Revised ceiling rates for coronary stents under cghs /cs(ma) rules w.e.f. 21.02.2013

| February 22, 2013 | Reply

F.No. Misc. 1002/2006/CGHS(R&H)/CGHS(P)
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
************

Maulana Azad Road, Nirman Bhawan
New Delhi 110 108 dated the 21st February, 2013.

OFFICE MEMORANDUM

Subject: Revision of Ceiling Rates and guidelines for various Coronary Stents for CGHS/CS(MA) beneficiaries.

With reference to the above mentioned subject the undersigned is directed to draw attention to the Office Memorandum of even number dated 31.10.2011 and to state that ceiling rates for all DCGI approved Coronary Stents have been revised in super cession of the Office Memorandum of even No. dated 31.10.2011 of the Ministry of Health & Family Welfare as per the ceiling rates mentioned below:

S.No.

Type of Coronary Stents

Ceiling Rate
1. DRUG ELUTING CORONARY STENTS All DCGI and FDA approved Drug Eluting Stents

 

All DCGI and CE approved Drug Eluting Stents

 

All DCGI approved Drug Eluting Stents

 

 

Rs.25,000/-

2. BARE METAL CORONARY STENTS COBALT STENTS (including Coated and other Stents)

 

All DCGI and FDA approved

All DCGI and CE approved

All DCGI approved

-

 

 

Rs. 12,000/-

3. BARE METAL STAINLESS STELL STENTS Rs.10,000/- the rates were already notified vide OM of even number dated 7thFebruary 2013

 

Reimbursement to beneficiaries/empanelled hospitals shall be allowed subject to the ceiling rates or actuals, whichever are lower.

2. Coronary Stents shall be permitted on the advice of Govt. Specialist, of which not more than two shall be of Drug Eluting Stents (in any of the coronary stents as per the decision of treating specialist). Permission shall be granted as per the laid down procedure. If more than two drug eluting stents are implanted in an empanelled hospital and no written informed consent was obtained from the beneficiary that he/she would bear the difference in cost between the DES and Bare Metal Stent, and the hospital has charged this amount from the beneficiary, the additional amount shall be paid to the beneficiary and shall be deducted from the pending bills of hospitals.

3. It is essential for the empanelled hospitals to quote the Batch number when a coronary/vascular stent of any type is implanted in the case of a CGHS/CS (MA) beneficiary and also enclose a copy of the relevant invoices pertaining to the procurement of the stents by the hospitals. In addition to this, the outer pouch of the Stent packet along with the sticker on it on which details of the stent are printed shall also be enclosed with the medical bill for claiming reimbursement from the Govt. In case of treatment from a private non-empanelled hospital, where the treatment was taken in an emergency, it is the responsibility of the beneficiary to obtain the batch number, invoice and outer pouches of the stent(s) before the submission of the medical claim to CGHS/ concerned department, as the case may be.

4. The empanelled hospital shall submit a self certified undertaking that the hospital has not charged the CGHS / CS (MA) beneficiary more than the rate at which the stent has been procured by the hospital and in case of any detection and establishment that the hospital has overchanged, the hospital shall be removed from the list of hospitals empanelled under CGHS without any further notice.

5. UTI-ITSL, while processing the hospital bills of coronary / vascular stents shall ensure that the hospitals have enclosed copies of the relevant invoices pertaining to the procurement of the stents by the hospitals and the outer pouch of the Stent packet along with the sticker on it on which details of the stent are printed and that the prescribed rates and the guidelines have been followed, before making provisional payments to the hospitals.

6. The revised rates and guidelines shall come into force from the date of issue and shall be in force till they are revised.

7. This issues with the concurrence of Integrated Finance Division vide Note dated 20.12.2012 of AS&FA, Min. of H&FW.

(RAVI KANT)
UNDER SECRETARY TO GOVERNMENT OF INDIA
Tel.No. 23061441

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