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Thread: No code in the CGHS code book

  1. #1
    Junior Member shivnamas is on a distinguished road
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    Default No code in the CGHS code book

    Dear Friends,

    If there is no code in the CGHS code book (CGHS rate list) for any procedures/surgery, in what basis we will get reimbursement. If no code, I believe we will claim the actual rate paid to CGHS recognized hospital.

    Can any one clarify this?


    Thanks in advance

  2. #2
    Senior Member jitendraacr is on a distinguished road
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    Dear friend
    If rates are not quoted in CGHS list, rates of AIIMS are applicable in such cases. If these are also not available with AIIMS, actual payment is reimbursable.
    Jitendra

  3. #3
    Junior Member shivnamas is on a distinguished road
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    Quote Originally Posted by jitendraacr View Post
    Dear friend
    If rates are not quoted in CGHS list, rates of AIIMS are applicable in such cases. If these are also not available with AIIMS, actual payment is reimbursable.
    Jitendra
    Dear Mr. Jitendra,

    I had undergone a surgery on my right knee, which is not in CGHS code book. I had informed the same to my dept. prior to this surgery. but, while claiming for reimbursement, my office is not passing the bill citing the reason that there is no code available. Is there any notification or circular, saying that if there is no CGHS code then actual can be reimbursed? If so, who is the sanction authority for working employees? CGHS director or head of department? I would be grateful, If you could provide some information.

  4. #4
    Junior Member bansonjoy is on a distinguished road
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    Default bansonjoy

    The claim for reimbursement of medical expenses is made at CGHS approved package rates. In case CGHs rates are not available, then AIIMS rate are to be taken. In the absence of even AIIMS rates, reimbursement is to be made at actuals.

  5. #5
    Junior Member shivnamas is on a distinguished road
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    Default hi

    Quote Originally Posted by bansonjoy View Post
    The claim for reimbursement of medical expenses is made at CGHS approved package rates. In case CGHs rates are not available, then AIIMS rate are to be taken. In the absence of even AIIMS rates, reimbursement is to be made at actuals.
    dear friend. thanks for your reply. i would appreciate if you give some reference or link or O.M. No. etc?

    plz

  6. #6
    Junior Member shivnamas is on a distinguished road
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    Quote Originally Posted by bansonjoy View Post
    The claim for reimbursement of medical expenses is made at CGHS approved package rates. In case CGHs rates are not available, then AIIMS rate are to be taken. In the absence of even AIIMS rates, reimbursement is to be made at actuals.
    thanks. can u give some ref. or OM No. regarding this. or link also would be appreciated.

    bye

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