CGHS (Central Government Health Scheme) serves over 40 lakh central government employees, pensioners, and their dependants across 75+ cities in India. For empanelled hospitals, CGHS provides guaranteed, cashless revenue — but the package rates (last revised in March 2014 and partially in 2022) are a common source of confusion. This is the most complete, updated CGHS package rate reference for 2026, covering OPD consultation charges, all major surgical packages, diagnostic rates, and the exact claim process for empanelled hospitals.
What Is CGHS and How Does Empanelment Work?
CGHS is a healthcare benefit scheme for central government employees (serving and retired), their dependent family members, widows of government servants, and MPs. Unlike PMJAY (which is income-based), CGHS entitlement is employment-based — all central government employees earning above Grade Pay 2400 are eligible, regardless of salary level.
CGHS operates through a network of CGHS Wellness Centres (government-run primary care centres) and empanelled private hospitals for specialist and surgical care. Private hospitals that want CGHS patients must apply for empanelment with the Ministry of Health and Family Welfare through the CGHS portal.
As of 2026, there are over 1,000 empanelled private hospitals under CGHS across 75+ cities. Entry into CGHS empanelment is competitive in metro cities (Delhi, Mumbai, Bangalore, Chennai, Hyderabad) but more accessible in Tier 2 and Tier 3 cities.
CGHS vs PMJAY vs Market Rates: Key Comparison
Understanding how CGHS rates compare to PMJAY and open-market rates helps hospitals make an informed decision about the value of CGHS empanelment:
| Procedure | CGHS Rate | PMJAY Rate | Private Market Rate |
|---|---|---|---|
| CABG (Bypass Surgery) | ₹1,44,000 | ₹1,32,000 | ₹3,00,000–₹5,00,000 |
| Total Knee Replacement | ₹90,000 | ₹80,000 | ₹2,00,000–₹3,00,000 |
| Cataract Surgery (Phaco, IOL) | ₹10,000 | ₹6,000 | ₹25,000–₹45,000 |
| Normal Delivery | ₹15,000 | ₹9,000 | ₹30,000–₹60,000 |
| C-Section | ₹25,000 | ₹17,000 | ₹50,000–₹1,00,000 |
| Coronary Angiography | ₹12,000 | ₹10,000 | ₹25,000–₹40,000 |
| Haemodialysis (per session) | ₹2,000 | ₹1,500 | ₹3,000–₹5,000 |
| Chemotherapy Cycle (Day Care) | ₹22,000–₹40,000 | ₹18,000–₹35,000 | ₹40,000–₹1,00,000 |
Key insight: CGHS rates are generally 8-15% higher than PMJAY rates, and significantly lower than private market rates. For hospitals, CGHS is valuable because beneficiaries tend to be urban, educated, English-speaking, and willing to return for follow-ups — making them lower-complexity and higher-compliance patients compared to the average PMJAY cohort.
CGHS OPD Consultation Rates 2026
CGHS beneficiaries can consult specialists at empanelled hospitals in OPD. The fixed CGHS consultation rates are:
| Consultation Type | CGHS Rate |
|---|---|
| General Physician / Family Doctor | ₹250 |
| Specialist Consultation (DM/MS) | ₹350 |
| Super-Specialist Consultation (MCh/DM) | ₹500 |
| Telemedicine Consultation | ₹200 |
| Follow-up Consultation (within 7 days) | ₹150 |
| Emergency Consultation (after hours) | ₹600 |
CGHS beneficiaries must present their CGHS card and the referral from the CGHS Wellness Centre for specialist OPD visits (except emergencies). Without a referral, they must pay out of pocket and claim reimbursement later.
CGHS Surgical Package Rates: Top Specialties
General Surgery
| Procedure | CGHS Rate | Stay |
|---|---|---|
| Laparoscopic Cholecystectomy | ₹22,000 | 2 days |
| Open Appendectomy | ₹15,000 | 3 days |
| Laparoscopic Appendectomy | ₹20,000 | 2 days |
| Hernia Repair (Open) | ₹12,000 | 2 days |
| Hernia Repair (Laparoscopic) | ₹18,000 | 2 days |
| Haemorrhoidectomy | ₹10,000 | 1 day |
| Thyroidectomy (Total) | ₹32,000 | 3 days |
| Mastectomy (Modified Radical) | ₹48,000 | 5 days |
Ophthalmology
| Procedure | CGHS Rate | Stay |
|---|---|---|
| Cataract (Phacoemulsification + Monofocal IOL) | ₹10,000 | Day Care |
| Cataract (Phaco + Premium/Toric IOL) | ₹15,000 | Day Care |
| Glaucoma Surgery (Trabeculectomy) | ₹14,000 | 1 day |
| Retinal Detachment Repair | ₹28,000 | 2 days |
| Vitrectomy | ₹30,000 | 2 days |
| Intravitreal Injection (Anti-VEGF) | ₹4,500 per injection | Day Care |
CGHS Diagnostic Test Rates 2026
CGHS beneficiaries can get prescribed diagnostic tests done at CGHS-empanelled labs at fixed rates. The lab must be NABL-accredited for most categories. Key rates:
| Test | CGHS Rate |
|---|---|
| Complete Blood Count (CBC) | ₹100 |
| Blood Sugar Fasting + PP | ₹80 |
| HbA1c | ₹200 |
| Lipid Profile | ₹250 |
| Liver Function Test (LFT) | ₹300 |
| Kidney Function Test (KFT/RFT) | ₹250 |
| Thyroid Profile (T3/T4/TSH) | ₹350 |
| ECG (12-lead) | ₹100 |
| Chest X-Ray (PA view) | ₹150 |
| Ultrasound Abdomen | ₹700 |
| CT Scan (Abdomen + Pelvis with contrast) | ₹3,500 |
| MRI Brain (with contrast) | ₹5,500 |
| 2D Echo | ₹1,500 |
| TMT (Treadmill Test) | ₹1,200 |
CGHS Claim Process for Empanelled Hospitals
For cashless treatment, CGHS empanelled hospitals must follow this process:
- Verify CGHS Card: The beneficiary must present a valid CGHS card (plastic card or digital). Check validity date, beneficiary category (serving/pensioner), and entitled ward category (private/semi-private/general — based on pay grade).
- Check Entitlement Ward: Beneficiaries are entitled to ward categories based on their pay level. Serving employees in pay matrix Level 1-7 get general ward, Level 8-13 get semi-private, Level 14+ get private ward. Using a higher ward without patient consent and additional payment is a CGHS compliance violation.
- Prior Permission for Elective Cases: For non-emergency elective procedures, the beneficiary must obtain prior permission from the CGHS Additional Director. Without prior permission, the hospital may not receive payment and the beneficiary will need to claim reimbursement.
- Claim Submission: Submit claims to the CGHS Additional Director's office within 30 days of discharge. Claims must include: discharge summary, clinical notes, original bills, investigation reports, prior permission letter (if applicable), and the CGHS Essentiality Certificate for implants.
- Payment Timeline: CGHS must settle bills within 30 days of claim submission. In practice, Delhi and Mumbai offices typically settle within 45-60 days; other cities may take 60-90 days.
Frequently Asked Questions About CGHS Rates
Are CGHS rates negotiable for private hospitals?
No. CGHS package rates are fixed by the Ministry of Health and are non-negotiable. All empanelled hospitals must accept CGHS rates as full and final payment — no additional billing to the beneficiary is permitted. The only exception is for services not in the CGHS package list, where billing at market rates is allowed with proper disclosure.
How often are CGHS package rates revised?
CGHS rates were last comprehensively revised in 2014, with partial revisions in specific specialties in 2022. As of 2026, hospitals and medical associations are actively lobbying for a comprehensive rate revision. Hospitals considering CGHS empanelment should factor in that rates may be below current costs for some procedures.
Can CGHS beneficiaries go directly to empanelled hospitals without referral?
For emergencies, yes — CGHS beneficiaries can go directly to any empanelled hospital without a referral. For elective OPD consultations with specialists, they need a referral from the CGHS Wellness Centre. The referral specifies the specialist and the number of permitted follow-up visits. Without referral, they pay cash and claim reimbursement later at CGHS rates.
What is the CGHS empanelment process for new hospitals?
Apply online at cghs.gov.in with: NABH/NABL certificates (mandatory for most categories), clinical establishment registration, fire NOC, building completion certificate, bed strength certificate, specialist doctor details with registration numbers, equipment inventory, and bank details. The CGHS Medical Officer conducts a physical inspection within 30-45 days. Approval takes 60-90 days after inspection. Read the full CGHS empanelment guide.
Does CGHS cover medicines and ICU charges separately?
For IPD packages, medicines and ICU charges are included in the package rate — similar to PMJAY. For OPD, prescribed medicines can be obtained free from CGHS dispensaries (generic drugs). If the prescribed medicine is not available at the dispensary, the beneficiary can buy it from any pharmacy and claim reimbursement at CGHS rates using Form CGHS-2A.
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