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Directorate General of CGHS clarifies the CGHS rates for Cancer surgery at hospitals empanelled under CGHS
F. No. S-11045/36/2012 – CGHS (HEC)
Government of India
Ministry of Health & Family Welfare
Directorate General of CGHS
Maulana Azad Road, Nirman Bhawan
New Delhi 110 108
Dated: 26th November 2014
O F F I C E O R D E R
Subject: CGHS Rates for Cancer Surgery for hospitals empanelled under CGHS
The undersigned is directed to draw attention to the Office Memorandum of even no. dated the 1st October, 2014 and to clarify that CGHS rates for Cancer surgery at Hospitals empanelled under CGHS shall be as per the details given below:
2.1 Rates of Tata Memorial Hospital, Mumbai (2012), as mentioned below for Cancer surgical procedures are treated as CGHS rates for NABH accredited hospitals. For Non-NABH accredited hospitals the rates would be reduced by 15%. These rates are for treatment for Semi private ward entitled class with 10% decrease for G1. Ward and 15 % enhancement for Private ward entitled beneficiaries.
2.2 The duration of treatment for different categories of Surgery will be as follows:
Category – I ………………………………… 1-2 days
Category – II ………………………………… 3-5 days
(7-10 days in respect of operations involving Abdominal / thoracic cavity)
Category III, IV, V & VI ……………………. 12… 14 days
2.3 The surgical procedures are enlisted under Categories – I, II, III, IV, V & VI and the list is annexed to this Office Order.
2.4 Rates applicable for room rent (Accommodation Charges) for different categories of wards are given below:
General ward – Rs.1000/- per day
Semi-private ward – Rs.2000/- per day
Private ward – Rs.3000/- per day
CGHS beneficiaries are entitled to facilities of private, semi-private or general ward depending on their basic pay / pension. The entitlement is as follows:-
S.No. Basic Pay (without the inclusion of grade pay) Entitlement 1. Upto Rs. 13,950/- General Ward 2. Between Rs. 13,951/- and Rs.19,530/- Semi-Private Ward Rs. 19,540/- and above Private Ward
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 provided the patient has been admitted in a room as per his/her entitlement.
2.5 Investigation rates and procedure charges for Chemotherapy shall be as per CGHS prescribed rates of concerned city. In case of Chemotherapy the rates prescribed are procedural charges only. Room rent, investigations and cost of medicines are reimbursable in addition to procedural charges.
2.6 Consultation fee shall be as per CGHS rates applicable.
2.7 Investigations rates shall be as per CGHS prescribed rates of concerned city.
2.8 Cost of Implants / stents/ grafts is reimbursable in addition to package rates as per CGHS ceiling rates for Implants/ stents / grafts.
2.9 The rates applicable for Anesthesia, Operation Theatre and Surgery Charges under Grades- I, II, II, IV, V & VI are given below.
Sr. No. DESCRIPTION Rate in Rupees ANAESTHESIOLOGY CHARGES 1 Anesthesia Fess – Grade I 2700 2 Anesthesia Fess – Grade II 5000 3 Anesthesia Fess – Grade III 8000 4 Anesthesia Fess – Grade IV 10000 5 Anesthesia Fess – Grade V 14000 6 Anesthesia Fess – Grade VI 18000 SURGICAL ONCOLOGY – Operation Theatre (Hospital Service Charges) 1 Minor OT – Service Charges 1000 2 Minor OT – Drugs/Consumables (Without GA) 500 3 Minor OT – Drugs/Consumables (With GA) 750 4 Minor OT – Service Charges – Less than 2 Hrs. 5000 5 Minor OT – Service Charges – 2 To 4 Hrs 10000 6 Minor OT – Service Charges – More than 4 Hrs 20000 SURGERY CHARGES 1 Minor OT – Surgery Charges 870 2 Grade I Surgery 5000 3 Grade II Surgery 12500 4 Grade III Surgery 20000 5 Grade IV Surgery 25000 6 Grade V Surgery 35000 7 Grade VI Surgery 45000
2.10 The admissible amount of Cancer surgery shall be calculated as per the formula given below:
‘Room rent as applicable + Anesthesia charges ( as per category) + OT charges (as per category) + Surgery charges ( as per category) + Investigations at CGHS rates + Cost of Medicines and Surgical Disposables.’
Anesthesia charges (as per category) + OT charges (as per category) + Surgery charges (as per category) prescribed above are applicable for semi-private ward. If the beneficiary is entitled for general ward there will be a decrease of 10% in these rates; for private ward entitlement there will be an increase of 15%.
Other conditions as prescribed in Office Memorandum of even number dated 1stOctober, 2014 remain unchanged.