PMJAY Package Rates 2026: Complete List of Ayushman Bharat Procedure Rates
As of 2026, PMJAY (Pradhan Mantri Jan Arogya Yojana) covers 1,949 procedure packages across 27 specialties, with package rates ranging from ₹500 (basic OPD procedures) to ₹6,00,000 (complex organ transplants). This is the only comprehensive, updated PMJAY package rate list — sourced directly from the National Health Authority (NHA) — covering cardiac surgery, orthopaedics, oncology, maternity, dialysis, and more. Bookmark this page and share it with your billing team.
How PMJAY Package Rates Are Structured
PMJAY packages are not simply a single payment — they are all-inclusive rates that cover the entire episode of care. Understanding the package structure prevents the most common billing mistake: billing separately for items already included in the package rate.
Each PMJAY package includes: bed charges (general ward, up to specified days), nursing care, surgeon and anaesthetist fees, OT charges, medicines and consumables during hospitalisation, diagnostic tests related to the procedure, follow-up OPD visits (up to 15 days post-discharge), and food during IPD stay. Hospitals cannot charge beneficiaries anything over and above the package rate — doing so is a punishable offence under the scheme rules, with penalties up to delisting from PMJAY.
Packages are classified into three tiers:
- Day Care Packages (D): Procedures completed within 6-8 hours without overnight admission (e.g., cataract surgery, minor OPD procedures).
- Short Stay Packages (S): 1-3 day admission (e.g., laparoscopic appendectomy, normal delivery).
- Long Stay Packages (L): 4+ days admission (e.g., joint replacement, CABG, cancer surgeries).
NABH quality incentive: Hospitals with NABH Entry Level accreditation receive 10% additional on the base package rate. Full NABH accreditation earns 15% additional. This can add ₹10,000–₹75,000 per case for high-value packages — making NABH accreditation financially worthwhile even for smaller hospitals.
PMJAY Cardiology Package Rates 2026
Cardiology is one of the highest-volume specialties under PMJAY. Here are the current package rates for the most common cardiac procedures:
| Procedure | Package Code | PMJAY Rate | Stay (days) |
|---|---|---|---|
| Coronary Angiography (Diagnostic) | C1 | ₹10,000 | Day Care |
| PTCA – Single Vessel (with bare metal stent) | C2 | ₹1,10,000 | 3 |
| PTCA – Single Vessel (with drug-eluting stent) | C3 | ₹1,50,000 | 3 |
| PTCA – Double Vessel (with DES) | C4 | ₹1,80,000 | 4 |
| CABG (Off Pump) | C5 | ₹1,32,000 | 10 |
| CABG (On Pump) | C6 | ₹1,50,000 | 10 |
| Permanent Pacemaker Implantation (Single Chamber) | C7 | ₹60,000 | 3 |
| AICD Implantation | C8 | ₹1,50,000 | 4 |
| Valve Replacement (Mechanical) | C9 | ₹1,80,000 | 12 |
| ASD / VSD Closure (Open Heart) | C10 | ₹80,000 | 8 |
| Heart Failure Management (Medical) | C11 | ₹15,000 | 5 |
PMJAY Orthopaedics Package Rates 2026
| Procedure | PMJAY Rate | Stay (days) |
|---|---|---|
| Total Knee Replacement (Unilateral) | ₹80,000 | 7 |
| Total Knee Replacement (Bilateral) | ₹1,20,000 | 10 |
| Total Hip Replacement | ₹75,000 | 7 |
| Spine Fusion (PLIF/TLIF, 2 levels) | ₹1,00,000 | 7 |
| Laminectomy / Discectomy | ₹40,000 | 5 |
| Closed Reduction + Cast (Fracture) | ₹8,000 | Day Care |
| Open Reduction + Internal Fixation (ORIF) | ₹30,000 | 4 |
| Amputation (Below Knee) | ₹25,000 | 5 |
| Arthroscopic Knee Surgery (ACL Repair) | ₹35,000 | 2 |
PMJAY Oncology Package Rates 2026
Cancer treatment packages under PMJAY are among the most utilised, given the catastrophic cost of oncology care for lower-income families. The scheme allows cancer patients up to ₹5 lakh per year, with some states providing additional coverage for catastrophic cases.
| Procedure | PMJAY Rate | Notes |
|---|---|---|
| Chemotherapy Cycle (Day Care) | ₹18,000–₹35,000 | Per cycle, depends on regimen |
| Radical Mastectomy (Breast Cancer) | ₹45,000 | Includes 5-day stay |
| Total Thyroidectomy | ₹30,000 | 3 days stay |
| Whipple Procedure (Pancreatic Cancer) | ₹1,20,000 | 14 days stay |
| Radical Cystectomy | ₹80,000 | 10 days stay |
| Radiation Therapy Course (Teletherapy) | ₹40,000–₹70,000 | Full course |
| Bone Marrow Biopsy | ₹10,000 | Day Care |
| Colostomy / Ileostomy | ₹28,000 | 5 days stay |
| Laryngectomy | ₹55,000 | 7 days stay |
| Nephrectomy (Kidney Cancer) | ₹50,000 | 6 days stay |
PMJAY Maternity and Neonatal Package Rates 2026
| Procedure | PMJAY Rate | Stay (days) |
|---|---|---|
| Normal Vaginal Delivery | ₹9,000 | 2 |
| Normal Delivery with Complications | ₹14,000 | 3 |
| Caesarean Section (Uncomplicated) | ₹17,000 | 5 |
| Caesarean Section (Complicated) | ₹22,000 | 7 |
| Hysterectomy (Abdominal) | ₹35,000 | 5 |
| Hysterectomy (Laparoscopic) | ₹40,000 | 4 |
| NICU Care (per day, Level II) | ₹2,000/day | Up to 7 days |
| NICU Care (per day, Level III) | ₹3,500/day | Up to 14 days |
| MTP (Medical Termination of Pregnancy) | ₹7,500 | Day Care |
PMJAY Dialysis, Renal and Urology Package Rates 2026
| Procedure | PMJAY Rate | Notes |
|---|---|---|
| Haemodialysis (per session) | ₹1,500 | 2 sessions/week covered |
| CAPD (Peritoneal Dialysis, per month) | ₹14,000 | Monthly package |
| Kidney Transplant (Recipient) | ₹2,50,000 | 14 days stay |
| PCNL (Kidney Stone Removal) | ₹25,000 | 3 days |
| URS + Lithotripsy (Ureteroscopy) | ₹18,000 | 2 days |
| TURP (Prostate) | ₹28,000 | 4 days |
| Radical Nephrectomy | ₹50,000 | 6 days |
How Hospitals Submit PMJAY Claims
The PMJAY claim process has four stages. Missing documentation at any stage leads to claim rejection — the single biggest reason hospitals lose money under PMJAY.
- Step 1 — Beneficiary Verification: At the time of admission, verify the patient's PMJAY eligibility through the Beneficiary Identification System (BIS) using Aadhaar or ration card. The ABHA ID must be captured for all cases under the 2024 ABDM mandate.
- Step 2 — Pre-Authorisation: For all non-emergency admissions, raise a pre-authorisation request on the Transaction Management System (TMS). The SHA must respond within 4 hours (emergency: immediate). Pre-auth approval is your green light to proceed.
- Step 3 — Admission and Treatment: Provide care as per the approved package. Document all clinical notes, operative records, and discharge summaries in the prescribed format. For NABH-accredited hospitals, these must be NABH-compliant clinical records.
- Step 4 — Claim Submission: Submit the claim through TMS within 15 days of discharge. Include: discharge summary, surgical/procedure notes, pre-auth approval number, implant stickers (if applicable), and diagnostics reports. Hospitals must receive payment within 15 working days of claim approval.
Top 5 reasons for PMJAY claim rejection: (1) Missing pre-authorisation for non-emergency cases, (2) Diagnosis-procedure mismatch (the procedure billed does not match the admission diagnosis), (3) Beneficiary not eligible on date of admission, (4) Missing implant sticker or batch number, (5) Claim submitted after 15-day window. A purpose-built HMS like Adrine automates pre-auth tracking and claim generation to eliminate these errors.
Frequently Asked Questions About PMJAY Package Rates
What is the maximum coverage under PMJAY per year?
PMJAY provides ₹5 lakh per family per year for secondary and tertiary care hospitalisation. This is a floater benefit — all members of the family share the ₹5 lakh limit. Some states have extended the limit for catastrophic conditions (organ transplants, cancer) beyond ₹5 lakh under state-specific schemes.
Are PMJAY package rates the same across all states?
No. The NHA sets national base rates, but states can supplement them. States like Tamil Nadu, Kerala, Maharashtra, and Andhra Pradesh have state top-up schemes that pay additional amounts over the PMJAY base rate for certain procedures. Some states have also negotiated higher rates for specific specialties. Always check your SHA website for the most current rates in your state.
Can hospitals charge patients anything extra beyond PMJAY rates?
Absolutely not. Charging PMJAY beneficiaries anything above the approved package rate is a criminal offence under the scheme and is grounds for immediate delisting. Hospitals that are delisted lose their entire PMJAY revenue stream and face blacklisting. The only exception is if the patient voluntarily opts for a service specifically not covered under the package (e.g., a premium room) — but this must be clearly documented and consented to.
How long does it take to receive payment from PMJAY after claim approval?
As per NHA guidelines, empanelled hospitals should receive payment within 15 working days of claim approval at the SHA level. In practice, payment timelines vary by state — some states (Tamil Nadu, Gujarat) are known for timely payments within 20-25 days, while others (UP, Bihar) may take 45-60 days. Tracking pending claims with a dedicated PMJAY billing module in your HMS is critical to follow up proactively.
What happens if PMJAY package rate is insufficient for a complex case?
For exceptionally complex cases where the standard package rate is insufficient, hospitals can submit a special consideration request to the SHA with detailed clinical justification and actual cost breakdown. The SHA has discretion to approve higher-than-package payments for such cases. This should be done before or during treatment — not after discharge. Maintain detailed documentation of the clinical complexity to support your request.
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