items under CGHS.
by Hon’ble High Court of Delhi in the case of Sh. Kanhiya Singh Vs UOI and
others [W.P.(C) 9044/2011], regarding admissibility and non-admissibility of
certain items under CGHS, the following clarifications are issued:-
includes lump sum cost of inpatient treatment I day care / diagnostic
procedures for which a CGHS beneficiary has been permitted by the competent
authority or for treatment under emergency from the time of admission to the
time of discharge including (but not limited to) –
Accommodation charges including patients diet,(iv)
Doctor I consultant visit charges,(viii)
ICU / ICCU charges,(ix)
Monitoring charges,(x) Transfusion
Operation theatre charges,(xiii)
Procedural charges / surgeon’s fee,(xiv)
Cost of surgical disposables and all sundries used during hospitalization,(xv)
Cost of medicines,(xvi)
Related routine and essential investigations,(xvii)
Physiotherapy charges etc.(xviii)
Nursing care and charges for its services.
Implants / stents / grafts is reimbursable in addition to package rates as per
CGHS ceiling rates for Implants / stents I grafts or as per actual, in case
there is no CGHS prescribed ceiling rate.
treatment of the CGHS beneficiary, the hospital will not ask the beneficiary or
his / her attendant to purchase separately the medicines / sundries I equipments
or accessories from outside and will provide the treatment within the package
rate, fixed by the CGHS, which includes the cost of all the items.
conservative treatment, where there is no CGHS package rate, the above
mentioned items are admissible – items wise at CGHS rates or as per AIIMS rates
(if there is no CGHS rate) or as per actual Of there is no CGHS I AIIMS rate)
for any item.
rates envisage up to a maximum duration of indoor treatment as follows:
12 days for Specialized (Super Specialties) treatment;7 days for other Major Surgeries;3 days for Laparoscopic surgeries I normal deliveries; and1 day for day care / Minor (OPD) surgeries.
the beneficiary is required to stay in the hospital for his / her recovery for
a period more than the period covered in the prescribed package rate, in exceptional
cases, supported by relevant medical records and certified as such by the hospital,
the additional reimbursement shall be limited to accommodation charges as per
entitlement, investigations charges at approved rates, and doctors visit
charges (not more than 2 visits per day per visit by specialists / consultants)
and cost of medicines for additional stay).
No additional charge on account of
extended period of stay shall be allowed if that extension is due to infection
on the consequences of surgical procedure or due to any improper proceed.
list is however not exhaustive. Some patients may require additional facilities/
procedures, which are admissible depending upon the medical requirements as
advised by the treating doctors/specialists, with proper justification.
Therefore, it is not possible to indicate a comprehensive list of items, which
are not admissible.
purpose of reimbursement under CGHS:
Telephone chargesToiletriesSanitary napkinsTalcum powderMouth fresheners
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