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Rules, Rights & Rites -173 Procedures for undergoing medical tests and investigations at CGHS-empaneled hospitals to ensure hassle-free reimbursement.

 Rules, Rights & Rites -173


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Procedures for undergoing medical tests and investigations at CGHS-empaneled hospitals to ensure hassle-free reimbursement.

• Most CGHS beneficiaries must obtain a referral from a CGHS Wellness Centre before consulting with a specialist at an empanelled Health Care Organization (HCO).

• Beneficiaries over the age of 70 are exempt from the requirement to obtain a referral for specialist consultations.

• If a specialist at an empanelled hospital prescribes tests (excluding MRI and CT scans) that cost less than ₹3,000 each, these must be performed at that same hospital where the consultation took place. 

• If a beneficiary chooses to have these tests done at a different empanelled centre or lab, they must obtain prior endorsement from their CGHS Wellness Centre.

• Separate endorsement or permission is always required for specific high-cost investigations, such as MRI and CT Scans, regardless of where they are performed.

(DG (P) No. CA-30/14/2025-CA/PB-DOP dated 22.1.2026)


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