Text of M.H. & F.W., O.M. No. S-11011/7/95-CGHS(P)Dated 12/6/1996

Ceiling for Reimbursement of the Cost of Coronary Stents, Rotablotar, Single Chamber Pacemaker and Dual Chamber Pacemaker to CGHS Beneficiaries

The undersigned is directed to say that the matter regarding fixation of ceiling limit for reimbursement of the cost of Coronary stents, Rotablator, Single/Dual Chamber Pacemaker, has been under consideration of the Government for some time past. It has now been decided to fix the following ceiling with regard to purchase of the aforesaid items:

Sl.No

Name of the item

Maximum Ceiling per item

1.


2.

3.


4.


5

Coronary Stent


Rotablator

Pacemaker (Single Chamber) without rate response

Pacemaker (Single Chamber) with rate response

Pacemaker (Dual Chamber)

Rs. 50,000 (Per stent subject to a maximum of two stents in a patient)

Rs. 50,000 or the actual cost, which ever is less

Rs. 37,000 or the actual cost, which ever is less


Rs. 65,000 or the actual cost, which ever is less


Rs. 1,15,500 or the actual cost, which ever is less

2. The cost of Coronary Stents mentioned above will be admissible over and above the cost of Angioplasty and the cost of Rotablator over and above the charges of Balloon Angioplasty. The number of stents in a patient should not exceed two. However, in exceptional circumstances, when the use of more than two Stents becomes necessary to bail out the patient, prior permission of Director, CGHS will have to be obtained.

3. The facility for implementation of the aforesaid devices can be availed of b CGHS beneficiaries on the recommendations of Senior Cardiologist and Medical Supdt. Of the Government hospitals or of the private hospitals/institutions approved for angioplasty and by-pass surgery under CGHS.

4. When Stents or Rotablators are implemented/used in private hospitals not recognized by CGHS under emergency conditions, ex-post facto approval of the Ministry of Health will have to be obtained, which will be based on the certificte regarding reasonableness of the cost by the treating physician and recommendation of Director, CGHS.

5. The beneficiary will have to invite three quotations for purchase of the requisite item and the reimbursements will be made to him on the basis of the lowest of the three quotations or the cost ceiling fixed above, whichever is less.

6. Since permanent pacemakers are not implanted in emergencies which is always tackled by inserting temporary pacing system, in all such cases, prior permission of Director, CGHS, will have to be obtained.

7. This issues with the approval of Finance Division vide their Diary No. 1030/96-F.II, dated 19/4/1996.

8. These orders will be applicable from the date of issue.

9. In so far as the persons serving in the office of the Comptroller and Auditor-General are concerned, this issue with the approval of C & AG vide their U.O. No. 201 Audit (Rules) 12-96, dated 11/6/1996.