F. No. 22-49/2011-E/CGHS/AD/HE VOL-III

ADDITIONAL DIRECTOR OF CGHS

Ministry of Health & Family Welfare

2ND Floor, Sangam Place, Civil Lines, Allahabad

Dated:- 28th October, 2014


Following is new CGHS approved list of procedures/investigations and rates for CGHS Allahabad. All technically and otherwise declared eligible Health Care Organizations interested in empanelment with CGHS are requested to go through the list and submit their MoA, PBG & Letter of rate acceptance. The HCOs which have already submitted these requisite documents need not submit them again if they wish to get empanelled/continue their empanelment with CGHS. However, the HCOs which do not wish to get empanelled/continue their empanelment with CGHS but have already submitted these documents may withdraw their documents and opt out of CGHS. The Last date of submission/withdrawal of requisite documents is 30.10.2014.

 

Sr. No.

CGHS TREATMENT PROCEDURES/INVESTIGATIONS LIST

Non-NABH  &                  Non-NABL RATES

NABH & NABL RATES

1

Consultation  OPD

135.00

135.00

2

Consultation- for Inpatients

270.00

270.00

3

Dressings of wounds

50.00

58.00

4

Suturing  of wounds with local anesthesia

108.00

124.00

5

Aspiration Pleural Effusion - Diagnostic

120.00

138.00

6

Aspiration Pleural Effusion - Therapeutic

193.00

222.00

7

Abdominal Aspiration - Diagnostic

345.00

397.00

8

Abdominal Aspiration - Therapeutic

460.00

529.00

9

Pericardial Aspiration

380.00

437.00

10

Joints Aspiration

317.00

365.00

11

Biopsy Skin

230.00

265.00

12

Removal of Stitches

36.00

41.00

13

Venesection

124.00

143.00

14

Phimosis Under LA

1,311.00

1,508.00

15

Sternal puncture

173.00

199.00

16

Injection for Haemorrhoids

414.00

476.00

17

Injection for  Varicose Veins

350.00

403.00

18

Catheterisation

75.00

86.00

19

Dilatation of Urethra

500.00

575.00

20

Incision & Drainage

420.00

483.00

21

Intercostal Drainage

125.00

144.00

22

Peritoneal Dialysis

1,374.00

1,580.00

 

 TREATMENT PROCEDURES  SKIN

 

 

23

Excision of Moles

345.00

397.00

24

Excision of Warts

310.00

357.00

25

Excision of Molluscum contagiosum

130.00

150.00

26

Excision of Venereal Warts

160.00

184.00

27

Excision of Corns

140.00

161.00

28

I/D Injection Keloid

97.00

112.00

29

Chemical Cautery (s)

110.00

127.00

 

 TREATMENT PROCEDURES OPTHALMOLOGY

 

 

30

Subconjunctival/subtenon’s injection in one eye

69.00

79.00

31

Subconjunctival/subtenon’s injection in both eyes

138.00

159.00

32

Pterygium Surgery

86.00

99.00

33

Conjunctival Peritomy

58.00

67.00

34

Conjunctival wound repair or exploration following blunt trauma

115.00

132.00

35

Removal of corneal foreign body

115.00

132.00

36

Cauterization of ulcer/subconjunctival injection in one eye

69.00

79.00

37

Cauterization of ulcer/subconjunctival injection in both eyes

138.00

159.00

38

Corneal grafting—Penetrating keratoplasty

5,750.00

6,613.00

39

Corneal grafting—Lamellar keratoplasty

5,000.00

5,750.00

40

Cyanoacrylate /fibrin glue application for corneal perforation

690.00

794.00

41

Bandage contact lenses for corneal perforation

460.00

529.00

42

Scleral grafting or conjunctival flap for corneal perforation

2,300.00

2,645.00

43

Keratoconus correction with therapeutic contact lenses

1,200.00

1,380.00

44

UV radiation for cross-linking for keratoconus

1,800.00

2,070.00

45

EDTA for band shaped keratopathy

863.00

992.00

46

Arcuate keratotomy for astigmatism

2,800.00

3,220.00

47

Re-suturing (Primary suturing) of corneal wound

1,150.00

1,323.00

48

Penetrating keratoplasty ---- with glaucoma surgery

12,000.00

13,800.00

49

Penetrating keratoplasty --- with vitrectomy

12,144.00

13,966.00

50

Penetrating keratoplasty ---- with IOL implantation

12,290.00

14,134.00

51

DALK- Deep anterior lamellar keratoplasty

17,250.00

19,838.00

52

Keratoprosthesis stage I and II

11,500.00

13,225.00

53

DSAEK- Descemet’s stripping automated endothelial keratoplasty

16,675.00

19,176.00

54

ALTK- Automated lamellar therapeutic keratoplasty

16,500.00

18,975.00

55

Probing and Syringing of lacrimal sac in one eye

69.00

79.00

56

Probing and Syringing of lacrimal sac in both eye

138.00

159.00

57

Dacryocystorhinostomy—Plain

2,588.00

2,976.00

58

Dacryocystorhinostomy—Plain  with intubation and/or with lacrimal implants

9,500.00

10,925.00

59

Dacryocystorhinostomy—conjunctival with implant

9,200.00

10,580.00

60

Caliculoplasty

2,300.00

2,645.00

61

Dacryocystectomy

1,725.00

1,984.00

62

Punctal plugs for dry eyes

130.00

150.00

63

Refraction

40.00

46.00

64

Indirect Ophthalmoscopy

67.00

77.00

65

Orthoptic check-up- with synoptophore

44.00

51.00

66

Lees’ charting or Hess’ charting

100.00

115.00

67

Orthoptic exercises

50.00

58.00

68

Pleoptic exercises

50.00

58.00

69

Perimetry/field test—Goldman

144.00

166.00

70

Perimetry/field test— automated

144.00

166.00

71

Fluorescein angiography for fundus or iris

920.00

1,058.00

72

Ultrasound A- Scan

777.00

894.00

73

Ultrasound B- Scan

230.00

265.00

74

Fundus Photo Test

200.00

230.00

75

Indocyanin green angiography

920.00

1,058.00

76

Corneal endothelial cell count with specular microscopy

230.00

265.00

77

Corneal topography

331.00

381.00

78

Corneal pachymetry

230.00

265.00

79

Auto-refraction

35.00

40.00

80

Macular function tests

44.00

51.00

81

Potential acuitymetry

100.00

115.00

82

Laser interferometry

173.00

199.00

83

OCT-Optical coherence tomography

2,125.00

2,444.00

84

HRT- Heidelberg’s retinal tomogram

150.00

173.00

85

GDX--- Nerve fibre layer analyzer

88.00

101.00

86

UBM- Ultrasound biomicroscopy

150.00

173.00

87

Non Contact tonometry

50.00

58.00

88

IOP measurement with schiotz

30.00

35.00

89

IOP measurement with applation tonometry

50.00

58.00

90

Three mirror examination for reti

58.00

67.00

91

90 D lens examination

50.00

58.00

92

Gonioscopy

58.00

67.00

93

Chalazion incision and curettage in one eye

400.00

460.00

94

Chalazion incision and curettage in both eyes

413.00

475.00

95

Ptosis surgery with fasanella servat PROCEDURES

2,300.00

2,645.00

96

Ptosis surgery with LPS resection one lid

5,500.00

6,325.00

97

Ptosis surgery with Sling surgery one lid

6,670.00

7,671.00

98

Ectropion surgery- one lid

1,400.00

1,610.00

99

Ectropion surgery- both lids

2,500.00

2,875.00

100

Epicanthus correction

1,550.00

1,783.00

101

Cantholysis and canthotomy

575.00

661.00

102

Entropion surgery- one lid

1,380.00

1,587.00

103

Entropion surgery- both lids

2,000.00

2,300.00

104

Tarsorraphy

650.00

748.00

105

Suturing of lid lacerations

1,150.00

1,323.00

106

Lid retraction repair

1,700.00

1,955.00

107

Concretions removal

115.00

132.00

108

Bucket handle PROCEDURES for lid tumors

345.00

397.00

109

Cheek rotation flap for lid tumors

6,900.00

7,935.00

110

Orbitotomy

8,000.00

9,200.00

111

Enucleation

3,000.00

3,450.00

112

Enucleation with orbital implants and artificial prosthesis

3,000.00

3,450.00

113

Evisceration

3,105.00

3,571.00

114

Evisceration with orbital implants and artificial prosthesis

5,124.00

5,893.00

115

Telecanthus correction

4,658.00

5,357.00

116

Orbital decompression

5,175.00

5,951.00

117

Exenteration

5,175.00

5,951.00

118

Exenteration with skin grafting

6,210.00

7,142.00

119

Fracture orbital repair

8,280.00

9,522.00

120

Retinal laser PROCEDURESs

1,500.00

1,725.00

121

Retinal detachment surgery

11,500.00

13,225.00

122

Retinal detachment surgery with scleral buckling

13,800.00

15,870.00

123

Buckle removal

1,150.00

1,323.00

124

Silicone oil removal

2,800.00

3,220.00

125

Anterior retinal cryopexy

1,162.00

1,336.00

126

Squint correction for one eye

4,500.00

5,175.00

127

Squint correction for both eyes

6,750.00

7,763.00

128

Trabeculectomy

6,210.00

7,142.00

129

Trabeculotomy

6,210.00

7,142.00

130

Trabeculectomy with Trabeculotomy

9,315.00

10,712.00

131

Trephition

2,300.00

2,645.00

132

Goniotomy

345.00

397.00

133

Glaucoma surgery with Glaucoma valves

6210+valve

7142.00+Valve

134

Cyclocryotherapy

1,150.00

1,323.00

135

YAG laser iridotomy

1,500.00

1,725.00

136

YAG laser capsulotomy

1,093.00

1,257.00

137

ALT-Argon laser trabeculoplasty

1,495.00

1,719.00

138

PDT-Photodymic therapy

3,450.00

3,968.00

139

TTT- Transpupillary thermal therapy

3,000.00

3,450.00

140

PTK- Phototherapeutic keratectomy

7,500.00

8,625.00

141

Argon/diode laser for retinal detatchment

1,150.00

1,323.00

142

Intralase application for keratoconus

5,750.00

6,613.00

143

EOG- electro-oculogram

900.00

1,035.00

144

ERG- Electro-retinogram

794.00

913.00

145

VEP- visually evoked potential

800.00

920.00

146

Vitrectomy- pars plana

10,350.00

11,903.00

147

Intravitreal injections- of antibiotics

1,100.00

1,265.00

148

Intravitreal injections- of lucentis excluding cost of drug

3,000.00

3,450.00

149

X- Ray orbit

115.00

132.00

150

CT-orbit and brain

173.00

199.00

151

MRI- Orbit and brain

3,450.00

3,968.00

152

Dacryocystography

340.00

391.00

153

Orbital angio-graphical studies

1,500.00

1,725.00

154

ECCE with IOL

3,450.00

3,968.00

155

SICS with IOL

4,500.00

5,175.00

156

Phaco with foldable IOL (silicone and acrylic)/PMMA IOL

10,781.00

12,398.00

157

Pars plana  lensectomy with/without IOL

10,350.00

11,903.00

158

Secondary IOL implantation- AC IOL PC IOL or scleral fixated IOL

6,210.00

7,142.00

159

Cataract extraction with IOL with capsular tension rings (Cionni’s ring)

12,150.00

13,973.00

160

Optic nerve sheathotomy

7,500.00

8,625.00

161

Iridodialysis repair or papillary reconstruction

4,500.00

5,175.00

162

Iris cyst removal

850.00

978.00

163

Lid Abscess incision and Drainage

1,700.00

1,955.00

164

Orbital Abscess incision and Drainage

3,000.00

3,450.00

165

Biopsy

414.00

476.00

166

Paracentesis

230.00

265.00

167

Scleral graft for scleral melting or perforation

2,800.00

3,220.00

168

Amniotic membrane grafting

1,100.00

1,265.00

169

Cyclodiathermy

2,300.00

2,645.00

170

Intraocular foreign body removal

187.00

215.00

171

Electrolysis

230.00

265.00

172

Perforating injury repair

4,500.00

5,175.00

173

Botulinum injection for blepharospasm or squint

2,500.00

2,875.00

 

 TREATMENT PROCEDURES DENTAL PROCEDURESS

 

 

174

Flap Operation per  quadrant

324.00

373.00

175

Gingivectomy per quadrant

234.00

269.00

176

Reduction & immobilization of fracture- Maxilla Under LA

900.00

1,035.00

177

Reduction & immobilization of fracture-Mandible Under LA

3,150.00

3,623.00

178

splints/Cirucum mandibular wiring under LA

510.00

587.00

179

splints/Cirucum mandibular wiring under GA

990.00

1,139.00

180

Internal wire fixation/plate fixation of  Maxilla under LA

2,800.00

3,220.00

181

Internal wire fixation/plate fixation of Maxilla under GA

4,000.00

4,600.00

182

Internal wire fixation/plate fixation of Mandible under LA

3,150.00

3,623.00

183

Internal wire fixation/plate fixation of  Mandible under GA

3,825.00

4,399.00

184

Extraction per  tooth under LA

80.00

92.00

185

Complicated Ext. per Tooth under LA

100.00

115.00

186

Extraction of impacted tooth under LA

160.00

184.00

187

Extraction in mentally retarded/patients with systemic diseases/patient with special needs under short term GA

845.00

972.00

188

Cyst & tumour of Maxilla /mandible by enucleation/ excision/ marsupalisation upto 4 cms under LA

240.00

276.00

189

Cyst & tumour of Maxilla/mandible by enucleation/ excision/ marsupalisation  size more than   4 cms under LA

365.00

420.00

190

Cyst & tumour of Maxilla/mandible by enucleation/excision/marsupalisation size more than 4 cms under GA

950.00

1,093.00

191

TM joint ankylosis- under GA

6,750.00

7,763.00

192

Biopsy Intraoral-Soft tissue

374.00

430.00

193

Biopsy Intraoral-Bone

374.00

430.00

194

Hemi-mandibulectomy with graft

18,900.00

21,735.00

195

Hemi-mandibulectomy without  graft

18,900.00

21,735.00

196

Segmental-mandibulectomy with graft

3,400.00

3,910.00

197

Segmental-mandibulectomy without  graft

990.00

1,139.00

198

Maxillectomy- Total with graft

2,500.00

2,875.00

199

Maxillectomy- Total without graft

1,950.00

2,243.00

200

Maxillectomy- partial with graft

3,000.00

3,450.00

201

Maxillectomy- partial  without graft

2,500.00

2,875.00

202

Release of fibrous bands & grafting -in (OSMF) treatment under GA

1,500.00

1,725.00

203

Pre-prosthetic surgery- Alveoloplasty

500.00

575.00

204

Pre-prosthetic surgery - ridge augmentation

1,200.00

1,380.00

205

Root canal Treatment(RCT) Anterior teeth(per tooth)

500.00

575.00

206

Root canal Treatment(RCT) Posterior teeth (per tooth)

700.00

805.00

207

Apicoectomy- Single root

450.00

518.00

208

Apicoectomy-Multiple roots

585.00

673.00

209

Metal Crown-per unit

500.00

575.00

210

Metal Crown with Acrylic facing per unit

700.00

805.00

211

Complete single denture-metal based

1,500.00

1,725.00

212

Complete denture- acrylic based per arch

950.00

1,093.00

213

Removable  partial denture-Metal based-upto 3 teeth

630.00

725.00

214

Removable partial denture-Metal based-more than 3 teeth

900.00

1,035.00

215

Removable partial denture-Acrylic based-upto 3 teeth

500.00

575.00

216

Removable partial denture-Acrylic based-more than 3 teeth

264.00

304.00

217

Amalgum restoration-per tooth

200.00

230.00

218

Composite Restoration-per tooth-anterior tooth

250.00

288.00

219

Glas Ionomer-per tooth

200.00

230.00

220

Scaling & polishing

300.00

345.00

221

Removable Orthodontics appliance- per  Arch

700.00

805.00

222

Fixed Orhtodontics-per Arch

1,150.00

1,323.00

223

Space maintainers-Fixed

500.00

575.00

224

Habit breaking appliances-removable

800.00

920.00

225

Habit breaking appliances-Fixed

1,500.00

1,725.00

226

Expansion plate

1,000.00

1,150.00

227

Feeding appliance for cleft palate

1,350.00

1,553.00

228

Maxillo-facial prosthesis (sal/auricular/orbital/facial lost part)

3,150.00

3,623.00

229

Functional orthodentic appliances

2,700.00

3,105.00

230

Obturator (Maxillo-facial)

1,500.00

1,725.00

231

Occlusal night guard(splint)

800.00

920.00

 

 TREATMENT PROCEDURES ENT

 

 

232

Pure Tone Audiogram

172.00

198.00

233

Impedence with stepedeal reflex

230.00

265.00

234

SISI Tone Decay

132.00

152.00

235

Multiple hearing assessment test to Adults

115.00

132.00

236

Speech Discrimination Score

90.00

104.00

237

Speech Assessment

120.00

138.00

238

Speech therapy per session of 30-40 minutes

131.00

151.00

239

Cold Calorie Test for Vestibular function

172.00

198.00

240

Removal of foreign body From Nose

345.00

397.00

241

Removal of foreign body From Ear

230.00

265.00

242

Syringing (Ear)

166.00

191.00

243

Polyp removal under LA

575.00

661.00

244

Polyp removal under GA

850.00

978.00

245

Peritonsillar abscess Drainage under LA

1,449.00

1,666.00

246

Myringoplasty

6,900.00

7,935.00

247

Staepedectomy

9,200.00

10,580.00

248

Myringotomy with Grommet insertion

4,600.00

5,290.00

249

Tympanotomy

7,763.00

8,927.00

250

Tympanoplasty

13,800.00

15,870.00

251

Mastoidectomy

14,950.00

17,193.00

252

Otoplasty

16,100.00

18,515.00

253

Labyrinthectomy

13,800.00

15,870.00

254

Skull Base surgery

25,000.00

28,750.00

255

Facial Nerve Decompression

15,525.00

17,854.00

256

Septoplasty

5,750.00

6,613.00

257

Submucous Resection

7,314.00

8,411.00

258

Septo-rhinoplasty

16,100.00

18,515.00

259

Rhinoplasty- Non-cosmetic

11,500.00

13,225.00

260

Fracture Reduction

4,250.00

4,888.00

261

Intra nasal Diathermy

1,150.00

1,323.00

262

Turbinectomy

5,750.00

6,613.00

263

Endoscopic DCR

13,000.00

14,950.00

264

Endoscopic Surgery

13,800.00

15,870.00

265

Septal Perforation Repair

13,800.00

15,870.00

266

Antrum Puncture

880.00

1,012.00

267

Lateral Rhinotomy

1,000.00

1,150.00

268

Cranio-facial resection

25,500.00

29,325.00

269

Caldwell Luc Surgery

10,626.00

12,220.00

270

Angiofibroma Excision

17,000.00

19,550.00

271

Endoscopic Hypophysectomy

21,500.00

24,725.00

272

Endoscopic Optic Nerve Decompression

29,498.00

33,923.00

273

Decompression of Orbit

25,500.00

29,325.00

274

Punch/Wedge biopsy

674.00

775.00

275

Tonsillectomy

5,000.00

5,750.00

276

Uvulo-palatoplasty

15,000.00

17,250.00

277

FESS for antrochoal polyp

5,750.00

6,613.00

278

FESS for ethmoidal polyp

5,750.00

6,613.00

279

Polyp removal ear

748.00

860.00

280

Polyp removal Nose(Septal polyp)

748.00

860.00

281

Mastoidectomy plus Ossciculoplasty including TORP or PORP

2,415.00

2,777.00

282

Endolymphatic sac decompression

2,875.00

3,306.00

283

Diagnostic endoscopy under GA

2,300.00

2,645.00

284

Yonges operation for Atrophic rhinitis

6,900.00

7,935.00

285

Vidian neurectomy for vasomotor Rhinitis

10,350.00

11,903.00

286

Nasal Packing-anterior

345.00

397.00

287

Nasal Packing-posterior

805.00

926.00

288

Ranula Excision

6,159.00

7,083.00

289

Tongue Tie excision

1,350.00

1,553.00

290

Sub Mandibular Duct Lithotomy

269.00

309.00

291

Adenoidectomy

5,640.00

6,486.00

292

Palatopharyngoplasty

8,165.00

9,390.00

293

Pharyngoplasty

17,193.00

19,772.00

294

Styloidectomy

9,200.00

10,580.00

295

Direct laryngoscopy including Biopsy under GA

5,000.00

5,750.00

296

Oesophagoscopy/foreign body removal from

1,800.00

2,070.00

297

Bronchoscopy with F.B.removal

2,438.00

2,804.00

298

Other Major Surgery

15,000.00

17,250.00

299

Other Minor Surgery

8,500.00

9,775.00

 

 TREATMENT PROCEDURES FOR HEAD AND NECK

 

 

300

Ear Lobe Repair one side

500.00

575.00

301

Excision of Pinna for Growth (Squamous/Basal/ Injuries) Skin Only

3,600.00

4,140.00

302

Excision of Pinna for Growth (Squamous/Basal/ Injuries) Skin and Cartilage

3,800.00

4,370.00

303

Partial Amputation of Pinna

4,500.00

5,175.00

304

Total Amputation of Pinna

6,200.00

7,130.00

305

Total Amputation & Excision of External Auditory Meatus

1,500.00

1,725.00

306

Excision of Cystic Hygroma

5,175.00

5,951.00

307

Excision of Cystic Hygroma Extensive

7,452.00

8,570.00

308

Excision of Branchial Cyst

10,350.00

11,903.00

309

Excision of Branchial Sinus

9,315.00

10,712.00

310

Excision of Pharyngeal Diverticulum

10,580.00

12,167.00

311

Excision of Carotid Body-Tumours

11,615.00

13,357.00

312

Operation for Cervical Rib

12,500.00

14,375.00

313

Block Dissection of Cervical Lymph Nodes

15,000.00

17,250.00

314

Pharyngectomy & Reconstruction

15,000.00

17,250.00

315

Operation for Carcinoma Lip - Wedge-Excision

8,050.00

9,258.00

316

Operation for Carcinoma Lip - Vermilionectomy

5,758.00

6,622.00

317

Operation for Carcinoma Lip - Wedge Excision and Vermilonectomy

9,000.00

10,350.00

318

Estlander Operation

7,475.00

8,596.00

319

Abbe Operation

9,800.00

11,270.00

320

Cheek Advancement

9,775.00

11,241.00

321

Excision of the Maxilla

19,320.00

22,218.00

322

Excision of mandible-segmental

15,000.00

17,250.00

323

Mandibulectomy

18,900.00

21,735.00

324

Partial  Glossectomy

5,520.00

6,348.00

325

Hemiglossectomy

7,000.00

8,050.00

326

Total Glossectomy

22,885.00

26,318.00

327

Commondo Operation

22,000.00

25,300.00

328

Parotidectomy - Superficial

12,075.00

13,886.00

329

Parotidectomy -  Total

14,000.00

16,100.00

330

Parotidectomy -  Radical

19,550.00

22,483.00

331

Repair of Parotid Duct

11,500.00

13,225.00

332

Removal of Submandibular Salivary gland

8,625.00

9,919.00

333

Hemithyroidectomy