CGHS Medical Reimbursement: UPSC Issues Clarification on Follow-up Tests and Referrals
The Union Public Service Commission (UPSC) has issued a clarification on CGHS medical reimbursement guidelines, covering follow-up consultations, diagnostic investigations, special tests and unlisted procedures.
The clarification was issued through an Office Memorandum dated August 11, 2026, following queries raised with CGHS Headquarters regarding difficulties faced while processing medical reimbursement claims.
Key CGHS Clarifications
Follow-up investigations: Subsequent consultations, investigations and minor procedures should be undertaken at the same empanelled hospital where the primary consultation was taken.
Tests up to ₹3,000: If a specialist prescribes a test costing up to ₹3,000, it should be conducted at the same hospital/HCO. If the beneficiary wants to use another CGHS-empanelled hospital, HCO or Diagnostic Centre, prior referral/endorsement from the CGHS Wellness Centre is required.
CT, MRI and PET scans: CGHS referral/endorsement is mandatory for CT Scan, MRI Scan, PET Scan and other investigations costing more than ₹3,000.
Consultation validity: Each consultation is valid for seven days, provided the follow-up relates to the same specialty.
Eye consultation: Eye consultation fees include refraction, tonometry and fundus examination.
Unlisted procedures: Prior permission from the concerned Department/Office is mandatory before undertaking an unlisted investigation or procedure advised by a specialist at a CGHS-empanelled hospital.
UPSC has advised its staff and officials to follow these CGHS guidelines to ensure hassle-free processing of medical reimbursement claims. The clarification has been issued with the approval of the Competent Authority.
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