Health Ministry Revises CGHS Rates by City Tier & Hospital Accreditation

The revised rate structure aims to rationalise healthcare costs by differentiating rates based on hospital accreditation, city classification, and patient ward entitlement.

The Ministry of Health and Family Welfare has announced a revision of rates under the Central Government Health Scheme (CGHS), effective October 13, 2025.

The changes will apply to treatments at CGHS-empanelled healthcare organisations (HCOs), medical reimbursement claims by central government employees, pensioners, and other eligible beneficiaries, as well as cashless treatment for pensioners and specific categories under existing rules.

The revised rate structure aims to rationalise healthcare costs by differentiating rates based on hospital accreditation, city classification, and patient ward entitlement. Non-accredited hospitals (Non-NABH and Non-NABL) will receive 15 percent lower rates compared with NABH- or NABL-accredited hospitals. Super-specialty hospitals will be eligible for 15 percent higher rates for relevant treatments than NABH-accredited hospitals within the same city category.

Hospitals in Tier-II and Tier-III cities will receive rates 10 percent and 20 percent lower, respectively, than those in Tier-I cities. Package rates are based on semi-private ward entitlement. For general ward patients, rates are reduced by 5 percent, while private ward rates are increased by 5 percent on the admissible amount. Charges for outpatient consultations, investigations, day care procedures, and radiotherapy remain unchanged across all ward categories.

In cancer treatment, existing CGHS rates for surgeries will continue. However, chemotherapy, investigations, and radiotherapy procedures will follow the revised rate structure.

A key administrative reform accompanies the rate revision. All existing Memoranda of Agreement (MoAs) with private empanelled hospitals will cease to be valid from 12:00 AM on October 13, 2025. Hospitals seeking to continue under CGHS must reapply through the revised Hospital Engagement Module and submit an undertaking by October 13, confirming acceptance of the new terms. Failure to comply will result in automatic de-empanelment. Revised MoAs must be signed within 90 days of the new rates taking effect.

Commenting on the revision, Ameera Shah, President of NATHEALTH and Executive Chairperson of Metropolis Healthcare, said, “NATHEALTH – Healthcare Federation of India welcomes the Government’s decision to revise the Central Government Health Scheme (CGHS) rates. This reform, along with the earlier GST relief, reflects the Government’s commitment to strengthening healthcare delivery and addressing long-standing concerns of the sector. CGHS is a vital programme for millions of beneficiaries, and the revised rates will improve access to safe and effective healthcare while enhancing system efficiency.

She added, “CGHS and other government-sponsored schemes be periodically benchmarked to the Consumer Price Index (CPI), thereby ensuring predictability, sustainability, and a win–win value proposition for patients, providers, and policymakers. NATHEALTH and its members remain committed to partnering with the Government to drive healthcare reforms that deliver accessible, affordable, and high-quality care for every Indian.”

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