CGHS Rates for Orbit, Globe, and Ocular Oncology Surgery

Surgical procedures involving the orbit (the bony socket containing the eye), the globe (the eyeball itself), and ocular oncology (treatment of eye cancers) are highly specialized. These interventions address a wide array of conditions, from traumatic injuries and infections to tumors and congenital defects. Procedures can range from reconstructive surgery like orbital fracture repair to the removal of the eye (enucleation or evisceration) or even the entire orbital contents (exenteration) in cases of advanced cancer.

For beneficiaries of the Central Government Health Scheme (CGHS), access to these critical treatments is available at empanelled healthcare facilities. This guide provides information on the CGHS package rates for various orbital, globe, and ocular oncology surgeries, including treatments for retinoblastoma, a common eye cancer in children. Understanding these rates and coverage details helps patients navigate their treatment journey more effectively.

CGHS Orbit, Globe & Ocular Oncology Surgery Rates (effective 13 October 2025)

Ophthalmology codes carry no separate super-speciality rate.

• Orbitotomy per eye, Non-NABH — Rs 23,375
• Orbitotomy per eye, NABH — Rs 27,500
• Enucleation per eye(for non-malignant conditions), Non-NABH — Rs 11,390
• Enucleation per eye(for non-malignant conditions), NABH — Rs 13,400
• Enucleation with orbital implants and artificial (Cost of implants included) per eye, Non-NABH — Rs 17,000
• Enucleation with orbital implants and artificial (Cost of implants included) per eye, NABH — Rs 20,000
• Evisceration per eye, Non-NABH — Rs 11,390
• Evisceration per eye, NABH — Rs 13,400
• Evisceration with orbital implants and artificial (Cost of implants included) prosthesis per eye, Non-NABH — Rs 17,000
• Evisceration with orbital implants and artificial (Cost of implants included) prosthesis per eye, NABH — Rs 20,000
• Orbital decompression /with incision or excision biopsy per eye, Non-NABH — Rs 29,750
• Orbital decompression /with incision or excision biopsy per eye, NABH — Rs 35,000
• Exenteration per eye, Non-NABH — Rs 17,000
• Exenteration per eye, NABH — Rs 20,000
• Exenteration with skin grafting per eye, Non-NABH — Rs 29,750
• Exenteration with skin grafting per eye, NABH — Rs 35,000
• Fracture orbital repair per eye, Non-NABH — Rs 29,750
• Fracture orbital repair per eye, NABH — Rs 35,000
• Orbital Abscess incision and Drainage per eye, Non-NABH — Rs 7,225
• Orbital Abscess incision and Drainage per eye, NABH — Rs 8,500
• Globe exploration per eye, Non-NABH — Rs 8,500
• Globe exploration per eye, NABH — Rs 10,000
• Retinoblastoma[RB] EUA both eyes, Non-NABH — Rs 2,550
• Retinoblastoma[RB] EUA both eyes, NABH — Rs 3,000
• RB intravitreal/intravenous/subtenons chemotherapy affected eye excluding the cost of the chemotherapy drug, Non-NABH — Rs 2,975
• RB intravitreal/intravenous/subtenons chemotherapy affected eye excluding the cost of the chemotherapy drug, NABH — Rs 3,500
• RB TTT/ Cryotherapy affected eye, Non-NABH — Rs 3,825
• RB TTT/ Cryotherapy affected eye, NABH — Rs 4,500
• Plaque brachytherapy-surface affected eye, Non-NABH — Rs 12,750
• Plaque brachytherapy-surface affected eye, NABH — Rs 15,000
• Plaque brachytherapy-intraocular affected eye, Non-NABH — Rs 17,000
• Plaque brachytherapy-intraocular affected eye, NABH — Rs 20,000

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 rate guide is intended for CGHS beneficiaries who have been advised to undergo surgery related to the eye socket, eyeball, or for eye-related tumors. It provides rate information for specific procedures performed at CGHS-empanelled hospitals.

The procedures covered include, but are not limited to: Orbitotomy (surgical incision into the orbit), Enucleation (removal of the entire eyeball, leaving orbital structures intact), Evisceration (removal of the contents of the eyeball, leaving the scleral shell), and Exenteration (removal of the entire orbital contents). It also covers reconstructive procedures like orbital fracture repair and treatment for orbital abscesses.

Additionally, this guide includes rates for the management of ocular tumors, specifically retinoblastoma. This covers diagnostic evaluations under anaesthesia (EUA), local treatments like TTT/Cryotherapy, brachytherapy, and the administration of chemotherapy (note that the cost of the drug itself is separate).

What CGHS covers vs. what you pay separately

The CGHS package rates listed in the table are generally comprehensive. They include the cost of the operation, surgeon's fees, anaesthesia, standard OT charges, and room rent as per the beneficiary's ward entitlement for a specified duration of stay.

However, patients should be aware of potential additional costs. While some procedures explicitly state that the cost of implants is included (such as 'Enucleation with orbital implants'), for other procedures, specialized or high-cost implants, prostheses, or consumables may be billed separately. For example, the package rate for retinoblastoma chemotherapy covers the administration procedure but specifically excludes the cost of the chemotherapy drug.

It is important to have a detailed discussion with the hospital's billing department before admission. Inquire about any items that are not part of the CGHS package and would require out-of-pocket payment. This ensures clarity on the total expected expenses.

How to use this at a CGHS-empanelled hospital

To avail of these benefits, you must first obtain a referral from a CGHS Wellness Centre or a government hospital specialist. This referral must clearly state the required procedure.

Present your CGHS card, the specialist's prescription, and any other required documents at the CGHS counter of the empanelled hospital. The hospital will then initiate the process for pre-authorization for the cashless facility.

Before the procedure, confirm the exact procedure code and name with the hospital administration to ensure it aligns with the CGHS-approved list. This helps prevent billing discrepancies. The rate applicable—whether NABH or non-NABH—is determined by the hospital's current accreditation status, which you can verify at the hospital.

Frequently Asked Questions

What is the difference between enucleation and evisceration?

Enucleation is the surgical removal of the entire eyeball (globe), leaving the eye muscles and other orbital contents intact. Evisceration is the removal of the contents of the eyeball, preserving the outer white shell (sclera) and the attached eye muscles. The choice between them depends on the medical condition being treated.

Is treatment for retinoblastoma covered under CGHS?

Yes, CGHS provides coverage for several procedures related to the diagnosis and treatment of retinoblastoma. This includes Examination Under Anaesthesia (EUA), local treatments like TTT and cryotherapy, plaque brachytherapy, and the administration of chemotherapy.

Does the CGHS package for chemotherapy include the cost of the cancer drugs?

No. The CGHS rate for retinoblastoma chemotherapy covers the procedural aspect of administering the drug (intravitreal, intravenous, or subtenons injection). The cost of the chemotherapy drug itself is excluded from this package and is billed separately.

What is an orbital exenteration?

Orbital exenteration is a radical surgical procedure that involves the removal of the entire contents of the eye socket, including the eyeball, extraocular muscles, fat, and connective tissues. It is typically performed to treat malignant tumors that have spread extensively within the orbit.

Are artificial eyes or orbital implants included in the CGHS rates?

It depends on the specific procedure. The CGHS list includes separate codes for 'Enucleation with orbital implants' and 'Evisceration with orbital implants' where the cost of implants and the artificial prosthesis is explicitly included in the package rate. For other procedures, you must confirm with the hospital whether implants or prostheses are covered or need to be paid for separately.

What is an orbitotomy?

An orbitotomy is a surgical procedure where an incision is made into the orbit (the bony socket of the eye) to access its contents. It is performed for various reasons, such as to remove a tumor, drain an abscess, repair a fracture, or obtain a tissue sample for biopsy.

How do I know which rate—NABH or non-NABH—applies to my treatment?

The applicable rate is based on the accreditation status of the hospital where you are receiving treatment. If the hospital is accredited by the National Accreditation Board for Hospitals & Healthcare Providers (NABH), the NABH rates apply. If not, the non-NABH rates apply. You can confirm the hospital's accreditation status at their reception or CGHS desk.

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.