Question 1

Does the CGHS rate for Excision of mammary fistula apply to private patients?

Accepted Answer

No. CGHS reference rates apply only to CGHS beneficiaries — central government employees, pensioners, and their dependents with a valid CGHS card. Private, self-paying patients are charged the hospital's regular rate, which is typically higher.

Question 2

What if the hospital charges more than the CGHS rate?

Accepted Answer

Empanelled hospitals agree in writing to accept CGHS rates for beneficiaries. If you are overcharged as a beneficiary, raise it with the hospital billing desk first, then with your CGHS wellness centre. The Supreme Court in 2024 directed the central government to standardise hospital charges — until that takes effect, the CGHS rate is your enforceable reference.

Question 3

What do X, Y, and Z city tiers mean?

Accepted Answer

CGHS classifies cities by cost-of-living tier. Tier X covers metros (Delhi, Mumbai, Bengaluru, Chennai, Hyderabad, Kolkata, Ahmedabad and NCR towns). Tier Y covers other large cities (Pune, Jaipur, Lucknow, Bhopal, Chandigarh, Patna, Nagpur etc.). Tier Z covers all remaining CGHS cities. Tier Y rates are roughly 10% lower than X; Tier Z is roughly 20% lower.

Question 4

Why are NABH, Non-NABH and Super Speciality rates different?

Accepted Answer

NABH-accredited hospitals meet nationally verified quality standards and are paid 10% more than Non-NABH. Super-speciality hospitals — which provide tertiary procedures like cardiac surgery, transplants, advanced oncology — are paid 15% more than Non-NABH. The accreditation status of each hospital is shown on its detail page.

Question 5

How do ward entitlements (General, Semi-private, Private) affect the rate?

Accepted Answer

The rate above assumes a Semi-private ward. Beneficiaries entitled to General Ward pay approximately 5% less; those entitled to Private Ward pay approximately 5% more. Your ward entitlement is determined by your pay level at retirement (or current pay, for serving employees).

Question 6

When was this rate last revised?

Accepted Answer

These are the rates from the CGHS revision effective 13 October 2025, notified on 3 October 2025 by the Ministry of Health & Family Welfare. Check the official notification on cghs.mohfw.gov.in for any subsequent amendments.

Excision of mammary fistula

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