CGHS Rates for IOL, Retina & Complex Eye Surgery (2025)

This page provides a guide to the Central Government Health Scheme (CGHS) rates for a range of specialised ophthalmology procedures beyond standard cataract surgery. These include treatments for complications, paediatric conditions, retinal issues, and eye injuries. For CGHS beneficiaries, understanding these rates is crucial for navigating treatment at empanelled private hospitals.

The procedures covered here involve intricate surgical work, such as exchanging or repositioning an intraocular lens (IOL), performing cataract surgery on children, removing membranes from the retina, and addressing eye trauma like a perforating injury or an intraocular foreign body. CGHS has established specific package rates for these interventions to ensure standardised billing.

The rates for these procedures vary based on the accreditation status of the hospital (NABH-accredited or non-NABH). The rate table above provides the precise figures for each procedure under both categories. This guide will help you understand who these rates apply to, what costs are included in the package, and what you might need to pay for separately.

CGHS Cataract, IOL & Retina-Related Procedure Rates (effective 13 October 2025)

Ophthalmology codes carry no separate super-speciality rate.

• Subconjunctival/sub-tenon’s injections in one eye, Non-NABH — Rs 425
• Subconjunctival/sub-tenon’s injections in one eye, NABH — Rs 500
• Subconjunctival/sub-tenon’s injections in both eyes, Non-NABH — Rs 680
• Subconjunctival/sub-tenon’s injections in both eyes, NABH — Rs 800
• Membranectomy one eye, Non-NABH — Rs 10,200
• Membranectomy one eye, NABH — Rs 12,000
• Membranectomy both eyes, Non-NABH — Rs 12,750
• Membranectomy both eyes, NABH — Rs 15,000
• Cataract extraction with IOL with capsular tension rings (Cionni’s ring)(cost of the ring included) excluding the cost of IOL per eye, Non-NABH — Rs 29,750
• Cataract extraction with IOL with capsular tension rings (Cionni’s ring)(cost of the ring included) excluding the cost of IOL per eye, NABH — Rs 35,000
• Paediatric cataract surgery +parsplana capsulotomy + anterior vitrectomy excluding the cost of IOL - one eye, Non-NABH — Rs 17,000
• Paediatric cataract surgery +parsplana capsulotomy + anterior vitrectomy excluding the cost of IOL - one eye, NABH — Rs 20,000
• Paediatric cataract surgery +parsplana capsulotomy + anterior vitrectomy excluding the cost of IOL - Both Eyes, Non-NABH — Rs 21,250
• Paediatric cataract surgery +parsplana capsulotomy + anterior vitrectomy excluding the cost of IOL - Both Eyes, NABH — Rs 25,000
• IOL exchange [excluding IOL cost] per eye, Non-NABH — Rs 8,500
• IOL exchange [excluding IOL cost] per eye, NABH — Rs 10,000
• IOL reposition per eye, Non-NABH — Rs 5,100
• IOL reposition per eye, NABH — Rs 6,000
• IOL explantation per eye, Non-NABH — Rs 6,800
• IOL explantation per eye, NABH — Rs 8,000
• Iridodialysis repair or pupillary reconstruction /Cyclodialysis repair per eye, Non-NABH — Rs 11,390
• Iridodialysis repair or pupillary reconstruction /Cyclodialysis repair per eye, NABH — Rs 13,400
• Iris cyst removal /synechiolysis/surgical iridectomy per eye, Non-NABH — Rs 4,250
• Iris cyst removal /synechiolysis/surgical iridectomy per eye, NABH — Rs 5,000
• Paracentesis (eye) per eye, Non-NABH — Rs 4,250
• Paracentesis (eye) per eye, NABH — Rs 5,000
• Intraocular foreign body removal per eye, Non-NABH — Rs 7,225
• Intraocular foreign body removal per eye, NABH — Rs 8,500
• Electrolysis (eye) - Both Eyes, Non-NABH — Rs 850
• Electrolysis (eye) - Both Eyes, NABH — Rs 1,000
• Perforating injury repair (eye) per eye, Non-NABH — Rs 11,390
• Perforating injury repair (eye) per eye, NABH — Rs 13,400
• Epiretinal Membrane (ERM) Removal (per eye), Non-NABH — Rs 2,550
• Epiretinal Membrane (ERM) Removal (per eye), NABH — Rs 3,000
• Eye laser pulse therapy /Lipiflow/IPL [Intense pulse light] per eye, Non-NABH — Rs 2,975
• Eye laser pulse therapy /Lipiflow/IPL [Intense pulse light] per eye, NABH — Rs 3,500
• Malyugin Ring /pupil dilator/iris expander per eye, Non-NABH — Rs 8,500
• Malyugin Ring /pupil dilator/iris expander per eye, NABH — Rs 10,000
• PFCL Injection Per Eye Including Cost of The Drug, Non-NABH — Rs 2,321
• PFCL Injection Per Eye Including Cost of The Drug, NABH — Rs 2,730
• Methylprednisolone Injection IV Infusion per day Excluding the cost of the drug, Non-NABH — Rs 2,125
• Methylprednisolone Injection IV Infusion per day Excluding the cost of the drug, NABH — Rs 2,500

Rates shown are as per the CGHS approved package rates (Office Memorandum F.No.5-16/CGHS(HQ)/HEC/2024(PartI) dated 03.10.2025, effective 2025-10-13) (2025 (effective 13.10.2025)) and are subject to periodic revision. Always verify the latest approved rates on the official source.

Who This Covers

This information is for CGHS beneficiaries who have been advised by a specialist to undergo specific eye surgeries or procedures listed in the rate table. This includes patients who:

• Require an existing Intraocular Lens (IOL) to be exchanged, repositioned, or removed due to complications.

• Are children needing paediatric cataract surgery, which is a more complex procedure than adult surgery and often involves additional steps like anterior vitrectomy.

• Have been diagnosed with conditions requiring membranectomy (removal of a membrane) or epiretinal membrane (ERM) removal to improve vision.

• Need treatment for iris-related issues, such as an iris cyst, iridodialysis repair, or synechiolysis.

• Have sustained an eye injury, such as a perforating injury or have an intraocular foreign body that needs surgical removal.

• Require specific injections like Subconjunctival/sub-tenon’s injections, PFCL injections, or Methylprednisolone infusions for eye conditions.

• Need adjunctive devices during surgery, such as a Malyugin Ring or a capsular tension ring (Cionni's ring).

What CGHS Covers vs. What You Pay Separately

The CGHS rates are typically 'package rates'. This means the approved amount is intended to cover the entire cost associated with the procedure itself, including the surgeon's fee, operation theatre charges, anaesthesia, standard medicines, and a defined period of hospital stay. However, for many specialised procedures, the cost of high-value implants or specific drugs is explicitly excluded from the package.

For several procedures on this list, such as 'IOL exchange', 'Paediatric cataract surgery', and 'IOL explantation', the CGHS rate note specifies that the cost of the Intraocular Lens (IOL) is excluded. This means the beneficiary must pay for the new lens out-of-pocket. Similarly, for a 'Methylprednisolone Injection IV Infusion', the rate excludes the cost of the drug itself.

In contrast, for procedures like 'Cataract extraction with IOL with capsular tension rings (Cionni’s ring)', the cost of the ring is included. For 'PFCL Injection', the cost of the drug is included. It is important to ask the hospital's billing department for a detailed cost estimate before the procedure. This will clarify which components are covered by the CGHS package and which will be billed separately, helping you understand the total potential expense.

How to Use This at a CGHS-Empanelled Hospital

To avail of these rates for treatment at a private hospital empanelled with CGHS, beneficiaries should follow a clear process:

1. Obtain a referral for the specific procedure from a CGHS Wellness Centre doctor or a government hospital specialist.

2. Choose a CGHS-empanelled hospital for the treatment. At the hospital's CGHS desk, present your CGHS card and the specialist's prescription or referral letter.

3. Before admission, confirm the exact procedure code and description with the hospital administration. For example, ensure they are billing under 'IOL exchange' and not a different, unlisted procedure. This helps prevent billing disputes.

4. Understand that the applicable rate (NABH or non-NABH) is determined by the hospital's own accreditation status, not by a patient's choice. An NABH-accredited hospital will charge the NABH rate. You can confirm a hospital's accreditation status at their reception or on the NABH website.

Official Source

The rates and procedures mentioned are based on the Office Memorandum F.No.5-16/CGHS(HQ)/HEC/2024(PartI) dated 03.10.2025, from the Central Government Health Scheme, with rates effective from 13.10.2025. Beneficiaries should always cross-verify rates and guidelines with the latest official circulars.

Source: CGHS approved package rates (Office Memorandum F.No.5-16/CGHS(HQ)/HEC/2024(PartI) dated 03.10.2025, effective 2025-10-13)

Source URL: https://delhijalboard.delhi.gov.in/sites/default/files/Jalboard/universal-tab/new_cghs_rates_applicable.pdf

Source Year: 2025 (effective 13.10.2025)

Frequently Asked Questions

Does the CGHS rate for IOL exchange include the cost of the new lens?

No. The CGHS rate list explicitly states that the cost for 'IOL exchange' is 'excluding IOL cost'. The beneficiary is responsible for the cost of the new Intraocular Lens.

My child needs cataract surgery. Is it different from adult surgery under CGHS?

Yes. CGHS has a separate and specific listing for 'Paediatric cataract surgery'. This procedure is more complex and the rate covers additional steps like pars plana capsulotomy and anterior vitrectomy. However, the cost of the IOL is excluded from this package rate.

What is Epiretinal Membrane (ERM) Removal?

Epiretinal Membrane (ERM) Removal is a delicate microsurgical procedure to peel away a thin layer of scar-like tissue that has formed over the retina, specifically the macula. This membrane can cause distorted or blurred central vision, and its removal can help improve sight.

Are injections in the eye covered, and is the medicine cost included?

It varies. For 'PFCL Injection Per Eye', the CGHS rate includes the cost of the drug. However, for 'Methylprednisolone Injection IV Infusion', the rate explicitly excludes the drug cost. For 'Subconjunctival/sub-tenon’s injections', you should confirm with the hospital if the specific drug being used is considered part of the package or an additional cost.

What should I do if I have a foreign object in my eye?

An intraocular foreign body is a medical emergency. You should seek immediate attention at a hospital. CGHS has a specific package rate for the surgical 'Intraocular foreign body removal' at an empanelled facility.

My surgeon mentioned using a Malyugin Ring. Is that covered by CGHS?

Yes, there is a specific CGHS code and rate for the use of a 'Malyugin Ring /pupil dilator/iris expander per eye'. This indicates that the use of this device during surgery is a billable item under the scheme.

What is the difference between NABH and non-NABH rates?

NABH (National Accreditation Board for Hospitals & Healthcare Providers) is a quality standard. Hospitals that are NABH-accredited can charge a slightly higher rate as approved by CGHS, reflecting their certified standards of care. The rate you pay depends on the hospital's accreditation, not your choice.

Related

• How to apply for a CGHS card
• CGHS rate list for common procedures
• CGHS vs Ayushman Bharat: what's the difference

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.