For the first time since 2014, the Union Health Ministry is revising rates under the Central Government Health Scheme (CGHS), introducing differential pricing by city tier, hospital accreditation, ward entitlement, and hospital type. The new rates will take effect from October 13, 2025.
Glimpse:
The CGHS reimbursement rates for nearly 2,000 medical procedures will now vary depending on city classification (Tier I, II, III), NABH/NABL accreditation status, super-specialty status, and ward category. Non-accredited hospitals will see 15% lower rates, while super-specialty units with over 200 beds will get 15% higher reimbursements. Tier II and III cities will get discounted rates of 19% and 20% below Tier I, respectively. (Rates will apply starting October 13.)
over a decade. Nearly 2,000 tests, procedures and hospitalization packages have been restructured under a new multi-dimensional rate system that considers city tier, hospital accreditation, hospital type, and ward entitlement.
These revised rates become effective from October 13, 2025.
Under the new framework:
Hospital accreditation matters: Hospitals with NABH / NABL accreditation will receive the base (standard) rates, while non-accredited facilities will be reimbursed 15% less.
Super-specialty incentive: In specialties and hospitals exceeding 200 beds, rates will be 15% higher than standard NABH hospital rates.
City tiers: Tier II hospitals (in smaller metros) will have rates 19% lower than Tier I; Tier III hospitals (smaller towns / rural cities) will see rates 20% lower.
Ward adjustments: For the general ward, rates will be 5% lower than those in semi-private; for private ward entitlements, they will be 5% higher.
Uniform categories: Some services such as outpatient consultation, day-care procedures, investigations, and minor procedures will have uniform rates across hospitals and wards.
Hospitals empanelled under CGHS will need to accept the new rates by October 13, or risk de-panelment. All existing Memoranda of Agreement (MoAs) will cease, and hospitals must reapply under the updated “Hospital Engagement Module.”
Analysts believe this rate revision could lead to a 25–30% uplift in realizations for many hospitals, especially those heavily reliant on CGHS revenues. Major private hospital chains are expected to gain significantly from the change.
This policy shift comes in response to long-standing complaints from central government employees and pensioners who struggled with hospitals refusing cashless treatment under outdated and unrevised rates.
“These new CGHS rates are not just numbers they restore trust. Hospitals can now agree to cashless care and patients won’t be forced to pay out of pocket for procedures long overdue for an update.”
By
HB Team
