The Central Government has revised the rates for approximately 2,000 medical procedures and tests under the Central Government Health Scheme (CGHS). These revisions, which mark the first major overhaul since 2014, will take effect on October 13, 2025. The aim is to benefit over one crore central government employees and pensioners by making cashless healthcare more accessible.

Need for Revision

For years, CGHS beneficiaries have reported difficulties in obtaining cashless treatment at CGHS-empanelled hospitals. Hospitals often cited outdated package rates and delays in reimbursements as reasons for refusing cashless services, which forced patients to pay out of pocket and then wait months for reimbursement. In August 2025, the Central Government Employees Union (GENC) demanded reforms, highlighting the financial strain caused by the lack of cashless services and instances of denied emergency medical care. The revised rates address these issues, ensuring fair and viable rates for hospitals, which should reduce disputes and facilitate easier cashless treatment.

New Rate Structure

The new rate structure is multi-dimensional, taking into account several factors. Previously, rates differed primarily based on whether a hospital had National Accreditation Board for Hospitals (NABH) accreditation. Consultation fees were also uniform across cities and wards for both outpatient (OPD) and inpatient (IPD) consultations. The revised structure considers:

• Accreditation Status: Non-NABH/NABL accredited hospitals will receive 15% lower package rates compared to those with NABH/NABL accreditation. Super-specialty hospitals will attract 15% higher rates than NABH-accredited hospitals for the corresponding super-specialties within the same city category.
• City Classification: Rates will vary depending on the city tier. Tier-II cities will have rates 10% lower than the base rate, while Tier-III cities will have rates 20% lower. Tier-I cities will have standard base rates.
• Ward Entitlement: The new package rates are based on semi-private wards. Beneficiaries entitled to a general ward will see a 5% decrease in rates, while those entitled to a private ward will see a 5% increase.
• Hospital Type: Super speciality hospitals (200+ beds) will have 15% higher rates than the base rate.

For example, a procedure costing Rs 1,000 in a NABH-accredited facility in a Tier-I city would cost Rs 850 in a non-NABH facility in the same city. The same procedure in a Tier-II city NABH facility would cost Rs 900, while the price would be Rs 800 in a Tier-III NABH facility. Rates for consultations, radiotherapy, investigations, day-care procedures, and minor procedures not requiring admission will remain uniform irrespective of ward entitlement. Existing CGHS rules and rates will continue for cancer surgeries, but the revised rates will apply to chemotherapy, investigations, and radiotherapy.

Benefits and Inclusivity

These revisions aim to provide easier cashless treatment, reduce out-of-pocket payments, ensure faster reimbursements, and improve overall healthcare access for CGHS cardholders. The reforms also focus on inclusivity. On September 16, 2025, the Health Ministry updated CGHS rules to extend medical benefits to dependent transgender children and siblings of central government employees and pensioners, regardless of age. They must be financially dependent and have valid certification under the Transgender Persons (Protection of Rights) Act, 2019.

Compliance

Healthcare organizations must submit their acceptance of the new rates by October 13 to remain empanelled under CGHS. All previous agreements with private hospitals become void from October 13, necessitating fresh empanelment on the CGHS portal. As of October 5, approximately 4.26 million beneficiaries are covered by CGHS in 80 cities across India. Beneficiaries can download the updated rate list from the Circulars/Notifications section of the CGHS website, which includes procedure codes and revised package rates that differ for NABH and non-NABH hospitals.