India Pharma Outlook Team | Monday, 06 October 2025
In a substantial change, the Union Health Ministry has unveiled comprehensive changes to rates for nearly 2,000 medical procedures under the Central Government Health Scheme (CGHS), the first major revision in rates since 2014.
The revised CGHS rates will be effective from October 13, and they are aimed primarily at price standardisation and addressing prolonged disputes between beneficiaries and hospitals.
Under the new structure, rates have been rationalised on four criteria -- hospital accreditation, type of hospital, city classification and the entitlement of ward. Previously, rates were reliant almost exclusively on whether hospitals were accredited by NABH. Rates will now be more equitably ascertained by a multi-dimensional rate system.
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According to the health ministry, base rates will be applied to semi-private room rates. General ward entitlement will incur 5% less cost, while private ward entitlements will incur 5% more cost to participants. Non-accredited hospitals rates will be at 15% less than NABH or NABL-accredited hospitals, while for super-specialty hospitals, rates will be 15% higher.
The classification of hospitals into tiers will also play a part in the pricing – Rates for Tier-II hospitals will be 10% less, and rates for Tier-III hospitals will be 20% less than those sold by Tier-I cities. Radiotherapy, investigations and day-care procedures will continue to have a uniform rate across wards.
The revision is welcomed by hospitals that had cited the package rates out-of-date and beneficial for the more than 4.26 million CGHS beneficiaries that span over 80 cities who have also had problems cashless treatment and delayed reimbursement. It is hoped that the new rates will create a more equal and sustainable healthcare system.
