Government of India
Ministry of Health and Family Welfare
Department of Health and Family Welfare
Nirman Bhawan, New Delhi
Dated the 1st October, 2012.
Subject: Clarification regarding admissible / non-admissible items under CGHS.
The undersigned is directed to refer to the directions given by Hon’ble
High Court of Delhi in the case of Sh. Kanhiya Singh Vs UOI and others
[W.P.(C)9044/2011], regarding admissibility and non-admissibility of
certain items under CGHS, the following clarifications are issued:-
2. “CGHS Package Rate” means and includes lump sum cost of inpatient
treatment / day care / diagnostic procedures for which a CGHS
beneficiary has been permitted by the competent authority or for
treatment under emergency from the time of admission to the time of
discharge including (but not limited to ) – (i) registration charges,
(ii) Admission charges, (iii) Accommodation charges including patients
diet, (iv) Operation charges, (v) Injection charges, (vi) Dressing
charges, (vii) Doctor / consultant visit charges, (viii) ICU /ICCU
Charges, (ix) Monitoring charges, (x) Transfusion charges, (xi)
Anesthesia charges, (xii) Operation theatre charges, (xiii) Procedural
charges / surgeon’s fee, (xiv) Cost of surgical disposables and all
sundries used during hospitalization, (xv) Cost of surgical disposables
and all sundries used during hospitalization, (xv) Cost of medicines,
(xvi) Related routine and essential investigations, (xvii) Physiotherapy
charges etc. (xviii) Nursing care and charges for its services.
3. Cost of Implants / Stents / Grants is reimbursable in addition to
package rates as per CGHS ceiling rates for Implants / Stents / Grafts
or as per actual, in case there is no CGHS prescribed ceiling rate.
4. During In-patient treatment of the CGHS beneficiary, the hospital
will not ask the beneficiary or his / her attendant to purchase
separately the medicines / sundries / equipments or accessories from
outside and will provide the treatment within the package rate, fixed by
the CGHS, which includes the cost of all the items.
5. In cases of conservative treatment, where there is no CGHS package
rate, the above mentioned items are admissible – items wise at CGHS
rates or as per AIIMS rates (if there is no CGHS rate) or as per actual
(if there is no CGHS / AIIMS rate) for any item.
6. Package rates envisage up to a maximum duration of indoor treatment as follows:
12 days for Specialized (Super Specialties) treatment:
7 days for other Major Surgeries;
3 days for Laparoscopic surgeries / normal deliveries; and
1day for day care / Minor (OPD) surgeries.
7. However, if the beneficiary is required to stay in the hospital for
his / her recovery for a period more than the period covered in the
prescribed package rate, in exceptional cases, supported by relevant
medical records and certified as such by the hospital, the additional
reimbursement shall be limited to accommodation charges s per
entitlement, investigations charges at approved rates, and doctors visit
charges (not more than 2 visits per day per visit by specialists /
consultants) and cost of medicines for additional stay). No additional
charge on account of extended period of stay shall be allowed if that
extension is due to infection on the consequences of surgical procedure
or due to any improper proceed.
8. The above list is however not exhaustive. Some patients may require
additional facilities/ procedures, which are admissible depending upon
the medical requirements as advised by the treating doctors/specialists,
with proper justification. Therefore, it is not possible to indicate a
comprehensive list of items, which are not admissible. However, the
following items are not admissible for the purpose of reimbursement
Deputy Secretary to the Government of India