CGHS Revises Healthcare Rates: Major Update for Central Government Employees and Pensioners

CGHS Revises Healthcare Rates: Major Update for Central Government Employees and Pensioners

The Ministry of Health and Family Welfare has announced significant revisions to the Central Government Health Scheme (CGHS) rates, bringing important changes that will affect all central government employees, pensioners, and their families.

📄 Download Official CGHS Rate Notification

⬇️ Download Original PDF Notification

Official notification from Ministry of Health & Family Welfare

Key Implementation Details

Effective Date: October 13, 2025 at 12:00 AM

Who It Affects:

  • All healthcare services at CGHS-empanelled Healthcare Organisations (HCOs)
  • Medical reimbursement claims for serving employees, pensioners, and other eligible CGHS beneficiaries
  • Cashless treatment for central government pensioners and specified categories

The revised rates are now available on the official CGHS website at https://cghs.mohfw.gov.in.

Understanding the New Rate Structure

Hospital Classification System

The new rates are structured based on several key factors:

Accreditation Status:

  • Non-NABH and Non-NABL hospitals: 15% lower rates than accredited facilities
  • NABH/NABL accredited hospitals: Standard rates
  • Super specialty hospitals: 15% higher rates than NABH-accredited hospitals

City-Based Pricing:

  • Tier I Cities (X): Standard rates (Delhi, Mumbai, Chennai, Kolkata, Bengaluru, Hyderabad, Pune, Ahmedabad)
  • Tier II Cities (Y): 10% lower than Tier I
  • Tier III Cities (Z): 20% lower than Tier I
  • North-East region and Union Territories of Jammu & Kashmir and Ladakh follow Tier II rates

Ward Entitlement Variations

All published rates are for semi-private ward entitlement:

  • General Ward: 5% reduction from listed rates
  • Semi-Private Ward: Listed rates apply
  • Private Ward: 5% increase over listed rates

Important Procedural Changes

Multiple Surgery Guidelines

When multiple procedures are performed in the same operation theatre session:

  • Primary surgery: 100% of package rate
  • Second surgery: 50% of package rate
  • Third and subsequent surgeries: 25% of respective package rates

Package Duration Coverage

The new rates include specific coverage periods:

  • Super specialty treatments: Up to 12 days
  • Major surgeries: Up to 7 days
  • Laparoscopic surgeries/elective angioplasty/normal deliveries: Up to 3 days
  • Day care/minor surgeries: 1 day

Critical Hospital Empanelment Updates

Immediate Action Required:
All existing Memoranda of Agreement (MoAs) with private hospitals will cease to be valid from October 13, 2025 at 12:00 AM.

For Healthcare Organizations:

  • Fresh empanelment required through revised Hospital Engagement Module
  • New MoAs must be executed within 90 days
  • Hospitals must submit an undertaking by October 13, 2025, confirming acceptance of new terms
  • Failure to submit undertaking will result in automatic de-panelment

Sample Rate Examples (Tier I Cities - NABH Hospitals)

Basic Consultations:

  • OPD Consultation: ₹350
  • Super Specialty Consultation: ₹700

Common Laboratory Tests:

  • Complete Blood Count (CBC): ₹300
  • Kidney Function Test: ₹500
  • Liver Function Test: ₹500
  • Thyroid Function Test: ₹450

Imaging Services:

  • Chest X-Ray: ₹230
  • USG Whole Abdomen: ₹800
  • CT Scan Head (without contrast): ₹1,035
  • MRI Brain (without contrast): ₹2,750

Major Procedures:

  • Normal Delivery: ₹31,500
  • Caesarean Section: ₹47,700
  • Appendectomy (Open): ₹31,500
  • Laparoscopic Cholecystectomy: ₹47,700

What This Means for You

For Serving Employees

  • Updated reimbursement rates for medical expenses
  • Improved coverage for specialized treatments
  • Standardized pricing across different hospital categories

For Pensioners

  • Enhanced cashless treatment facilities
  • Clearer rate structure for better financial planning
  • Continued access to quality healthcare services

For All CGHS Beneficiaries

  • More transparent pricing system
  • Better categorization of hospitals and services
  • Improved access to super specialty care

Important Reminders

For Non-Empanelled Hospitals:
In exceptional circumstances where treatment is taken from non-empanelled private hospitals, reimbursement will be restricted to Non-NABH rates of the respective city.

For Cancer Treatment:
Existing CGHS rules and rates continue for cancer surgeries, but revised rates apply to chemotherapy, investigations, and radiotherapy.

Rate Uniformity:
Rates for consultations, radiotherapy, investigations, day care procedures, and minor procedures remain uniform regardless of ward entitlement.

Action Items for CGHS Beneficiaries

  1. Review your ward entitlement on your CGHS card to understand applicable rates
  2. Verify hospital empanelment status before seeking treatment after October 13, 2025
  3. Keep updated on hospital empanelment through the CGHS website
  4. Plan medical expenses according to the new rate structure
  5. Understand procedure combinations if multiple treatments are needed

This comprehensive revision aims to provide better healthcare access while ensuring cost-effective treatment for all central government employees and pensioners. The new rate structure reflects current medical costs and ensures quality care across different healthcare facilities.

Contact Information:
For queries related to this update, contact your respective CGHS Wellness Centre for additional guidance and support.

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