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Empanelment of Exclusive Cancer Hospitals and Units under CGHS

The undersigned is directed to draw attention to the Office Memorandum of even number dated 23rd June 2011 and to state that this Ministry has been receiving representations seeking clarification about the rates applicable for treatment of CGHS beneficiaries at Exclusive Cancer Hospitals / Cancer Units empanelled under CGHS. The matter has been examined by this Ministry and it has now been decided to clarify that the rates applicable for Cancer treatment are as per the details given below

2.1 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 / thoraciccavity)
Category – III, IV & V —14 days.

2.2. The surgical procedures are enlisted under Categories – I, II, Ill, IV & V and the list
is annexed to this Office Memorandum (at Annexure-I).

2.3. Rates applicable for room rent (Accommodation Charges) for different categories of wards as 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 Category pay) Entitlement
1. Upto Rs. 13,950/- General Ward
2. Between Rs 13,951/- and Rs.19,530 Semi-Private Ward
3. 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.

2.4 The Super-specialty rates of CGHS Delhi for Cancer Radio-therapy and Chemotherapy shall be applicable as CGHS rates for Cancer Radiotherapy and
Chemotherapy (placed at Annexure —Il). In case of Chemotherapy the rates prescribed are procedural charges only. Room rent, investigations and cost of medicines are reimbursable in addition to the procedural charges.

Chemotherapy medicines shall be procured fran, CGHS wherever feasible and as per available brand. In case, medicines are supplied by hospital,
they shall provide the same on credit basis to pensioners and a shall offer a discount of 10% on MRP. The hospital in such cases shall certify that the Chemotherapy medicines have not been supplied by the CGHS.

2.5 Consultation fee shall be as per CGHS rates applicable for NABH Accredited hospitals.

2.6 Investigation rates shall be as per CGHS prescribed rates of concerned city.

2.7 Cost of Implants / stents / grafts is reimbursable in addition to package rates as
per CGHS ceiling rates for Implants / stents / grafts or as per actual, in case
there is no CGHS prescribed ceiling rates.

2.8 The rates applicable for Anaesthesia, Operation Theatre and Surgery Charges under Categories —I, II, III, IV & V are given below

Anesthesiology Charges Rates in Rupees
Anesthesia Fees – Category I 2,310
Anesthesia Fees – Category II 2,755
Anesthesia Fees – Category III 4,830
Anesthesia Fees – Category IV 5,775
Anesthesia Fees – Category V 6,615
SURGICAL ONCOLOGY – Operation Theatre (Hospital Service Charges) Rates in Rupees
Minor OT – Service Charges 870
Minor OT – Drugs/Consumables (Without GA) 325
Minor OT – Drugs/Consumables (With GA) 540
Minor OT – Service Charges – Less than 2 Hrs. 3,465
Minor OT – Service Charges – 2 To 4 Hrs. 5,775
Minor OT – Service Charges – More than 4 Hrs. 8,455
SURGICAL CHARGES Rates in Rupees
Minor OT – Service Charges 870
Category I Surgery 2,755
Category II Surgery 6,930
Category III Surgery. 9,660
Category IV Surgery 15,095
Category V Surgery 17,325

2.9 The admissible amount for 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 s 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%.

5. Other conditions as prescribed n Office Memorandum of even number dated the June 23, 2011 remain unchanged.

Download Order of Ministry of Health and Family Welfare No: REC/2008/JD(Gr)/CGHS/CGHSS(P) dated 12.09.2011

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