CGHS rates: a clear guide to the 2025 revision for private hospitals

CGHS rates are the package prices the Central Government Health Scheme pays empanelled hospitals, laboratories and clinics for treating its beneficiaries, and since 13 October 2025 they have come from one revised CGHS rate list that pays a provider differently according to its city, its accreditation and the patient’s ward entitlement. The practical problem for private hospitals is that the new CGHS rates arrived with a requirement to re-apply for empanelment on new terms, under deadlines that moved several times in 2026.

This guide covers what the revision says, how the CGHS package rates are built, what a package includes, how empanelment and billing work, and which dates still matter as of November 2026. Figures come from the memoranda of the Directorate General of CGHS in the Ministry of Health and Family Welfare, or from the reports named.

What the October 2025 revision of CGHS rates did

The Directorate General of CGHS notified the revised CGHS rates in office memorandum F.No. 5-16/CGHS(HQ)/HEC/2024(PartI) dated 3 October 2025, signed by Director (CGHS) Dr Satheesh Y. H., “in supersession of all previous memoranda on the subject”. Its Annexure VI lists ten earlier orders it replaces, the oldest dated 26 November 2014.

The new CGHS rates took effect on 13 October 2025 and apply to all services at CGHS-empanelled healthcare organisations (HCOs), to medical reimbursement claims, and to cashless treatment for pensioners and other entitled groups. Treatment at a non-empanelled private hospital in exceptional cases is reimbursed only at the non-NABH rate for that city.

Annexure I, the CGHS rate list, runs to 1,998 numbered items for each of three city tiers. Business Standard reported on 5 October 2025 that this was the “first major revamp since 2014”. The empanelment document that CGHS issued with its memorandum of 22 December 2025 says “approximately 42 lakh beneficiaries are covered by CGHS in 81 cities all over India”. The memorandum was copied to the AIIMS institutes, JIPMER, PGIMER Chandigarh, Safdarjung Hospital and the National Health Authority (NHA).

Who the CGHS rate list applies to

The CGHS rate list binds every empanelled HCO: hospitals, laboratories and imaging centres, and eye, dental, chemotherapy and dialysis centres, which the December 2025 empanelment memorandum lists in its fee tables. AYUSH day care centres and hospitals are empanelled under a parallel process. Annexure VII sets out who is treated on credit:

• Pensioners, former MPs, former governors and freedom fighters: cashless, billed online and paid by the Central Government Health Scheme.
• Sitting MPs: cashless, billed to the Lok Sabha or Rajya Sabha secretariat.
• Serving CGHS and health ministry staff: cashless, with physical bills to the city Additional Director or department.
• Serving staff of other departments: credit only in emergencies, against a head of department letter.
• Autonomous body staff: no credit; they pay at CGHS rates and claim reimbursement from their department.
• Accredited journalists: no credit; treatment is paid for at CGHS rates.

The CGHS package rates now reach further. The Department of Ex-Servicemen Welfare issued order F.No.22(16)/2025-D(WE)/Res-I on 5 December 2025 applying the revised CGHS rates to the Ex-Servicemen Contributory Health Scheme (ECHS) from 15 December 2025, with the same differentials. Our Policy and payers section follows other public payer schemes.

How CGHS package rates vary by city, accreditation and ward

The base price in the CGHS rate list is the NABH rate for a semi-private ward in a Tier I city. Each other price is a fixed percentage away from it:

• Non-NABH and non-NABL organisations: 15% less than accredited ones.
• Super speciality hospitals: 15% more than NABH hospitals for the matching super specialities in the same city category.
• Tier II (Y) cities: 10% less than Tier I (X); Tier III (Z) cities: 20% less. Tier II CGHS rates also apply in the North-East, Jammu and Kashmir and Ladakh.
• General ward: 5% below the semi-private package; private ward: 5% above.
• Consultations, radiotherapy, investigations, day care and minor procedures: the same for every ward.
• Cancer surgery: existing rules and rates continue; revised rates apply to chemotherapy, investigations and radiotherapy.

The Tier I cities are the urban agglomerations of Hyderabad, Delhi, Ahmedabad, Bengaluru, Mumbai, Pune, Chennai and Kolkata, as classified in office memorandum No. 2/5/2017-E.II(B) of 7 July 2017; the rate list says the latest Department of Expenditure instructions prevail in case of any discrepancy. The indicative Tier II list includes Jaipur, Lucknow, Kochi, Chandigarh, Indore and Coimbatore. The HCO applies the ward adjustment at billing, using the entitlement printed on the beneficiary’s card. The table shows five items from Annexure I.

Item (code)	Tier I non-NABH	Tier I NABH	Tier I super speciality	Tier II NABH	Tier III NABH
OPD consultation (CN001)	Rs 350	Rs 350	Rs 350	Rs 350	Rs 350
Complete haemogram (LB012)	Rs 255	Rs 300	Rs 300	Rs 270	Rs 240
Ventilator, per day (CC003)	Rs 2,550	Rs 3,000	Rs 3,000	Rs 2,700	Rs 2,400
ICU per day, with room rent (CC001)	Rs 5,400	Rs 5,400	Rs 5,400	Rs 5,400	Rs 5,400
Atrioventricular canal repair (CV010)	Rs 2,00,600	Rs 2,36,000	Rs 2,71,400	Rs 2,12,400	Rs 1,88,800

Annexure III ties ward entitlement to basic pay. General ward covers basic pay up to Rs 36,500, with room charges of Rs 1,500 a day; semi-private covers Rs 36,501 to Rs 50,500, at Rs 3,000; private applies from Rs 50,501, at Rs 4,500, for a single air-conditioned room with an attendant bed. ICU and isolation beds are Rs 5,400 a day for everyone, and day care is Rs 1,500.

What CGHS package rates cover and what cannot be billed

Annexure II defines the package as “an all-inclusive lump sum cost” from admission to discharge, covering accommodation and diet, anaesthesia, medicines and consumables, doctor visits, ICU and nursing care, theatre charges, physiotherapy, routine investigations, transfusion, and equipment such as infusion pumps. CGHS package rates apply whether a service is in-house or outsourced, and “No differential pricing shall be applied for outsourced services”.

Packages assume a maximum stay of 12 days for super speciality treatment, 7 days for other major surgery, 3 days for laparoscopic surgery, elective angioplasty and normal delivery, and 1 day for day care. For multiple procedures:

1. The primary procedure, the one with the highest package rate, is paid at 100%.
2. The second in the same theatre session is paid at 50%, and the third and later at 25% each.
3. Identical procedures at two sites in one session, such as bilateral knee replacement, pay 50% for the second side.
4. A procedure on a later day within the package period of an earlier one is paid at 75%.

Lenses, stents, meshes and valves are paid on top at CGHS ceiling rates; unlisted implants at invoice or the National Pharmaceutical Pricing Authority (NPPA) rate, whichever is less. The chemotherapy package covers procedural charges only, with room rent, investigations and anti-cancer drugs paid separately.

Annexure III also folds equipment into the CGHS package rates and room charges: C-arm and theatre equipment, DVT and infusion pumps, portable X-ray and bedside diagnostics, and the attendant bed in a private ward. Room rent includes nursing care, housekeeping, infection control, laundry, diet and biomedical waste management, and “must not be charged separately under any circumstances”.

Annexure IV splits exclusions in two. Toiletries, telephone, attendant food and similar items are not reimbursed and may be charged to the patient. Glucometer strips, ECG electrodes, ventilator circuits and copies of records may be billed to neither CGHS nor the patient. Billing “extraordinarily high quantities” of consumables “will be viewed seriously as potential inflation and penalised”.

Super speciality status and consultation fees

Super speciality status adds 15% to the CGHS rates, so its definition matters. Annexure V requires 200 or more beds, NABH or equivalent accreditation such as Joint Commission International, ACHS or another body approved by the International Society for Quality in Health Care, and CGHS-empanelled facilities in all ten listed super specialities: nephrology and urology, neurosurgery, cardiothoracic surgery, medical, surgical and radiation oncology, transplants, endocrinology, joint replacement, and gastroenterology and GI surgery. The December 2025 memorandum adds that NABL accreditation is “mandatory for in house laboratories”.

Consultations are flat fees: Rs 350 for a specialist, Rs 700 for a super specialist or any psychiatrist, Rs 350 for indoor consultations, and Rs 350 for an eye consultation including refraction. A consultation stays valid for 7 days in the same speciality.

A health ministry memorandum, file S.11030/168/2025-EHS, circulated in January 2026 with its date field left blank in the copies seen, says “OPD consultation charges @ Rs. 700/- shall be admissible for consultations rendered by Super Specialists (DM/MCh)” and caps indoor consultations at two a day per specialist. A CGHS memorandum of 24 March 2026 clarified, ab initio, that the super specialist consultation fee applies to DM, MCh, DNB-SS or equivalent qualifications, with equivalence set by National Medical Commission norms, and corrected the description of MRI code RI134. It is deemed part of the October 2025 memorandum.

Empanelment on the new CGHS rates: steps, fees and guarantees

The October memorandum ended all existing agreements with private hospitals at midnight on 13 October 2025. To keep billing at the new CGHS rates, each HCO had to submit an undertaking by that date or be “deemed to be de-panelled”, then seek fresh empanelment and sign a new memorandum of agreement (MoA).

The process is set out in CGHS memorandum F.No. 5-34/CGHS/HEC(HQ)/2025 of 22 December 2025:

1. Register on the Ayushman Bharat Digital Mission Health Facility Registry; an HFR ID is “mandatory to onboard on HEM portal”.
2. Pay the non-refundable fee through Bharatkosh: Rs 25,000 for super speciality hospitals, Rs 10,000 for other hospitals, Rs 5,000 for laboratories and diagnostic centres, eye hospitals, and dental, chemotherapy and dialysis centres.
3. Attend the mandatory pre-empanelment briefing.
4. Apply on the Hospital Engagement Module (HEM) portal run with the NHA.
5. Pass document scrutiny and a physical inspection, compulsory for new HCOs.
6. Sign the MoA within 15 days of approval and lodge the performance bank guarantee (PBG).
7. Create logins within 2 working days, after which CGHS notifies the empanelment on its website.

Hospitals need 50 beds in Tier I cities and 30 in Tier II and III, a year of operation, and turnover of Rs 4 crore in Tier I (Rs 6 crore for super speciality) or Rs 2 crore elsewhere (Rs 3 crore). CGHS business “should not exceed more than 50% of the total”. A non-NABH hospital in a Tier I city needs entry-level NABH or a Quality Council of India recommendation; in Tier II and III cities, the North-East and Jammu and Kashmir it may be provisionally empanelled but must obtain a QCI recommendation or NABH accreditation within 6 months.

The PBG is Rs 20 lakh for a Tier I hospital and Rs 25 lakh for a Tier I super speciality hospital, or Rs 10 lakh and Rs 12 lakh in Tier II, Tier III and the North-East; other facilities pay Rs 4 lakh or Rs 2 lakh. It must run for 42 months, charities pay half, and HCOs already at ABDM “M3” compliance get 20% off. Empanelment lasts three years and covers all services at CGHS rates.

How CGHS bills are submitted and paid

Claims go electronically through the NHA portal, with geotagging and Aadhaar-enabled biometric checks on patients. For claims on that portal, such as pensioner claims, “the CGHS will make eligible payments within 90 days of claim submission”. A processing fee of “2% of the claim amount plus applicable taxes”, minimum Rs 12.50 and maximum Rs 1,500 per claim, is deducted and may not be passed to patients. Records must be kept for 5 years, and discharge medicines “must not exceed Rs.2000/- in any case”.

An HCO has 5 working days to answer a show-cause notice and may be suspended for up to 6 months. Confirmed violations can bring de-empanelment “for a minimum of two (2) years or more”, penalties or blacklisting.

Payment routes differ by card. Pensioner credit bills are submitted online to the bill clearing agency software and paid by the Central Government Health Scheme, with physical bills kept for at least 5 years for audit. Air India pensioners are billed through a separate agency, which the memorandum names as UTIITSL, and bills for serving employees of other departments are paid by those departments.

Deadlines and clarifications since October 2025

Date	Instrument	What it did
3 Oct 2025	CGHS memorandum	Notified the revised CGHS rates from 13 October 2025
5 Dec 2025	DESW order	Applied the CGHS rate list to ECHS from 15 December 2025
22 Dec 2025	CGHS memorandum	Opened fresh empanelment; MoA deadline 31 March 2026
Jan 2026	Health ministry memorandum	Limited the Rs 700 fee to DM or MCh super specialists
28 Mar 2026	CGHS memorandum, as reported	Allowed until 30 April 2026
16 Jul 2026	CGHS memorandum	Extended empanelment to 15 August 2026
15 Aug 2026	CGHS memorandum	Extended empanelment to 15 September 2026
Sep 2026	CGHS memorandum	Discontinued HCOs not renewed, from 16 September 2026
30 Sep 2026	CGHS memorandum	Extended AYUSH empanelment to 30 November 2026

The December memorandum warned that failure to apply “will result in the de-empanelment” from 1 April 2026. Medical Dialogues reported on 1 April 2026 that a memorandum issued on 28 March by the CGHS Director allowed until 30 April, with de-empanelment from 1 May, after hospitals reported problems with the HEM 2.0 portal. Citing The Times of India, it quoted the managing director of Aakash Healthcare as saying CGHS payment delays often stretch beyond three to six months. We did not find an official copy of the 28 March memorandum.

ECHS moved on a similar track. A Department of Ex-Servicemen Welfare order of 27 July 2026 extended the deadline for signing the revised ECHS agreement to 30 September 2026 and told the Central Organisation ECHS to open its portal for fresh empanelment before that date, so the CGHS rate list and its terms also reach ECHS-empanelled hospitals.

Further extensions followed. A memorandum of 16 July 2026, issued after one of 1 July, extended validity to 15 August, and the memorandum of 15 August 2026 extended existing empanelment “till 15.09.2026” and said ineligible or non-applying hospitals would be de-empanelled from 16 September and must post a notice at their entrance. Eye hospitals, subject to pending court petitions, could continue to 30 September.

A headquarters memorandum of September 2026 then discontinued HCOs whose empanelment had not been renewed from 16 September, let admitted patients finish treatment on credit, set 45 days for pending bills and left those HCOs free to apply afresh. An order of 18 September from the Prayagraj office applying it de-empanelled 12 HCOs in Prayagraj and Varanasi. Medical Dialogues also reported that a CGHS memorandum of 4 June 2026 approved a request by BLK-Max Super Speciality Hospital in New Delhi to withdraw from the panel, with effect from 22 May 2026; the report did not give a reason for the request.

What the revised CGHS rates mean for private hospitals

The CGHS rate list turns accreditation and scale into price. For atrioventricular canal repair in a Tier I city, a NABH hospital gets Rs 2,36,000, a non-NABH hospital Rs 2,00,600 and a super speciality hospital Rs 2,71,400; the NABH price is Rs 2,12,400 in a Tier II city and Rs 1,88,800 in a Tier III city. Groups with sites in several tiers will earn different yields on the same procedure.

Participation also carries fixed costs: the fee, a guarantee of up to Rs 25 lakh held for 42 months, a 2% deduction on NHA-processed claims, and the new MoA’s requirement to reach ABDM M3 compliance within a year. The 50% cap on CGHS business shuts out hospitals that rely mainly on CGHS patients, while the bed and turnover thresholds keep small nursing homes out.

The cost of losing the panel is also clearer. A hospital de-empanelled for misconduct cannot reapply for at least two years, and one that simply misses a deadline stops receiving new CGHS patients on credit, as the Prayagraj order shows, though it may apply afresh once it meets the criteria. For hospitals with a large pensioner catchment, the CGHS rates therefore carry operational weight beyond the price of each procedure.

On the revenue side, ECHS adoption widens the volume priced on CGHS package rates, and the 90-day payment commitment gives finance teams a benchmark to hold CGHS to. For context on medical prices, see our analysis of health inflation in September 2026.

What to watch next

• AYUSH deadline: existing AYUSH empanelment runs to 30 November 2026.
• Eye hospitals: citing petitions pending in various courts, the August memorandum let existing eye hospitals continue to 30 September 2026 and told them to meet the revised criteria in that period; we found no later memorandum on them.
• ECHS: a July 2026 order told ECHS to open fresh empanelment before 30 September 2026; signing figures have not been published.
• Unlisted procedures: Annexure II says these “shall be reviewed periodically”, so the CGHS rate list may grow.
• Digital compliance: newly empanelled HCOs must reach M3 within a year of empanelment.

We record new CGHS memoranda and deadlines on The Tracker.