CGHS Rates for Lacrimal System & Eyelid Surgery

The lacrimal system and eyelids are crucial for eye health, responsible for producing, distributing, and draining tears to keep the eye lubricated and clear of debris. When these structures are affected by blockages, malpositions, or injuries, it can lead to significant discomfort, chronic watering, dry eyes, or impaired vision.

Common issues include blocked tear ducts causing excessive tearing (epiphora), eyelid malpositions like ectropion (eyelid turning outward) and entropion (eyelid turning inward), and conditions requiring reconstructive surgery after trauma or tumour removal. Surgical interventions are often necessary to restore normal function and appearance.

For Central Government Health Scheme (CGHS) beneficiaries, understanding the coverage for these specialized ophthalmology procedures is essential. This guide provides information on the approved rates for a range of lacrimal and eyelid surgeries, from simple probing to complex reconstructions like Dacryocystorhinostomy (DCR). The rates vary by procedure and hospital accreditation, as detailed in the official CGHS rate list.

CGHS Lacrimal System & Eyelid Surgery Rates (effective 13 October 2025)

Ophthalmology codes carry no separate super-speciality rate.

• Probing and Syringing of lacrimal sac- in one eye, Non-NABH — Rs 850
• Probing and Syringing of lacrimal sac- in one eye, NABH — Rs 1,000
• Probing and Syringing of lacrimal sac- in both eye, Non-NABH — Rs 1,275
• Probing and Syringing of lacrimal sac- in both eye, NABH — Rs 1,500
• Dacryocystorhinostomy-Plain with intubation and/or with lacrimal implants excluding the cost of implant per eye, Non-NABH — Rs 17,000
• Dacryocystorhinostomy-Plain with intubation and/or with lacrimal implants excluding the cost of implant per eye, NABH — Rs 20,000
• Dacryocystorhinostomy-conjunctival with implant excluding the cost of implant per eye, Non-NABH — Rs 17,000
• Dacryocystorhinostomy-conjunctival with implant excluding the cost of implant per eye, NABH — Rs 20,000
• Canaliculoplasty per eye, Non-NABH — Rs 4,497
• Canaliculoplasty per eye, NABH — Rs 5,290
• Dacryocystectomy per eye, Non-NABH — Rs 7,820
• Dacryocystectomy per eye, NABH — Rs 9,200
• Punctal plugs for dry eyes - Both Eyes, Non-NABH — Rs 383
• Punctal plugs for dry eyes - Both Eyes, NABH — Rs 450
• Punctoplasty (per eye), Non-NABH — Rs 5,525
• Punctoplasty (per eye), NABH — Rs 6,500
• Punctal plug(Collagen/silicone) per eye, Non-NABH — Rs 3,400
• Punctal plug(Collagen/silicone) per eye, NABH — Rs 4,000
• Ectropion surgery- one lid, Non-NABH — Rs 7,225
• Ectropion surgery- one lid, NABH — Rs 8,500
• Ectropion surgery- both lids, Non-NABH — Rs 11,390
• Ectropion surgery- both lids, NABH — Rs 13,400
• Epicanthus correction - Both Eyes, Non-NABH — Rs 7,225
• Epicanthus correction - Both Eyes, NABH — Rs 8,500
• Cantholysis and canthotomy- Both Eyes, Non-NABH — Rs 2,975
• Cantholysis and canthotomy- Both Eyes, NABH — Rs 3,500
• Entropion surgery- one lid, Non-NABH — Rs 7,225
• Entropion surgery- one lid, NABH — Rs 8,500
• Entropion surgery- both lids, Non-NABH — Rs 11,390
• Entropion surgery- both lids, NABH — Rs 13,400
• Tarsorrhaphy- Both Eyes, Non-NABH — Rs 2,550
• Tarsorrhaphy- Both Eyes, NABH — Rs 3,000
• Suturing of lid lacerations- Both Eyes, Non-NABH — Rs 4,250
• Suturing of lid lacerations- Both Eyes, NABH — Rs 5,000
• Lid retraction repair per eye, Non-NABH — Rs 7,225
• Lid retraction repair per eye, NABH — Rs 8,500
• Concretions removal- Both Eyes, Non-NABH — Rs 425
• Concretions removal- Both Eyes, NABH — Rs 500
• Bucket handle procedure for lid tumours per eye (for non-malignant conditions), Non-NABH — Rs 11,390
• Bucket handle procedure for lid tumours per eye (for non-malignant conditions), NABH — Rs 13,400
• Eyelid reconstruction with flap one eye, Non-NABH — Rs 17,000
• Eyelid reconstruction with flap one eye, NABH — Rs 20,000
• Eyelid reconstruction with flap both eyes, Non-NABH — Rs 21,250
• Eyelid reconstruction with flap both eyes, NABH — Rs 25,000
• Cheek rotation flap for lid tumours per eye (for non-malignant conditions), Non-NABH — Rs 17,000
• Cheek rotation flap for lid tumours per eye (for non-malignant conditions), NABH — Rs 20,000
• Telecanthus correction- Both Eyes, Non-NABH — Rs 11,390
• Telecanthus correction- Both Eyes, NABH — Rs 13,400
• Lid Abscess incision and Drainage per eye, Non-NABH — Rs 4,250
• Lid Abscess incision and Drainage per eye, NABH — Rs 5,000
• Botulinum injection for blepharospasm or squint /epiphora/entropion/lid retraction (excluding cost of drug) per eye, Non-NABH — Rs 4,250
• Botulinum injection for blepharospasm or squint /epiphora/entropion/lid retraction (excluding cost of drug) per eye, NABH — Rs 5,000
• Mucous membrane grafting MMG one eyelid, Non-NABH — Rs 17,000
• Mucous membrane grafting MMG one eyelid, NABH — Rs 20,000
• Mucous membrane grafting MMG two eyelids, Non-NABH — Rs 21,250
• Mucous membrane grafting MMG two eyelids, NABH — Rs 25,000

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 page is for CGHS beneficiaries who have been advised to undergo surgical procedures related to the eye's lacrimal drainage system or eyelids. The listed rates apply to individuals diagnosed with conditions such as:

Blocked tear ducts, requiring procedures like probing, syringing, or Dacryocystorhinostomy (DCR) to create a new drainage path for tears.

Severe dry eye syndrome that can be managed with the insertion of punctal plugs to conserve tears.

Eyelid malpositions, including Ectropion (outward-turning lid) and Entropion (inward-turning lid), which require surgical correction to protect the cornea and improve comfort.

Congenital abnormalities like Epicanthus (skin folds over the inner corner of the eye) or Telecanthus (abnormal distance between the inner corners of the eyes).

Eyelid injuries or lacerations that need suturing and repair.

Benign (non-malignant) eyelid tumours that require removal and subsequent reconstruction using techniques like a bucket handle procedure or a cheek rotation flap.

Conditions like blepharospasm (involuntary eyelid twitching) or epiphora (excessive tearing) that may be treated with Botulinum injections.

Eyelid scarring or defects requiring mucous membrane grafting for reconstruction.

What CGHS Covers vs. What You Pay Separately

The CGHS package rates for lacrimal and eyelid surgeries are designed to be comprehensive, covering the cost of the main operation, surgeon's fees, anaesthesia, standard drugs and consumables, and hospital stay as per the beneficiary's ward entitlement.

However, it is important to note that the cost of certain high-value implants, specialized materials, or specific drugs is explicitly excluded from some package rates. For instance, the rates for Dacryocystorhinostomy (DCR) with implants and Botulinum injections specifically state that the cost of the lacrimal implant/stent and the Botulinum drug itself are not included in the package. Similarly, while there is a procedure rate for inserting punctal plugs, the cost of the silicone or collagen plug may be an additional expense.

Patients are responsible for the cost of these non-covered items. Before undergoing the procedure, beneficiaries should have a detailed discussion with the hospital's billing department to get a clear estimate of any out-of-pocket expenses. This ensures transparency and helps in financial planning for the treatment.

How to Use This at a CGHS-Empanelled Hospital

To avail the benefits for these procedures at a CGHS-empanelled hospital, beneficiaries should follow a standard process.

First, obtain a valid referral from a CGHS Wellness Centre or a government specialist. The referral must clearly state the diagnosed condition and the specific surgical procedure required, using the correct terminology from the CGHS list.

Upon visiting the empanelled hospital, present your CGHS card along with the referral letter at the dedicated CGHS counter. The hospital staff will verify your eligibility and confirm the procedure code and the corresponding package rate.

It is important to understand that CGHS has different rates for NABH (National Accreditation Board for Hospitals & Healthcare Providers) accredited hospitals and non-NABH hospitals. The rate applicable to your procedure is determined by the accreditation status of the hospital you choose, not by your personal preference. NABH-accredited facilities are reimbursed at a higher rate.

Before giving final consent for the surgery, confirm all financial details. Specifically ask about any costs not covered by the CGHS package, such as specific implants, grafts, or drugs, to avoid any unexpected charges later.

Frequently Asked Questions

What is Dacryocystorhinostomy (DCR)?

Dacryocystorhinostomy, or DCR, is a surgical procedure performed to treat a blocked tear duct. It creates a new channel between the lacrimal sac and the inside of your nose, allowing tears to bypass the blockage and drain normally.

The rate list mentions procedures for 'one eye' and 'both eyes'. How is this determined?

The CGHS rate list has separate codes and rates for unilateral (one eye) and bilateral (both eyes) procedures. Your ophthalmologist will determine if the surgery is needed in one or both eyes, and this must be clearly specified in your referral letter to be covered correctly.

What is the difference between Ectropion and Entropion surgery?

Ectropion is a condition where the eyelid, usually the lower one, turns outward. Entropion is the opposite, where the eyelid turns inward, causing the eyelashes to rub against the cornea. The surgeries for both conditions aim to reposition the eyelid to its normal alignment to protect the eye and relieve symptoms.

The rate for a Botulinum injection excludes the drug cost. What does this mean for me?

This means that the CGHS package rate covers the professional fee for the doctor to administer the injection. However, the patient is required to pay for the actual Botulinum toxin medication separately. You should inquire about the price of the drug at the hospital pharmacy before the procedure.

Are punctal plugs for dry eyes fully covered by CGHS?

The CGHS list provides a rate for the procedure of inserting punctal plugs. However, the cost of the plug itself (which can be made of collagen or silicone) may be an additional expense that the patient needs to cover. Confirm with the hospital's billing desk whether the cost of the implant is included or separate.

What is eyelid reconstruction with a flap?

Eyelid reconstruction with a flap is a surgical technique used to repair the eyelid after the removal of a tumour or following a significant injury. It involves moving a piece of nearby tissue (a 'flap') with its own blood supply to rebuild the eyelid, restoring its structure and function.

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.