Revised CGHS Rates Implemented for ECHS Healthcare Organisations: Complete Details
The Ministry of Defence has officially notified the revised CGHS rates for all treatments availed under the Ex-Servicemen Contributory Health Scheme (ECHS). These new rates, aligned with the latest CGHS package structure issued by the Ministry of Health & Family Welfare, will significantly impact billing, reimbursements, and empanelment rules for ECHS beneficiaries across India.
This notification supersedes all previous circulars and comes into effect from 15 December 2025.
1. Effective Date and Scope of the Revised CGHS Rates
As per the official order dated 05 December 2025, the revised CGHS package rates will apply to the following areas:
a) Services at Empanelled Healthcare Organisations (HCOs)
All ECHS beneficiaries availing treatment at empanelled hospitals will now be charged as per the updated CGHS rates.
b) Medical Reimbursement Claims
Service pensioners and eligible dependents submitting MRCs will now receive reimbursement based on the revised CGHS rates.
c) Cashless Treatment
Cashless facilities under ECHS will continue as per existing rules, but billing must follow the new rate structure.
The revised rate list (Annexure-I) applies to semi-private ward entitlement and is available on the official ECHS website.
2. Structure of Differential CGHS Rates
The updated CGHS rates have been rationalised based on several parameters. This ensures fairness and consistency across different hospital categories and geographies.
a) Accreditation Status
- Non-NABH/NABL hospitals → 15% lower than accredited hospitals.
(NABH: National Accreditation Board for Hospitals; NABL: National Accreditation Board for Testing & Calibration Laboratories)
b) Super Speciality Hospitals
- Charged 15% higher than NABH rates for equivalent procedures within the same city category.
c) City Classification
Rates vary depending on the city tier:
- X (Tier I) cities → Standard rate
- Y (Tier II) cities → 10% lower
- Z (Tier III) cities → 20% lower
- NE region, J&K, Ladakh → Follow Y-category rates
d) Ward Entitlement Adjustments
Base CGHS package rates correspond to semi-private ward.
Adjustments:
- General ward → 5% less
- Private ward → 5% more
e) Uniform Rates
Consultation, radiotherapy, investigations, minor/day-care procedures remain the same across all ward categories.
f) Cancer Treatment
- CGHS rules for cancer surgeries remain unchanged.
- Revised rates apply to investigations, radiotherapy, and chemotherapy.
3. Supporting Guidelines and Definitions
The complete policy includes seven annexures (II–VII) detailing:
- Package rate inclusions/exclusions
- Ward category definitions
- ICU and nursing charges
- Equipment and consumable policies
- Super speciality hospital criteria
- Relevant Ministry of Defence circulars and ECHS orders
These annexures help hospitals and beneficiaries understand the billing mechanism and claim admissibility.
4. Renewal of Empanelment (MoA) for Existing Hospitals
One of the major changes announced is the mandatory renewal of agreements with all empanelled hospitals.
Key instructions:
a) Automatic Cancellation of Old MoAs
All existing MoAs will cease to be valid from 15 December 2025 (12:00 AM).
b) Mandatory Online Re-Empanelment
Hospitals must apply through the Hospital Empanelment Module.
c) Execution of New MoA
A fresh MoA must be signed within 90 days of implementation of revised rates.
d) Mandatory Undertaking by Hospitals
To continue providing services from 15 December onwards, each empanelled HCO must:
- Submit an undertaking confirming acceptance of the new MoA terms.
- Submit it before 15 December 2025.
Failure to do so will result in automatic de-empanelment.
The undertaking format is provided in the PDF (page 3), requiring declaration of full acceptance of all clauses in the latest GSL (Guidelines for Empanelment).
5. Important Highlights from the CGHS Rate List (Annexure–I)
The annexure includes hundreds of updated rates for investigations, radiology, medical tests, and procedures. The document shows:
- Separate rate tables for Tier I, Tier II, and Tier III cities.
- Differential rates for NABH, Non-NABH, and super speciality hospitals.
- Clear formulas for calculating ward-specific rates:
- General = A – 5%
- Semi-Private = A
- Private = A + 5%
The PDF includes detailed examples of:
- Multiple surgeries in a single OT session
- Identical surgeries at different anatomical sites
- Follow-up procedures within the package period
These examples help hospitals correctly apply billing rules.
Conclusion
The revised CGHS rates bring clarity, uniformity, and transparency to the billing and reimbursement processes under ECHS. Beneficiaries can now expect updated hospital charges aligned with national healthcare standards, while empanelled hospitals must comply with the new rates and undertake timely re-empanelment to continue offering services.
This revised structure aims to improve service delivery and ensure fair pricing across all ECHS-affiliated medical facilities.