CGHS Knee Replacement Rate List: Package Rates and Implant Ceiling

Total knee replacement (TKR) is one of the most searched procedures among CGHS beneficiaries, and the scheme reimburses it at a fixed package rate at empanelled hospitals.

The package covers the surgery and hospital stay; the knee implant itself is reimbursed separately against a notified ceiling.

CGHS Total Knee Replacement (TKR) Package Rates

Package rate for the surgery and standard stay. The knee implant is reimbursed separately (see below).

• Total Knee Replacement (unilateral), Non-NABH — Rs 1,10,000
• Total Knee Replacement (unilateral), NABH — Rs 1,26,500
• TKR Revision Stage-I, Non-NABH — Rs 35,000
• TKR Revision Stage-I, NABH — Rs 40,250

Knee Implant Ceiling (Reimbursed Separately)

• Cemented knee implant ceiling — Rs 60,000
• Bone cement ceiling — Rs 5,000

Rates shown are as per the CGHS approved package rates (Office Memorandum No. S.11045/36/2012-CGHS (HEC) dated 01.10.2014, as updated by city rate lists) (2014, periodically revised) and are subject to periodic revision. Always verify the latest approved rates on the official source.

Bilateral Knee Replacement

CGHS rate lists do not carry a separate "bilateral" knee line. A both-knee surgery is generally billed as the package rate plus a second knee-implant ceiling, subject to the hospital and approving authority.

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.

High-value implants such as knee and hip prostheses, coronary stents and spinal cages are not part of the package and are reimbursed separately against notified implant ceiling rates.

Rates for NABH-accredited hospitals are set 15% higher than the non-NABH rate. The same procedure code can show slightly 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) major 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 CGHS cover the knee implant cost?

Yes. The implant is reimbursed separately from the surgery package, up to the notified ceiling (around Rs 60,000 for a cemented knee implant plus bone cement).

What is the CGHS rate for knee replacement?

In the Delhi/NCR list the TKR package is about Rs 1,10,000 (non-NABH) and Rs 1,26,500 (NABH), with the implant reimbursed separately. Figures vary slightly by city list and are revised periodically.

Is prior permission needed for knee replacement under CGHS?

Yes, planned knee replacement needs a referral from the CGHS wellness centre and prior permission. Emergencies are handled without prior permission.

Related

• Knee replacement cost in India (private hospitals)
• Understanding knee osteoarthritis
• Ayushman Bharat (PM-JAY) knee replacement package

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.