CGHS Package Rates & Inclusions
Last updated: October 13, 2025
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.
Package Inclusions
The package rate includes but is not limited to the following:
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.
Note: 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 Duration Limits
Package rates envisage up to a maximum duration of indoor treatment as follows:
Ward Entitlement Adjustment
Base Rates
The prescribed package rates are based on semi-private ward entitlement.
Adjustments
- •A 5% decrease shall apply for beneficiaries entitled to general ward
- •A 5% increase shall apply for beneficiaries entitled to private ward
Uniform Rates
Investigations and radiotherapy rates shall remain uniform regardless of ward entitlement or admission status, unless the test necessitates hospital admission.
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
Implants and Consumables
Reimbursable Implants
Implants such as lenses, stents, meshes, and valves are reimbursable in addition to the package rates as per CGHS ceiling rates.
Unlisted Implants
Unlisted implants will be reimbursed based on the actual invoice or as per NPPA (National Pharmaceutical Pricing Authority) rates whichever is less.
Consumables
All consumables and medicines, including guidewires and catheters, are deemed inclusive in the package rate.
Drug-Eluting Balloon
Drug-eluting balloon used in lieu of a stent is payable as per NPPA rates or actual invoice whichever is less.
Unlisted Procedures and Investigations
The current guidelines for Unlisted Procedures and Investigations shall continue. These procedures shall be reviewed periodically.
Multiple Surgical Procedures in One OT Session
Reimbursement Rules
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
Bilateral Procedures
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%.
Procedures Within Package Period
Any procedure within the package period of an earlier procedure shall be reimbursed at 75% of the applicable package rate.
Important Note
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.
Consultation Fees
| Type of Consultation | Payable Fee (₹) | Key Conditions / Notes |
|---|---|---|
| OPD – Specialist | ₹350 | Includes emergency/casualty consultations |
| OPD – Super Specialist (DM/MCh) | ₹700 | Applies uniformly to all empanelled hospitals (multi/super specialty); in-house or visiting |
| OPD – Psychiatry (All hospitals) | ₹700 | Enhanced fixed rate for all psychiatric consultations |
| Indoor (IPD) Consultation – Specialist / Super Specialist | ₹350 | Flat rate for all indoor consultations regardless of specialty level |
| Eye Consultations | ₹350 | Fee includes: Refraction, Tonometry and Fundus examination |
Note: 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.