Central Government Health Scheme (CGHS Mumbai)

Permission for Oxygen Concentrator/ CPAP/ BIPAP

Documents required to be submitted by pensioner beneficiary at parent Wellness Centre:

  1. Request letter of beneficiary.
  2. CGHS card copies of card holder and of dependent patient.
  3. Duly filled Specified proforma to be filled by treating empanelled hospital/Government specialist clearly specifying type of equipment required along with flow rate.
  4. Detailed reports (sleep studies, thyroid function tests, electrolytes, Blood gas analysis etc).
  5. Affidavit to undertake maintenance of the equipment and to return the equipment to CGHS once its utility is over.
  6. Undertaking from Card holder that he has not been reimbursed the cost of Oxygen Concentrator/CPAP/BiPAP in the preceding five years for the said dependent.
  7. The replacement of the machine is permissible after 5 years subject to submission of condemnation /un serviceable certificate provided by the service engineer. The procedure for getting permission for replacement of the device involves the same procedure.

Permission shall be accorded after the application is examined by the committee. In case of serving employees, the permission shall be obtained from their parent department.

Reimbursement procedure 

Documents required are:

  1. Covering letter from Card holder.
  2. Copy of CGHS card.
  3. Duly filled claim form and bank mandate form and other relevant documents.
  4. Bill/Receipt (original) indicating the details.
  5. Payment proof.
  6. The original permission letters.

The reimbursement shall be restricted to ceiling rates or the actual, whichever is lower. 

Checklist for permission for CPAP, BiPAP and Oxygen Concentrator

Guidelines for procurement and reimbursement of CPAP, BiPAP and Oxygen Concentrator

Revision of ceiling rates for reimbursement of the cost of CPAP, BiPAP & Oxygen Concentrator - June 2019

Guidelines for issue of Oxygen Concentrator for post COVID patients - March 2021

Undertaking

Certificate of Medical Necessity for CPAP

Certificate of Medical Necessity for BiPAP and Bilevel Ventilatory Support

Certificate of Medical Necessity for Oxygen Concentrator

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