11.08.2026
F No. D-12015/420/2024-Admn-IV Union Public Service Commission
Administration-IV Section
Dated the 11th August, 2026
OFFICE MEMORANDUM
Subject: Clarification regarding existing CGHS Guidelines.
The
To
undersigned is directed to refer CGHS OM No. Z/15025/19/2024/DIR/CGHS/EHS dated 28.06.2024, SOP dated 02.09.2024 and CGHS OM No. 5-16/CGHS(HQ)/HEC/2024 (Part-1) dated 03.10.2025 and to say that certain issues relating to reimbursement of medical claims have frequently been noticed in this office during scrutiny/processing of claims due to lack of clarity in the existing CGHS
guidelines/instructions.
2. Accordingly, the issues were taken up with the CGHS (HQ) for necessary clarification and in response, the CGHS (HQ) has conveyed the following guidelines:--
a) Subsequent follow-up consultations/investigations/minor procedures can be done only at the same empanelled hospital where primary consultation was availed.
i. If any investigation/test amounting up to Rs. 3000/- (each test/investigation) is prescribed by the Specialist of an empanelled hospital/HCO, the investigation/test must be undertaken at the same hospital/HCO, where primary consultation has been taken.
ii.
iii.
If the beneficiary wants to get the tests/investigations done from any other CGHS empanelled hospital/HCO/Diagnostic Centre, he/she has to take prior referral/endorsement from CGHS Wellness Centre.
Referral/endorsement from CGHS shall be required for special investigations like CT Scan, MRI Scan, PET Scan and any other investigation costing over Rs. 3,000/-.
b) Each consultation will be considered valid for a period of 7 days, provided it pertains to the same specialty.
c) Eye consultation fees include refraction, tonometry and fundus examination.
d) Prior permission of the Department/Office is mandatory for undergoing an unlisted investigation/procedure advised by specialist of a CGHS empanelled hospital.
3. All the staff/officials are advised to follow the aforesaid guidelines issued by the CGHS (Ministry of Health & Family Welfare) for hassle-free medical reimbursement.
4. This issues with the approval of the Competent Authority.
Lo iler 26 (Subhasis Roy)
Under Secretary (Admn.)
Undor Secretary view that r Union Public Service Commission /Now Delhi