The healthcare industry has hailed the government’s decision to revise the rates of nearly 2,000 medical procedures under the Central Government Health Scheme (CGHS), accepting its long-pending demand that also brings relief to hospitals and beneficiaries.
The revised rates, effective October 13, apply to all CGHS-empanelled healthcare organisations and medical reimbursement claims of serving employees, pensioners and other beneficiaries.
“NatHealth– Healthcare Federation of India welcomes the Government’s decision to revise the Central Government Health Scheme (CGHS) rates. This reform, along with the earlier GST relief, reflects the Government’s commitment to strengthening healthcare delivery and addressing long-standing concerns of the sector," Ameera Shah, president, NatHealth, and executive chairperson, Metropolis Healthcare Ltd, said.
The revised CGHS rates will now vary depending on the hospital’s quality, location, and type. Accredited hospitals meeting NABH or NABL standards will receive full rates, while non-accredited ones will get 15% less. Super-speciality hospitals will be paid 15% more to reflect higher treatment costs. Meanwhile, hospitals in smaller cities will get slightly lower rates, 10% less in Tier-II cities and 20% less in Tier-III cities compared to major metros, ensuring that reimbursements are aligned with local cost structures and hospital standards
The revised rates also mandate fresh memoranda of agreement between hospitals and the CGHS directorate within 90 days, with existing MoAs expiring on October 13.
The revision comes after repeated calls from the healthcare industry, which said outdated reimbursement rates made it difficult for private hospitals to sustain CGHS empanelment.
The revision will benefit private hospitals as the cost of treatment for CGHS patients will go up. Healthcare stocks such as Apollo Hospitals Ltd, Max Healthcare Ltd, Global Health Ltd, Narayana Health, Fortis Healthcare and Yatharth Hospitals were trading up to 6 percent higher on October 6.
The new structure is expected to improve participation and ease access for millions of beneficiaries, including central government employees and pensioners.
Shah thanked the government for considering NatHealth recommendations and acting upon them through this important policy measure.
“CGHS is a vital programme for millions of beneficiaries, and the revised rates will improve access to safe and effective healthcare while enhancing system efficiency,” Shah said.
Shah suggested benchmarking CGHS and other government-sponsored schemes to the Consumer Price Index (CPI) to ensure predictability and sustainability for all stakeholders — patients, providers, and policymakers alike.
The government last updated the rates for consultations and treatment in private hospitals in 2023. OPD consultation fees were raised from Rs 150 to Rs 350, while in-patient consultation fees had gone up from Rs 300 to Rs 350. ICU charges were set at Rs 5,400, inclusive of accommodation across all ward categories. The charges remain the same after the latest revision.
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