The Ministry of Health and Family Welfare has announced a significant revision of rates under the Central Government Health Scheme (CGHS), effective October 13, 2025. This revision introduces a differential payment structure designed to promote quality and standardization in healthcare services.
Differential Rate Structure
The new CGHS Office Memorandum (OM) dated October 3, 2025, differentiates payments to healthcare facilities (HCOs) based on their accreditation status and geographic location.
1. Accreditation-Based Rate Difference
Healthcare facilities holding accreditation from the National Accreditation Board for Hospitals and Healthcare Providers (NABH) or the National Accreditation Board for Testing and Calibration of Laboratories (NABL) will receive higher rates than non-accredited facilities.
Non-NABH and Non-NABL HCOs: Will receive rates that are 15 percent lower than the rates given to NABH/NABL accredited HCOs.
Accredited Facilities (NABH/NABL): By extension, NABL accredited medical laboratories will effectively receive 15 percent higher rates than their non-accredited counterparts, incentivizing adherence to international quality standards in testing and calibration.
2. Geographic-Based Rate Difference
Further rate differentiation is applied based on the city tier classification:
- Tier I (X) Cities: Base rates apply.
- Tier II (Y) Cities: Rates shall be 10 percent lower than those located in Tier I (X) cities.
- Tier III (Z) Cities: Rates shall be 20 percent lower than those located in Tier I (X) cities.
The Tier II (Y) rates will also apply to HCOs located in the North-East region and the Union Territories of Jammu and Kashmir and Ladakh, recognizing the unique regional operational environments.