CGHS clarifies rules for consultations, tests after UPSC query

The Central Government Health Scheme (CGHS) has clarified rules for consultations and tests following a query from the Union Public Service Commission (UPSC). The UPSC, in an office memorandum dated August 11, 2026, said it sought clarifications after noticing recurring issues with reimbursement of medical claims due to unclear instructions.

Among the key clarifications: follow-up treatment must be at the same hospital where the primary consultation took place. Investigations costing up to Rs 3,000 prescribed by a specialist must be done at the same hospital. For tests at another CGHS-empanelled facility, prior referral from the CGHS Wellness Centre is required. Investigations costing more than Rs 3,000, such as CT, MRI, or PET scans, also need CGHS referral.

A consultation is valid for only seven days for the same speciality. The eye consultation fee includes refraction, tonometry, and fundus examination. Any unlisted investigation or procedure requires prior permission from the concerned department.