What is the Ayushman Bharat package code for piles and fistula treatment?

Question

Piles fistula ayushman Bharat package code Package name

HexaHealth Team · Accepted Answer

Hello,

Under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), treatments for piles (haemorrhoids) and fistula (an abnormal passage near the anus, commonly called bhagandar) is covered for eligible patients. However, the applicable package code depends on the procedure required, the current package list, the state scheme rules, and the hospital's empanelment.

Package codes can vary or change between scheme versions and states. Therefore, the codes mentioned below should be verified with the hospital's Ayushman Mitra before treatment. Not every patient with piles or fistula needs surgery, and laser or stapler treatment is not automatically covered in every hospital.

What are the treatment options for piles?

Piles are swollen blood vessels in or around the anus. Doctors generally classify internal piles into four grades based on how far they protrude and whether they go back inside on their own.

Grade	What happens?	Possible treatment
Grade 1	Piles remain inside the anus and may cause bleeding.	Usually treated with dietary changes, fibre, fluids, and medicines. A procedure may be needed in selected cases.
Grade 2	Piles come out during bowel movements but go back inside on their own.	Medicines and lifestyle changes may help. A procedure or surgery may be considered if symptoms continue.
Grade 3	Piles come out and need to be pushed back inside manually.	A doctor may recommend a procedure or surgery, depending on the symptoms and examination.
Grade 4	Piles remain outside and cannot be pushed back inside.	Surgical treatment may be recommended, depending on the patient's condition.

Important: The grade alone does not decide Ayushman coverage. The treating surgeon must assess the patient and identify the appropriate procedure and package.

What are the differences between laser, stapler, and conventional piles surgery?

Treatment	What does it involve?	What should you know about PM-JAY?
Stapled haemorrhoidopexy	A special stapling device is used to reposition selected internal piles.	Coverage depends on the applicable package and whether the hospital is authorised to provide that treatment under the scheme.
Laser treatment	Laser energy is used in selected procedures to treat piles.	Do not assume laser treatment has a separate national package or is automatically covered. Ask the hospital to check the applicable state and PM-JAY package.
Conventional haemorrhoidectomy	The surgeon removes the affected piles using a conventional surgical technique.	Coverage depends on the approved procedure package, eligibility, and hospital empanelment.

No procedure is guaranteed to be painless or suitable for every patient. Recovery time and discomfort vary. The surgeon should recommend the treatment based on the patient's condition, rather than choosing a procedure only because it is described as advanced.

What are the Ayushman package codes for piles and fistula?

The codes SG032A and SG032B have been cited for certain conventional and stapled piles procedures in some package references. Similarly, SG033 and SG034 have been cited for certain fistula procedures. However, these codes should not be treated as universally current or applicable to every state and hospital without checking the active package list.

Piles: The applicable code depends on the exact procedure recommended by the surgeon.
Fistula (bhagandar): The package depends on the type and complexity of the fistula and the procedure required.
Laser treatment: Coverage must be checked against the active package and state-specific rules. Do not assume that an unspecified surgical package will automatically cover it.
Package updates: If the scheme has updated a code, the hospital must use the applicable active code and follow the required approval process.

Because package codes and rates can change, the hospital's Ayushman Mitra should check the current government system before advising you about coverage.

How can you check whether your piles or fistula treatment is covered?

Consult a general surgeon or colorectal surgeon for an examination.
Ask the doctor to write the exact diagnosis and recommended procedure, such as haemorrhoidectomy, stapled haemorrhoidopexy, fistulotomy, or another suitable treatment.
Visit the Ayushman Mitra desk at a hospital that is currently empanelled under PM-JAY.
Show the doctor's prescription, diagnosis, and Ayushman Card.
Ask the Ayushman Mitra to check the current package code, the hospital's eligibility to provide that package, and whether pre-authorisation is required.
Before admission, ask which expenses are included in the approved package and whether any amount would be payable by you.

If the treatment is approved under an applicable PM-JAY package, eligible beneficiaries may receive cashless treatment according to the scheme's rules. However, approval is not automatic, and not every procedure or hospital charge is necessarily covered.

Which documents should you keep ready?

Ayushman Card, if available
Aadhaar Card or another accepted government identity document
Ration Card or family details, if required
Doctor's prescription and diagnosis
Relevant examination reports or investigations
Previous treatment records, if available
Any additional documents requested by the hospital for pre-authorisation

Please share your city and state so we can guide you correctly.

The applicable package code and coverage can depend on the state where you plan to receive treatment. Please tell us:

City and state: Where do you want to get treatment?
Hospital type: Are you considering a government or private hospital?
Diagnosis: Is it piles, fistula (bhagandar), or both?
Recommended procedure: Has your doctor advised laser, stapler, conventional surgery, or another procedure?

With these details, the relevant package information and hospital-checking steps can be narrowed down more accurately.

Wishing you and your family good health always.
Warm regards,
Team HexaHealth