Definition of CGHS Package Rates, Ward Entitlement, Chemotherapy Charges, Implants and Consumables, Investigations and Consultation: Annexure-II of CGHS O.M. dated 03.10.2025

Definition of CGHS Package Rates, Ward Entitlement, Chemotherapy Charges, Implants and Consumables, Investigations and Consultation: Annexure-II of CGHS O.M. dated 03.10.2025

Annexure-II

Definition of Package Rates and inclusions

1. Definition of CGHS Package Rate

The CGHS Package Rate shall be construed as an all-inclusive lump sum cost, applicable from the time of admission to the time of discharge, encompassing the entire treatment cycle of an inpatient/day care/diagnostic procedure for which the CGHS beneficiary has been permitted treatment—either through prior approval or in emergency cases. The package rate includes but is not limited to the following:

2. Accommodation charges including patient’s diet
3. Admission charges
4. Anaesthesia charges
5. Cost of medicines and consumables/disposables
6. Cost of surgical disposables and all sundries used during hospitalization
7. Doctor/consultant visit charges
8. Dressing charges
9. ICU/ICCU charges
10. Injection charges
11. Monitoring charges
12. Nursing care charges
13. O2 charges, Ventilator charges as routinely required, if any etc.
14. Operation charges
15. Operation theatre charges
16. Physiotherapy charges etc.
17. Procedural charges/surgeon’s fee
18. Registration charges
19. Related routine and essential investigations during the admission of patient
20. Transfusion charges and Blood processing charges
21. Equipment Charges including flowtron, Infusion pump, syringe pump etc.

• Uniformity of Rates for In-House and Outsourced Services – The CGHS package rates shall apply uniformly, irrespective of whether the services (diagnostic, laboratory, imaging, physiotherapy, or any clinical service) are provided in-house by the hospital or outsourced to an external service provider. Hospitals shall not charge or seek reimbursement beyond the prescribed CGHS package rate under the pretext of outsourced service provision. No differential pricing shall be applied for outsourced services.
• Package rates envisage up to a maximum duration of indoor treatment as follows:
  • Up to 12 days for Specialized (Super Specialties) treatment
  • Up to 7 days for other Major Surgeries
  • Up to 3 days for/ Laparoscopic surgeries / elective Angioplasty / normal deliveries and
  • 1 day for day care / Minor (OPD) surgeries.

2. Ward Entitlement Adjustment

• The prescribed package rates are based on semi-private ward entitlement.
• A 5% decrease shall apply for beneficiaries entitled to general ward.
• A 5% increase shall apply for beneficiaries entitled to private ward.
• Investigations and radiotherapy rates shall remain uniform regardless of ward entitlement or admission status, unless the test necessitates hospital admission.

3. Chemotherapy Charges

• The package rate for chemotherapy includes procedural charges only.
• Room rent, investigations, and anti-cancer medicines are reimbursable in addition to the procedural charges.
• CGHS will provide anti-cancer medicines wherever feasible. If not provided, the HCO shall provide the medicine and submit the GST purchase invoice from external vendor, similar to implant protocols

4. Implants and Consumables

• Implants such as lenses, stents, meshes, and valves are reimbursable in addition to the package rates as per CGHS ceiling rates.
• Unlisted implants will be reimbursed based on the actual invoice or as per NPPA (National Pharmaceutical Pricing Authority) rates whichever is less.
• All consumables and medicines, including guidewires and catheters, are deemed inclusive in the package rate.
• Drug-eluting balloon used in lieu of a stent is payable as per NPPA rates or actual invoice whichever is less.

5. Unlisted Procedures and Investigations

• The current guidelines for Unlisted Procedures and Investigations shall continue. These procedures shall be reviewed periodically.

6. Multiple Surgical Procedures in One OT Session

• When multiple surgeries are performed in a single operative session:
  • The primary procedure (with the highest package rate) shall be reimbursed at 100%.
  • The second procedure shall be reimbursed at 50% of its package rate.
  • The third and subsequent procedures shall be reimbursed at 25% of their respective package rates.
• If identical surgeries are performed at different anatomical sites (e.g., bilateral cataract or bilateral knee replacement), the second procedure will be reimbursed at 50%.
• Any procedure within the package period of an earlier procedure shall be reimbursed at 75% of the applicable package rate.
• Individual steps of a procedure must not be itemized or charged separately. All integral steps are deemed included within the package. The package must fully cover the scope of the procedure as per standard clinical protocols.

7. Consultation

• The consultation fee is inclusive of the cost of examination consumables such as paper gloves, unsterile gloves, or examination gloves, if used during the examination of the patient.
• Each consultation will be considered valid for a period of 7 days, provided it pertains to the same specialty.

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

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