Angioplasty & Heart Stent CGHS Rates: Package, Eligibility & Documents

Quick answer

For Central Government Health Scheme (CGHS) beneficiaries in India, Angioplasty and Heart Stent procedures are covered, with package rates determined by the type of stent used. To be eligible, you must be a CGHS beneficiary and the procedure needs to be recommended by a CGHS-recognized specialist. The process typically involves obtaining a referral from a CGHS Medical Officer or specialist, followed by approval from the Additional Director, CGHS, for treatment at an empanelled hospital. Required documents generally include your CGHS card, referral letters, and diagnostic reports. The package rates are comprehensive, covering various aspects of the treatment, but certain exclusions may apply. For the most accurate and current package rates, it's best to consult the latest CGHS rate list or inquire directly with a CGHS-empanelled hospital.

Understanding Angioplasty and Heart Stents under CGHS

Angioplasty is a medical procedure used to open blocked or narrowed arteries, often in the heart, to restore blood flow. A heart stent is a small mesh tube typically placed during angioplasty to help keep the artery open. For Central Government Health Scheme (CGHS) beneficiaries, these procedures are covered under specific guidelines and package rates.

CGHS Package Rates for Angioplasty and Heart Stent

The CGHS package rates for angioplasty and heart stent procedures are fixed and vary based on the type of stent used. These rates are comprehensive and generally include the cost of the stent, the procedure itself, hospital stay, doctor's fees, and essential investigations.

As of recent revisions, the CGHS package rates for angioplasty with different types of stents are as follows:

• Bare Metal Stent (BMS): The package rate for angioplasty with a Bare Metal Stent is ₹75,000.
• Drug-Eluting Stent (DES): The package rate for angioplasty with a Drug-Eluting Stent is ₹90,000.
• Bio-absorbable Stent/Biodegradable Stent: The package rate for angioplasty with a Bio-absorbable Stent or Biodegradable Stent is ₹1,40,000.

It's important to note that these rates are subject to change, and beneficiaries should always verify the latest rates with the CGHS department or an empanelled hospital. These rates are for a single stent. If multiple stents are required, the cost will increase accordingly.

Eligibility for CGHS Beneficiaries

To be eligible for angioplasty and heart stent procedures under CGHS, you must be a valid CGHS beneficiary. This includes central government employees, pensioners, and their eligible dependent family members. The need for the procedure must be certified by a cardiologist or a specialist recognized by CGHS.

Referral and Permission Steps

The process for availing angioplasty and heart stent under CGHS typically involves the following steps:

1. Consultation with CGHS Medical Officer/Specialist: The first step is to consult a CGHS Medical Officer or a specialist at a CGHS Wellness Centre. They will assess your condition and, if necessary, refer you to a cardiologist.
2. Cardiologist's Recommendation: The cardiologist, either at a government hospital or a CGHS-empanelled private hospital, will recommend the angioplasty procedure and the type of stent required based on your medical condition.
3. Approval from CGHS: For treatment at a private empanelled hospital, prior approval from the Additional Director, CGHS, of the concerned city is usually required. The hospital will typically send the recommendation and necessary documents to CGHS for approval. In emergency cases, treatment can be initiated, and post-facto approval can be sought.
4. Treatment at Empanelled Hospital: Once approval is granted, you can undergo the procedure at any CGHS-empanelled hospital.

Required Documents

When seeking approval and undergoing the procedure, you will typically need the following documents:

• Valid CGHS Plastic Card or Index Card.
• Referral letter from the CGHS Medical Officer or specialist.
• Recommendation letter from the cardiologist detailing the need for angioplasty and the type of stent.
• Relevant diagnostic reports (e.g., angiography reports, ECG, ECHO).
• Aadhar card or other valid identification.

Exclusions

While CGHS package rates are comprehensive, certain exclusions may apply. These can include:

• Experimental procedures or stents not approved by CGHS.
• Treatment for conditions not directly related to the angioplasty.
• Personal expenses such as telephone calls, extra food for attendants, etc.
• Certain high-end consumables or medications not part of the standard package, unless specifically approved.

It is crucial to clarify any potential exclusions with the empanelled hospital and the CGHS authorities before the procedure to avoid unexpected costs.

Related guides

• Angioplasty & Heart Stent Cost in India: CGHS, Govt, Private & Insurance

Sources

• CGHS Delhi. "CGHS Package Rates for various procedures/treatments under CGHS."
• Central Government Health Scheme (CGHS) official website.

Disclaimer

The information provided in this guide is for general informational purposes only and does not constitute medical or financial advice. CGHS package rates and policies are subject to change. For the most accurate and up-to-date information, beneficiaries should always consult with their CGHS Medical Officer, the CGHS department, or a CGHS-empanelled hospital. Medical decisions should always be made in consultation with a qualified healthcare professional.