Clarification regarding CGHS rates applicable for in-patients

Central Government Health Scheme :-

Regarding CGHS rates applicable in the empanelled hospitals in various cities, the Department of Health and Family Welfare has issued an Office Memorandum [No.S.11011/23/2009-CGHS D.II/Hospital Cell (Part IX)] on 30th September, 2011. The order has been published on its website of http://msotransparent.nic.in/cghsnew/index.asp

The Deapartment has clarified in an earlier order [No.W.11011/23/2009-CGHS D.II/Hospital Cell (Part I) dated 11th April 2011] that “the treatment of casualty OPD shall be treated as treatment under emergency and credit facility shall be extended to the CGHS beneficiaries. However, routine OPD consultation shall not be considered a medical emergency” and also “NABL Accreditation is not prescribed for imaging centres and therefore, list of rates prescribed NABL centres shall be applicable for Imaging Centres”.

Continuing in the order, “Empanelled hospitals, Diagnostic Labs and Imaging Centres shall send hospital bills (Credit bills) in respect of Pensioners, ex-MPs, Freedom Fighters, etc., to CGHS through UTI-TSL, where as hospital bills (credit bills) in respect of serving employees of Ministry of Health & Family Welfare shall be sent manually to the officer in the Ministry of Health & Family Welfare or Dte.GHS, CGHS or other organisations under the Ministry of Health & Family Welfare, who referred the beneficiary for treatment, as the case may be”.

Similarly, one of the main clairfication of the latest order is that “for any day care procedure requiring short admission – a few hours to one day – accommodation charge for one day as per entitlement shall be applicable”.

Moreover “If CGHS rate is not available for any procedure / investigation / category (say super-speciality) in any CGHS covered city, the CGHS rate notified for such procedure / investigation / category for the nearest CGHS city or the rate notified under CGHS, Delhi, whichever is lower shall be applicable as CGHS rate for such procedure / investigation / category for that city”.

And also clarified that “Since NABL Accreditation for in-house laboratories of hospitals has been made optional, rates prescribed for NABL Accredited laboratories shall be applicable for the in-house laboratories of hospitals, for the investigations under taken for in-patients”.