Revision of ceiling rates and guidelines for various Coronary/Vascular Stents for ECHS beneficiaries.

Central Organisation, ECHS

Adjutant General’s Branch

Integrated Headquarters

Ministry of Defence (Army)

Maude Lines

Delhi Cantt-110010

B/49773/AG/ECHS/Rates/Policy

26 Apr 2013

I . Reference Para 2 (a) to Para (b) to this Organisation letter, No.B/49773/AG/ECHS/Rates/Policy dated 25 Nov 2011.

2. CGHS has revised the rates of CoronaryVascular Stents on 21, Feb2013.  Revised rates and guidelines for Coronary/Vascular Stents for reimbursement  to ECHS beneficiaries are given in succeeding Paras. DCGI approved CorortaryNascular Stents will be reimbursed as per the ceiling rates mentioned below:-

(i) All DCGI and FDA approved Drug Eluting Stents. – Rs 25,000/-

(ii) All DCGI and CE approved Drug Eluting Stents – Rs 25,000/-

(iii) All DCGI approved Drug Eluting Stents Rs 25 000/-

(i) Stainless Steel Stents- Rs 10,000/-

(ii) Cobalt Stents.

(aa) All DCGI and FDA approved – Rs 12,000/-

(ab) All DCG1 and CE approved – Rs 12,000/-

(ac) ALL DCGI approved – Rs 12,000/-

(iii) Coated/other stents – Rs 25,000/-  

(i) Stainless steel stents – Rs 20,000/-

(ii) Cobalt stents – Rs 22,000/-

(iii) Nitinol/other stents – Rs 25,000/-

3. Reimbursement of beneficiaries/empanelled hospitals shall be limited to ceiling rates or as per actuals, whichever is lower.

4. Maximum three stents of which not more than two are drug eluting are permitted. In special cases when a patient requires additional stents prior approval of service cardiologist win be obtained as per procedure laid down vide our letter No B/49778/AG/ECHS/PA/ Ruling dt 28 Jun 11.

5. If more than two drugs eluting 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, and the hospital charge this amount from the beneficiary, the additional amount shall be deducted from the pending bills of hospitals and shall be paid to the beneficiary.

6. 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 ECHS 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 ECHS.  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 pauches of the stent(s) before the submission of the medical claim to ECHS, as the case may be.

7. The empanelled hospital shall submit a self certified undertaking that the hospital has not charged the ECHS 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 ECHS without any further notice.

8. UTI-ITSL, while processing the hospital bills of coronary/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.

9. The revised rates and guidelines shall come into forte from the date of issue and shall be in force till they are revised. 

sd/-

(Vijay Anand)

Col

Dir (Med)