Posts Tagged ‘CGHS Rates’

Guidelines for special provisions to CGHS beneficiaries aged 80 years and above

Guidelines for special provisions to CGHS beneficiaries aged 80 years and above

Government of India
Ministry of Health and Family Welfare
Department of Health Family Welfare
Directorate General of CGHS

Nirman Bhawan, New Delhi 110 011
Dated the 11th July, 2017

OFFICE MEMORANDUM

Subject: – Guidelines for special provisions to CGHS beneficiaries aged 80 years and above

With reference to the above mentioned subject the undersigned is directed to convey the approval of competent authority for special provisions under CGHS to the beneficiaries aged 80
years and below.

a) Consultation of Doctor at CGHS Wellness Centre without standing in Queue

b) CGHS Doctors shall enquire by phone, at least once in a month to enquire about their well being / make a home visit if residing within 5 K.M.s of CGHS WC

c) Settlement of medical claims on priority out of turn

d) Follow up treatment from same specialist in non-empanelled hospital from where he/she was earlier taking treatment- as a special case in view of advanced age and to difficulty to change physician subject to the reimbursement limited to CGHS rates and collection of medicines as per CGHS guidelines.

sd/-
(Dr.D.C.Joshi)
Director, CGHS

Authority: http://cghs.gov.in/

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Delegation of powers for settlement of reimbursement claims/Permissions ex-post-facto approval in respect of Pensioner CGHS beneficiaries, etc

Delegation of powers for settlement of reimbursement claims/Permissions ex-post-facto approval in respect of Pensioner CGHS beneficiaries, etc: CGHS OM No: Z.15025/79/2/DIR/CGHS dated 05.10.2016

Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, New Delhi 110108

No: Z.15025/79/2/DIR/CGHS
Dated the 5th October, 2016

OFFICE MEMORANDUM

Subject: Delegation of powers for settlement of reimbursement claims/Permissions ex-post-facto approval in respect of Pensioner CGHS beneficiaries, etc.
With reference to the above subject the undersigned is directed to state that that the matter has been reviewed by the Ministry in view of the difficulties faced by the CGHS pensioner beneficiaries Therefore, with a view to streamline and to simplify the procedures. it has now been decided to further delegate powers to the Addl. Directors of CGHS Cities / Zones in respect of CGHS pensioner beneficiaries. etc. as under:

i) Permission / ex-post facto approval in non-empanelled hospitals / Diagnostic Labs /Imaging Centre:

Requests for permission ex-post facto approval for elective treatment / investigations in non-empanelled hospitals / diagnostic centres in respect of Pensioners/ex-MF’s/freedom Fighters, etc. shall be considered by Addl. Director of concerned CGHS city / Zone subject to the reimbursement being restricted to CGHS package rates or actual expenditure, whichever is less

ii) Permission / ex-post facto approval in cases involving procedural lapse:

Requests for approval of elective treatment l investigations in empanelled hospitals / diagnostic centres without recommendation of Govt. Specialist or CMO and without prior permission in respect of Pensioners/ex-MPs/freedom Fighters, etc, shall be considered by Addl. Director of concerned CGHS city / Zone subject to the reimbursement being restricted to CGHS rates or actual expenditure whichever is less.

iii) Delegation of Powers for Settlement of Medical Reimbursement Claims (at approved rates) of Individual Pensioner Beneficiary. etc,

Revised Delegated Powers
a) Additional Director, CGHS of City/Zone Rs. 7,00,000/-
b) Director, CGHS Rs. 15,00,000/-
c) Addl. Secretary & DG, CGHS Rs. 25,00,000/-

iv) Delegation of Powers for settlement of Hospital Bills (at approved rates) for the Treatment given to Pensioner Beneficiaries, etc,

Revised Delegated Powers
a) Additional Director, CGHS of City/Zone Rs. 7,00,000/-
b) Director, CGHS Rs. 15,00,000/-
c) Addl. Secretary & DG, CGHS Rs. 25,00,000/-

v) Delegation of Powers for Permission / ex-post facto Approval / Settlement of Medical Reimbursement Claims of Individual Beneficiaries / Hospital Bills in respect of Unlisted procedures / Implants (no CGHS rates)

If there is no CGHS package rate for treatment I CGHS Ceiling rate for implant approval shall be granted as per AIIMS package rate (if only procedural charge. it shall not be considered as package rates)/ AIIMS rate for implant and if there is no CGHS/AIIMS rate approval shall be granted as per actual rate.

Revised Delegated Powers
a) Additional Director, CGHS of City/Zone Rs. 7,00,000/-
b) Director, CGHS Rs. 15,00,000/-
c) Addl. Secretary & DG, CGHS Rs. 25,00,000/-

2. The revised delegations mentioned above will be subject to the conditions that it will not include any case involving relaxation of rules, irrespective of the amount involved. Further, cases where the amounts exceed the monetary limits prescribed above will have to be referred to the Ministry of Health & Family Welfare for obtaining the concurrence of Integrated Finance Division in the Ministry of Health & Family Welfare.

3. The above delegations are in supersession of all the earlier instructions in the matter in respect of the delegations now being conveyed.

This issues with the concurrence of Integrated Finance Division, Ministry of Health & Family Welfare, vide Dy. No C- 3373 dt. 20.09.2016

sd/-
(Dr.D.C.Joshi)
Director, CGHS

Source: www.cghs.nic.in

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CGHS Rates for Dental Treatment Procedure: Corrigendum dated 21-7-2015

CGHS Rates for Dental Treatment Procedure: Corrigendum dated 21-7-2015

F. No. S-11011/34/2015-CGHS (HEC)
Ministry of Health 85 Family Welfare
Directorate General of Health Scheme
(Hospital Empanelment Cell)

Nirman Bhawan, New Delhi.
Dated .21st July, 2015

CORRIGENDUM

Subject: – Change in approved treatment procedure mentioned at Sr. No. 216 in CGHS approved rate list.

With reference to the above mentioned subject the undersigned is directed to draw attention to OM No. 8-1 1045/36/2012-CGHS (HEC) dated 01.10.2014 whereby CGHS treatment procedures were notified along with their rates for Delhi/ NCR, by Government for empanelled hospitals under CGHS.

 

 In this regard it has been decided with approval of competent authority to revise the treatment procedure mentioned at Sr. No. 216 as follows:-
Sr. No. of CGHS List Presently mentioned as To be read as
216 Removable partial denture-Acrylic based-more than 3 teeth Removable partial denture- Acrylic based-more than 3 teeth /per tooth

Rate of Rs.264/- for Non-NABH and Rs.304/- for NABH HCOs at Sr. No. 216 would remain the same.

D. C. J oshi

Director (CGHS)

Source: http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File1107.pdf

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Revision of rates for various treatment procedures under ECHS

Revision of rates for various treatment procedures under ECHS

Central Organisation, ECHS
Adjutant General’s Branch
integrated Headquarters
Ministry of Qefence (Army)
Maude Line’s
Delhi Cantt-110010

B/49773/AG/ECHS/Rates/Policy

10 Feb 2015

REVISION OF RATES FOR VARIOUS TREATMENT

PROCEDURES UNDER ECHS

1. Ref this office letter No B/49773/AG/ECHS/Rates/Policy dt 07 Oct 2014 and B/49773/AG/ECHS/Rates/Policy dt 19 Nov 2014

2. CGHS has revised the rates for various treatment procedures vide their OM No S-11011/48/2014-CGHS (HEC) dt 18 Feb 2015. The rates of under mentioned treatment procedures alongwith their CGHS code are as under:-

Sr. No. CGHS Code Treatment Procedure Current Rate Revised Rates
Non-NABH NABH Non-NABH NABH
Gynae & Obst
1 648 RVF Repair 140000 16100 18975 21821
2 1590 USG for Obstetrics –Anomalies scan 323 380 770 887
Nephrology & Urology
1 793 Epididymectomy 8000 9200 15938 18750
2 888 Lithotripsy Extra corporeal shock wave 19000 21850 19550 22483
3 746 Ureteric Catheterization 690 794 8278 10950
4 807 Kidney transplant (Related) 3500 4025 200000 230000
5 808 Kidney transplant (Unrelated including immunosuppressant therapy) 143000 164450 300000 345000
General Surgery
1 372 Secondary suture of wounds 290 334 3400 4000
2 390 Haemorrhoidectomy 2500 2875 20720 24375
3 391 Stappler Haemorrhoidectomy 4025 4629 38000 43700
4 393 Varicose vein surgery; Trendelenburg operation with suturing or ligation. 8625 9919 10000 11500
5 18 Catheterization 83 95 425 500
6 477 Fissure in Ano-Fissurectomy 5750 6613 13800 15870
7 506 Laparoscopic Paraumblical Hernia Repair 12580 14800 17500 20125
Ophthalmology
1 32 Pterygium Surgery 86 99 5500 6325
2 34 Conjunctival wound repair or exploration following blunt trauma 115 132 3300 3795
Imaging Investigations
1 150 CT-orbit and brain 173 199 1600 1840
2 991 Foramen magnum decompression for Chari Malformation 1100 1265 93750 107813
Cardiology
1 534 DVR 53000 60950 155422 178735

2. Reimbursement to beneficiaries/ empanelled hospitals shall be limited to ceiling rate or as per actuals, whichever is lower. The other terms and conditions as regards to CGHS package rates remain unchanged.

3. The revised rates shall come into force for ECHS from the date of issue and shall be in force till further orders and are applicable in all cities.

(Vijay Anand)
Col
Dir (Med)
for MD ECHS

Source: http://echs.gov.in/images/pdf/med/med128.pdf

Be the first to comment - What do you think?  Posted by admin - February 23, 2015 at 2:16 am

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CGHS Delhi and NCR: Revision of rates for various treatment procedures

Revision of rates for various treatment procedures under CGHS.

F. No.S-11011/48/2014 – CGHS (HEC)
Ministry of Health & Family Welfare
Directorate General Central Govt. Health Scheme
(Hospital Empanelment Cell)
Nirman Bhavan, New Delhi,
Dated the February 18, 2015
OFFICE MEMORANDUM

Subject:- Revision of rates for various treatment procedures under CGHS.

With reference to the above mentioned subject the undersigned is directed to draw attention to O.M. No. S.11045/36/2012-CGHS (HEC) dated 1.10.2014 whereby CGHS package rates for various treatment procedures were notified by the Government empanelled hospitals under CGHS Delhi and NCR. This Directorate has been receiving representations from different stake holders regarding discrepancies in these notified rates. The matter was examined in this Directorate and now it has been decided with the approval of competent authority to revise the rates of following treatment procedures under CGHS.

Sr. No. TREATMENT PROCEDURE Revised Rates Non-NABH Revised Rates NABH
Gynae & Obst
1 RVF Repair 18975 21821
2 USG for Obstetrics –Anomalies scan 770 887
Nephrology & Urology
1 Epididymectomy 15938 18750
2 Lithotripsy Extra corporeal shock wave 19550 22483
3 Ureteric Catheterization 8278 10950
4 Kidney transplant (Related) 200000 230000
5 Kidney transplant (Unrelated including immunosuppressant therapy) 300000 345000
General Surgery
1 Secondary suture of wounds 3400 4000
2 Haemorrhoidectomy 20720 24375
3 Stappler Haemorrhoidectomy 38000 43700
4 Varicose vein surgery; Trendelenburg operation with suturing or ligation. 10000 11500
5 Catheterization 425 500
6 Fissure in Ano-Fissurectomy 13800 15870
7 Laparoscopic Paraumbilical Hernia Repair 17500 20125
Ophthalmology
1 Pterygium Surgery 5500 6325
2 Conjunctival wound repair or exploration following blunt trauma 3300 3795
Imaging Investigations
1 CT-orbit and brain 1600 1840
2 Foramen magnum decompression for Chari Malformation 93750 107813
Cardiology
1 DVR 155422 178735

 

Reimbursement to beneficiaries/empanelled hospitals shall be limited to ceiling rate or as per actual, whichever is lower. The other terms and conditions as regards to CGHS package rates remain unchanged.
2. The revised rates shall come into force from the date of issue and shall be in force till further orders and are applicable in all CGHS cities.
3. This issues with concurrence of Integrated Finance Division of Ministry of Health and Family Welfare vide diary no.C-2289 dated 13/02/2015.

 

(Dr. (Mrs. Sharda Verma)
Director CGHS

Source: http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File924.pdf

Be the first to comment - What do you think?  Posted by admin - February 20, 2015 at 5:05 am

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Arbitrary Rates for Medical Treatment by CGHS empanelled hospitals queried in Lok Sabha

Arbitrary Rates for Medical Treatment by CGHS empanelled hospitals queried in Lok Sabha

GOVERNMENT OF INDIA
MINISTRY OF HEALTH AND FAMILY WELFARE
LOK SABHA
UNSTARRED QUESTION NO 2402
ANSWERED ON 25.07.2014

ARBITRARY RATES FOR MEDICAL TREATMENT

2402 . Dr. VIRENDRA KUMAR
Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:-

(a) whether certain Government hospitals/private CGHS empanelled hospitals across the country including the Institute of Liver and Biliary Sciences in Delhi are reportedly charging arbitrary ratesfor treatment/diagnostic tests from Central Government Employees instead of rates approved by CGHS;

(b) if so, the details thereof and thereasons therefor including action taken against the offenders;

(c) whether the Government has issuedany direction to these hospitals to charge the rates for treatment of diagnostic testsas per CGHS approved rates from CGHS beneficiaries and if so, the details thereof;

(d) the mechanism put in place tomonitor the effective implementation of the directions of the Government in the matter;and

(e) the corrective measures taken/proposed to be taken by the Government in this regard including reimbursement offull expenses incurred on medical treatmentof the CGHS beneficiaries?

ANSWER

THE MINISTER OF HEALTH AND FAMILY WELFARE (DR. HARSH VARDHAN)

(a) & (b): There are certain complaints of overcharging by the CGHS empanelled private hospitals. However it does not include the Institute of Liver and Biliary Sciences in Delhi, which is an autonomous body under State Government of Delhi.

The Complaints received against some Private CGHS empanelled hospitals are as under:

Delhi

1.Kukreja Hospital
2. Indraprastha Apollo Hospital
3. JeewanHopsital& Nursing Home
4. Dr B.L.Kapoor Hospital
5. Yashoda super speciality Hospital
6. Fortis Flt Lt. RajanDhall Hospital
7. Medanta the Mediciti
8. National Heart Institute
9.Saral Advanced Diagnostics Pvt. Ltd.
10.NoidaMedicare centre
11. Max Super speciality Hospital
12. Escort’s Hospital Faridabad
13.Kailash Hospital & Heart Institute
14. Mata Chanan Devi Hospital
15. Dr Lal Path Lab

Excess amount charged has been deducted and paid to the beneficiaries.

Bengaluru:

1. Fortis Hospital , Cunningham Road
2. Fortis Hospital Bennerghatta Road
3. Shankar Eye Hospital
4. Imperial Hospital

Warning letters were issued by Addl. Director, CGHS and the excess amount charged was recovered and paid to the beneficiaries.

Patna

Show Cause Notice was issued to Ruban Memorial Hospital

Jabalpur

1. Jabalpur Hospital & Res.Centre
2. Marble city Hospital & Res. Centre

Warning letters were issued by Addl. Director, CGHS and the excess amount charged was returned to the beneficiaries.

(c): The CGHS empanelled hospitals and diagnostic centres are to charge only the approved package rates and this clause is part of Memorandum of Agreement (MOA) signed between CGHS and CGHS empanelled hospitals and diagnostic centres at the time of empanelment.

(d)& (e): Monitoring is done by the officers of CGHS, including Addl. Director of the concerned city, Joint Director(Grievances), Hospital Cell and Hospital Empanelment Cell.

As and when any instance of excess charging comes to the knowledge of CGHS, the matter is taken up with the concerned hospital / diagnostic centre and Show Cause Notice is issued seeking explanation. In case of unsatisfactory reply or no reply suitable action is taken as per terms and conditions of Memorandum of Agreement signed by the hospitals like forfeiture of performance bank guarantee , recovery of excess amount and in extreme cases removal from CGHS panel.

Source: Lok Sabha

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Clarification of CGHS rates on 2014 which have been placed on CGHS website for information and acceptance only

Clarification of CGHS rates on 2014 which have been placed on CGHS website for information and acceptance only

F. No. S. 11011/20/2014-CGHS (HEC)
Directorate General of Central Govt. Health Scheme
Ministry of Health & Family Welfare

Nirman Bhavan, New Delhi
Dated, 16th July, 2014

CLARIFICATION

It has been brought to the notice of the undersigned that some of the CGHS empanelled Health Care Organizations have started charging new CGHS rates 2014 which have been placed on CGHS website for information and acceptance only. Since these rates have not yet been notified by Ministry of Health and Family Welfare, the empanelled HCOs cannot charge these new rates and CGHS 2010 rates would prevail. Charging these new rates 2014 from CGHS beneficiaries by empanelled health care organizations would amount to overcharging and suitable action including recovery of overcharged amount and forfeiture of performance bank guarantee would be initiated against those HCOs by CGHS.

Dr. (Mrs.) Sharda Verma
Director (CGHS)

Source: http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File712.pdf

Be the first to comment - What do you think?  Posted by admin - July 18, 2014 at 12:53 pm

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Revision of CGHS Rates for various Coronary Stents / Angioplasty

Revision of CGHS Rates for various Coronary Stents / Angioplasty

No. Misc. 1002/2006/CGHS(R&H)ICGHS(P)
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
CGHS (P)

Nirman Bhavan, New Delhi
Dated: the 29 April, 2014

OFFICE MEMORANDUM

Sub:- Revision of Ceiling Rates for various Coronary Stents / Angioplasty& Angioplasty with Balloon for CGHS/CS (MA) beneficiaries.

With reference to the above mentioned subject, the undersigned is directed to draw attention to the Office Memoranda of even No. dated 7/2/2013, 21/2/2013 and 7/2/2014 and to state that the ceiling rates for reimbursement of drug eluting coronary stents for CGHS beneficiaries I CS(MA) bencficiaries prescribed in the above referred to Office Memoranda are revised w.c.f. the date of issue of this office memorandum as follows:

Revised ceiling rates of Drug Eluting Stents: Rs. 23,625/- (Inclusive of all taxes). Other terms and conditions shall remain the some.

2. This issues with the approval of the competent authority.

(Ravi Kant)
Under Secretary to the Government of India

Be the first to comment - What do you think?  Posted by admin - May 7, 2014 at 9:42 am

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Government to revise rates for CGHS empanelled hospitals

Government to revise rates for CGHS empanelled hospitals

In a good news for lakhs of beneficiaries under the Central Government Health Scheme (CGHS), the Government is in the process of revising the rates of medical procedures offered by empanelled hospitals and diagnostic centres and giving them early payment assurance to encourage more medical institutions join the scheme.

The Ministry of Health and Family Welfare has floated e-tenders for empanelment of hospitals and decided that the rates of various medical procedures would be fixed by an average of rates quoted in e-tenders instead of the old system where the lowest quotation became the rate.

Rates of all medical procedure centres under CGHS would be revised by April next year.

Not just that, the Government is also revising its policy by providing empanelled hospitals assured upfront payment of 70 per cent of the total bill within five days of its presentation and balance admissible amount within a maximum period of 30 days.

The direction for a 10 per cent deduction in case of early/cash payment to hospitals under CGHS has also been done away with, highly-placed sources in the Ministry told PTI.

“These measures will put an end to the problems of delayed payments which discourage hospitals from getting empanelled under the scheme,” a Health Ministry official said.

Under the new policy finalised by the Ministry, the category of super specialty hospitals empanelled under the CGHS has also been done away with.

“Now, hospitals, exclusive eye hospitals/centres, exclusive dental clinics and diagnostic centres shall be empanelled for all facilities available in the health care organisation as approved by National Accreditation Board for Hospitals/National Accreditation Board for Labs and the Quality Council of India and shall not be empanelled for selected specialities/facilities,” the new policy says.

The changes will help rope in more hospitals, clinics and diagnostic centres under the CGHS as many renowned and big hospitals were shying away from being empanelled under the scheme due to pending payments and low rates for medical procedures.

Sources said payments of bills amounting to around Rs 100 crore of private hospitals are pending with the government under CGHS alone, even though hospitals are crying hoarse that pending payments are to the tune of over Rs 400 crore.

Officials, however, say this huge amount is not pending under CGHS and it may include payments under ECHS, ESI and health bills of other big departments like Delhi Police and others.

Source : www.business-standard.com
[http://www.business-standard.com/article/pti-stories/govt-to-revise-rates-for-cghs-empanelled-hospitals-113122900482_1.html]

Be the first to comment - What do you think?  Posted by admin - January 8, 2014 at 4:47 pm

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Issuance of Blood Sugar Level Testing Strips under CGHS

Issuance of Blood Sugar Level Testing Strips under CGHS

 

GOVERNMENT OF INDIA
MINISTRY OF HEALTH AND FAMILY WELFARE
LOK SABHA

UNSTARRED QUESTION NO 2384

ANSWERED ON   23.08.2013

ISSUANCE OF BLOOD SUGAR LEVEL TESTING STRIPS

2384 . Shri SURESH KALMADI
Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:-

(a) whether blood sugar level testing strips are not issued to the diabetic patients to the Central Government Health Scheme (CGHS) beneficiaries;

(b) if so, the name of other such devices which are not issued to the CGHS beneficiaries;

(c) the reasons for not issuing such devices keeping in view that these devices are very costly and poor/middle class patients cannot afford them; and

(d) the corrective steps taken/being taken by the Government for issuance of such devices including blood sugar level testing strips to the CGHS beneficiaries?

ANSWER

THE MINISTER OF HEALTH AND FAMILY WELFARE (SHRI GHULAM NABI AZAD)

(a): As per the existing guidelines, the competent authority grants permission for reimbursement of expenses on glucostrips to CGHS beneficiaries in the following categories related to diabetic mellitus, on the advice of specialists of Government Hospitals:-

1. Diabetic Cellulitis

2. Diabetic foot/Diabetic Gangrene

3. Diabetes Mellitus with CRF stage III & above

4. Diabetes Mellitus type I

5. Brittle Diabetes Mellitus

6. Diabetes Mellitus Type II during initiation of Insulin (one month only).

The maximum limit of glucostrips to be reimbursed has been kept as 25 per month limited to the rate of Rs. 25/- per strip.

(b) to (d ): Glucometer is issued to the CGHS beneficiaries suffering from diabetic gangrene to monitor the sugar level on regular basis. However, the cost of the Glucostics to be used in the Glucometer would have to be borne by the beneficiaries themselves.

Source: http://karnmk.blogspot.in/2013/12/issuance-of-blood-sugar-level-testing.html

Be the first to comment - What do you think?  Posted by admin - December 6, 2013 at 6:00 am

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Central Government Health Scheme : New Rates for Undergoing Angioplasty

Central Government Health Scheme : New Rates for Undergoing Angioplasty

Central Government Health Scheme – New revised package rates for Coronary Angioplasty under CGHS:

New Rates for Undergoing Angioplasty

The Government has revised the CGHS package rates for coronary angioplasty and angioplasty with balloon w.e.f. 7/2/2013 as per the following details:

Coronary Angioplasty and Angioplasty with Balloon

Coronary Angioplasty –  Rs. 50,000/-
Coronary Angioplasty with Balloon –  Rs. 55,000/-

All the empanelled private hospitals have not discontinued to provide angioplasty treatment to CGHS beneficiaries. However, ‘3’ hospitals in Delhi & NCR have  filed Writ Petitions in Hon’ble High Court of Delhi against the revised rates.

Meanwhile, the continuous empanelment scheme has been revived on 14th February, 2013 to empanel more number of eligible private hospitals under CGHS to provide inpatient healthcare facilities to CGHS beneficiaries.

This information was given by the Minister for Health & Family Welfare ShriGhulamNabi Azad in written reply to a question in the RajyaSabha today.

Be the first to comment - What do you think?  Posted by admin - March 20, 2013 at 4:19 pm

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CGHS Rates 2013 : A revised list of package rates applicable under CGHS Kolkata

CGHS Rates 2013 : A revised list of package rates applicable under CGHS Kolkata 

Ministry of Health and Family Welfare has issued a new updated revised package rates for all investigations applicable under CGHS Kolkata, Pensioners and existing employees of Central Government are requested to download the rate list and keep in their computer and mobile also. The rates are given as NABL and Non NABL Imagin centres.

The rate list has been provided with the titles of treatment such as Dental, Pulmonary, Osteology, Neurosciences, Gastro and Hepatobiliary, Genitourinary, Endocrinology, Radio-Isotope Therapy etc., the total number of 490 investigation names are available in the list.

Please click the link to get the CGHS rate list of Kolkata…

Be the first to comment - What do you think?  Posted by admin - January 28, 2013 at 4:34 pm

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Guidelines & Ceiling Rates for Liver Transplant Surgery in respect of CGHS / CS(MA) beneficiaries

F.No.S-14025/3/2010-MS/CGHS (P)
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, New Delhi
Dated the 16th January, 2013
OFFICE MEMORANDUM

Subject :- Guidelines & Ceiling Rates for Liver Transplant Surgery in respect of CGHS / CS(MA) beneficiaries
With reference to the above mentioned matter the undersigned is directed to state that the Ministry of Health and Family Welfare has been receiving requests from the Central Government employees and pensioners covered under CGHS / CS(MA) Rules, 1944 seeking approvals for Liver Transplantation surgery in respect of themselves and their eligible family members under CGHS / CS(MA) Rules. The Ministry has been examining these proposals on case to case basis for allowing the medical treatment to the beneficiaries on merits. In view of the increasing number of cases, the matter has been reviewed by this Ministry and it has now been decided to issue guidelines and ceiling rates for permission / reimbursement for Liver Transplant Surgery in respect of CGHS / CS (MA) beneficiaries as per the details mentioned below: –

I. SELECTION CRITERIA

A. INDICATIONS

1. Adult Liver diseases

Acute liver failure Non-Paracetamol (Viral, drug, induced, Wilson’s, Autoimmune hepatitis etc.) Prothrombin time >100 sec or 3 of 5: Interval jaundice-encephalopathy > 7 days
Age < 10 or > 40 Years Prothrombin time > 50 sec. / INR > 3.5 Bilirubin > 30 umol/1 Cause non-viral or unknown.
Paracetamol induced Arterial Ph <7.30 or all 3 criteria Encephalopathy grade III or IV
Prothrombin time >100 sec./INR > 6.5 Creatinine >300 umol/I
Chronic Liver disease Cirrhosis (Non- Cholestatic) Child-Pugh score >or equal 10 or Meld Score > 14
Cholestatic with or without Cirrhosis According to American criteria based on MELD scoring
Miscellaneous case to case basis
Liver Tumors Heptocellular
Carcinoma
Single Tumor <6.5 cm or Two Tumors < or equal 4.5 cm
No Vascular invasion
No distant Metastasis
Other types Case to case basis

2. Pediatric Liver diseases: – EHBA and Metabolic Liver Disease to be decided on case to case basis. 

B. CONTRAINDICATIONS

Absolute Systemic extra hepatic infcctions
Extra hepatic malignancy (if not definitely cured)
Irreversible brain damage
Irreversible multi-organ failure
Substance abusc ( if not abstinent for > 6 months)
Relative HIV seropositivity
Age > 65 years
Mental incapacity
Extra hepatic disease limiting the chance of survival
Residency outside India (unless emergency)
II. Type of Transplant: permitted for reimbursement.
(a) Cadaveric donor
(b) Live donor
      i.Related (Near Relatives)
      ii. Unrelated (Only after approval by Authorization Committee)
III. Centres Approved for Liver Transplantation Surgery 
Liver Transplant Surgery shall be allowed only in Government Hospitals/ Pvt. Hospitals, which are registered under the Transplantation of Human Organs Act, 1994, as amended from time to time.
IV. Permission / ex-post facto approval for Liver Transplantation Surgery
The Liver Transplant Surgery will be permitted / reimbursed only after the request has been approved and recommended by a Standing Committee, comprising of the following:
1. Addi. DG, CGHS/DDG (M) (as the case may be) Chairman
2 HOD, GI Surgery, AIIMS Member
3. HOD, Gastroenterology and Human Nutrition, Member AIIMS
4. HOD, Gastroenterology, G.B. Pant Hospital Member
5 HOD, GI Surgery, R&R Hospital Member
6. HOD, Gastroenterology, R&R Hospital Member
7. Joint Director (R & H), CGHS/Addl. DDG(MG-l1) Member Secy.

The above Standing Committee shall consider the cases in respect of CGHS as well as CS (MA) beneficiaries.

V. Documents required to be submitted for consideration of reimbursement / permission.
1. Recommendation by Govt. Gastroenterologist / GI Surgeon by at least one surgeons doing Liver Transplant Surgery.
2. CT /MRI Liver report.
3. Etiology evaluation report.
4. Histopathological report, wherever available
5. Current Child Pugh /MELD score report
6. Other relevant document.
VI. Reimbursement Criteria :-
As Liver Transplant Surgery is a planned surgery and ther dore, prior permission has to be obtained before the surgery is undertaken. However,if for some reason it is done in emergency to save the life of the patient, the Standing Committee shall consider the cases referred to it for recommending grant of ex-post-facto permission on a case to case basis.
VII. Submission of Application:
CGHS / CS (MA) beneficiaries will submit their request for permission for Liver Transplant to the Standing Committee, through their respective Department in case of serving employees and the Additional Director, CGHS of the concerned zone or city, in case of pensioner CGHS beneficiary. The Department concerned will refer the cases to the office of Director, CGHS in case of a CGHS beneficiary and to the Medical Services Division of Department of Health and Family Welfare in case of CS (MA) beneficiaries for processing the case and its submission before the Standing Committee for their consideration and recommendations.
VIII. Ceiling Rate for reimbursement for Liver Transplantation surgery under CGHS / CS(MA) rule.
(a) The package rate for Liver Transplantation surgery involving live liver donor shall be as follows:
Rs. 11,50,000/- ( Rupees Eleven lakh fifty thousand only) + pre transplant evaluation of donor and recipient- Rs. 2,50,000/- (Rupees Two lakh fifty thousand only).
(b) The package rate for Liver Transplant surgery involving a deceased donor shall be:
Rs. 11,00,000/- ( Rupees Eleven lakh only)
This includes, the cost of consumables during the organ retrieval and the cost of preservative solution, etc.
i) The package charges include the following
1. 30 days stay of the recipient and 15 days for the donor starting one day prior to the transplant surgery.
2. Charges for Medical and Surgical Consumables, surgical and Procedure Charges, Operation theater Charges, Anesthesia Charges, Pharmacy, Investigations and in house doctor consultation for both donor and recipient during the above period. This also includes all post operative investigations and procedures during the above mentioned period.
ii) The package excludes:
1. Charges for drugs like Basiliximab/Daclizumab, HBIG, and peg Interferon.
2. Cross Matching charges for Blood and Blood products.
Note: 1. The extra stay if any may be reimbursed after justification by the treating specialists for the reason of additional stay and only as per CGHS guidelines.
2. The drugs mentioned above would be reimbursed as per CGHS rates or actual whichever is lower.
This Office Memorandum shall come into effect from the date of issue.
This issues with concurrence of the Integrated Finance Division of this Ministry vide their Diary No. C-1603 dated 26th December, 2012.
sd/-
[V.P. Singh]
Deputy Secretary to the Government of India

Source: www.msotransparent.nic.in
[http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File562.pdf]

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Continuation of empanelment of private hospitals, diagnostic laboratories and imaging centres under CGHS and revalidation of CGHS package rates – regarding

Continuation of empanelment of private hospitals, diagnostic laboratories and imaging centres under CGHS and revalidation of CGHS package rates – regarding

Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare,
Nirman Bhawan, Maulana Azad Road,
New Delhi 110 001
No. S 11041/23/2009/-CGHS (Hosp. Cell) / CGHS (P)/Pt-IX
Dated the 15th October, 2012
OFFICE MEMORANDUM
Sub: Continuation of empanelment of private hospitals, diagnostic laboratories and imaging centres under CGHS and revalidation of CGHS package rates – regarding.
The undersigned is directed to refer to the various office memoranda issued by this office from time to time vide which private hospitals, diagnostic laboratories and imaging centres were empanelled under CGHS in Delhi & NCR and other CGHS covered cities from 7th October 2010 onwards which would be completing empanelment period of ‘2’ years before 31st March 2013 and to state that it has been decided to extend the validity of empanelment of such empanelled hospitals, diagnostic laboratones and imaging centers on the same terms and conditions under which they were empanelled, till 31st March 2013 or till next empanelment, whichever is earlier.
2. Similarly, the CGHS rates notified in 2010-11 in Delhi & NCR and other cities are also revalidated till further revision of the rates.
3. The private hospitals, diagnostic laboratories and imaging centres, which are not interested to continue their empanelment under CGHS shall have to submit letters seeking withdrawal of empanelment on or before 31st October 2012, failing which it shall be construed that they intend to continue their empanelment under CGHS as per the terms and conditions of MOA signed with CGHS by them. The private hospitals, diagnostic laboratories and imaging centres are also required to submit revalidated Performance Bank Guarantee (in case they expire prior to 31st March, 2013.)
4. The hospitals shall however complete the treatment as per the same terms and conditions in respect of CGHS beneficiaries, who were already admitted prior to issue of this O.M.
6. These Orders shall be effective from the date of its issue.
sd/-
[V.P.Singh]
Deputy Secretary to the Government of India
Source : http://msotransparent.nic.in/cghsnew/index.asp

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