CGHS Breast Surgery Rate List: Mastectomy and Reconstruction

For breast cancer and other breast conditions needing surgery, CGHS reimburses mastectomy at fixed package rates, and separately covers post-mastectomy reconstruction.

The figures below are from the Delhi/NCR rate list.

CGHS Breast Surgery Package Rates

• Local mastectomy — simple, Non-NABH / NABH — Rs 12,650 / Rs 14,548
• Radical mastectomy — formal or modified, Non-NABH / NABH — Rs 28,750 / Rs 33,063
• Post-mastectomy reconstruction (mammoplasty), Non-NABH / NABH — Rs 12,000 / Rs 13,800

Rates shown are as per the CGHS approved package rates, Delhi & NCR 2014 rate list (updated 25.05.2021) (2014, periodically revised) and are subject to periodic revision. Always verify the latest approved rates on the official source.

Chemotherapy and Radiotherapy Are Separate

Breast cancer treatment usually combines surgery with chemotherapy and/or radiotherapy. Those are billed under their own CGHS codes, not the mastectomy package — see our CGHS cancer treatment rate guide for chemotherapy and radiotherapy figures.

How CGHS Package Rates Work

A CGHS "package rate" is an all-inclusive amount covering admission, surgeon and anaesthetist charges, operation theatre, nursing, routine investigations, medicines and accommodation for the standard length of stay.

Rates for NABH-accredited hospitals are set higher (generally 15%) than the non-NABH rate. The same procedure code can show different figures across city rate lists and revision dates, so always check the list for your CGHS city.

Referral and Prior Permission

For planned (non-emergency) procedures, a CGHS beneficiary needs a referral from the CGHS wellness centre and prior permission from the competent authority. Emergency treatment at an empanelled hospital is reimbursed up to CGHS rates without prior permission.

• Carry a valid CGHS card and follow your ward entitlement (based on pay/pension)
• Use an empanelled hospital for cashless treatment up to CGHS rates
• Obtain prior permission and referral for planned surgery

Frequently Asked Questions

Does the mastectomy package include chemotherapy?

No. The mastectomy package covers the surgery and standard hospital stay. Chemotherapy cycles and radiotherapy courses are reimbursed under separate CGHS codes.

Is breast reconstruction covered by CGHS?

Yes — post-mastectomy reconstruction (mammoplasty) has a notified package rate (Rs 12,000 non-NABH / Rs 13,800 NABH on the Delhi/NCR list).

Related

• CGHS chemotherapy and radiotherapy rates
• CGHS rate list for common procedures

Medical Disclaimer

The information provided in this article is for general informational and educational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.