Revision of ceiling rates for reimbursement of the cost of Cardiac pacemaker, AlCD, Combo-device, Rotablator and Aortic Stent Graft for beneficiaries of CGHS/CS(MA) Rules

Revision of ceiling rates for reimbursement of the cost of Cardiac pacemaker, AlCD, Combo-device, Rotablator and Aortic Stent Graft for beneficiaries of CGHS/CS(MA) Rules.

Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
Directorate General of CGHS
Office of the Director, CGHS

No: S-11011/29/2018-CGHS(HEC)/ DIR/CGHS

Nirman Bhawan, New Delhi
Dated the 6th August, 2018

OFFICE MEMORANDUM

Subject:- Revision of ceiling rates for reimbursement of the cost of Cardiac pacemaker, AlCD, Combo-device, Rotablator and Aortic Stent Graft for beneficiaries of CGHS/CS(MA) Rules.

With reference to the above subject attention is drawn to the OM No 12034/02/2014/Misc./- CGHS D.lll dated 22nd July 2014 vide which ceiling rates for reimbursement of the cost of Cardiac pacemaker, AICD, Combo-device, Rotablator and Aortic Stent Graft for beneficiaries of CGHS/CS (MA) Rules were prescribed and to state that the matter has been reviewed by the Ministry and it is decided to revise the ceiling rates as per the details given under:

Sl.No.	Cardiac Device	Ceiling Rate
1	Single Chamber Cardiac Pacemaker without Rate Response	Rs.34,840/- + GST
2	Single Chamber Cardiac Pacemaker with Rate Response	Rs. 44,9281-+ GST
3	Dual Chamber Cardiac Pacemaker	Rs.83,200/-+ GST
4	Bi-Ventricular Cardiac Pacemaker	Rs.1,95,000/-+ GST
5	Implantable Cardioverter Defibrillator (Single Chamber) (ICD/AICD-Single Chamber)	Rs.1,75 786/-4+ GST
6	Implantable Cardioverter Defibrillator (Dual Chamber) (ICD/AICD-Single Chamber)	Rs. 3,75,000/-+ GST
7	Combo Device (CRT-D)	Rs, 4.90,000/-+ GST
8	Aortic Stent Graft (expandable, bifurcated and including delivery system)	Rs. 4,40.960/- + GST
9	Rotablator with Advancer	Rs.49,920/-+ GST
10	Rotablator Burr	Rs.23,920/-+ GST

2. Other terms and conditions prescribed under OM No 12034/02/2014/Misc./-CGHS D.III dated 22nd July 2014 shall remain unchanged.

3. These rates shall remain valid till the rates for the above devices are notified by National Pharmaceutical Pricing Authority (NPPA).

4. Issued with the concurrence of SS&FA, Ministry of Health & Family Welfare vide CD - No.1295 dated 25.07.2018.

(Dr. Atul Prakash)
Director, CGHS

Revision of ceiling rates for Intra Ocular Lenses (IOL): ECHS Order

Revision of ceiling rates for Intra Ocular Lenses (IOL): ECHS Order

Central Organisation, ECHS
Adjutant General‘s Branch
Integrated Headquarters
Ministry of Defence (Army)
Maude Lines
Delhi Cantt-110010

B/49773/AG/ECHS/Rates/Policy

19 Dec 2014

REVISION OF CEILING RATES FOR INTRA OCULAR LENSES (IOL)

1. Refer this office letters:-
(a) B/49773/AG/ECHS/Rates/Policy dt 10 Jan 2011.
(b) B/49773/AG/ECHS/Rates/Policy dt 28 Oct 2014.
(c) B/49773/AG/ECHS/Rates/Policy dt 24 Nov 2014.

2. The following ceiling rates for IOL are hereby made at para 16 of Appx ‘C’ of above mentioned letter on the basis of CGHS OM No 536/2012/R & H/CGHS dt 21 Aug 14 and even no of dt 11 Nov 2014:-

(i) Hydrophobic Foldable IOL
(Multi-piece/Single piece Aspheric) Rs. 5,800/-
(ii) Hydrophilic Acrylic IOL Rs. 4,500/-
(iii) PMMA IOL (AC/PC) Rs. 500/-
(iv) Scleral Fixated IOL Rs. 3,500/-

3. Reimbursement for LASIK Surgery and INTACS Rings is not recommended.

4. Therapeutic and Bandage contact Lenses for Keratoconus of Corneal Ulcers can be considered on a case to case basis.

5. Further, reimbursement for IOL Implants will be limited to ceiling rates or’actual, whichever is less and will be reimbursable in addition to the package rates for cataract surgery procedure. The reimbursement at the above mentioned ceiling rates will be done as per the rates fixed for the various types of IOL mentioned above and the IOL actually used in the surgery. It is mandatory for the operating surgeon of all private empanelled hospital/ECHS beneficiaries to attach the empty IOL sticker, bearing the signature and stamp of the operating surgeon on it, along with the bill in support of type of IOL used, containing its batch number. In the event of the private empanelled hospital not giving the batch number and/or empty IOL sticker, then the beneficiary will be required to obtain the same from the hospital before the competent authority finally settles the claim for reimbursement.

6. Beneficiaries undergoing IOL Implantation: This office has been receiving numerous queries regarding the cost of IOL which is in addition to the cost, of surgery as mentioned in our earlier ECHS letter under ref. Once again it is clarified that the cost of lens (IOL) would be reimbursable in addition to package charges for treatment procedures. The same has also been clarified by CGHS at para 3 of their Office Memorandum No 5-11045/36/2012 dt 26 Nov 2014 In addition it is clarified that if a beneficiary had been implanted Hydrophilic IOL in one. eye earlier and now requires IOL in other eye, then in such a case Hydrophilic IOL would be permitted as per old rates of 2008. In all such cases prior permission by competent authority permitting use of Hydrophilic IOL based on advice of specialist would be required.

7. Para 16,17 & 18 of Appx ‘C’ of this office letter No 8/49773/AG/ECHS/Rates/Policy dt 10 Jan 2011, B/49773/AG/ECHS/Rates/Policy dt 28 Oct 2014 & even no of dt 24 Nov 2014 are hereby cancelled.

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

Source: http://echs.gov.in/images/pdf/med/med120.pdf

Revision of Ceiling Rates for Coronary Angioplasty and Coronary Angioplasty with Balloon for CGHS beneficiaries

Revision of Ceiling Rates for Coronary Angioplasty and Coronary Angioplasty with Balloon for CGHS beneficiaries

 

F.No. Misc.1002/2006/CGHS(R&H)/CGHS(P)

Government of India

Ministry of Health & Family Welfare

Department of Health & Family Welfare

 

 

Maulana Azad Road, Nirman Bhawan

New Delhi 110 108 dated the 7th February, 2013.

 

 

OFFICE MEMORANDUM

 

 

Subject: Revision of Ceiling Rates for Coronary Angioplasty and Coronary Angioplasty with Balloon for CGHS beneficiaries.

 

With reference to the above mentioned subject the undersigned is directed to draw attention to the Office Memorandum No. S.11011/23/2009/Hospital Cell dated 17.08.2010 and other Office Memoranda issued subsequently whereby the CGHS package rates for Coronary Angioplasty were fixed by the Government for empanelled hospitals under CGHS in Delhi and NCR and other CGHS cities and to state that in supersession of the earlier CGHS rates ceiling rates the following ceiling rates are approved for reimbursement to CGHS beneficiaries / CGHS empanelled hospitals as per the details given below: 

 

Coronary Angioplasty : Rs.50,000/- (for semi-private ward)

Coronary Angioplasty with Balloon : Rs.55,000/- (for semi-private ward)

 

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.

 

2. The revised rates shall come into force from the date of issue and shall be in force till further orders.

 

3. This issues with the concurrence of Integrated Finance Division vide Note dated 20/12/2012 of AS & FA.

 

sd/-

(RAVI KANT)

UNDER SECRETARY TO GOVERNMENT OF INDIA

 

Source : www.msotransparent.nic.in

[http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File567.pdf]