|
File No.
File No.: Z15025/19/2024/DIR/CGHS/EHS · I/3687286/2024
|
Issued From · Date
Nirman Bhawan, New Delhi · 28th June, 2024
|
| Government of India · Ministry of Health & Family Welfare · EHS Section | |
INFO Partially modifies MoHFW OM No. Z.15025/117/DIR/CGHS/EHSS dated 15.01.2018 and 10.12.2018. Issues revised guidelines for referral procedures for Consultation, Investigations and Treatment in Government and Private hospitals empanelled with CGHS.
Office Memorandum
Subject
Revised guidelines for Referral Process in CGHS — regarding.
✦ ✦ ✦
In partial modification of MoHFW OM No. Z.15025/117/DIR/CGHS/EHSS dated 15.01.2018 and 10.12.2018, the undersigned is directed to convey approval of the Competent Authority for issue of revised guidelines for referral procedures for Consultation, Investigations and Treatment in Government and Private hospitals (empanelled with CGHS), as per details given below:
Section A — Government Hospitals (incl. TMH, AIIMSs, INIs)
| Cl. | Provision |
|---|---|
| A. | Government hospitals (including all AIIMSs, Institutions of National Importance, North East Institutions, Tata Memorial Hospital and all other central government medical institutions): No referral / permission / endorsement required for consultation, investigation, treatment, or any procedure including unlisted ones. |
NOTE In continuation of OM No. Z.15025/18/2020 dated 09.10.2020, the term "Government hospital" includes all AIIMSs, Institutions of National Importance (INIs), North East Institutions, Tata Memorial Hospital and all other central government medical institutions. No referral required for any consultation, investigation, treatment or unlisted procedures.
Section B — Private Empanelled Hospitals
| Cl. | Provision |
|---|---|
| B.i | Single referral for Specialist Consultation: Referral by any CGHS Medical Officer is valid for 3 months. Beneficiary may consult up to 3 specialists with max 6 consultations in this period. |
| B.ii | Investigations & treatment by specialist of empanelled hospital: No further endorsement for routine listed investigations and minor procedures (no admission needed) within 3-month validity. However, endorsement required for CT, MRI, PET Scan and any test over Rs. 3,000/-. |
| B.iii | Referral/endorsement required from CGHS MO for any procedure requiring admission — valid for 3 months. |
| B.iv | Unlisted investigations/treatment procedures: Considered per delegated powers vide OM Z.15025/14/2023/DIR/CGHS dated 27.12.2023 for pensioners and OM No. S 12020/4/97-CGHS(P) dated 07.04.1999 for serving employees. |
| B.v | Senior citizen provision: Direct OPD consultation at empanelled private hospitals without referral for CGHS beneficiaries aged 70 years and above (revised from 75 years per O.M. No. Z15025/35/2019/DIR/CGHS/CGHS(P) dated 29.05.2019). Tele-consultation via e-Sanjeevani also available. |
| B.vi | Emergency and post-operative follow-up: Instructions remain as per extant rules (O.M. No. S.I1011/29/2019-EHS dated 13.09.2019 and O.M. No. Z15025/35/2019/DIR/CGHS/CGHS(P) dated 29.05.2019). |
|
(Hemlata Singh)
Under Secretary to the Government of India · Tel: 011-23061778
|
REFOMs Referenced in this Order — Direct Links
| Date | Subject & File No. | Link |
|---|---|---|
| 07.04.1999 | No. S-12020/4/97-CGHS(P) Delegation of Powers under CGHS — referral system, permission cases & ex-post-facto approval |
|
| 15.01.2018 | No. Z.15025/117/2017/DIR/CGHS/EHS Simplification of referral system under CGHS — OPD consultation at private empanelled hospitals |
|
| 10.12.2018 | No. Z.15025/117/2017/DIR/CGHS/EHS Revision of guidelines for simplification of referral system — 30-day referral validity, 3 specialists |
|
| 29.05.2019 | No. Z15025/35/2019/DIR/CGHS/CGHS(P) (i) Consultation from Specialists at CGHS empanelled hospitals for beneficiaries aged 75 years and above |
|
| 29.05.2019 | No. Z15025/35/2019/DIR/CGHS/CGHS(P) (ii) Post-operative follow-up treatment from hospitals empanelled under CGHS for critically ill beneficiaries |
|
| 13.09.2019 | No. S.I1011/29/2019-EHS Emergency treatment in CGHS empanelled hospitals — no prior permission or advance payment required |
|
| 09.10.2020 | No. Z15025/18/2020/DIR/CGHS Clarification regarding treatment of CGHS beneficiaries at government hospitals — definition expanded to include AIIMSs, INIs, TMH, PSUs |
|
| 27.12.2023 | No. Z.15025/14/2023/DIR/CGHS Delegation of Financial Powers for settlement of reimbursement claims/Permissions for Pensioner CGHS beneficiaries — Addl. Dir. upto Rs. 1L, Dir. CGHS upto Rs. 3L, AS&DG upto Rs. 5L |
|
| 28.06.2024 | No. Z15025/19/2024/DIR/CGHS/EHS — This OM + all above in one compiled PDF Full document with all referenced orders compiled together (dtf.in) |
◆
OMsAll Related CGHS OMs — TMH Cancer Treatment Series
| 13.09.2022 | OM F. No. Z15025/26/2022/DIR/CGHS Original OM — Cancer treatment at TMH/ACTREC. Referral required. MoU signed. Valid 2 years. Extended by 2026 OM. |
⇩ PDF ▶ View Post |
| 28.06.2024 | OM File No. Z15025/19/2024/DIR/CGHS/EHS Revised Referral Guidelines — No referral for TMH & all Central Govt hospitals. 3-month referral for private hospitals. Age 70+ direct OPD. |
|
| 20.02.2026 | OM F. No. Z15025/26/2022/DIR/CGHS (Revised) Revised procedure — No referral. Credit covers BMT, Proton Therapy, CAR-T Cell Therapy. Valid upto 22.04.2028. |
⇩ PDF ▶ View Post |
SUMMARYQuick Reference Summary
File No. Z15025/19/2024/DIR/CGHS/EHS · 28.06.2024
| ► | No referral for any treatment at Government hospitals, AIIMSs, INIs, Tata Memorial Hospital. |
| ► | Single referral for private empanelled hospitals valid for 3 months — up to 3 specialists, 6 consultations. |
| ► | No re-endorsement for routine listed investigations & minor procedures within 3-month validity. |
| ► | Endorsement required for CT, MRI, PET Scan and investigations costing over Rs. 3,000/-. |
| ► | Age for direct consultation relaxed: 70 years and above (was 75 years earlier). |
| ► | Tele-consultation via e-Sanjeevani available for eligible beneficiaries. |
Post a Comment