| SERIAL NUMBER | Procedure | 1st Qtr | Per Qtr (for next 3 Qtrs) | Requirements while submitting for follow-up Preauth | Requirements while submitting for follow-up Claims |
|---|---|---|---|---|---|
| 101 | FP0101 : Pemphigus/Pemphgoid | 1400 | 700 | Previous Discharge Summary | (Clinical Evaluation-Mandatory) and Relevant Investigations as per Initial Diagnosis |
