CGHS Rate List 2025: Complete Guide to Government Hospital Rates

What Are CGHS Rates?

CGHS stands for the Central Government Health Scheme. It is the health cover run by the Ministry of Health and Family Welfare for serving and retired central government employees, Members of Parliament, judges, and their dependents. Around 45 lakh people are enrolled.

For its beneficiaries to get treated at private hospitals, CGHS negotiates a rate for every procedure (a bypass surgery, a cataract, a chest X-ray) and empanels hospitals that agree to accept those rates. That negotiated schedule is the CGHS rate list. It is published by the Directorate General of CGHS and updated periodically. The most recent major revision, in October 2025, moved the whole system onto a new platform called TMS 2.0.

Each procedure has a short alphanumeric code. Cardiology procedures start with CN, laboratory investigations with LB, and so on. That coding is what makes CGHS a genuinely useful benchmark. Unlike most Indian pricing lists, you can look up an exact procedure and get an exact number.

Who Do CGHS Rates Apply To?

Directly, they apply to CGHS beneficiaries (the roughly 45 lakh central government cardholders and their families) when they are treated at an empanelled hospital. The same rates are also adopted by the Ex-Servicemen Contributory Health Scheme (ECHS), which added another 55 lakh beneficiaries when it adopted the revised rates in December 2025. Several state government schemes and public sector insurers use CGHS as a reference too.

If you are none of those, and you walked into a private hospital as a cash patient, CGHS rates do not legally cap what the hospital can charge you. But the story does not end there. Consumer courts, state health authorities, and increasingly the Supreme Court have started treating CGHS rates as a "reasonableness benchmark". A 2024 PIL specifically pushed the Court to endorse CGHS as an interim reference for private hospital pricing in the absence of any binding rate regulation.

In practice this means CGHS rates are useful to three groups: CGHS and ECHS beneficiaries who want to check their bills, private patients arguing that a charge is excessive, and insurance companies pushing back on inflated hospital claims. This guide is for all three.

How Do CGHS Rates Actually Work?

A single procedure does not have a single CGHS price. The final rate for your case is the standard rate for that procedure, adjusted for three things: the hospital's accreditation, the city category, and the ward you were admitted to. Get those three inputs right and you can arrive at the exact rate CGHS would pay.

1. Rate tiers by hospital accreditation

Until 2025, NABH accreditation earned a hospital a 15 percent premium over the base rate. The October 2025 revision inverted that logic. NABH is now the standard. Non-accredited hospitals are paid less, and super speciality hospitals more.

2. City categories

CGHS groups all 80 covered cities into three tiers. X category cities are paid the full standard rate. Y cities are paid 10 percent less. Z cities, which covers most smaller centres, are paid 20 percent less.

3. Ward adjustments

The published rate assumes semi-private ward. If the patient was in a general ward, the rate is 5 percent lower; in a private room, 5 percent higher. Radiotherapy, investigations, day care procedures, and minor procedures do not get a ward adjustment. They are uniform.

4. Package rules for multiple procedures

When more than one procedure is done in the same admission, CGHS does not simply add up the full rates. The primary surgery is paid at 100 percent, the second at 50 percent, the third at 25 percent. This matters because a common overcharging pattern is to bill every procedure at full rate as if they were unrelated.

What is included in the package

The package rate covers surgeon and anaesthetist fees, operating theatre charges, routine medicines during stay, standard consumables, room charges for the approved length of stay, nursing, and typical post-operative care. It does not cover implants, high-end consumables, and prostheses. Those are billed separately, but hospitals cannot exceed NPPA ceilings on regulated devices.

What Do Common Procedures Cost at CGHS Rates?

The table below shows approximate CGHS rates for common procedures in an X-category city at a NABH-accredited hospital, alongside typical rack rates at private hospitals in the same cities. These figures are indicative. Always check the current published rate for your exact code and city before quoting a number.

Sources: CGHS 2025 rate list (DGCGHS), Ministry of Health and Family Welfare. Private hospital ranges compiled from public price disclosures at leading chain hospitals in Delhi, Mumbai, and Bengaluru. Rack rates commonly negotiate down 20–40 percent when patients push back with a rate reference.

How Do I Check the CGHS Rate for My Procedure?

The official source is cghs.gov.in, which hosts the published rate list and links out to the TMS 2.0 platform used for empanelled hospital billing. The full list is also downloadable as a PDF that runs to more than a hundred pages. Practically, three steps get you to the right number:

1. Identify the exact procedure on your bill. Hospitals rarely use CGHS terminology, so this often requires matching a hospital's internal description to the closest CGHS entry.
2. Find the CGHS procedure code. Cardiology codes start with CN, laboratory investigations with LB, radiology with RD, and so on. The code is what you cite in any dispute.
3. Apply the three adjustments (accreditation, city category, ward) to the standard rate to arrive at the payable amount for your case.

This is easy for a single line item. It quickly becomes unworkable for a 30-page hospital bill. That is where a bill audit service (including BillOkay) is useful. We do the mapping for every line automatically and hand you the difference in rupees.

What Is a CGHS Empanelled Hospital?

A CGHS empanelled hospital is a private or public hospital that has signed an agreement to treat CGHS beneficiaries at approved CGHS rates. Empanelment is granted city by city and specialty by specialty. A hospital can be empanelled for cardiology but not orthopaedics, or for one city's CGHS wellness centres but not another.

The CGHS empanelled hospital list is maintained on cghs.gov.in under each city's page and is updated periodically. If you are a CGHS beneficiary planning a procedure, the empanelled list is the single most important document you will look at, because it decides whether the hospital bills CGHS directly (cashless) or you pay first and reimburse (a much slower path).

If you are not a CGHS beneficiary, the list still matters for a different reason. An empanelled hospital has contractually agreed that these procedures can be delivered at CGHS rates. When they charge a private patient three times more for the same procedure in the same hospital, that gap is difficult to defend in a consumer forum.

Can I Use CGHS Rates to Challenge My Hospital Bill?

Yes, with realistic expectations about how far it goes. There are three distinct settings to think about.

If you are a CGHS beneficiary

Your bill at an empanelled hospital must not exceed CGHS rates for the procedures on the list. If it does, you have a direct grievance path through the CGHS wellness centre and the Additional Director, CGHS, of your city. Overcharging by an empanelled hospital is a breach of the empanelment agreement and has led to de-listings in the past.

If you are an insured private patient

Your bill is settled between the hospital and the insurer or TPA. CGHS rates are one of the reference points insurers use to argue a charge is unreasonable. When the insurer refuses a claim item as excessive, they usually quote a benchmark, often CGHS, GIPSA, or the internal TPA rate card. If the disallowed amount lands on you at discharge, showing that the disallowed charge exceeds CGHS is a strong argument in the ombudsman process.

If you are an uninsured private patient

This is the group with the weakest legal position and the biggest need. CGHS rates are not binding on private hospitals for cash patients. But consumer forums and the Supreme Court have accepted CGHS rates as a reasonableness benchmark. In 2024, a PIL specifically sought to make CGHS rates the interim reference for private hospital charges. The Court did not make them binding, but multiple state consumer forums have since ordered refunds where charges were "significantly above" CGHS.

In practice, the CGHS rate list is most powerful before payment, not after. If you are still at the hospital and the bill is being prepared, quoting the CGHS rate for a procedure you can name and code often produces a discount, because the hospital does not want the alternative of a consumer forum complaint that will take a year but is not going in their favour.

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