Subject: Revision of Ceiling Rates and guidelines for various
Coronary /Vascular Stents for CGHS/CS (MA)
beneficiaries.
In supersession of the Office Memorandum of even No dated
12.09.2007 of the Ministry of Health & Family Welfare for the
revised rates and guidelines for Coronary / Vascular Stents for
reimbursement of CGHSICS(MA) beneficiaries, all DCGI approved Coronary /
Vascular Stents are approved for reimbursement to CGHSICS(MA)
beneficiaries as per the ceiling rates mentioned below
1. DRUG ELUTING CORONARY STENTS-
i. All DCGI and FDA approved Drug Eluting Stents – Rs. 65,000/-
ii. Ail DCGI and CE approved Drug Eluting Stents – Rs. 50000/-
iii All DCGI approved Drug Eluting Stents – – Rs 40000/-
2 BARE METAL CORONARY STENTS
i) STAINLESS STEEL STENTS – Rs.12000/-
ii) COBALT STENTS – Rs.20,000/.
a) All DCGI and FDA approved
b) Ail DCGI and CE approved – Rs. 18,000/-
c) All DCGI approved – Rs. 15,000/-
iii) COATED I OTHER STENTS – Rs. 25,000/-
3. BARE METAL VASCULAR (NON CORONARY ) STENTS
i) STAINLESS STEEL STENTS – Rs 20000/-
ii) COBALT STENTS – Rs 22,000/-
iii) NITINOL / OTHER STENTS – Rs 25,000!-
Reimbursement to beneficiaries /empanelled hospitals shall
be limited to ceiling rates or as per actuals, whichever is lower.
2. Coronary Stents shall be permitted on the advice of Govt.
Specialist, of which not more than two shall be of Drug Eluding Stents.
Permission shall be granted as per the laid down procedure. If more than
two drug eluding 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,
arid the hospital has charged this amount from the beneficiary, the
additional amount shall be deducted from the pending bills of hospitals
and shall be paid to the beneficiary
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 CGHSI 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
overcharged the hospital shall be removed from the list of hospitals
empanelled under CGHS without any further notice.
5. UTI-TSL, while processing the hospital bills of coronary I
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 for a period of one year or tilt
they are revised, whichever may be earlier.
7. This issues with the concurrence of Finance Division vide Dy.
No 2979 dated 20.10.2011 of the office of AS&FA Min. of H&FW
COMMENTS