Billing Guidelines for Admissible and Non-Admissible Items: Annexure-IV CGHS O.M F.No.5-16/CGHS(HQ)/HEC/2024(PartI) dated 03.10.2025

Billing Guidelines for Admissible and Non-Admissible Items: Annexure-IV CGHS O.M F.No.5-16/CGHS(HQ)/HEC/2024(PartI) dated 03.10.2025

Annexure-IV

Admissible and Non-Admissible Items (Billing Guidelines)

This annexure provides clarification on items and charges that are includable or excludable in bills as per CGHS. The HCO must adhere to these when billing CGHS or CGHS beneficiaries.

1. Consumables and Materials: Common medical consumables (cotton, gauze, gloves, syringes, needles, catheters, IV sets, tubing, dressing materials, etc.)

• These items are considered part of the treatment package for surgical procedures and included in respective package rates. No separate charge for such items is admissible in bills of surgical packages.
• In non-surgical (medical management) cases where no package rate exists, reasonable use of consumables is allowed and can be billed under consumables head. The HCO must ensure rational use of all consumables. Billing for extraordinarily high quantities without clinical need will be viewed seriously as potential inflation and penalised.
• Vague billing entries like “consumables kit” or “procedure kit” without specifics (e.g., “lumbar puncture kit”, “dressing kit”, “nebulization kit”) are not acceptable. Such items shall be disallowed.

2. Non-Admissible Items: The following categories of items shall not be reimbursed by CGHS and the amount may be collected from beneficiary:

• Toiletries and Personal Use Items: e.g. soap, shampoo, toothbrush, toothpaste, comb, sanitary pads, diapers, hand sanitizers for personal use, mouthwash, tissue papers, etc. (These are considered personal hygienic items and not part of treatment costs.)
• Cosmetics and Other Miscellaneous Personal Items: e.g. razors/shaving blades, beauty creams, powders, deodorants, oils (like coconut oil), talcum powder, makeup items, etc.
• Non-Medical Services/Overheads: e.g. telephone charges for patient calls, bedside television charges, internet fees, patient’s attendant food, hospital gown for attendant, carry bags for medicines or belongings, etc. (Basic cost of a patient’s own gown/drapes is included in ward charge, but if a hospital bills a kit, it is not reimbursable).
• Attendant Charges: Any charge for providing an attendant (ayah / ward boy) specifically to the patient or charges for extra bedding for the attendant (except one attendant bed included in a private ward) are not reimbursable. Professional nursing care is separate and included in the ward charges.
• Mortuary or Cremation charges: If a patient expires, any charge like mortuary fee or transportation for last rites are not covered CGHS expense.
• Extra Bedding/Blankets beyond norm: already included in ward charges; cannot charge separately.
• Implant Upgrades: If the patient opts for an implant or prosthesis of higher value than what CGHS covers the difference in cost would not be reimbursable. The beneficiary may decide to bear that difference, with prior consent. Such differences should not be billed to CGHS/claimed.

(In summary, anything that is not directly related to treatment and is primarily for patient convenience or personal preference is non-admissible.)

3. Inadmissible Additional Charges: The HCO shall not separately bill for the following components, as they are considered part of standard charges for related services. Hence these are neither to be billed to CGHS nor amount to be collected from Beneficiaries :

• Glucometer strips – Cost of blood glucose test strips is included as part of performing a Random Blood Sugar (RBS) test at bedside. No separate charge per strip is admissible if bedside glucose monitoring is done; it’s covered under investigation or ward service.
• ECG leads/electrodes – included in the cost of an ECG. The hospital cannot charge for ECG electrodes or leads separately when billing for an ECG test.
• Ventilator circuits or consumables – when a patient is on a ventilator, the disposables (tubing, filters, circuits) are considered included in the ventilator/ICU charge. No separate line item for “ventilator consumables” should be billed.
• Ward facilities included in room charge: Items such as an air-bed, water bed, alpha bed or ripple mattress for bed sore prevention, routine air conditioning or heating charges, infusion pumps, DVT pump usage in ward, pulse oximeter or basic monitors, medical record photocopy charges, etc., are all included in the room/ward daily charge. They must not appear as separate charges.
• Issuance of Medical Records/Films: Providing the patient with discharge summary, lab reports, X-ray/CT/MRI films or CD copies of scans is part of the treatment rates. No fee should be charged for giving these to patient (aside from very exceptional cases like multiple copies of a large file, but even then CGHS doesn’t pay for it).
• Vacutainers, syringes for investigations: Blood collection tubes, needles, lancets used for drawing samples are part of the lab test cost and not billable as separate “consumable” to CGHS.

(Essentially, any item that is by-nature a part of performing a test or procedure or running a ward facility cannot be carved out to charge extra.)

4. List of common Non admissible items

This list includes commonly non-admissible items and services that cannot be billed to CGHS.

Table 2 List of non-admissible items

Note: The aforementioned categories are illustrative in nature and shall be deemed to include all other analogous items.

5. List of items already included under packages.

The following items are deemed to be integral components of the package rates and shall, under no circumstances, be billed separately to CGHS or recovered from the beneficiaries

Table 3 . List of included items

Note: The aforementioned categories are illustrative in nature and shall be deemed to include all other analogous items.

*****

Read: CGHS rates applicable for treatment at healthcare organisations located at X, Y and Z cities

Follow us on Telegram Channel, Twitter and Facebook for all the latest updates