ABSENCE OR APLASIA OF
Q55.4 8,320.00 5,824.00 2,496.00
SPERMATIC CORD; CONGENITAL MALFORMATION OF VAS
DEFERENS, EPIDIDYMIS, SEMINAL VESICLES OR PROSTATE
NOS
OTHER CONGENITAL MALFORMATIONS OF PENIS;

Q55.6 CONGENITAL MALFORMATION OF PENIS NOS; CURVATURE 8,320.00 5,824.00 2,496.00
OF PENIS (LATERAL); HYPOPLASIA OF PENIS
CONGENITAL MALFORMATION OF MALE GENITAL ORGAN,
UNSPECIFIED; CONGENITAL ANOMALYNOS OF MALE
Q55.9 8,320.00 5,824.00 2,496.00
GENITAL ORGAN ; CONGENITAL DEFORMITY NOS OF MALE
GENITAL ORGAN
MALE PSEUDOHERMAPHRODITISM, NOT ELSEWHERE
Q56.1 8,320.00 5,824.00 2,496.00
CLASSIFIED; MALE PSEUDOHERMAPHRODITISM NOS
Q56.3 PSEUDOHERMAPHRODITISM, UNSPECIFIED 8,320.00 5,824.00 2,496.00
Q60.0 RENAL AGENESIS, UNILATERAL 11,830.00 8,281.00 3,549.00
Q60.1 RENAL AGENESIS, BILATERAL 11,830.00 8,281.00 3,549.00
Q60.2 RENAL AGENESIS, UNSPECIFIED 11,830.00 8,281.00 3,549.00
Q60.3 RENAL HYPOPLASIA, UNILATERAL 11,830.00 8,281.00 3,549.00
Q60.5 RENAL HYPOPLASIA, UNSPECIFIED 11,830.00 8,281.00 3,549.00
Q60.6 POTTER'S SYNDROME 11,830.00 8,281.00 3,549.00
CONGENITAL SINGLE RENAL CYST; CONGENITAL CYST OF
Q61.0 11,830.00 8,281.00 3,549.00
KIDNEY; SINGLE CYST OF KIDNEY
Page 107 of 126

First Case Rate

POLYCYSTIC KIDNEY, AUTOSOMAL RECESSIVE; POLYCYSTIC
Q61.1 11,830.00 8,281.00 3,549.00
KIDNEY, INFANTILE TYPE
POLYCYSTIC KIDNEY, AUTOSOMAL DOMINANT; POLYCYSTIC
Q61.2 11,830.00 8,281.00 3,549.00
KIDNEY, ADULT TYPE
Q61.3 POLYCYSTIC KIDNEY, UNSPECIFIED 11,830.00 8,281.00 3,549.00
Q61.4 RENAL DYSPLASIA 11,830.00 8,281.00 3,549.00
Q61.5 MEDULLARY CYSTIC KIDNEY; SPONGE KIDNEY NOS 11,830.00 8,281.00 3,549.00
OTHER CYSTIC KIDNEY DISEASES; FIBROCYSTIC KIDNEY;
Q61.8 11,830.00 8,281.00 3,549.00
FIBROCYSTIC RENAL DEGENERATION OR DISEASE
CYSTIC KIDNEY DISEASE, UNSPECIFIED; MECKEL-GRUBER
Q61.9 11,830.00 8,281.00 3,549.00
SYNDROME
Q62.0 CONGENITAL HYDRONEPHROSIS 11,830.00 8,281.00 3,549.00
ATRESIA AND STENOSIS OF URETER; CONGENITAL
OCCLUSION OF URETER; CONGENITAL OCCLUSION OF
Q62.1 11,830.00 8,281.00 3,549.00
URETEROPELVIC JUNCTION; CONGENITAL OCCLUSION OF
URETEROVESICAL ORIFICE; IMPERVIOUS URETER
CONGENITAL MEGALOURETER; CONGENITAL DILATATION
Q62.2 11,830.00 8,281.00 3,549.00
OF URETER
OTHER OBSTRUCTIVE DEFECTS OF RENAL PELVIS AND
Q62.3 11,830.00 8,281.00 3,549.00
URETER; CONGENITAL URETEROCELE
DUPLICATION OF URETER; ACCESSORY OF URETER,
Q62.5 11,830.00 8,281.00 3,549.00
DOUBLE OF URETER
MALPOSITION OF URETER; DEVIATION OF URETER OR
URETERIC ORIFICE; DISPLACEMENT OF URETER OR
Q62.6 URETERIC ORIFICE; ECTOPIC OF URETER OF URETERIC 11,830.00 8,281.00 3,549.00
ORIFICE; IMPLANTATION, ANOMALOUS OF URETER OR
URETERIC ORIFICE
Q62.7 CONGENITAL VESICO-URETERO-RENAL REFLUX 11,830.00 8,281.00 3,549.00
Q63.0 ACCESSORY KIDNEY 11,830.00 8,281.00 3,549.00
Q63.1 LOBULATED, FUSED AND HORSESHOE KIDNEY 11,830.00 8,281.00 3,549.00
ECTOPIC KIDNEY; CONGENITAL DISPLACED KIDNEY;
Q63.2 11,830.00 8,281.00 3,549.00
MALROTATION OF KIDNEY
Q63.3 HYPERPLASTIC AND GIANT KIDNEY 11,830.00 8,281.00 3,549.00
Q63.8 11,830.00 8,281.00 3,549.00
KIDNEY; CONGENITAL RENAL CALCULI
EXSTROPHY OF URINARY BLADDER; ECTOPIA VESICAE;
Q64.1 11,830.00 8,281.00 3,549.00
EXTROVERSION OF BLADDER
Q64.2 CONGENITAL POSTERIOR URETHRAL VALVES 11,830.00 8,281.00 3,549.00
OTHER ATRESIA AND STENOSIS OF URETHRA AND BLADDER
NECK; CONGENITAL BLADDER NECK OBSTRUCTION;
Q64.3 CONGENITAL STRICTURE OF URETHRA; CONGENITAL 11,830.00 8,281.00 3,549.00
STRICTURE OF URINARY MEATUS; CONGENITAL STRICTURE
OF VESICOURETHRAL ORIFICE; IMPERVIOUS URETHRA
MALFORMATION OF URACHUS; CYST OF URACHUS; PATENT
Q64.4 11,830.00 8,281.00 3,549.00
URACHUS; PROLAPSE OF URACHUS
OTHER CONGENITAL MALFORMATIONS OF BLADDER AND
URETHRA; ACCESSORY BLADDER; ACCESSORY URETHRA;
CONGENITAL HERNIA OF BLADDER; CONGENITAL
Q64.7 11,830.00 8,281.00 3,549.00
MALFORMATION OF BLADDER OR URETHRA NOS;
CONGENITAL PROLAPSE OF BLADDER (MUCOSA);
CONGENITAL PROLAPSE OF URETHRA; CONGENIT
Q64.8 11,830.00 8,281.00 3,549.00
URINARY SYSTEM
CONGENITAL MALFORMATION OF URINARY SYSTEM,
UNSPECIFIED; CONGENITAL ANOMALY NOS OF URINARY
Q64.9 11,830.00 8,281.00 3,549.00
SYSTEM; CONGENITAL DEFORMITY NOS OF URINARY
SYSTEM
Q65.6 UNSTABLE HIP; DISLOCATABLE HIP; SUBLUXATABLE HIP 6,890.00 4,823.00 2,067.00
Q67.3 PLAGIOCEPHALY 6,890.00 4,823.00 2,067.00
OTHER CONGENITAL DEFORMITIES OF SKULL, FACE AND
JAW; DEPRESSIONS IN SKULL; DEVIATION OF NASAL
Q67.4 6,890.00 4,823.00 2,067.00
SEPTUM, CONGENITAL; HEMIFACIAL ATROPHY OR
HYPERTROPHY; SQUASHED OR BENT NOSE, CONGENITAL
Q67.6 PECTUS EXCAVATUM; CONGENITAL FUNNEL CHEST 6,890.00 4,823.00 2,067.00
Q67.7 PECTUS CARINATUM; CONGENITAL PIGEON CHEST 6,890.00 4,823.00 2,067.00
CONGENITAL DEFORMITY OF STERNOCLEIDOMASTOID
MUSCLE; CONGENITAL, STERNOMASTOID TORTICOLLIS;
Q68.0 6,890.00 4,823.00 2,067.00
CONTRACTURE OF STERNOCLEIDOMASTOID MUSCLE;
STERNOMASTOID TUMOUR, CONGENITAL
Q74.3 ARTHROGRYPOSIS MULTIPLEX CONGENITA 16,900.00 11,830.00 5,070.00
CRANIOSYNOSTOSIS; ACROCEPHALY; ]IMPERFECT FUSION
Q75.0 16,900.00 11,830.00 5,070.00
OF SKULL; OXYCEPHALY; TRIGONOCEPHALY
Q75.1 CRANIOFACIAL DYSOSTOSIS; CROUZON'S DISEASE 16,900.00 11,830.00 5,070.00
Q75.2 HYPERTELORISM 16,900.00 11,830.00 5,070.00
MANDIBULOFACIAL DYSOSTOSIS; FRANCESCHETTI
Q75.4 16,900.00 11,830.00 5,070.00
SYNDROME; TREACHER COLLINS SYNDROME
Page 108 of 126

First Case Rate

SKULL AND FACE BONES; ABSENCE OF SKULL BONE,
Q75.8 16,900.00 11,830.00 5,070.00
CONGENITAL; CONGENITAL DEFORMITY OF FOREHEAD;
PLATYBASIA
CONGENITAL MALFORMATION OF SKULL AND FACE BONES,
Q75.9 UNSPECIFIED; CONGENITAL ANOMALY OF FACE BONES NOS; 16,900.00 11,830.00 5,070.00
CONGENITAL ANOMALY OF SKULL NOS
Q76.0 SPINA BIFIDA OCCULTA 16,900.00 11,830.00 5,070.00
CONGENITAL SCOLIOSIS DUE TO CONGENITAL BONY
Q76.3 MALFORMATION; HEMIVERTEBRA FUSION OR FAILURE OF 6,890.00 4,823.00 2,067.00
SEGMENTATION WITH SCOLIOSIS
OTHER CONGENITAL MALFORMATIONS OF SPINE, NOT
ASSOCIATED WITH SCOLIOSIS; CONGENITAL ABSENCE OF
VERTEBRA UNSPECIFIED OR NOT ASSOCIATED WITH
Q76.4 16,900.00 11,830.00 5,070.00
SCOLIOSIS; CONGENITAL FUSION OF SPINE UNSPECIFIED
OR NOT ASSOCIATED WITH SCOLIOSIS; CONGENITAL
KYPHOSIS UNSPECIFIED O
Q78.0 OSTEOGENESIS IMPERFECTA; FRAGILITAS OSSIUM 6,890.00 4,823.00 2,067.00
Q78.2 OSTEOPETROSIS; ALBERS-SCHöNBERG SYNDROME 6,890.00 4,823.00 2,067.00
OTHER SPECIFIED OSTEOCHONDRODYSPLASIAS;
Q78.8 6,890.00 4,823.00 2,067.00
OSTEOPOIKILOSIS
OSTEOCHONDRODYSPLASIA, UNSPECIFIED;
Q78.9 6,890.00 4,823.00 2,067.00
CHONDRODYSTROPHY NOS; OSTEODYSTROPHY NOS
Q79.0 CONGENITAL DIAPHRAGMATIC HERNIA 14,690.00 10,283.00 4,407.00
OTHER CONGENITAL MALFORMATIONS OF DIAPHRAGM;
Q79.1 ABSENCE OF DIAPHRAGM; CONGENITAL MALFORMATION 14,690.00 10,283.00 4,407.00
OF DIAPHRAGM NOS; EVENTRATION OF DIAPHRAGM
Q79.2 EXOMPHALOS; OMPHALOCELE 14,690.00 10,283.00 4,407.00
Q79.3 GASTROSCHISIS 14,690.00 10,283.00 4,407.00
Q79.4 PRUNE BELLY SYNDROME 14,690.00 10,283.00 4,407.00
OTHER CONGENITAL MALFORMATIONS OF ABDOMINAL
Q79.5 14,690.00 10,283.00 4,407.00
WALL
Q80.2 LAMELLAR ICHTHYOSIS; COLLODION BABY 15,340.00 10,738.00 4,602.00
Q80.9 CONGENITAL ICHTHYOSIS, UNSPECIFIED 15,340.00 10,738.00 4,602.00
Q81.2 EPIDERMOLYSIS BULLOSA DYSTROPHICA 15,340.00 10,738.00 4,602.00
Q81.8 OTHER EPIDERMOLYSIS BULLOSA 15,340.00 10,738.00 4,602.00
Q81.9 EPIDERMOLYSIS BULLOSA, UNSPECIFIED 15,340.00 10,738.00 4,602.00
Q82.0 HEREDITARY LYMPHOEDEMA 15,340.00 10,738.00 4,602.00
Q82.2 MASTOCYTOSIS; URTICARIA PIGMENTOSA 15,340.00 10,738.00 4,602.00
Q82.3 INCONTINENTIA PIGMENTI 15,340.00 10,738.00 4,602.00
Q82.4 ECTODERMAL DYSPLASIA (ANHIDROTIC) 15,340.00 10,738.00 4,602.00
OTHER SPECIFIED CONGENITAL MALFORMATIONS OF SKIN;
ABNORMAL PALMAR CREASES; ACCESSORY SKIN TAGS;
BENIGN FAMILIAL PEMPHIGUS [HAILEY-HAILEY]; CUTIS
Q82.8 15,340.00 10,738.00 4,602.00
LAXA (HYPERELASTICA); DERMATOGLYPHIC ANOMALIES;
INHERITED KERATOSIS PALMARIS ET PLANTARIS;
KERATOSIS FOLLICULA
Q84.8 15,340.00 10,738.00 4,602.00
INTEGUMENT; APLASIA CUTIS CONGENITA
Q85.1 TUBEROUS SCLEROSIS; BOURNEVILLE'S DISEASE; EPILOIA 15,080.00 10,556.00 4,524.00
OTHER PHAKOMATOSES, NOT ELSEWHERE CLASSIFIED;

Q85.8 PEUTZ-JEGHERS SYNDROME; STURGE-WEBER(- 14,040.00 9,828.00 4,212.00
DIMITRI)SYNDROME; VON HIPPEL-LINDAU SYNDROME
Q85.9 PHAKOMATOSIS, UNSPECIFIED; HAMARTOSIS NOS 14,040.00 9,828.00 4,212.00
CONGENITAL MALFORMATION SYNDROMES
PREDOMINANTLY AFFECTING FACIAL APPEARANCE;
ACROCEPHALOPOLYSYNDACTYLY;
Q87.0 ACROCEPHALOSYNDACTYLY [APERT]; CRYPTOPHTHALMOS 15,080.00 10,556.00 4,524.00
SYNDROME; CYCLOPIA; SYNDROME GOLDENHAR;
MOEBIUS SYNDROME; ORO-FACIAL-DIGITAL SYNDROME;
ROBIN SYNDROM
PREDOMINANTLY ASSOCIATED WITH SHORT STATURE;
AARSKOG SYNDROME; COCKAYNE SYNDROME; DE LANGE
Q87.1 SYNDROME ; DUBOWITZ SYNDROME; NOONAN; SYNDROME 15,080.00 10,556.00 4,524.00
PRADER-WILLI SYNDROME; ROBINOW-SILVERMAN-SMITH
SYNDROME ;
RUSSELL-SILVER; SYN
PREDOMINANTLY INVOLVING LIMBS; HOLT-ORAM
SYNDROME; KLIPPEL-TRéNAUNAY-WEBER SYNDROME;
Q87.2 NAIL PATELLA SYNDROME; 15,080.00 10,556.00 4,524.00
RUBINSTEIN-TAYBI SYNDROME; SIRENOMELIA
SYNDROME; THROMBOCYTOPENIA SYNDROME WITH
ABSENT RADIUS [TAR]; VAT
Page 109 of 126

First Case Rate

CONGENITAL MALFORMATION SYNDROMES INVOLVING
Q87.3 EARLY OVERGROWTH; BECKWITH-WIEDEMANN 15,080.00 10,556.00 4,524.00
SYNDROME; SOTOS; SYNDROME WEAVER SYNDROME
Q87.4 MARFAN'S SYNDROME 15,080.00 10,556.00 4,524.00
OTHER CONGENITAL MALFORMATION SYNDROMES WITH
Q87.5 6,890.00 4,823.00 2,067.00
OTHER SKELETAL CHANGES
OTHER SPECIFIED CONGENITAL MALFORMATION
SYNDROMES, NOT ELSEWHERE CLASSIFIED; ALPOR
Q87.8 15,080.00 10,556.00 4,524.00
SYNDROME; LAURENCE-MOON(-BARDET)-BIEDL
SYNDROME; ZELLWEGER SYNDROME
CONGENITAL MALFORMATIONS OF SPLEEN; ASPLENIA
Q89.0 15,080.00 10,556.00 4,524.00
(CONGENITAL); CONGENITAL SPLENOMEGALY
Q89.1 CONGENITAL MALFORMATIONS OF ADRENAL GLAND 15,080.00 10,556.00 4,524.00
CONGENITAL MALFORMATIONS OF OTHER ENDOCRINE
GLANDS; CONGENITAL MALFORMATION OF PARATHYROID
Q89.2 15,080.00 10,556.00 4,524.00
OR THYROID GLAND; PERSISTENT THYROGLOSSAL DUCT;
THYROGLOSSAL CYST
SITUS INVERSUS; DEXTROCARDIA WITH SITUS INVERSUS;
MIRROR-IMAGE ATRIAL ARRANGEMENT WITH SITUS
INVERSUS; SITUS INVERSUS OR TRANSVERSES
Q89.3 8,710.00 6,097.00 2,613.00
ABDOMINALIS; SITUS INVERSUS OR TRANSVERSUS
THORACIS; TRANSPOSITION OF ABDOMINAL VISCERA;
TRANSPOSITION OF THORACIC VISCE
CONJOINED TWINS; CRANIOPAGUS; DICEPHALY; DOUBLE
Q89.4 15,080.00 10,556.00 4,524.00
MONSTER; PYGOPAGUS; THORACOPAGUS
MULTIPLE CONGENITAL MALFORMATIONS, NOT
ELSEWHERE CLASSIFIED; MONSTER NOS; MULTIPLE
Q89.7 15,080.00 10,556.00 4,524.00
CONGENITAL ANOMALIES NOS; MULTIPLE CONGENITAL
DEFORMITIES NOS
Q89.8 OTHER SPECIFIED CONGENITAL MALFORMATIONS 15,080.00 10,556.00 4,524.00
CONGENITAL MALFORMATION, UNSPECIFIED; CONGENITAL
Q89.9 15,080.00 10,556.00 4,524.00
ANOMALY NOS; CONGENITAL DEFORMITY NOS
Q90.0 TRISOMY 21, MEIOTIC NONDISJUNCTION 16,510.00 11,557.00 4,953.00
Q90.2 TRISOMY 21, TRANSLOCATION 16,510.00 11,557.00 4,953.00
Q90.9 DOWN'S SYNDROME, UNSPECIFIED; TRISOMY 21 NOS 16,510.00 11,557.00 4,953.00
Q91.0 TRISOMY 18, MEIOTIC NONDISJUNCTION 16,510.00 11,557.00 4,953.00
Q91.2 TRISOMY 18, TRANSLOCATION 16,510.00 11,557.00 4,953.00
Q91.3 EDWARDS' SYNDROME, UNSPECIFIED 16,510.00 11,557.00 4,953.00
Q91.7 PATAU'S SYNDROME, UNSPECIFIED 16,510.00 11,557.00 4,953.00
TRISOMY AND PARTIAL TRISOMY OF AUTOSOMES,
Q92.9 16,510.00 11,557.00 4,953.00
UNSPECIFIED
WHOLE CHROMOSOME MONOSOMY, MOSAICISM (MITOTIC
Q93.1 16,510.00 11,557.00 4,953.00
NONDISJUNCTION)
Q93.2 CHROMOSOME REPLACED WITH RING OR DICENTRIC 16,510.00 11,557.00 4,953.00
DELETION OF SHORT ARM OF CHROMOSOME 5; CRI-DU-
Q93.4 16,510.00 11,557.00 4,953.00
CHAT SYNDROME
OTHER DELETIONS OF PART OF A CHROMOSOME;
Q93.5 16,510.00 11,557.00 4,953.00
ANGELMAN SYNDROME
Q93.7 DELETIONS WITH OTHER COMPLEX REARRANGEMENTS 16,510.00 11,557.00 4,953.00
Q93.9 DELETION FROM AUTOSOMES, UNSPECIFIED 16,510.00 11,557.00 4,953.00
BALANCED REARRANGEMENT AND STRUCTURAL MARKER,
Q95.9 16,510.00 11,557.00 4,953.00
UNSPECIFIED
Q96.9 TURNER'S SYNDROME, UNSPECIFIED 16,510.00 11,557.00 4,953.00
SEX CHROMOSOME ABNORMALITY, FEMALE PHENOTYPE,
Q97.9 16,510.00 11,557.00 4,953.00
UNSPECIFIED
Q98.4 KLINEFELTER'S SYNDROME, UNSPECIFIED 16,510.00 11,557.00 4,953.00
Q99.2 FRAGILE X CHROMOSOME; FRAGILE X SYNDROME 16,510.00 11,557.00 4,953.00
Q99.8 OTHER SPECIFIED CHROMOSOME ABNORMALITIES 16,510.00 11,557.00 4,953.00
R02 GANGRENE, NOT ELSEWHERE CLASSIFIED 17,160.00 12,012.00 5,148.00
R29.0 TETANY; CARPOPEDAL SPASM 21,450.00 15,015.00 6,435.00
R32 UNSPECIFIED URINARY INCONTINENCE; ENURESIS NOS 11,700.00 8,190.00 3,510.00
R41.0 DISORIENTATION, UNSPECIFIED; CONFUSION NOS 10,660.00 7,462.00 3,198.00
R41.3 OTHER AMNESIA; AMNESIA NOS 10,660.00 7,462.00 3,198.00
DIZZINESS AND GIDDINESS; LIGHT-HEADEDNESS; VERTIGO
R42 7,410.00 5,187.00 2,223.00
NOS
R50.9 FEVER, UNSPECIFIED; HYPERPYREXIA NOS; PYREXIA NOS 9,100.00 6,370.00 2,730.00
R51 HEADACHE; FACIAL PAIN NOS 7,150.00 5,005.00 2,145.00
SENILITY; OLD AGE WITHOUT MENTION OF PSYCHOSIS;
R54 SENESCENCE WITHOUT MENTION OF PSYCHOSIS; SENILE 10,660.00 7,462.00 3,198.00
ASTHENIA; SENILE DEBILITY
R56.0 FEBRILE CONVULSIONS 9,100.00 6,370.00 2,730.00
OTHER AND UNSPECIFIED CONVULSIONS; FIT NOS; SEIZURE
R56.8 9,100.00 6,370.00 2,730.00
(CONVULSIVE) NOS
R57.0 CARDIOGENIC SHOCK 41,600.00 29,120.00 12,480.00
R57.1 HYPOVOLAEMIC SHOCK 41,600.00 29,120.00 12,480.00
R57.8 OTHER SHOCK; ENDOTOXIC SHOCK 41,600.00 29,120.00 12,480.00
Page 110 of 126

First Case Rate

SHOCK, UNSPECIFIED; FAILURE OF PERIPHERAL
R57.9 41,600.00 29,120.00 12,480.00
CIRCULATION NOS
S00.0 SUPERFICIAL INJURY OF SCALP 5,200.00 3,640.00 1,560.00
S00.1 CONTUSION OF EYELID AND PERIOCULAR AREA; BLACK EYE 5,200.00 3,640.00 1,560.00
OTHER SUPERFICIAL INJURIES OF EYELID AND
S00.2 5,200.00 3,640.00 1,560.00
PERIOCULAR AREA
S00.3 SUPERFICIAL INJURY OF NOSE 5,200.00 3,640.00 1,560.00
S00.4 SUPERFICIAL INJURY OF EAR 5,200.00 3,640.00 1,560.00
S00.5 SUPERFICIAL INJURY OF LIP AND ORAL CAVITY 5,200.00 3,640.00 1,560.00
S00.7 MULTIPLE SUPERFICIAL INJURIES OF HEAD 5,200.00 3,640.00 1,560.00
S00.8 SUPERFICIAL INJURY OF OTHER PARTS OF HEAD 5,200.00 3,640.00 1,560.00
S00.9 SUPERFICIAL INJURY OF HEAD, PART UNSPECIFIED 5,200.00 3,640.00 1,560.00
S01.0 OPEN WOUND OF SCALP 5,200.00 3,640.00 1,560.00
S01.1 OPEN WOUND OF EYELID AND PERIOCULAR AREA 5,200.00 3,640.00 1,560.00
S01.2 OPEN WOUND OF NOSE 5,200.00 3,640.00 1,560.00
S01.3 OPEN WOUND OF EAR 5,200.00 3,640.00 1,560.00
S01.4 OPEN WOUND OF CHEEK AND TEMPOROMANDIBULAR AREA 5,200.00 3,640.00 1,560.00
S01.5 OPEN WOUND OF LIP AND ORAL CAVITY 5,200.00 3,640.00 1,560.00
S01.7 MULTIPLE OPEN WOUNDS OF HEAD 5,200.00 3,640.00 1,560.00
S01.8 OPEN WOUND OF OTHER PARTS OF HEAD 5,200.00 3,640.00 1,560.00
S01.9 OPEN WOUND OF HEAD, PART UNSPECIFIED 5,200.00 3,640.00 1,560.00
FRACTURE O F VAULT OF SKULL; FRACTURE OF FRONTAL
S02.0 13,910.00 9,737.00 4,173.00
BONE; FRACTURE OF PARIETAL BONE
CLOSED FRACTURE OF VAULT OF SKULL/ FRONTAL BONE/
S02.00 13,910.00 9,737.00 4,173.00
PARIETAL BONE
OPEN FRACTURE OF VAULT OF SKULL/ FRONTAL BONE/
S02.01 13,910.00 9,737.00 4,173.00
PARIETAL BONE
FRACTURE OF BASE OF SKULL: FRACTURE OF ANTERIOR
FOSSA, MIDDLE FOSSA, POSTERIOR FOSSA; FRACTURE OF
S02.1 OCCIPUT; FRACTURE OF ORBITAL ROOF; FRACTURE OF 13,910.00 9,737.00 4,173.00
ETHMOID SINUS & FRONTAL SINUS; FRACTURE OF
SPHENOID; FRACTURE OF TEMPORAL BONE
CLOSED FRACTURE OF BASE OF SKULL/ ANTERIOR FOSSA/
MIDDLE FOSSA/ POSTERIOR FOSSA/ OCCIPUT/ ORBITAL
S02.10 13,910.00 9,737.00 4,173.00
ROOF/ ETHMOID SINUS/ FRONTAL SINUS/ SPHENOID/
TEMPORAL BONE
OPEN FRACTURE OF BASE OF SKULL/ ANTERIOR FOSSA/
MIDDLE FOSSA/ POSTERIOR FOSSA/ OCCIPUT/ ORBITAL
S02.11 13,910.00 9,737.00 4,173.00
ROOF/ ETHMOID SINUS/ FRONTAL SINUS/ SPHENOID/
TEMPORAL BONE
S02.20 CLOSED FRACTURE OF NASAL BONES 13,910.00 9,737.00 4,173.00
S02.21 OPEN FRACTURE OF NASAL BONES 13,910.00 9,737.00 4,173.00
S02.30 CLOSED FRACTURE OF ORBITAL FLOOR 13,910.00 9,737.00 4,173.00
S02.31 OPEN FRACTURE OF ORBITAL FLOOR 13,910.00 9,737.00 4,173.00
S02.40 CLOSED FRACTURE OF MALAR AND MAXILLARY BONES 13,910.00 9,737.00 4,173.00
S02.41 OPEN FRACTURE OF MALAR AND MAXILLARY BONES 13,910.00 9,737.00 4,173.00
S02.50 CLOSED FRACTURE OF TOOTH 13,910.00 9,737.00 4,173.00
S02.60 CLOSED FRACTURE OF MANDIBLE 13,910.00 9,737.00 4,173.00
S02.61 OPEN FRACTURE OF MANDIBLE 13,910.00 9,737.00 4,173.00
CLOSED MULTIPLE FRACTURES INVOLVING SKULL AND
S02.70 13,910.00 9,737.00 4,173.00
FACIAL BONES
OPEN MULTIPLE FRACTURES INVOLVING SKULL AND
S02.71 13,910.00 9,737.00 4,173.00
FACIAL BONES
CLOSED FRACTURES OF OTHER SKULL AND FACIAL BONES
S02.80 13,910.00 9,737.00 4,173.00
INCLUDING ALVEOLUS, ORBIT NOS, PALATE
OPEN FRACTURES OF OTHER SKULL AND FACIAL BONES
S02.81 13,910.00 9,737.00 4,173.00
INCLUDING ALVEOLUS, ORBIT NOS, PALATE
CLOSED FRACTURE OF SKULL AND FACIAL BONES, PART
S02.90 13,910.00 9,737.00 4,173.00
UNSPECIFIED
OPEN FRACTURE OF SKULL AND FACIAL BONES, PART
S02.91 13,910.00 9,737.00 4,173.00
UNSPECIFIED
INJURY OF OPTIC NERVE AND PATHWAYS; INJURY OF OPTIC
S04.0 CHIASM; INJURY OF 2ND CRANIAL NERVE; INJURY OF 11,440.00 8,008.00 3,432.00
VISUAL CORTEX
INJURY OF OCULOMOTOR NERVE; INJURY OF 3RD CRANIAL
S04.1 11,440.00 8,008.00 3,432.00
NERVE
INJURY OF ABDUCENT NERVE; INJURY OF 6TH CRANIAL
S04.4 11,440.00 8,008.00 3,432.00
NERVE
S04.5 INJURY OF FACIAL NERVE; INJURY OF 7TH CRANIAL NERVE 11,440.00 8,008.00 3,432.00
INJURY OF ACOUSTIC NERVE; INJURY OF AUDITORY NERVE;
S04.6 11,440.00 8,008.00 3,432.00
INJURY OF 8TH CRANIAL NERVE
INJURY OF OTHER CRANIAL NERVES; INJURY OF
GLOSSOPHARYNGEAL [9TH] NERVE; INJURY OF
S04.8 11,440.00 8,008.00 3,432.00
HYPOGLOSSAL [12TH] NERVE; INJURY OF; INJURY OF
OLFACTORY [1ST] NERVE; INJURY OF VAGUS [10TH] NERVE
S04.9 INJURY OF UNSPECIFIED CRANIAL NERVE 11,440.00 8,008.00 3,432.00
Page 111 of 126

First Case Rate

INJURY OF CONJUNCTIVA AND CORNEAL ABRASION
S05.0 11,440.00 8,008.00 3,432.00
WITHOUT MENTION OF FOREIGN BODY
CONCUSSION; COMMOTIO CEREBRI (WITHOUT OPEN
S06.00 11,440.00 8,008.00 3,432.00
INTRACRANIAL WOUND)
CONCUSSION; COMMOTIO CEREBRI (WITH OPEN
S06.01 11,440.00 8,008.00 3,432.00
INTRACRANIAL WOUND)
TRAUMATIC CEREBRAL OEDEMA (WITHOUT OPEN
S06.10 11,440.00 8,008.00 3,432.00
INTRACRANIAL WOUND)
DIFFUSE BRAIN INJURY; CEREBRAL CONTUSION NOS;
S06.20 CEREBRAL LACERATION NOS; TRAUMATIC COMPRESSION 11,440.00 8,008.00 3,432.00
OF BRAIN NOS (WITHOUT OPEN INTRACRANIAL WOUND)
DIFFUSE BRAIN INJURY; CEREBRAL CONTUSION NOS;

S06.21 CEREBRAL LACERATION NOS; TRAUMATIC COMPRESSION 11,440.00 8,008.00 3,432.00
OF BRAIN NOS (WITHOUT OPEN INTRACRANIAL WOUND)
FOCAL BRAIN INJURY; FOCAL CEREBRAL; FOCAL CEREBRAL

CONTUSION; FOCAL CEREBRAL LACERATION; FOCAL
S06.30 11,440.00 8,008.00 3,432.00
TRAUMATIC INTRACEREBRAL HAEMORRHAGE (WITHOUT
OPEN INTRACRANIAL WOUND)
FOCAL BRAIN INJURY; FOCAL CEREBRAL; FOCAL CEREBRAL

CONTUSION; FOCAL CEREBRAL LACERATION; FOCAL
S06.31 11,440.00 8,008.00 3,432.00
TRAUMATIC INTRACEREBRAL HAEMORRHAGE (WITH OPEN
INTRACRANIAL WOUND)
EPIDURAL HAEMORRHAGE; EXTRADURAL HAEMORRHAGE,

S06.40 11,440.00 8,008.00 3,432.00
TRAUMATIC (WITHOUT OPEN INTRACRANIAL WOUND)
EPIDURAL HAEMORRHAGE; EXTRADURAL HAEMORRHAGE,

S06.41 11,440.00 8,008.00 3,432.00
TRAUMATIC (WITH OPEN INTRACRANIAL WOUND)
TRAUMATIC SUBDURAL HAEMORRHAGE (WITHOUT OPEN
S06.50 11,440.00 8,008.00 3,432.00
INTRACRANIAL WOUND)
TRAUMATIC SUBDURAL HAEMORRHAGE (WITH OPEN
S06.51 11,440.00 8,008.00 3,432.00
INTRACRANIAL WOUND)
TRAUMATIC SUBARACHNOID HAEMORRHAGE (WITHOUT
S06.60 11,440.00 8,008.00 3,432.00
OPEN INTRACRANIAL WOUND)
TRAUMATIC SUBARACHNOID HAEMORRHAGE (WITH OPEN
S06.61 11,440.00 8,008.00 3,432.00
INTRACRANIAL WOUND)
INTRACRANIAL INJURY WITH PROLONGED COMA
S06.70 11,440.00 8,008.00 3,432.00
(WITHOUT OPEN INTRACRANIAL WOUND)
OTHER INTRACRANIAL INJURIES; TRAUMATIC
HAEMORRHAGE CEREBELLAR; TRAUMATIC HAEMORRHAGE
S06.80 11,440.00 8,008.00 3,432.00
INTRACRANIAL NOS (WITHOUT OPEN INTRACRANIAL
WOUND)
OTHER INTRACRANIAL INJURIES; TRAUMATIC
S06.81 HAEMORRHAGE CEREBELLAR; TRAUMATIC HAEMORRHAGE 11,440.00 8,008.00 3,432.00
INTRACRANIAL NOS (WITH OPEN INTRACRANIAL WOUND)
INTRACRANIAL INJURY, UNSPECIFIED; BRAIN INJURY NOS

S06.90 11,440.00 8,008.00 3,432.00
(WITHOUT OPEN INTRACRANIAL WOUND)
INTRACRANIAL INJURY, UNSPECIFIED; BRAIN INJURY NOS
S06.91 11,440.00 8,008.00 3,432.00
(WITH OPEN INTRACRANIAL WOUND)
INJURY OF BLOOD VESSELS OF HEAD, NOT ELSEWHERE
S09.0 11,440.00 8,008.00 3,432.00
CLASSIFIED
S09.1 INJURY OF MUSCLE AND TENDON OF HEAD 11,440.00 8,008.00 3,432.00
S09.2 TRAUMATIC RUPTURE OF EAR DRUM 11,440.00 8,008.00 3,432.00
S09.7 MULTIPLE INJURIES OF HEAD 11,440.00 8,008.00 3,432.00
S09.8 OTHER SPECIFIED INJURIES OF HEAD 11,440.00 8,008.00 3,432.00
UNSPECIFIED INJURY OF HEAD; INJURY OF FACE NOS;
S09.9 11,440.00 8,008.00 3,432.00
INJURY OF EAR NOS; INJURY OF NOSE NOS
S14.0 CONCUSSION AND OEDEMA OF CERVICAL SPINAL CORD 23,920.00 16,744.00 7,176.00
S16 INJURY OF MUSCLE AND TENDON AT NECK LEVEL 9,360.00 6,552.00 2,808.00
FRACTURE OF THORACIC VERTEBRA; FRACTURE OF
S22.00 11,310.00 7,917.00 3,393.00
THORACIC SPINE NOS (CLOSED)
S22.10 MULTIPLE FRACTURES OF THORACIC SPINE (CLOSED) 11,310.00 7,917.00 3,393.00
S22.2 FRACTURE OF STERNUM 11,310.00 7,917.00 3,393.00
S22.20 FRACTURE OF STERNUM (CLOSED) 11,310.00 7,917.00 3,393.00
S22.3 FRACTURE OF RIB 11,310.00 7,917.00 3,393.00
S22.30 FRACTURE OF RIB (CLOSED) 11,310.00 7,917.00 3,393.00
S22.31 FRACTURE OF RIB (OPEN) 11,310.00 7,917.00 3,393.00
S22.4 MULTIPLE FRACTURES OF RIBS 11,310.00 7,917.00 3,393.00
S22.40 MULTIPLE FRACTURES OF RIBS (CLOSED) 11,310.00 7,917.00 3,393.00
S22.41 MULTIPLE FRACTURES OF RIBS (OPEN) 11,310.00 7,917.00 3,393.00
S22.80 FRACTURE OF OTHER PARTS OF BONY THORAX (CLOSED) 11,310.00 7,917.00 3,393.00
S22.90 FRACTURE OF BONY THORAX, PART UNSPECIFIED (CLOSED) 11,310.00 7,917.00 3,393.00
S34.0 CONCUSSION AND OEDEMA OF LUMBAR SPINAL CORD 23,920.00 16,744.00 7,176.00
Page 112 of 126

First Case Rate

INJURY OF MUSCLE AND TENDON OF ABDOMEN, LOWER
S39.0 9,360.00 6,552.00 2,808.00
BACK AND PELVIS
DISLOCATION OF SHOULDER JOINT; DISLOCATION OF
S43.0 9,360.00 6,552.00 2,808.00
GLENOHUMERAL JOINT
SPRAIN AND STRAIN OF SHOULDER JOINT; SPRAIN AND
S43.4 STRAIN OF CORACOHUMERAL (LIGAMENT); SPRAIN AND 9,360.00 6,552.00 2,808.00
STRAIN OF ROTATOR CUFF CAPSULE
SPRAIN AND STRAIN OF ACROMIOCLAVICULAR JOINT;
S43.5 9,360.00 6,552.00 2,808.00
SPRAIN AND STRAIN OF ACROMIOCLAVICULAR LIGAMENT
SPRAIN AND STRAIN OF OTHER AND UNSPECIFIED PARTS
S43.7 OF SHOULDER GIRDLE; SPRAIN AND STRAIN OF SHOULDER 9,360.00 6,552.00 2,808.00
GIRDLE NOS
S46.0 INJURY OF TENDON OF THE ROTATOR CUFF OF SHOULDER 9,360.00 6,552.00 2,808.00
S46.1 INJURY OF MUSCLE AND TENDON OF LONG HEAD OF BICEPS 9,360.00 6,552.00 2,808.00
INJURY OF MUSCLE AND TENDON OF OTHER PARTS OF
S46.2 9,360.00 6,552.00 2,808.00
BICEPS
INJURY OF MULTIPLE MUSCLES AND TENDONS AT
S46.7 9,360.00 6,552.00 2,808.00
SHOULDER AND UPPER ARM LEVEL
INJURY OF OTHER MUSCLES AND TENDONS AT SHOULDER
S46.8 9,360.00 6,552.00 2,808.00
AND UPPER ARM LEVEL
INJURY OF UNSPECIFIED MUSCLE AND TENDON AT
S46.9 9,360.00 6,552.00 2,808.00
SHOULDER AND UPPER ARM LEVEL
S53.4 SPRAIN AND STRAIN OF ELBOW 9,360.00 6,552.00 2,808.00
INJURY OF FLEXOR MUSCLE AND TENDON OF THUMB AT
S56.0 9,360.00 6,552.00 2,808.00
FOREARM LEVEL
INJURY OF LONG FLEXOR MUSCLE AND TENDON OF OTHER
S56.1 9,360.00 6,552.00 2,808.00
FINGER(S) AT FOREARM LEVEL
INJURY OF OTHER FLEXOR MUSCLE AND TENDON AT
S56.2 9,360.00 6,552.00 2,808.00
FOREARM LEVEL
INJURY OF EXTENSOR OR ABDUCTOR MUSCLES AND
S56.3 9,360.00 6,552.00 2,808.00
TENDONS OF THUMB AT FOREARM LEVEL
OPEN WOUND OF FINGER(S) WITHOUT DAMAGE TO NAIL;
S61.0 5,200.00 3,640.00 1,560.00
OPEN WOUND OF FINGER(S) NOS
S61.1 OPEN WOUND OF FINGER(S) WITH DAMAGE TO NAIL 5,200.00 3,640.00 1,560.00
S61.7 MULTIPLE OPEN WOUNDS OF WRIST AND HAND 5,200.00 3,640.00 1,560.00
S61.8 OPEN WOUND OF OTHER PARTS OF WRIST AND HAND 5,200.00 3,640.00 1,560.00
OPEN WOUND OF WRIST AND HAND PART, PART
S61.9 5,200.00 3,640.00 1,560.00
UNSPECIFIED
SPRAIN AND STRAIN OF WRIST; SPRAIN AND STRAIN OF
S63.5 CARPAL JOINT; SPRAIN AND STRAIN OF RADIOCARPAL 9,360.00 6,552.00 2,808.00
JOINT; SPRAIN AND STRAIN OF RADIOCARPAL LIGAMENT
SPRAIN AND STRAIN OF FINGER(S); SPRAIN AND STRAIN OF

INTERPHALANGEAL JOINT, HAND; SPRAIN AND STRAIN
S63.6 9,360.00 6,552.00 2,808.00
METACARPOPHALANGEAL JOINT; SPRAIN AND STRAIN OF
PHALANX, HAND; SPRAIN AND STRAIN OF THUMB
S63.7 9,360.00 6,552.00 2,808.00
OF HAND
INJURY OF FLEXOR MUSCLE AND TENDON OF OTHER
S66.1 9,360.00 6,552.00 2,808.00
FINGER AT WRIST AND HAND LEVEL
INJURY OF EXTENSOR MUSCLE AND TENDON OF OTHER
S66.3 9,360.00 6,552.00 2,808.00
INJURY OF INTRINSIC MUSCLE AND TENDON OF OTHER
S66.5 9,360.00 6,552.00 2,808.00
INJURY OF MULTIPLE FLEXOR MUSCLES AND TENDONS AT
S66.6 9,360.00 6,552.00 2,808.00
WRIST AND HAND LEVEL
INJURY OF OTHER MUSCLES AND TENDONS AT WRIST AND
S66.8 9,360.00 6,552.00 2,808.00
HAND LEVEL
INJURY OF UNSPECIFIED MUSCLE AND TENDON AT WRIST
S66.9 9,360.00 6,552.00 2,808.00
AND HAND LEVEL
S73.1 SPRAIN AND STRAIN OF HIP 9,360.00 6,552.00 2,808.00
INJURY OF QUADRICEPS MUSCLE AND TENDON; INJURY OF
S76.1 9,360.00 6,552.00 2,808.00
PATELLAR LIGAMENT (TENDON)
S76.2 INJURY OF ADDUCTOR MUSCLE AND TENDON OF THIGH 9,360.00 6,552.00 2,808.00
INJURY OF MUSCLE AND TENDON OF THE POSTERIOR
S76.3 9,360.00 6,552.00 2,808.00
MUSCLE GROUP AT THIGH LEVEL
INJURY OF OTHER AND UNSPECIFIED MUSCLES AND
S76.4 9,360.00 6,552.00 2,808.00
TENDONS AT THIGH LEVEL
S81.0 OPEN WOUND OF KNEE 5,200.00 3,640.00 1,560.00
S81.7 MULTIPLE OPEN WOUNDS OF LOWER LEG 5,200.00 3,640.00 1,560.00
S81.8 OPEN WOUND OF OTHER PARTS OF LOWER LEG 5,200.00 3,640.00 1,560.00
S81.9 OPEN WOUND OF LOWER LEG, PART UNSPECIFIED 5,200.00 3,640.00 1,560.00
SPRAIN AND STRAIN INVOLVING FIBULAR COLLATERAL
S83.4 LIGAMENT OF KNEE; SPRAIN AND STRAIN INVOLVING 9,360.00 6,552.00 2,808.00
TIBIAL COLLATERAL LIGAMENT OF KNEE
Page 113 of 126

First Case Rate

SPRAIN AND STRAIN INVOLVING ANTERIOR CRUCIATE
S83.5 LIGAMENT OF KNEE; SPRAIN AND STRAIN INVOLVING 9,360.00 6,552.00 2,808.00
POSTERIOR CRUCIATE LIGAMENT OF KNEE
S83.6 9,360.00 6,552.00 2,808.00
OF KNEE
INJURY OF OTHER MUSCLES AND TENDONS AT LOWER LEG
S86.8 9,360.00 6,552.00 2,808.00
LEVEL
INJURY OF UNSPECIFIED MUSCLE AND TENDON AT LOWER
S86.9 9,360.00 6,552.00 2,808.00
LEG LEVEL
S91.0 OPEN WOUND OF ANKLE 5,200.00 3,640.00 1,560.00
OPEN WOUND OF TOE(S) WITHOUT DAMAGE TO NAIL; OPEN
S91.1 5,200.00 3,640.00 1,560.00
WOUND OF TOE (S) NOS
S91.2 OPEN WOUND OF TOE(S) WITH DAMAGE TO NAIL 5,200.00 3,640.00 1,560.00
OPEN WOUND OF OTHER PARTS OF FOOT; OPEN WOUND OF
S91.3 5,200.00 3,640.00 1,560.00
FOOT NOS
S91.7 MULTIPLE OPEN WOUNDS OF ANKLE AND FOOT 5,200.00 3,640.00 1,560.00
SPRAIN AND STRAIN OF ANKLE INCLUDING
CALCANEOFIBULAR (LIGAMENT), DELTOID (LIGAMENT),
S93.4 9,360.00 6,552.00 2,808.00
INTERNAL COLLATERAL (LIGAMENT), TALOFIBULAR
(LIGAMENT), TIBIOFIBULAR , DISTAL (LIGAMENT)
SPRAIN AND STRAIN OF TOE(S) INCLUDING
S93.5 INTERPHALANGEAL (JOINT(S), METATARSOPHALANGEAL 9,360.00 6,552.00 2,808.00
(JOINT(S)
S93.6 OF FOOT INCLUDING TARSAL (LIGAMENT), 9,360.00 6,552.00 2,808.00
TARSOMETATARSAL (LIGAMENT)
INJURY OF MUSCLE AND TENDON OF LONG FLEXOR
S96.0 9,360.00 6,552.00 2,808.00
MUSCLE OF TOE AT ANKLE AND FOOT LEVEL
INJURY OF UNSPECIFIED MUSCLE AND TENDON AT ANKLE
S96.9 9,360.00 6,552.00 2,808.00
AND FOOT LEVEL
T00.0 SUPERFICIAL INJURIES INVOLVING HEAD WITH NECK 5,200.00 3,640.00 1,560.00
SUPERFICIAL INJURIES INVOLVING THORAX WITH
T00.1 5,200.00 3,640.00 1,560.00
ABDOMEN LOWER BACK AND PELVIS
SUPERFICIAL INJURIES INVOLVING MULTIPLE REGIONS OF
T00.2 5,200.00 3,640.00 1,560.00
UPPER LIMB(S)
T00.3 5,200.00 3,640.00 1,560.00
LOWER LIMB(S)
T00.6 5,200.00 3,640.00 1,560.00
UPPER LIMB(S) WITH LOWER LIMB(S)
SUPERFICIAL INJURIES INVOLVING OTHER COMBINATIONS
T00.8 5,200.00 3,640.00 1,560.00
OF BODY REGIONS
MULTIPLE SUPERFICIAL INJURIES, UNSPECIFIED;
MULTIPLE ABRASIONS NOS; MULTIPLE NONTHERMAL
T00.9 BLISTERS NOS; MULTIPLE BRUISES NOS; MULTIPLE 5,200.00 3,640.00 1,560.00
CONTUSIONS NOS; MULTIPLE HAEMATOMAS NOS;
MULTIPLE NONVENOMOUS INSECT BITE NOS
MULTIPLE DISLOCATIONS, SPRAINS AND STRAINS,
T03.9 9,360.00 6,552.00 2,808.00
UNSPECIFIED
T20.2 BURN OF SECOND DEGREE OF HEAD AND NECK 13,780.00 9,646.00 4,134.00
T20.3 BURN OF THIRD DEGREE OF HEAD AND NECK 13,780.00 9,646.00 4,134.00
T20.4 CORROSION OF UNSPECIFIED DEGREE OF HEAD AND NECK 11,050.00 7,735.00 3,315.00
T20.6 CORROSION OF SECOND DEGREE OF HEAD AND NECK 13,780.00 9,646.00 4,134.00
T21.0 BURN OF UNSPECIFIED DEGREE OF TRUNK 11,050.00 7,735.00 3,315.00
T21.2 BURN OF SECOND DEGREE OF TRUNK 11,050.00 7,735.00 3,315.00
T21.3 BURN OF THIRD DEGREE OF TRUNK 20,930.00 14,651.00 6,279.00
T21.5 CORROSION OF FIRST DEGREE OF TRUNK 11,050.00 7,735.00 3,315.00
T21.6 CORROSION OF SECOND DEGREE OF TRUNK 11,050.00 7,735.00 3,315.00
BURN OF SECOND DEGREE OF SHOULDER AND UPPER LIMB,
T22.2 11,050.00 7,735.00 3,315.00
EXCEPT WRIST AND HAND
BURN OF THIRD DEGREE OF SHOULDER AND UPPER LIMB,
T22.3 13,780.00 9,646.00 4,134.00
EXCEPT WRIST AND HAND
CORROSION OF FIRST DEGREE OF SHOULDER AND UPPER
T22.5 11,050.00 7,735.00 3,315.00
LIMB, EXCEPT WRIST AND HAND
CORROSION OF SECOND DEGREE OF SHOULDER AND UPPER
T22.6 11,050.00 7,735.00 3,315.00
LIMB, EXCEPT WRIST AND HAND
T23.2 BURN OF SECOND DEGREE OF WRIST AND HAND 11,050.00 7,735.00 3,315.00
T23.3 BURN OF THIRD DEGREE OF WRIST AND HAND 13,780.00 9,646.00 4,134.00
T23.4 CORROSION OF UNSPECIFIED DEGREE OF WRIST AND HAND 11,050.00 7,735.00 3,315.00
T23.6 CORROSION OF SECOND DEGREE OF WRIST AND HAND 13,780.00 9,646.00 4,134.00
T23.7 CORROSION OF THIRD DEGREE OF WRIST AND HAND 13,780.00 9,646.00 4,134.00
BURN OF SECOND DEGREE OF HIP AND LOWER LIMB,
T24.2 11,050.00 7,735.00 3,315.00
EXCEPT ANKLE AND FOOT
BURN OF THIRD DEGREE OF HIP AND LOWER LIMB, EXCEPT
T24.3 13,780.00 9,646.00 4,134.00
ANKLE AND FOOT
CORROSION OF FIRST DEGREE OF HIP AND LOWER LIMB,
T24.5 11,050.00 7,735.00 3,315.00
Page 114 of 126

First Case Rate

CORROSION OF SECOND DEGREE OF HIP AND LOWER LIMB,
T24.6 11,050.00 7,735.00 3,315.00
CORROSION OF THIRD DEGREE OF HIP AND LOWER LIMB,
T24.7 13,780.00 9,646.00 4,134.00
T25.2 BURN OF SECOND DEGREE OF ANKLE AND FOOT 11,050.00 7,735.00 3,315.00
T25.3 BURN OF THIRD DEGREE OF ANKLE AND FOOT 13,780.00 9,646.00 4,134.00
T25.5 CORROSION OF FIRST DEGREE OF ANKLE AND FOOT 11,050.00 7,735.00 3,315.00
T26.0 BURN OF EYELID AND PERIOCULAR AREA 11,050.00 7,735.00 3,315.00
T26.1 BURN OF CORNEA AND CONJUNCTIVAL SAC 13,780.00 9,646.00 4,134.00
BURN WITH RESULTING RUPTURE AND DESTRUCTION OF
T26.2 13,780.00 9,646.00 4,134.00
EYEBALL
T26.3 BURN OF OTHER PARTS OF EYE AND ADNEXA 13,780.00 9,646.00 4,134.00
T26.4 BURN OF EYE AND ADNEXA, PART UNSPECIFIED 11,050.00 7,735.00 3,315.00
T26.6 CORROSION OF CORNEA AND CONJUNCTIVAL SAC 13,780.00 9,646.00 4,134.00
T26.9 CORROSION OF EYE AND ADNEXA, PART UNSPECIFIED 11,050.00 7,735.00 3,315.00
T27.0 BURN OF LARYNX AND TRACHEA 13,780.00 9,646.00 4,134.00
BURN OF OTHER PARTS OF RESPIRATORY TRACT; THORACIC
T27.2 13,780.00 9,646.00 4,134.00
CAVITY
T27.3 BURN OF RESPIRATORY TRACT, PART UNSPECIFIED 11,050.00 7,735.00 3,315.00
T27.7 CORROSION OF RESPIRATORY TRACT, PART UNSPECIFIED 11,050.00 7,735.00 3,315.00
T28.0 BURN OF MOUTH AND PHARYNX 13,780.00 9,646.00 4,134.00
T28.1 BURN OF OESOPHAGUS 13,780.00 9,646.00 4,134.00
T28.2 BURN OF OTHER PARTS OF ALIMENTARY TRACT 13,780.00 9,646.00 4,134.00
T28.3 BURN OF INTERNAL GENITOURINARY ORGANS 13,780.00 9,646.00 4,134.00
T28.5 CORROSION OF MOUTH AND PHARYNX 13,780.00 9,646.00 4,134.00
T28.6 CORROSION OF OESOPHAGUS 13,780.00 9,646.00 4,134.00
T28.7 CORROSION OF OTHER PARTS OF ALIMENTARY TRACT 13,780.00 9,646.00 4,134.00
T28.8 CORROSION OF INTERNAL GENITOURINARY ORGANS 13,780.00 9,646.00 4,134.00
CORROSION OF OTHER AND UNSPECIFIED INTERNAL
T28.9 11,050.00 7,735.00 3,315.00
ORGANS
BURNS OF MULTIPLE REGIONS, NO MORE THAN FIRST-
T29.1 11,050.00 7,735.00 3,315.00
DEGREE BURNS MENTIONED
BURNS OF MULTIPLE REGIONS, NO MORE THAN SECOND-
T29.2 13,780.00 9,646.00 4,134.00
DEGREE BURNS MENTIONED
BURNS OF MULTIPLE REGIONS, AT LEAST ONE BURN OF
T29.3 13,780.00 9,646.00 4,134.00
THIRD DEGREE MENTIONED
CORROSIONS OF MULTIPLE REGIONS, NO MORE THAN
T29.6 13,780.00 9,646.00 4,134.00
SECOND-DEGREE CORROSIONS MENTIONED
BURN OF UNSPECIFIED BODY REGION, UNSPECIFIED
T30.0 11,050.00 7,735.00 3,315.00
DEGREE; BURN NOS
BURN OF SECOND DEGREE, BODY REGION UNSPECIFIED;
T30.2 11,050.00 7,735.00 3,315.00
SECODN-DEGREE BURN NOS
BURN OF THIRD DEGREE, BODY REGION UNSPECIFIED;
T30.3 11,050.00 7,735.00 3,315.00
THIRD-DEGREE BURN NOS
CORROSION OF UNSPECIFIED BODY REGION, UNSPECIFIED
T30.4 11,050.00 7,735.00 3,315.00
DEGREE; CORROSION NOS
CORROSION OF FIRST DEGREE, BODY REGION
T30.5 11,050.00 7,735.00 3,315.00
UNSPECIFIED; FIRST-DEGREE CORROSION NOS
CORROSION OF SECOND DEGREE, BODY REGION
T30.6 11,050.00 7,735.00 3,315.00
UNSPECIFIED; SECOND-DEGREE CORROSION NOS
CORROSION OF THIRD DEGREE, BODY REGION
T30.7 11,050.00 7,735.00 3,315.00
UNSPECIFIED; THRID-DEGREE CORROSION NOS
T31.0 BURNS INVOLVING LESS THAN 10% OF BODY SURFACE 11,050.00 7,735.00 3,315.00
T31.1 BURNS INVOLVING 10-19% OF BODY SURFACE 11,050.00 7,735.00 3,315.00
T31.9 BURNS INVOLVING 90% OR MORE OF BODY SURFACE 20,930.00 14,651.00 6,279.00
CORROSIONS INVOLVING LESS THAN 10% OF BODY
T32.0 11,050.00 7,735.00 3,315.00
SURFACE
T32.1 CORROSIONS INVOLVING 10-19% OF BODY SURFACE 11,050.00 7,735.00 3,315.00
T32.9 CORROSIONS INVOLVING 90% OR MORE OF BODY SURFACE 20,930.00 14,651.00 6,279.00
T34.1 FROSTBITE WITH TISSUE NECROSIS OF NECK 11,050.00 7,735.00 3,315.00
FROSTBITE WITH TISSUE NECROSIS OF OTHER AND
UNSPECIFIED SITES; FROSBITE WITH TISSUE NECROSIS
T34.9 13,780.00 9,646.00 4,134.00
NOS; FROSBITE WITH TISSUE OF LEG NOS; FROSBITE WITH
TISSUE NECROSIS OF TRUNK NOS
SUPERFICIAL FROSTBITE INVOLVING MULTIPLE BODY
T35.0 11,050.00 7,735.00 3,315.00
REGIONS; MULTIPLE SUPERFICIAL FROSBITE NOS
Page 115 of 126

First Case Rate

FROSTBITE WITH TISSUE NECROSIS INVOLVING MULTIPLE
T35.1 BODY REGIONS; MULTIPLE FROSBITE WITH TISSUE 11,050.00 7,735.00 3,315.00
NECROSIS NOS
T36.0 POISONING BY PENICILLINS 9,490.00 6,643.00 2,847.00
POISONING BY CEFALOSPORINS AND OTHER ß-LACTAM
T36.1 9,490.00 6,643.00 2,847.00
ANTIBIOTICS
T36.2 POISONING BY CHLORAMPHENICOL GROUP 9,490.00 6,643.00 2,847.00
T36.3 POISONING BY MACROLIDES 9,490.00 6,643.00 2,847.00
T36.4 POISONING BY TETRACYCLINES 9,490.00 6,643.00 2,847.00
T36.5 POISONING BY AMINOGLYCOSIDES; STREPTOMYCIN 9,490.00 6,643.00 2,847.00
T36.6 POISONING BY RIFAMYCINS 9,490.00 6,643.00 2,847.00
T36.8 POISONING BY OTHER SYSTEMIC ANTIBIOTICS 9,490.00 6,643.00 2,847.00
T36.9 POISONING BY SYSTEMIC ANTIBIOTIC, UNSPECIFIED 9,490.00 6,643.00 2,847.00
T37.0 POISONING BY SULFONAMIDES 9,490.00 6,643.00 2,847.00
T37.1 POISONING BY ANTIMYCOBACTERIAL DRUGS 9,490.00 6,643.00 2,847.00
POISONING BY ANTIMALARIALS AND DRUGS ACTING ON
T37.2 9,490.00 6,643.00 2,847.00
OTHER BLOOD PROTOZOA
T37.4 POISONING BY ANTHELMINTHICS 9,490.00 6,643.00 2,847.00
T37.5 POISONING BY ANTIVIRAL DRUGS 9,490.00 6,643.00 2,847.00
POISONING BY OTHER SPECIFIED SYSTEMIC ANTI-
T37.8 INFECTIVES AND ANTIPARASITICS; POISONING BY 9,490.00 6,643.00 2,847.00
HYDROXYQUINOLINE DERIVATIVES
POISONING BY SYSTEMIC ANTI-INFECTIVE AND
T37.9 9,490.00 6,643.00 2,847.00
ANTIPARASITIC, UNSPECIFIED
POISONING BY GLUCOCORTICOIDS AND SYNTHETIC
T38.0 11,050.00 7,735.00 3,315.00
ANALOGUES
T38.1 POISONING BY THYROID HORMONES AND SUBSTITUTES 11,050.00 7,735.00 3,315.00
T38.2 POISONING BY ANTITHYROID DRUGS 11,050.00 7,735.00 3,315.00
POISONING BY INSULIN AND ORAL HYPOGLYCAEMIC
T38.3 11,050.00 7,735.00 3,315.00
[ANTIDIABETIC] DRUGS
POISONING BY ORAL CONTRACEPTIVES; POISONING BY
T38.4 11,050.00 7,735.00 3,315.00
MULTIPLE-AND-SINGLE-INGREDIENT PREPARATIONS
POISONING BY OTHER ESTROGENS AND PROGESTOGENS;
T38.5 11,050.00 7,735.00 3,315.00
MIXTURES AND SUBSTITUTES
POISONING BY ANTIGONADOTROPHINS, ANTIESTROGENS,
T38.6 ANTIANDROGENS, NOT ELSEWHERE CLASSIFIED; 11,050.00 7,735.00 3,315.00
POISONING BY TAMOXIFEN
T38.7 POISONING BY ANDROGENS AND ANABOLIC CONGENERS 11,050.00 7,735.00 3,315.00
T39.0 POISONING BY SALICYLATES 9,620.00 6,734.00 2,886.00
T39.1 POISONING BY 4-AMINOPHENOL DERIVATIVES 9,620.00 6,734.00 2,886.00
POISONING BY OTHER NONSTEROIDAL ANTI-
T39.3 9,620.00 6,734.00 2,886.00
INFLAMMATORY DRUGS [NSAID]
POISONING BY OTHER NONOPIOID ANALGESICS AND
T39.8 9,620.00 6,734.00 2,886.00
ANTIPYRETICS, NOT ELSEWHERE CLASSIFIED
POISONING BY NONOPIOID ANALGESIC, ANTIPYRETIC AND
T39.9 9,620.00 6,734.00 2,886.00
ANTIRHEUMATIC, UNSPECIFIED
POISONING BY OTHEROPIOIDS; POISONING BY CODEINE;
T40.2 8,710.00 6,097.00 2,613.00
POISONING BY MORPHINE
POISONING BY OTHER SYNTHETIC NARCOTICS; POISONING
T40.4 8,710.00 6,097.00 2,613.00
BY PETHIDINE
T40.6 POISONING BY OTHER AND UNSPECIFIED NARCOTICS 8,710.00 6,097.00 2,613.00
T40.7 POISONING BY CANNABIS (DERIVATIVES) 8,710.00 6,097.00 2,613.00
POISONING BY OTHER AND UNSPECIFIED
PSYCHODYSLEPTICS [HALLUCINOGENS]; POISONING BY
T40.9 8,710.00 6,097.00 2,613.00
MESCALINE; POISONING BY PSILOCIN; POISONING BY
PSILOCYBINE
T41.0 POISONING BY INHALED ANAESTHETICS 8,710.00 6,097.00 2,613.00
POISONING BY INTRAVENOUS ANAESTHETICS;
T41.1 8,710.00 6,097.00 2,613.00
THIOBARBITURATES
T41.3 POISONING BY LOCAL ANAESTHETICS 8,710.00 6,097.00 2,613.00
POISONING BY THERAPEUTIC GASES; CARBON DIOXIDE;
T41.5 8,710.00 6,097.00 2,613.00
OXYGEN
T42.0 POISONING BY HYDANTOIN DERIVATIVES 8,710.00 6,097.00 2,613.00
T42.1 POISONING BY IMINOSTILBENES; CARBAMAZEPINE 8,710.00 6,097.00 2,613.00
T42.2 POISONING BY SUCCINIMIDES AND OXAZOLIDINEDIONES 8,710.00 6,097.00 2,613.00
T42.3 POISONING BY BARBITURATES 8,710.00 6,097.00 2,613.00
T42.4 POISONING BY BENZODIAZEPINES 8,710.00 6,097.00 2,613.00
POISONING BY OTHER ANTIEPILEPTIC AND SEDATIVE-
T42.6 HYPNOTICDRUGS; POISONING BY 8,710.00 6,097.00 2,613.00
METHAQUALONE;POISONING BY VALPROIC ACID
POISONING BY ANTIEPILEPTIC AND SEDATIVE-HYPNOTIC
DRUGS, UNSPECIFIED; POISONING BY DRAUGHT SLEEPING
T42.7 8,710.00 6,097.00 2,613.00
NOS; POISONING BY SLEEPING DRUG NOS;POISONING BY
SLEEPING TABLET NOS
POISONING BY ANTIPARKINSONISM DRUGS AND OTHER
T42.8 CENTRAL MUSCLE-TONE DEPRESSANTS; POISONING BY 8,710.00 6,097.00 2,613.00
AMANTADINE
POISONING BY OTHER AND UNSPECIFIED
T43.2 8,710.00 6,097.00 2,613.00
ANTIDEPRESSANTS
Page 116 of 126

First Case Rate

POISONING BY PHENOTHIAZINE ANTIPSYCHOTICS AND
T43.3 8,710.00 6,097.00 2,613.00
NEUROLEPTICS
POISONING BY BUTYROPHENONE AND THIOXANTHENE
T43.4 8,710.00 6,097.00 2,613.00
NEUROLEPTICS
POISONING BY OTHER AND UNSPECIFIED ANTIPSYCHOTICS
T43.5 8,710.00 6,097.00 2,613.00
AND NEUROLEPTICS
POISONING BY PSYCHOSTIMULANTS WITH ABUSE
T43.6 8,710.00 6,097.00 2,613.00
POTENTIAL
T43.9 POISONING BY PSYCHOTROPIC DRUG, UNSPECIFIED 8,710.00 6,097.00 2,613.00
POISONING BY OTHER PARASYMPATHOMIMETICS
T44.1 8,710.00 6,097.00 2,613.00
[CHOLINERGICS]
POISONING BY GANGLIONIC BLOCKING DRUGS, NOT
T44.2 8,710.00 6,097.00 2,613.00
POISONING BY OTHER PARASYMPATHOLYTICS
[ANTICHOLINERGICS AND ANTIMUSCARINICS] AND
T44.3 8,710.00 6,097.00 2,613.00
SPASMOLYTICS, NOT ELSEWHERE CLASSIFIED; POISONING
BYPAPAVERINE
POISONING BY PREDOMINANTLY ?-ADRENORECEPTOR
T44.4 AGONISTS, NOT ELSEWHERE CLASSIFIED; POISONING BY 8,710.00 6,097.00 2,613.00
METARAMINOL
POISONING BY PREDOMINANTLY ß-ADRENORECEPTOR
T44.5 8,710.00 6,097.00 2,613.00
AGONISTS, NOT ELSEWHERE CLASSIFIED
POISONING BY ?-ADRENORECEPTOR ANTAGONISTS, NOT
T44.6 8,710.00 6,097.00 2,613.00
POISONING BY ß-ADRENORECEPTOR ANTAGONISTS, NOT
T44.7 8,710.00 6,097.00 2,613.00
POISONING BY OTHER AND UNSPECIFIED DRUGS
PRIMARILY AFFECTING THE AUTONOMIC NERVOUS
T44.9 8,710.00 6,097.00 2,613.00
SYSTEM; DRUG STIMULATING BOTH ?-AND ß-
ADRENORECEPTORS
T45.0 POISONING BY ANTIALLERGIC AND ANTIEMETIC DRUGS 8,710.00 6,097.00 2,613.00
POISONING BY ANTINEOPLASTIC AND
IMMUNOSUPPRESSIVE DRUGS; POISONING BY
T45.1 8,710.00 6,097.00 2,613.00
ANTINEOPLASTIC ANTIBIOTICS; POISONING BY
CYTARABINE
T45.2 POISONING BY VITAMINS, NOT ELSEWHERE CLASSIFIED 8,710.00 6,097.00 2,613.00
T45.3 POISONING BY ENZYMES, NOT ELSEWHERE CLASSIFIED 8,710.00 6,097.00 2,613.00

T45.4 POISONING BY IRON AND ITS COMPOUNDS 9,490.00 6,643.00 2,847.00
T45.5 POISONING BY ANTICOAGULANTS 9,490.00 6,643.00 2,847.00
T45.6 POISONING BY FIBRINOLYSIS-AFFECTING DRUGS 9,490.00 6,643.00 2,847.00
POISONING BY ANTICOAGULANT ANTAGONISTS, VITAMIN K
T45.7 9,490.00 6,643.00 2,847.00
AND OTHER COAGULANTS
POISONING BY OTHER PRIMARILY SYSTEMIC AND
HAEMATOLOGICAL AGENTS; POISONING BY LIVER
T45.8 PREPARATIONS AND OTHER ANTIANAEMIC AGENTS; 9,490.00 6,643.00 2,847.00
POISONING BY NATURAL BLOOD AND BLOOD PRODUCTS;
POISONING BY PLASMA SUBSTITUTE
PRIMARILY SYSTEMIC AND HAEMATOLOGICAL AGENT,
T45.9 9,490.00 6,643.00 2,847.00
UNSPECIFIED
POISONING BY CARDIAC-STIMULANT GLYCOSIDES AND
T46.0 16,250.00 11,375.00 4,875.00
DRUGS OF SIMILAR ACTION
T46.1 POISONING BY CALCIUM-CHANNEL BLOCKERS 16,250.00 11,375.00 4,875.00
POISONING BY OTHER ANTIDYSRHYTHMIC DRUGS, NOT
T46.2 16,250.00 11,375.00 4,875.00
POISONING BY CORONARY VASODILATORS, NOT
T46.3 16,250.00 11,375.00 4,875.00
ELSEWHERE CLASSIFIED; POISONING BY DIPYRIDAMOLE
POISONING BY OTHER ANTIHYPERTENSIVE DRUGS, NOT
ELSEWHERE CLASSIFIED; POISONING BY
T46.5 16,250.00 11,375.00 4,875.00
CLONIDINE;POISONING BY GUANETHIDINE; POISONING BY
RAUWOLFIA
POISONING BY ANTIHYPERLIPIDAEMIC AND
T46.6 16,250.00 11,375.00 4,875.00
ANTIARTERIOSCLEROTIC DRUGS
POISONING BY PERIPHERAL VASODILATORS;POISONING BY
T46.7 16,250.00 11,375.00 4,875.00
NICOTIMIC ACID (DERIVATIVES)
POISONING BY OTHER AND UNSPECIFIED AGENTS

T46.9 16,250.00 11,375.00 4,875.00
PRIMARILY AFFECTING THE CARDIOVASCULAR SYSTEM
T47.0 POISONING BY HISTAMINEH2-RECEPTOR ANTAGONISTS 10,790.00 7,553.00 3,237.00

POISONING BY OTHER ANTACIDS AND ANTI-GASTRIC-
T47.1 10,790.00 7,553.00 3,237.00
SECRETION DRUGS
T47.2 POISONING BY STIMULANT LAXATIVES 10,790.00 7,553.00 3,237.00
T47.3 POISONING BY SALINE AND OSMOTIC LAXATIVES 10,790.00 7,553.00 3,237.00
POISONING BY OTHER LAXATIVES; POISONING BY
T47.4 10,790.00 7,553.00 3,237.00
INTESTINAL ATONIA DRUGS
T47.5 POISONING BY DIGESTANTS 10,790.00 7,553.00 3,237.00
T47.6 POISONING BY ANTIDIARRHOEAL DRUGS 10,790.00 7,553.00 3,237.00
Page 117 of 126

First Case Rate

POISONING BY OTHER AGENTS PRIMARILY AFFECTING THE
T47.8 10,790.00 7,553.00 3,237.00
GASTROINTESTINAL SYSTEM
POISONING BY AGENT PRIMARILY AFFECTING THE
T47.9 10,790.00 7,553.00 3,237.00
GASTROINTESTINAL SYSTEM, UNSPECIFIED
POISONING BY SKELETAL MUSCLE RELAXANTS
T48.1 10,790.00 7,553.00 3,237.00
[NEUROMUSCULAR BLOCKING AGENTS]
T48.3 POISONING BY ANTITUSSIVES 8,060.00 5,642.00 2,418.00
T48.4 POISONING BY EXPECTORANTS 8,060.00 5,642.00 2,418.00
T48.5 POISONING BY ANTI-COMMON-COLD DRUGS 8,060.00 5,642.00 2,418.00
POISONING BY ANTIASTHMATICS, NOT ELSEWHERE
T48.6 CLASSIFIED; ?-ADRENORECEPTOR AGONISTS USED IN 8,060.00 5,642.00 2,418.00
ASTHMA THERAPHY; POISONING BY SALBUTAMOL
POISONING BY LOCAL ASTRINGENTS AND LOCAL
T49.2 6,890.00 4,823.00 2,067.00
DETERGENTS
POISONING BY EMOLLIENTS, DEMULCENTS AND
T49.3 6,890.00 4,823.00 2,067.00
PROTECTANTS
POISONING BY KERATOLYTICS, KERATOPLASTICS AND
T49.4 6,890.00 4,823.00 2,067.00
OTHER HAIR TREATMENT DRUGS AND PREPARATIONS
POISONING BY OPHTHALMOLOGICAL DRUGS AND
T49.5 PREPARATIONS; POISONING BY EYE, NOSE AND THROAT 6,890.00 4,823.00 2,067.00
ANTI-INFECTIVES
T49.7 POISONING BY DENTAL DRUGS, TOPICALLY APPLIED 6,890.00 4,823.00 2,067.00
T49.8 OTHERTOPICAL AGENTS; SPERMICIDES 6,890.00 4,823.00 2,067.00
T49.9 POISONING BY TOPICAL AGENT, UNSPECIFIED 6,890.00 4,823.00 2,067.00
POISONING BY MINERALOCORTICOIDS AND THEIR
T50.0 8,190.00 5,733.00 2,457.00
ANTAGONISTS
T50.1 POISONING BY LOOP [HIGH-CEILING] DIURETICS 8,190.00 5,733.00 2,457.00
POISONING BY CARBONIC-ANHYDRASE INHIBITORS,
T50.2 BENZOTHIADIAZIDES AND OTHER DIURETICS;POISONING 8,190.00 5,733.00 2,457.00
BY ACETAZOLAMIDE
T50.4 POISONING BY DRUGS AFFECTING URIC ACID METABOLISM 8,190.00 5,733.00 2,457.00
POISONING BY ANALEPTICS AND OPIOID RECEPTOR
T50.7 8,710.00 6,097.00 2,613.00
ANTAGONISTS
POISONING BY OTHER AND UNSPECIFIED DRUGS,
MEDICAMENTS AND BIOLOGICAL SUBSTANCES; POISONING
BY ACIDIFYING AGENTS; POISONING BY ALKALIZING
T50.9 8,190.00 5,733.00 2,457.00
AGENTS; POISONING BY IMMUNOGLOBULIN; POISONING BY
IMMUNOLOGICALS; POISONING BY LIPOTROPIC DRUGS;
POISONING BY PARATHY
TOXIC EFFECT OF ETHANOL;TOXIC EFFECT OF ETHYL
T51.0 8,320.00 5,824.00 2,496.00
ALCOHOL
TOXIC EFFECT OF 2-PROPANOL; TOXIC EFFECT OF
T51.2 8,320.00 5,824.00 2,496.00
ISOPROPHYL ACLOHOL
TOXIC EFFECT OF FUSEL OIL; TOXIC EFFECT OF AMYL
T51.3 ALCOHOL; TOXIC EFFECT OF BUTYL ALCOHOL [1-BUTANOL]; 8,320.00 5,824.00 2,496.00
TOXIC EFFECT OF PROPYL ALCOHOL [1-PROPONOL]
T51.8 TOXIC EFFECT OF OTHER ALCOHOLS 8,320.00 5,824.00 2,496.00
T51.9 TOXIC EFFECT OF ALCOHOL, UNSPECIFIED 8,320.00 5,824.00 2,496.00
TOXIC EFFECT OF PETROLEUM PRODUCTS; TOXIC EFFECT
OF GASOLINE [PETROL]; TOXIC EFFECT OF KEROSINE
[PARAFFIN OIL]; TOXIC EFFECT OF PARAFFIN WAX; TOXIC
T52.0 8,320.00 5,824.00 2,496.00
EFFECT OF PETROLEUM ETHER; TOXIC EFFECT OF
PETROLEUM NAPHTHA; TOXIC EFFECT OF PETROLEUM
SPIRITS
TOXIC EFFECT OF HOMOLOGUES OF BENZENE; TOXIC
T52.2 EFFECT OF TOLUENE [METHYLBENZENE]; TOXIC EFFECT OF 8,320.00 5,824.00 2,496.00
XYLENE [DIMETHYLBENZENE]
T52.4 TOXIC EFFECT OF KETONES 8,320.00 5,824.00 2,496.00
T52.8 TOXIC EFFECT OF OTHER ORGANIC SOLVENTS 8,320.00 5,824.00 2,496.00
T52.9 TOXIC EFFECT OF ORGANIC SOLVENT, UNSPECIFIED 8,320.00 5,824.00 2,496.00
TOXIC EFFECT OF CARBON TETRACHLORIDE;TOXIC EFFECT
T53.0 8,320.00 5,824.00 2,496.00
OF TETRACHLOROMETHANE
TOXIC EFFECT OF CHLOROFORM; TOXIC EFFECT OF
T53.1 8,320.00 5,824.00 2,496.00
TRICHLOROMETHANE
TOXIC EFFECT OF DICHLOROMETHANE;TOXIC EFFECT OF
T53.4 8,320.00 5,824.00 2,496.00
METHYLENE CHLORIDE
TOXIC EFFECT OF OTHER HALOGEN DERIVATIVES OF
T53.6 8,320.00 5,824.00 2,496.00
ALIPHATIC HYDROCARBONS
TOXIC EFFECT OF HALOGEN DERIVATIVE OF ALIPHATIC
T53.9 8,320.00 5,824.00 2,496.00
AND AROMATIC HYDROCARBONS, UNSPECIFIED
TOXIC EFFECT OF OTHER CORROSIVE ORGANIC
T54.1 8,320.00 5,824.00 2,496.00
COMPOUNDS
TOXIC EFFECT OF CORROSIVE ACIDS AND ACID-LIKE
T54.2 SUBSTANCES; TOXIC EFFECT OF ACID 8,320.00 5,824.00 2,496.00
HYDROCHLORIE;TOXIC EFFECT OF ACID SULFURIE
TOXIC EFFECT OF CORROSIVE ALKALIS AND ALKALI-LIKE
T54.3 SUBSTANCES; TOXIC EFFECT OF POTASSIUM 8,320.00 5,824.00 2,496.00
HYDROXIDE;TOXIC EFFECT OF SODIUM HYDROXIDE
Page 118 of 126

First Case Rate

T54.9 TOXIC EFFECT OF CORROSIVE SUBSTANCE, UNSPECIFIED 8,320.00 5,824.00 2,496.00
T55 TOXIC EFFECT OF SOAPS AND DETERGENTS 8,320.00 5,824.00 2,496.00
T56.0 TOXIC EFFECT OF LEAD AND ITS COMPOUNDS 8,320.00 5,824.00 2,496.00
T56.1 TOXIC EFFECT OF MERCURY AND ITS COMPOUNDS 8,320.00 5,824.00 2,496.00
T56.5 TOXIC EFFECT OF ZINC AND ITS COMPOUNDS 8,320.00 5,824.00 2,496.00
T56.8 TOXIC EFFECT OF OTHER METALS 8,320.00 5,824.00 2,496.00
T57.0 TOXIC EFFECT OF ARSENIC AND ITS COMPOUNDS 8,320.00 5,824.00 2,496.00
T57.1 TOXIC EFFECT OF PHOSPHORUS AND ITS COMPOUNDS 8,320.00 5,824.00 2,496.00
T57.3 TOXIC EFFECT OF HYDROGEN CYANIDE 8,320.00 5,824.00 2,496.00
TOXIC EFFECT OF OTHER SPECIFIED IN ORGANIC
T57.8 8,320.00 5,824.00 2,496.00
SUBSTANCES
T57.9 TOXIC EFFECT OF INORGANIC SUBSTANCE, UNSPECIFIED 8,320.00 5,824.00 2,496.00
T58 TOXIC EFFECT OF CARBON MONOXIDE FROM ALL SOURCES 8,320.00 5,824.00 2,496.00
T59.0 TOXIC EFFECT OF NITROGEN OXIDES 8,320.00 5,824.00 2,496.00
T59.2 TOXIC EFFECT OF FORMAL DEHYDE 8,320.00 5,824.00 2,496.00
TOXIC EFFECT OF LACRIMOGENIC GAS; TOXIC EFFECT OF
T59.3 8,320.00 5,824.00 2,496.00
TEAR GAS
T59.4 TOXIC EFFECT OF CHLORINE GAS 8,320.00 5,824.00 2,496.00
T59.7 TOXIC EFFECT OF CARBON DIOXIDE 8,320.00 5,824.00 2,496.00
TOXIC EFFECT OF OTHER SPECIFIED GASES, FUMES AND
T59.8 8,320.00 5,824.00 2,496.00
VAPOURS
TOXIC EFFECT OF GASES, FUMES AND VAPOURS,
T59.9 8,320.00 5,824.00 2,496.00
UNSPECIFIED
TOXIC EFFECT OF ORGANOPHOSPHATE AND CARBAMATE
T60.0 8,320.00 5,824.00 2,496.00
INSECTICIDES
T60.1 TOXIC EFFECT OF HALOGENATED INSECTICIDES 8,320.00 5,824.00 2,496.00
T60.2 TOXIC EFFECT OF OTHER INSECTICIDES 8,320.00 5,824.00 2,496.00
T60.3 TOXIC EFFECT OF HERBICIDES AND FUNGICIDES 8,320.00 5,824.00 2,496.00
TOXIC EFFECT OF RODENTICIDES; TOXIC EFFECT OF
T60.4 8,320.00 5,824.00 2,496.00
THALLIUM
T60.8 TOXIC EFFECT OF OTHER PESTICIDES 8,320.00 5,824.00 2,496.00
T60.9 TOXIC EFFECT OF PESTICIDE, UNSPECIFIED 8,320.00 5,824.00 2,496.00
T61.0 TOXIC EFFECT OF CIGUATERA FISH POISONING 7,410.00 5,187.00 2,223.00
TOXIC EFFECT OF SCOMBROID FISH POISONING;TOXIC
T61.1 7,410.00 5,187.00 2,223.00
EFFECT OF HISTAMINE-LIKE SYNDROME
T61.2 TOXIC EFFECT OF OTHER FISH AND SHELLFISH POISONING 7,410.00 5,187.00 2,223.00
T61.8 TOXIC EFFECT OF OTHER SEAFOODS 7,410.00 5,187.00 2,223.00
T61.9 TOXIC EFFECT OF UNSPECIFIED SEAFOOD 7,410.00 5,187.00 2,223.00
T62.0 TOXIC EFFECT OF INGESTED MUSHROOMS 7,410.00 5,187.00 2,223.00
T62.1 TOXIC EFFECT OF INGESTED BERRIES 7,410.00 5,187.00 2,223.00
T62.2 TOXIC EFFECT OF OTHER INGESTED (PARTS OF) PLANT(S) 7,410.00 5,187.00 2,223.00
TOXIC EFFECT OF OTHER SPECIFIED NOXIOUS
T62.8 7,410.00 5,187.00 2,223.00
SUBSTANCES EATEN AS FOOD
TOXIC EFFECT OF NOXIOUS SUBSTANCE EATEN AS FOOD,
T62.9 7,410.00 5,187.00 2,223.00
UNSPECIFIED
TOXIC EFFECT OF SNAKE VENOM;TOXIC EFFECT OF SEA-
T63.0 7,410.00 5,187.00 2,223.00
SNAKE VENOM
TOXIC EFFECT OF VENOM OF OTHER REPTILES; TOXIC
T63.1 7,410.00 5,187.00 2,223.00
EFFECT OF LIZARD VENOM
T63.2 TOXIC EFFECT OF VENOM OF SCORPION 7,410.00 5,187.00 2,223.00
T63.3 TOXIC EFFECT OF VENOM OF SPIDER 7,410.00 5,187.00 2,223.00
TOXIC EFFECT OF VENOM OF OTHER ARTHROPODS;TOXIC
T63.4 7,410.00 5,187.00 2,223.00
EFFECT OF INSECT BITE OR STING, VENOMOUS
T63.5 TOXIC EFFECT OF CONTACT WITH FISH 7,410.00 5,187.00 2,223.00
TOXIC EFFECT OF CONTACT WITH OTHER MARINE
T63.6 ANIMALS; JELLYFISH; SEA ANEMONE; SHELLFISH; 7,410.00 5,187.00 2,223.00
STARFISH
TOXIC EFFECT OF CONTACT WITH OTHER VENOMOUS
T63.8 7,410.00 5,187.00 2,223.00
ANIMALS; VENOM OF AMPHIBIAN
TOXIC EFFECT OF CONTACT WITH UNSPECIFIED VENOMOUS
T63.9 7,410.00 5,187.00 2,223.00
ANIMAL
TOXIC EFFECT OF AFLATION AND OTHER MYCOTOXIN FOOD
T64 7,410.00 5,187.00 2,223.00
CONTAMINANTS
T65.0 TOXIC EFFECT OF CYANIDES 8,320.00 5,824.00 2,496.00
T65.2 TOXIC EFFECT OF TOBACCO AND NICOTINE 7,410.00 5,187.00 2,223.00
TOXIC EFFECT OF NITRO DERIVATIVES AND
AMINODERIVATIVES OF BENZENE AND ITS HOMOLOGUES;
T65.3 8,320.00 5,824.00 2,496.00
TOXIC EFFECT OF ANILINE [BENZENAMINE]; TOXIC EFFECT
OF NITROBENZENE; TOXIC EFFECT OF TRINITROTOLUENE
T65.4 TOXIC EFFECT OF CARBONDISULFIDE 8,320.00 5,824.00 2,496.00
TOXIC EFFECT OF PAINTS AND DYES, NOT ELSEWHERE
T65.6 8,320.00 5,824.00 2,496.00
CLASSIFIED
T65.8 TOXIC EFFECT OF OTHER SPECIFIED SUBSTANCES 8,320.00 5,824.00 2,496.00
T66 UNSPECIFIED EFFECTS OF RADIATION 12,090.00 8,463.00 3,627.00
Page 119 of 126

First Case Rate

HEAT STROKE AND SUNSTROKE; HEAT APOPLEXY; HEAT
T67.0 8,450.00 5,915.00 2,535.00
PYREXIA; SIRIASIS; THERMOPLEGIA
T67.1 HEAT SYNCOPE; HEAT COLLAPSE 8,450.00 5,915.00 2,535.00
T67.2 HEAT CRAMP 8,450.00 5,915.00 2,535.00
HEAT EXHAUSTION, ANHYDROTIC; HEAT PROSTRATION
T67.3 8,450.00 5,915.00 2,535.00
DUE TO WATER DEPLETION
HEAT EXHAUSTION DUE TO SALT DEPLETION; HEAT
T67.4 8,450.00 5,915.00 2,535.00
PROSTATION DUE TO SALT (AND WATER) DEPLETION
HEAT EXHAUSTION, UNSPECIFIED; HEAT PROSTRATION
T67.5 8,450.00 5,915.00 2,535.00
NOS
T67.6 HEAT FATIGUE, TRANSIENT 12,090.00 8,463.00 3,627.00
T67.8 OTHER EFFECTS OF HEAT AND LIGHT 12,090.00 8,463.00 3,627.00
T67.9 EFFECT OF HEAT AND LIGHT, UNSPECIFIED 8,450.00 5,915.00 2,535.00
T68 HYPOTHERMIA 12,090.00 8,463.00 3,627.00
T69.0 IMMERSION HAND AND FOOT; TRENCH FOOT 12,090.00 8,463.00 3,627.00
T69.9 EFFECT OF REDUCED TEMPERATURE, UNSPECIFIED 12,090.00 8,463.00 3,627.00
OTITIC BAROTRAUMA; AERO-OTITIS MEDIA; EFFECTS OF
T70.0 CHANGE IN AMBIENT ATMOSPHERIC PRESSURE ON 12,090.00 8,463.00 3,627.00
SINUSES
OTHER AND UNSPECIFIED EFFECTS OF HIGH ALTITUDE;
ALPINE SICKNESS; ANOXIA DUE TO HIGH ALTITUDE;
T70.2 12,090.00 8,463.00 3,627.00
BAROTRAUMA NOS; HYPOBAROPATHY; MOUNTAIN
SICKNESS
CAISSON DISEASE [DECOMPRESSION SICKNESS];
T70.3 12,090.00 8,463.00 3,627.00
COMPRESSED-AIR DISEASE; DIVER'S PALSY OR PARALYSIS
EFFECTS OF HIGH-PRESSURE FLUIDS; TRAUMATIC JET
T70.4 12,090.00 8,463.00 3,627.00
INJECTION (INDUSTRIAL)
OTHER EFFECTS OF AIR PRESSURE AND WATER PRESSURE;
T70.8 12,090.00 8,463.00 3,627.00
BLAST INJURY SYNDROME
EFFECT OF AIR PRESSURE AND WATER PRESSURE,
T70.9 12,090.00 8,463.00 3,627.00
UNSPECIFIED
EFFECTS OF LIGHTNING; SHOCK FROM LIGHTNING; STRUCK
T75.0 7,020.00 4,914.00 2,106.00
BY LIGHTNING NOS
DROWNING AND NONFATAL SUBMERSION; IMMERSION;
T75.1 9,230.00 6,461.00 2,769.00
SWIMMER'S CRAMP
EFFECTS OF VIBRATION; PNEUMATIC HAMMER SYNDROME;
T75.2 TRAUMATIC VASOSPASTIC SYNDROME; VARTIGO FROM 12,090.00 8,463.00 3,627.00
INFRASOUND
EFFECTS OF ELECTRIC CURRENT; ELECTROCUTION; SHOCK
T75.4 7,020.00 4,914.00 2,106.00
FROM ELECTRIC CURRENT
OTHER SPECIFIED INJURIES DUE TO ENVIRONMENTAL AND
OTHER EXTERNAL FACTORS CAUSES; EFFECTS OF
T75.8 12,090.00 8,463.00 3,627.00
ABNORMAL GRAVITATION [G] FORCES; EFFECTS OF
WEIGHTLESSNESS
T78.0 ANAPHYLACTIC SHOCK DUE TO ADVERSE FOOD REACTION 9,880.00 6,916.00 2,964.00
OTHER ADVERSE FOOD REACTIONS, NOT ELSEWHERE
T78.1 8,060.00 5,642.00 2,418.00
CLASSIFIED
ANAPHYLACTIC SHOCK, UNSPECIFIED; ALLERGIC SHOCK
T78.2 9,880.00 6,916.00 2,964.00
NOS; ANAPHYLACTIC REACTION NOS; ANAPHYLAXIS NOS
ANGIONEUROTIC OEDEMA; GIANT URTICARIA; QUINKE'S
T78.3 8,060.00 5,642.00 2,418.00
OEDEMA
ALLERGY, UNSPECIFIED; ALLERGIC REACTION NOS;
T78.4 8,060.00 5,642.00 2,418.00
HYPERSENSITIVITY NOS; IDIOSYNCRACY NOS
T78.8 OTHER ADVERSE EFFECTS, NOT ELSEWHERE CLASSIFIED 8,060.00 5,642.00 2,418.00
T78.9 ADVERSE EFFECT, UNSPECIFIED 8,060.00 5,642.00 2,418.00
T79.0 AIR EMBOLISM (TRAUMATIC) 12,090.00 8,463.00 3,627.00
T79.1 FAT EMBOLISM (TRAUMATIC) 12,090.00 8,463.00 3,627.00
T79.2 TRAUMATIC SECONDARY AND RECURRENT HAEMORRHAGE 12,090.00 8,463.00 3,627.00
POST-TRAUMATIC WOUND INFECTION, NOT ELSEWHERE
T79.3 12,090.00 8,463.00 3,627.00
CLASSIFIED
TRAUMATIC SHOCK; IMMEDIATE SHOCK FOLLOWING
T79.4 12,090.00 8,463.00 3,627.00
INJURY; DELAYED SHOCK FOLLOWING INJURY
TRAUMATIC ANURIA; CRUSH SYNDROME; RENAL FAILURE
T79.5 12,090.00 8,463.00 3,627.00
FOLLOWING CRUSHING
TRAUMATIC ISCHAEMIA OF MUSCLE; COMPARTMENT
T79.6 12,090.00 8,463.00 3,627.00
SYNDROME; VOLKMANN'S ISCHAEMIC CONTRACTURE
T79.7 TRAUMATIC SUBCUTANEOUS EMPHYSEMA 12,090.00 8,463.00 3,627.00
T79.8 OTHER EARLY COMPLICATIONS OF TRAUMA 12,090.00 8,463.00 3,627.00
HAEMORRHAGE AND HAEMATOMA COMPLICATING A
PROCEDURE, NOT ELSEWHERE CLASSIFIED;
T81.0 13,390.00 9,373.00 4,017.00
HAEMORRHAGE AT ANY SITE RESULTING FROM A
PROCEDURE
Page 120 of 126

First Case Rate

SHOCK DURING OR RESULTING FROM A PROCEDURE NOT
ELSEWHERE CLASSIFIED; COLLAPSE NOS DURING OR
FOLLOWING A PROCEDURE; ENDOTOXIC SHOCK DURING OR
T81.1 13,390.00 9,373.00 4,017.00
FOLLOWING A PROCEDURE; HYPOVOLAEMIC DURING OR
FOLLOWING A PROCEDURE; SEPTIC SHOCK DURING OR
FOLLOWING A PROCEDURE;
ACCIDENTAL PUNCTURE AND LACERATION DURING A

PROCEDURE NOT ELSEWHERE CLASSIFIED; ACCIDENTAL
PERFORATION OF BLOOD VESSEL BY CATHETER,
T81.2 13,390.00 9,373.00 4,017.00
ENDOSCOPE, INSTRUMENT, PROBE DURING A PROCEDURE;
ACCIDENTAL PERFORATION OF NERVE BY CATHETER,
ENDOSCOPE, INSTRUMENT, PROBE
DISRUPTION OF OPERATION WOUND, NOT ELSEWHERE
T81.3 CLASSIFIED; DEHISCENE OF OPERATION WOUND; RUPTURE 13,390.00 9,373.00 4,017.00
OF OPERATION WOUND
INFECTION FOLLOWING A PROCEDURE, NOT ELSEWHERE
CLASSIFIED; INTRA-ABDOMINAL ABSCESS
POSTPROCEDURAL ABCESS; INTRA-ABDOMINAL STITCH
T81.4 13,390.00 9,373.00 4,017.00
POSTPROCEDURAL ABSCESS; INTRA-ABDOMINAL
SUBPHRENIC POSTPROCEDURAL ABCESS; INTRA-
ABDOMINAL WOUND POSTPROCEDURAL ABCESS; SEPTICA
OTHER COMPLICATIONS OF PROCEDURES, NOT
ELSEWHERE CLASSIFIED; COMPLICATION OF INHALATION
T81.8 THERAPY; EMPHYSEMA (SUBCUTANEOUS) RESULTING 13,390.00 9,373.00 4,017.00
FROM A PROCEDURE; PERSISTENT POSTOPERATIVE
FISTULA
MECHANICAL COMPLICATION OF HEART VALVE
PROSTHESIS; MECHANICAL BREAKDOWN DUE TO HEART
VALVE PROSTHESIS; DISPLACEMENT DUE TO HEART VALVE
T82.0 13,390.00 9,373.00 4,017.00
PROSTHESIS; FAILURE DUE TO HEART VALVE PROSTHESIS;
LEAKAGE DUE TO HEART VALVE PROSTHESIS;
MALPOSITION DUE TO HEART VALVE
MECHANICAL COMPLICATION OF CARDIAC ELECTRONIC
DEVICE; CONDITIONS LISTED IN T82.0 DUE TO
T82.1 13,390.00 9,373.00 4,017.00
ELECTRODES; CONDITIONS LISTED IN T82.0 DUE TO PULSE
GENERATOR (BATTERY)
MECHANICAL COMPLICATION OF CORONARY ARTERY
T82.2 13,390.00 9,373.00 4,017.00
BYPASS AND VALVE GRAFTS
MECHANICAL COMPLICATION OF OTHER VASCULAR
GRAFTS; CONDITION LISTED IN T82.0 DUE TO AORTIC
T82.3 (BIFURCATION) GRAFT (REPLACEMENT); CONDITION 13,390.00 9,373.00 4,017.00
LISTED IN T82.0 DUE TO ARTERIAL (CAROTID) (FEMORAL)
GRAFT (BYPASS)
MECHANICAL COMPLICATION OF VASCULAR DIALYSIS
T82.4 13,390.00 9,373.00 4,017.00
CATHETER
MECHANICAL COMPLICATION OF OTHER CARDIAC AND
VASCULAR DEVICES AND IMPLANTS; CONDITIONS LISTED
IN T82.0 DUE TO ARTERIOVENOUS FISTULA SURGICALLY
T82.5 13,390.00 9,373.00 4,017.00
CREATED; ARTERIVENOUS SHUNT SURGICALLY CREATED;
ARTIFICIAL HEART; BALLON COUNTERPULSATION DEVICE;
INFUSION CAT
INFECTION AND INFLAMMATORY REACTION DUE TO OTHER

T82.7 13,390.00 9,373.00 4,017.00
CARDIAC AND VASCULAR DEVICES, IMPLANTS AND GRAFTS
OTHER COMPLICATIONS OF CARDIAC AND VASCULAR

PROSTHETIC DEVICES, IMPLANTS AND GRAFTS;
COMPLICATION DUE TO CARDIAC AND VASCULAR
T82.8 13,390.00 9,373.00 4,017.00
PROSTHETIC DEVICES, IMPLANTS AND GRAFTS; EMBOLISM
DUE TO CARDIAC AND VASCULAR PROSTHETIC DEVICES,
IMPLANTS AND GRAFTS; FIBROSIS D
MECHANICAL COMPLICATION OF OTHER URINARY DEVICES

AND IMPLANTS; CONCDITIONS LISTED IN T82.0 DUE TO
T83.1 13,390.00 9,373.00 4,017.00
URINARY ELECTRONIC STIMULTOR DEVICE; URINARY
SPHINCTER IMPLANT; URINARY STENT
MECHANICAL COMPLICATION OF GRAFT OF URINARY
T83.2 13,390.00 9,373.00 4,017.00
ORGAN
MECHANICAL COMPLICATION OF INTRAUTERINE
T83.3 13,390.00 9,373.00 4,017.00
CONTRACEPTIVE DEVICE
INFECTION AND INFLAMMATORY REACTION DUE TO
T83.5 PROSTHETIC DEVICE, IMPLANT AND GRAFT IN URINARY 13,390.00 9,373.00 4,017.00
SYSTEM
OTHER COMPLICATIONS OF GENITOURINARY PROSTHETIC
T83.8 13,390.00 9,373.00 4,017.00
DEVICES, IMPLANTS AND GRAFTS
UNSPECIFIED COMPLICATION OF GENITOURINARY
T83.9 13,390.00 9,373.00 4,017.00
PROSTHETIC DEVICE, IMPLANTS AND GRAFTS
MECHANICAL COMPLICATION OF INTERNAL JOINT
T84.0 13,390.00 9,373.00 4,017.00
PROSTHESIS
Page 121 of 126

First Case Rate

MECHANICAL COMPLICATION OF INTERNAL FIXATION
T84.1 13,390.00 9,373.00 4,017.00
DEVICE OF BONES OF LIMB
MECHANICAL COMPLICATION OF INTERNAL FIXATION
T84.2 13,390.00 9,373.00 4,017.00
DEVICE OF OTHER BONES
MECHANICAL COMPLICATION OF OTHER INTERNAL
T84.4 13,390.00 9,373.00 4,017.00
ORTHOPAEDIC DEVICES, IMPLANTS AND GRAFTS
T84.5 13,390.00 9,373.00 4,017.00
INTERNAL JOINT PROSTHESIS
T84.6 13,390.00 9,373.00 4,017.00
INTERNAL FIXATION DEVICE [ANY SITE]
T84.7 INTERNAL ORTHOPAEDIC PROSTHETIC DEVICES, IMPLANTS 13,390.00 9,373.00 4,017.00
AND GRAFTS
OTHER COMPLICATIONS OF INTERNAL ORTHOPAEDIC
T84.8 13,390.00 9,373.00 4,017.00
PROSTHETIC DEVICES, IMPLANTS AND GRAFTS
UNSPECIFIED COMPLICATION OF INTERNAL ORTHOPAEDIC

T84.9 13,390.00 9,373.00 4,017.00
PROSTHETIC DEVICE, IMPLANT AND GRAFT
MECHANICAL COMPLICATION OF VENTRICULAR
T85.0 13,390.00 9,373.00 4,017.00
INTRACRANIAL (COMMUNICATING) SHUNT
MECHANICAL COMPLICATION OF OTHER OCULAR
PROSTHETIC DEVICES, IMPLANTS AND GRAFTS CONDITIONS
T85.3 13,390.00 9,373.00 4,017.00
LISTED IN T82.0 DUE TO CORNEAL GRAFT; CONDITIONS
LISTED IN T82.0 DUE TO PROSTHETIC ORBIT OF EYE
MECHANICALCOMPLICATIONOFGASTROINTESTINALPROST
HETICDEVICESIMPLANTSAND; CONDITIONS LISTED IN
T85.5 13,390.00 9,373.00 4,017.00
T82.0 DUE TO BILE-DUCT PROSTHESIS; CONDITIONS LISTED
IN T82.0 OESOPHAGEAL ANTI-REFLUX DEVICE
MECHANICAL COMPLICATION OF OTHER SPECIFIED

INTERNAL PROSTHETIC DEVICES, IMPLANTS AND GRAFTS;
CONDITIONS LISTED IN T82.0 DUE TO EPIDURAL AND
T85.6 13,390.00 9,373.00 4,017.00
SUBDURAL INFUSION CATHETER; CONDITIONS LISTED IN
T82.0 DUE TO INTRAPERITONAEL DIALYSIS CATHETER;
CONDITIONS LISTED

T85.7 13,390.00 9,373.00 4,017.00
INTERNAL PROSTHETIC DEVICES, IMPLANTS AND GRAFTS
OTHER COMPLICATIONS OF INTERNAL PROSTHETIC
T85.8 DEVICES, IMPLANTS AND GRAFTS, NOT ELSEWHERE 13,390.00 9,373.00 4,017.00
CLASSIFIED
UNSPECIFIED COMPLICATION OF INTERNAL PROSTHETIC
T85.9 DEVICE, IMPLANT AND GRAFT; COMPLICATION OF 13,390.00 9,373.00 4,017.00
INTERNAL PROSTHETIC DEVICE, IMPLANTS AND GRAFT NOS
SHOCK DUE TO ANAESTHESIA; SHOCK DUE TO
T88.2 ANAESTHESIA IN WHICH THE CORRECT SUSTANCE WAS 41,600.00 29,120.00 12,480.00
PROPERLY ADMINISTERED
ANAPHYLACTIC SHOCK DUE TO ADVERSE EFFECT OF
T88.6 CORRECT DRUG OR MEDICAMENT PROPERLY 9,880.00 6,916.00 2,964.00
ADMINISTERED
UNSPECIFIED ADVERSE EFFECT OF DRUG OR MEDICAMENT;
ADVERSE EFFECT OF CORRECT DRUG OR MEDICAMENT
PROPERLY ADMINISTERED; ALLERGIC REACTIION TO
T88.7 8,060.00 5,642.00 2,418.00
CORRECT DRUG OR MEDICAMENT PROPERLY
ADMINISTERED; HYPERSENSITIVITY TO CORRECT DRUG OR
MEDICAMENT PROPERLY ADMINISTE
T90.0 SEQUELAE OF SUPERFICIAL INJURY OF HEAD 11,050.00 7,735.00 3,315.00
T90.1 SEQUELAE OF OPEN WOUND OF HEAD 11,050.00 7,735.00 3,315.00
T90.2 SEQUELAE OF FRACTURE OF SKULL AND FACIAL BONES 11,050.00 7,735.00 3,315.00
T90.5 SEQUELAE OF INTRA CRANIAL INJURY 11,050.00 7,735.00 3,315.00
T90.8 SEQUELAE OF OTHER SPECIFIED INJURIES OF HEAD 11,050.00 7,735.00 3,315.00
T90.9 SEQUELAE OF UNSPECIFIED INJURY OF HEAD 11,050.00 7,735.00 3,315.00
SEQUELAE OF SUPERFICIAL INJURY AND OPEN WOUND OF
T91.0 11,050.00 7,735.00 3,315.00
NECK AND TRUNK
T91.1 SEQUELAE OF FRACTURE OF SPINE 11,050.00 7,735.00 3,315.00
T91.2 SEQUELAE OF OTHER FRACTURE OF THORAX AND PELVIS 11,050.00 7,735.00 3,315.00
T91.3 SEQUELAE OF INJURY OF SPINAL CORD 11,050.00 7,735.00 3,315.00
T92.0 SEQUELAE OF OPEN WOUND OF UPPER LIMB 11,050.00 7,735.00 3,315.00
T92.1 SEQUELAE OF FRACTURE OF ARM 11,050.00 7,735.00 3,315.00
T92.8 SEQUELAE OF OTHER SPECIFIED INJURIES OF UPPER LIMB 11,050.00 7,735.00 3,315.00
T93.0 SEQUELAE OF OPEN WOUND OF LOWER LIMB 11,050.00 7,735.00 3,315.00
T93.1 SEQUELAE OF FRACTURE OF FEMUR 11,050.00 7,735.00 3,315.00
T93.2 SEQUELAE OF OTHER FRACTURES OF LOWER LIMB 11,050.00 7,735.00 3,315.00
SEQUELAE OF DISLOCATION SPRAIN AND STRAIN OF
T93.3 11,050.00 7,735.00 3,315.00
LOWER LIMB
Page 122 of 126

First Case Rate

T93.8 SEQUELAE OF OTHER SPECIFIED INJURIES OF LOWER LIMB 11,050.00 7,735.00 3,315.00
SEQUELAE OF INJURIES INVOLVING MULTIPLE BODY
T94.0 11,050.00 7,735.00 3,315.00
REGIONS
T94.1 SEQUELAE OF INJURIES, NOT SPECIFIED BY BODY REGIONS 11,050.00 7,735.00 3,315.00
SEQUELAE OF BURN, CORROSION AND FROSTBITE OF HEAD
T95.0 11,050.00 7,735.00 3,315.00
AND NECK
SEQUELAE OF BURN, CORROSION AND FROSTBITE OF
T95.2 11,050.00 7,735.00 3,315.00
UPPER LIMB
SEQUELAE OF BURN, CORROSION AND FROSTBITE OF
T95.3 11,050.00 7,735.00 3,315.00
LOWER LIMB
SEQUELAE OF OTHER SPECIFIED BURN CORROSION AND
T95.8 11,050.00 7,735.00 3,315.00
FROSTBITE
SEQUELAE OF UNSPECIFIED BURN, CORROSION AND
T95.9 11,050.00 7,735.00 3,315.00
FROSTBITE
SEQUELAE OF CERTAIN EARLY COMPLICATIONS OF
T98.2 11,050.00 7,735.00 3,315.00
TRAUMA
DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES
Y40.0 CAUSING ADVERSE EFFECTS IN THERAPEUTIC 9,490.00 6,643.00 2,847.00
USE: SYSTEMIC ANTIBIOTICS: PENICILLINS

CAUSING ADVERSE EFFECTS IN THERAPEUTIC
Y40.1 9,490.00 6,643.00 2,847.00
USE: SYSTEMIC ANTIBIOTICS: CEFALOSPORINS AND OTHER
BETA-LACTAM ANTIBIOTICS

USE: SYSTEMIC ANTIBIOTICS: CHLORAMPHENICOL GROUP

USE: SYSTEMIC ANTIBIOTICS: TETRACYCLINES

USE: SYSTEMIC ANTIBIOTICS: RIFAMYCINS

Y40.8 9,490.00 6,643.00 2,847.00
USE: SYSTEMIC ANTIBIOTICS: OTHER SYSTEMIC
ANTIBIOTICS

Y40.9 9,490.00 6,643.00 2,847.00
USE: SYSTEMIC ANTIBIOTICS: SYSTEMIC ANTIBIOTIC,
UNSPECIFIED
Y41.0 SULFONAMIDES 9,490.00 6,643.00 2,847.00

USE: SYSTEMIC ANTIBIOTICS: ANTIMYCOBACTERIAL DRUGS

USE: SYSTEMIC ANTIBIOTICS: ANTIVIRAL DRUGS

CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE:
Y41.8 SYSTEMIC ANTIBIOTICS: OTHER SPECIFIED SYSTEMIC ANTI- 9,490.00 6,643.00 2,847.00
INFECTIVES AND ANTIPARASITICS; HYDROXYQUINOLINE
DERIVATIVES

Y41.9 9,490.00 6,643.00 2,847.00
USE: SYSTEMIC ANTI-INFECTIVE AND ANTIPARASITIC,
UNSPECIFIED

USE: GLUCOCORTICOIDS AND SYNTHETIC ANALOGUES

USE: ANTITHYROID DRUGS
Page 123 of 126

First Case Rate

Y42.3 11,050.00 7,735.00 3,315.00
USE: INSULIN AND ORAL HYPOGLYCAEMIC [ANTIDIABETIC]
DRUGS

Y42.4 11,050.00 7,735.00 3,315.00
USE: ORAL CONTRACEPTIVES;MULTIPLE-AND SINGLE-
INGREDIENT PREPARATIONS

Y42.5 11,050.00 7,735.00 3,315.00
USE: OTHER ESTROGENS AND PROGESTOGENS;MIXTURES
AND SUBSTITUTES

USE: ANTIALLERGIC AND ANTIEMETIC DRUGS

USE: ANTICOAGULANTS

Y44.3 9,490.00 6,643.00 2,847.00
USE: ANTICOAGULANT ANTAGONISTS, VITAMIN K AND
OTHER COAGULANTS

USE: SALICYLATES

Y45.2 11,050.00 7,735.00 3,315.00
USE: PROPIONIC ACID DERIVATIVES;PROPANOIC ACID
DERIVATIVES

Y45.3 11,050.00 7,735.00 3,315.00
USE: OTHER NONSTEROIDAL ANTI-INFLAMMATORY DRUGS
[NSAID]

USE: 4-AMINOPHENOL DERIVATIVES
Y45.8 OTHER ANALGESICS AND ANTIPYRETICS 9,620.00 6,734.00 2,886.00
Y45.9 9,620.00 6,734.00 2,886.00
USE: ANALGESIC, ANTIPYRETIC AND ANTI-INFLAMMATORY
DRUG, UNSPECIFIED

USE: HYDANTOIN DERIVATIVES

USE: OTHER AND UNSPECIFIED ANTIEPILEPTICS

USE: BARBITURATES, NOT ELSEWHERE CLASSIFIED

USE: BENZODIAZEPINES

Y47.9 USE: SEDATIVE, HYPNOTIC AND ANTIANXIETY DRUG, 8,710.00 6,097.00 2,613.00
UNSPECIFIED;SLEEPING DRAUGHT NOS;SLEEPING DRUG
NOS;SLEEPING TABLET NOS

USE: OTHER ANTIPSYCHOTICS AND NEUROLEPTICS

USE: PSYCHODYSLEPTICS [HALLUCINOGENS]
Page 124 of 126

First Case Rate


Y51.3 USE: OTHER PARASYMPATHOLYTICS [ANTICHOLINERGICS 8,710.00 6,097.00 2,613.00
AND ANTIMUSCARINICS] AND SPASMOLYTICS, NOT
ELSEWHERE CLASSIFIED;PAPAVERINE

Y51.7 8,710.00 6,097.00 2,613.00
USE: BETA-ADRENORECEPTOR ANTAGONISTS, NOT

Y52.0 16,250.00 11,375.00 4,875.00
USE: CARDIAC-STIMULANT GLYCOSIDES AND DRUGS OF
SIMILAR ACTION

Y52.2 16,250.00 11,375.00 4,875.00
USE: OTHER ANTIDYSRHYTHMIC DRUGS, NOT ELSEWHERE
CLASSIFIED

Y53.8 10,790.00 7,553.00 3,237.00
USE: OTHER AGENTS PRIMARILY AFFECTING THE
GASTROINTESTINAL SYSTEM

USE: BENZOTHIADIAZINE DERIVATIVES

USE: AGENTS AFFECTING URIC ACID METABOLISM

USE: OXYTOCIC DRUGS;ERGOT ALKALOIDS

USE: ANTITUSSIVES

USE: EXPECTORANTS

Y55.6 USE: ANTIASTHMATICS, NOT ELSEWHERE CLASSIFIED: 8,060.00 5,642.00 2,418.00
AMINOPHYLLINE, SALBUTAMOL,
THEOBROMINE;THEOPHYLLINE

Y56.0 9,490.00 6,643.00 2,847.00
USE: LOCAL ANTIFUNGAL, ANTI-INFECTIVE AND ANTI-
INFLAMMATORY DRUGS, NOT ELSEWHERE CLASSIFIED

USE: LOCAL ASTRINGENTS AND LOCAL DETERGENTS

USE: EMOLLIENTS, DEMULCENTS AND PROTECTANTS

Y56.6 10,790.00 7,553.00 3,237.00
USE: OTORHINOLARYNGOLOGICAL DRUGS AND
PREPARATIONS

USE: BCG VACCINE

USE: TETANUS VACCINE
Page 125 of 126

First Case Rate


USE: VACCINE OR BIOLOGICAL SUBSTANCE, UNSPECIFIED
Z34.0 SUPERVISION OF NORMAL FIRST PREGNANCY 8,840.00 6,188.00 2,652.00

Z34.8 SUPERVISION OF OTHER NORMAL PREGNANCY 8,840.00 6,188.00 2,652.00
Z34.9 SUPERVISION OF NORMAL PREGNANCY, UNSPECIFIED 8,840.00 6,188.00 2,652.00
SUPERVISION OF PREGNANCY WITH HISTORY OF
Z35.0 8,840.00 6,188.00 2,652.00
INFERTILITY
SUPERVISION OF PREGNANCY WITH HISTORY OF ABORTIVE
Z35.1 8,840.00 6,188.00 2,652.00
OUTCOME
SUPERVISION OF PREGNANCY WITH OTHER POOR
Z35.2 8,840.00 6,188.00 2,652.00
REPRODUCTIVE OR OBSTETRIC HISTORY
Z35.4 SUPERVISION OF PREGNANCY WITH GRAND MULTIPARITY 8,840.00 6,188.00 2,652.00
Z35.5 SUPERVISION OF ELDERLY PRIMIGRAVIDA 8,840.00 6,188.00 2,652.00
Z35.6 SUPERVISION OF VERY YOUNG PRIMIGRAVIDA 8,840.00 6,188.00 2,652.00
SUPERVISION OF HIGH-RISK PREGNANCY DUE TO SOCIAL
Z35.7 8,840.00 6,188.00 2,652.00
PROBLEMS
Z35.8 SUPERVISION OF OTHER HIGH-RISK PREGNANCIES 8,840.00 6,188.00 2,652.00
Z35.9 SUPERVISION OF HIGH-RISK PREGNANCY, UNSPECIFIED 8,840.00 6,188.00 2,652.00
Z39.0 CARE AND EXAMINATION IMMEDIATELY AFTER DELIVERY 2,600.00 1,820.00 780.00
Page 126 of 126

AnnexA MedicalCaseRates

Uploaded by

Document Informationclick to expand document information

Document Informationclick to expand document information

Copyright:

Available Formats

AnnexA MedicalCaseRates

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

AnnexA MedicalCaseRates

Uploaded by

Copyright:

Available Formats

Annex A - List of Medical Case Rates

First Case Rate

A05.3 FOODBORNE VIBRIO PARAHAEMOLYTICUS INTOXICATION 7,800.00 5,460.00 2,340.00

A05.9 BACTERIAL FOODBORNE INTOXICATION, UNSPECIFIED 7,800.00 5,460.00 2,340.00

First Case Rate

TUBERCULOSIS OF LUNG, CONFIRMED BY CULTURE ONLY;

TUBERCULOSIS OF LUNG, CONFIRMED HISTOLOGICALLY

TUBERCULOSIS OF LUNG, CONFIRMED BY UNSPECIFIED

TUBERCULOSIS OF INTRATHORACIC LYMPH NODES,

RESPIRATORY TUBERCULOSIS UNSPECIFIED, CONFIRMED

TUBERCULOSIS OF LUNG, BACTERIOLOGICALLY AND

TUBERCULOSIS OF LUNG, BACTERIOLOGICAL AND

First Case Rate

TUBERCULOSIS OF INTRATHORACIC LYMPH NODES,

TUBERCULOSIS OF BRONCHUS, NOS, WITHOUT MENTION

TUBERCULOUS PLEURISY, WITHOUT MENTION OF

PRIMARY RESPIRATORY TUBERCULOSIS WITHOUT

OTHER RESPIRATORY TUBERCULOSIS, WITHOUT MENTION

First Case Rate

A30.1 HANSEN'S DISEASE : TUBERCULOID LEPROSY; TT LEPROSY 11,440.00 8,008.00 3,432.00

PNEUMONIA IN WHOOPING COUGH DUE TO BORDATELLA

First Case Rate

A49.9 BACTERIAL INFECTION, UNSPECIFIED; BACTERAEMIA NOS 11,570.00 8,099.00 3,471.00

EARLY CUTANEOUS CONGENITAL SYPHILIS: , EARLY

EARLY CONGENITAL SYPHILIS, UNSPECIFIED; CONGENITAL

LATE CONGENITAL NEUROSYPHILIS [JUVENILE

First Case Rate

A85.2 ARTHROPOD-BORNE VIRAL ENCEPHALITIS, UNSPECIFIED; 27,430.00 19,201.00 8,229.00

OTHER SPECIFIED VIRAL ENCEPHALITIS; ENCEPHALITIS

First Case Rate

First Case Rate

First Case Rate

C11.9 MALIGNANT NEOPLASM OF NASOPHARYNX, UNSPECIFIED 14,950.00 10,465.00 4,485.00

MALIGNANT NEOPLASM OF ARYEPIGLOTTIC FOLD,

MALIGNANT NEOPLASM OF HYPOPHARYNX, UNSPECIFIED;

First Case Rate

First Case Rate

MALIGNANT NEOPLASM OF NASAL CAVITY; MALIGNANT

MALIGNANT NEOPLASM OF MIDDLE EAR; MALIGNANT

First Case Rate

MALIGNANT NEOPLASM OF CONNECTIVE AND SOFT TISSUE

First Case Rate

C50.1 MALIGNANT NEOPLASM OF CENTRAL PORTION OF BREAST 15,340.00 10,738.00 4,602.00

MALIGNANT NEOPLASM OF ISTHMUS UTERI; MALIGNANT

First Case Rate

C67.3 MALIGNANT NEOPLASM OF ANTERIOR WALL OF BLADDER 18,330.00 12,831.00 5,499.00

MALIGNANT NEOPLASM OF BLADDER NECK; MALIGNANT

First Case Rate

C74.1 MALIGNANT NEOPLASM OF MEDULLA OF ADRENAL GLAND 14,820.00 10,374.00 4,446.00

C74.9 MALIGNANT NEOPLASM OF ADRENAL GLAND, UNSPECIFIED 14,820.00 10,374.00 4,446.00

MALIGNANT NEOPLASM OF PELVIS; MALIGNANT

C76.4 MALIGNANT NEOPLASM OF UPPER LIMB 20,930.00 14,651.00 6,279.00

First Case Rate

C82.2 LARGE CELL, FOLLICULAR NON-HODGKIN'S LYMPHOMA 18,070.00 12,649.00 5,421.00

C82.7 OTHER TYPES OF FOLLICULAR NON-HODGKIN'S LYMPHOMA 18,070.00 12,649.00 5,421.00

FOLLICULAR NON-HODGKIN'S LYMPHOMA, UNSPECIFIED;

C83.5 LYMPHOBLASTIC DIFFUSE NON-HODGKIN'S LYMPHOMA 18,070.00 12,649.00 5,421.00