Revision of lists and rates of artificial appliances for CGHS / CS(MA) beneficiaries and general guidelines for eligibility criteria therefor: DoHFW OM dated 8th July, 2014.
Government of India
Ministry of Health and Family Welfare
Department of Health and Family Welfare
Nirrnan Bhawan, New Delhi,
Dated the 8th July, 2014.
OFFICE MEMORANDUM
Sub: Revision of lists and rates of artificial appliances for CGHS / CS(MA) beneficiaries and general guidelines for eligibility criteria therefor.
The undersigned is directed to state that the rates of artificial appliances were revised in 1997 vide OM No. S-1 1011/5/95-CGHS-(P) dated 25.6.1997. The matter of revision of rates and updation of lists of artificial appliances has been under consideration of this Ministry for some time. The matter has been examined in consultation with the experts in Directorate General of Health Services and it has been decided to update the list of the artificial appliances and revised as per the details given in ongoing paras.
2. Keeping in View the various categories of appliances, the lists of artificial appliances have been categorized as per the following three Annexure and rates of artificial appliances will be as per the Annexure-I, II and III to this OM:
Annexure-I: This contains list, rates and specifications of various types of Prosthetics [i.e. artificial limbs) like prosthetics for lower extremity, prosthetics for upper extremity [Annexure-I has been divided into Annexure IA, IB, IC, ID and IE according to type].
Annexure-II: This contains the list, rates and specifications pertaining to the orthotics (i.e. callipers 85 braces) including lower extremity, upper extremity and spinal orthotics.[Annexure-ll has been divided into Annexure-IIA, IIB and IIC].
Annexure-III: This contains specifications and rates for items related to mobility aids.
3. The general guidelines for admissibility and reimbursement of expenses in respect of appliances mentioned in Annexures-I, II & III will be as under:
(i). Maintenance Cost will be borne by the beneficiary.
(ii). The appliances will be allowed for re-issue on completion of 5 years in case of adults and 2 years in the case of children except motorized wheel chair and tricycle.
(iii). Motorized wheel chair and tricycle will be re-issued after 5 years irrespective of age.
(iv). High end prosthetics /appliances will be reimbursed only to the following category of Govt. Servants 85 their dependent family members subject to fulfilling of other criteria
(a) Govt. Servants & their dependent family members participating at the State level sport activities duly certified by the competent Sports Authority.
(b) Upper Age limit for the sophisticated prosthetic appliances will be 45 years.
(c) Military or para-military personnel duly certified by their respective Medical Boards that the person has sustained injury while on field duty or undergone amputation because of injury sustained while performing such duty.
(d) The reimbursement will be made within the ceiling limit fixed for such appliances beyond which the beneficiary will bear the cost
(v). For admissibility of reimbursement, the appliances need to be prescribed by a Professor/ Senior Specialist or Specialist of equivalent rank working in any Govt. hospitals in the specialties of Physical Medicine and Rehabilitation (PMR) or Orthopaedic surgery. The prescription should be in generic name and not by proprietary name.
(vi). Prosthetic components and Orthotic joints used in appliances should have BIS/CE (Europian) Certification for the purposes of reimbursement and fabricated by firms having qualified Prosthesist/ Orthotists.
(vii). Keeping in view, the physical growth into consideration, individuals upto 12 years of age will be considered as children for the purpose of these guidelines in general. However, in order to rationalize the rates for some of the items, specific age group has been mentioned against the individual items in Annexure-I and Annexure-ll, based on the size of the appliances.
(viii).There may be certain items which are not included in Annexure, but may be prescribed by qualified Government Rehabilitation Specialist/Orthopaedic Surgeon, (not below the level of Consultants), depending on individual disabled patient’s requirements for example disability car gadgets. In such cases, items costing below Rs.50,000/- can be purchased with three quotations as per prescribed specifications with the permission of HOD of the concerned departments. For items costing above Rs. 50,000/- prior permission will have to be obtained from Additional Directors, CGHS of the concerned city or concerned DDG in the Dte.GHS looking after CS(MA) Rules, on the basis of three quotations and approval of Technical Standing Committee.
(ix). The artificial appliances should be procured from any Government Undertaking/ Authorised Alimco dealers, N .G.Os approved by Ministry of Health & Family Welfare/ and private manufactures. It should be certified by the prescribing Government Orthopaedic Surgeon / Government Rehabilitation Specialists (PMR) to the effect that the appliances are as per Specification and working satisfactorily.
(x). The list of items and rates will be revised every 5 years.
(xi). Reimbursement of items in the enclosed list will be made by HODs of the departments and CGHS in case of Pensioner CGHS beneficiaries, etc.
4. This OM supersedes all earlier orders issued from time to time under CGHS/CS (MA) Rules, 1944 on the subject for allowing reimbursement in respect of artificial appliances for CGHS/CS(MA) beneficiaries.
5. This OM will come into effect from the date of issue and will be valid till revision of the rates after five years.
6. This issues with the approval of Secretary (H8t.FW) and concurrence of Integrated Finance Division.
sd/-
(Ravi Kant)
Under Secretary to the Government of India
ANNEXURE-IA
LOWER EXTREMITY PROSTHETICS(Above 12 years)
| Sl.No. | Name of Prosthesis | ApprovedRate/Price |
| 1. | Transtibial prosthesis (Below Knee Prosthesis) (Its components include-S.S. Pylon/tube, SACH FOOT, Foot Adapter , Bonded Pylon/Pylon with 4 screw Adaptor, Tube Clamp Adaptor, Socket Adaptor, Sleeve Suspension, Foam Cover, Covering Socks, Socket charges, etc.) | Rs.20,000/- |
| 2. | Transtibial Prosthesis (Below Knee Prosthesis) with silicone / PU liner | Rs. 37000/- |
| 2.a | Transtibial Prosthesis (Below Knee Prosthesis) with silicone / PU liner with shuttle lock mechanism | Rs.45500/- |
| 3. | Symes Prosthesis Its component includes- SYME’S FOOT, Foot AdapterSleeve Suspension, Socket Mounting Adaptor, Covering Socks Socket charges, etc. | Rs.19300/- |
| 4. | Partial Foot Prosthesis ( Shoe with filler) | Rs.7000/- |
| 5. | Trans Femoral Prosthesis ( Above Knee Prosthesis) (Its components include-S.S. Pylon/tube, SACHFOOT, Foot Adapter, Bonded Pylon / Pylon with 4screw Adaptor ( 400mm) Polycentric Prosthetic KneeJoint, Socket Adaptor ,TES Belt, Foam cover, CoveringSocks, Socket fabrication & fitment charges) | Rs. 40840/- |
| 6. | Trans Femoral Prosthesis ( Above Knee Prosthesis) with Suction Valve | Rs.40840 + 3800=44640/- |
| 7. | Trans Femoral Prosthesis ( Above Knee Prosthesis) with Silicon/ PU liner | Rs.61140/- |
| 7.a | Trans Femoral Prosthesis ( Above Knee Prosthesis) with Silicon /PU liner with shuttle lock mechanism | Rs. 69640/- |
| 8. | Knee Disarticulation Prosthesis (Its components include-S.S. Pylon/ tube, SACHFOOT, Foot Adapter , Bonded pylon / Pylon with 4screw Adaptor ( 400mm) Polycentric Prosthetic KneeJoint, Socket Adaptor ,TES Belt, Foam cover, CoveringSocks, Socket fabrication & fitment charges) | Rs. 51940/- |
| 9. | Hip Disarticulation Prosthesis (Its components include-S.S. Pylon/ tube, SACHFOOT, Foot Adapter , Bonded pylon / Pylon with 4screw Adaptor ( 400mm) Single axis Prosthetic KneeJoint, Hip Joint (basic), Tube (Angle tube adaptor, 10degree) Short Tube, Socket Adaptor, Foam cover,Covering Socks, Socket fabrication & fitmentcharges.) | Rs.60300/- |
ANNEXURE-IB
LOWER EXTREMITY PROSTHETICS(CHILD UPTO THE AGE OF 12 YEARS)
| Sl.No. | Name of Prosthesis | Approvedrate/Price(Child 7-12years) | Approvedrate/Price(Child 0-6years) |
| 1. | Transtibial prosthesis (BelowKnee Prosthesis) (Its components include-S.S. Pylon/ tube, SACH FOOT, Foot Adapter , Bonded pylon / Pylon with 4 screw Adaptor, Tube Clamp Adaptor, Socket Adaptor, Sleeve Suspension, Foam cover, Covering Socks, Socket charges, etc.) | Rs.18,140/- | Rs.5000/- |
| 2. | Trans Tibial Prosthesis (BelowKnee Prosthesis) with silicone /PU liner | Rs. 35,140/- | Not applicable |
| 2.a | Trans Tibial Prosthesis withsilicone / PU liner with shuttlelock mechanism | Rs. 35140+ 8500 =43640 | Not Applicable |
| 3. | Symes Prosthesis Its component includes- SYME,S FOOT , Foot Adapter Sleeve Suspension,Socket mounting adaptor, Covering Socks Socket charges | Rs.19300/- | Rs.5000/- |
| 4. | PARTIAL FOOT PROSTHESIS (Shoe with filler) | Rs.4000/- | Rs.1500/- |
| 5. | Trans Femoral Prosthesis ( AboveKnee Prosthesis) (Its components include-S.S. Pylon/ tube, SACH FOOT, Foot Adapter , Bonded pylon / Pylon with 4 screw Adaptor (400mm) Polycentric Prosthetic KneeJoint, Socket Adaptor ,TES Belt, Foam cover, Covering Socks, Socket fabrication & fitment charges) | Rs. 49,980/- | Rs.12000/- |
| 6. | Trans Femoral Prosthesis ( AboveKnee Prosthesis) with SuctionValve | Rs.49980 + 3800=53,780/- | Not Applicable |
| 7. | Trans FemoralProsthesis(AboveKnee Prosthesis) with Silicon / PUliner | Rs.70,280/- | Not Applicable |
| 7.a. | Trans Femoral Prosthesis ( AboveKnee Prosthesis) with Silicon/PUliner with shuttle lock mechanism | Rs. 70280+ 8500=78780 | Not Applicable |
| 8. | Knee Disarticulation Prosthesis (Its components include-S.S. Pylon/ tube, SACH FOOT, Foot Adapter , Bonded pylon / Pylon with 4 screw Adaptor (400mm) Polycentric Prosthetic Knee Joint, Socket Adaptor ,TES Belt, Foam cover, Covering Socks, Socket fabrication & fitment charges) | Rs. 49,980/- | Rs.12000/- |
| 9. | Hip Disarticulation Prosthesis (Its components include-S.S. Pylon/ tube, SACH FOOT, Foot Adapter , Bonded pylon / Pylon with 4 screw Adaptor ( 400mm) Single axis Prosthetic Knee Joint, Hip Joint (basic), Tube (Angle tube adaptor, 10 degree) Short Tube, Socket Adaptor, Foam cover, Covering Socks, Socket fabrication & fitment charges.) | Rs.60300/- | Rs.15000/- |
NOTE:
1. Prescription of Trans Tibial Prosthesis may be considered as Below Knee Prosthesis.
2. Prescription of Trans Femoral Prosthesis may be considered as Above Knee Prosthesis.
ANNEXURE-IC
HIGH END LOWER EXTREMITY PROSTHETICS
| Sl.No. | Name of Prosthesis | ApprovedRate/Price (Above 12 years of age) | ApprovedRate/Price CHILD (7- 12 Years) | ApprovedRate/Price CHILD (0-6) Years |
| 1. | Transtibialprosthesis(Below Knee Prosthesis) (Its components include- S.S. Pylon/ tube, DYNAMIC RESPONSE FOOT, Foot Adapter , Bonded pylon / Pylon with 4 screw Adaptor, Tube Clamp Adaptor, Socket Adaptor, Sleeve Suspension, Foam cover, Covering Socks, Socket charges, etc.) | Rs.26,700/- | Not Applicable | Not Applicable |
| 2. | TranstibialProsthesis(BelowKneeProsthesis)with silicone / PU liner | Rs.43700/- | Not Applicable | Not Applicable |
| 3. | TranstibialProsthesis(BelowKneeProsthesis)with silicone / PU linerwithshuttlelockmechanism | Rs.52200 | Not Applicable | Not Applicable |
| 4. | TransFemoralProsthesis(AboveKneeProsthesis) (Its components include- S.S. Pylon/ tube, DYNAMIC FOOT, Foot Adapter, Bonded pylon / Pylon with 4 screw Adaptor (400mm) Polycentric Prosthetic Knee Joint, Socket Adaptor ,TES Belt, Foam cover, Covering Socks, Socket fabrication & fitment charges) | Rs. 47,540/- | Not Applicable | Not Applicable |
| 5. | TransFemoralProsthesis (Above KneeProsthesis) with SuctionValve | Rs.47540 + 3800=51,340/- | Not Applicable | Not Applicable |
| 6. | TransFemoralProsthesis(AboveKneeProsthesis)with Silicon/ PU liner | Rs.64,540/- | Not Applicable | Not Applicable |
| 7 | TransFemoralProsthesis(AboveKneeProsthesis)withSilicon/ PU liner with shuttlelock mechanism | 64540+ 8500=73040/- | Not Applicable | Not Applicable |
| 8. | KneeDisarticulationProsthesis (Its components include- S.S. Pylon/ tube, DYNAMIC FOOT, Foot Adapter , Bonded pylon / Pylon with 4 screw Adaptor ( 400mm) Polycentric Prosthetic Knee Joint, Socket Adaptor ,TES Belt, Foam cover, Covering Socks, Socket fabrication & fitment charges) | Rs.58640/- | Not Applicable | Not Applicable |
| 9. | PARTIALFOOTPROSTHESIS | |||
| 9a. | Shoe fillerwith carbonplate | Rs.9000/- | Rs.5000/- | Rs.3000/- |
| 9b. | GREATTOESILICONPROSTHESIS | Rs.9000/- | Rs.5000/- | Rs.3000/- |
| 9c. | SiliconeProsthesisForSecond Toe to Vth Toe | Rs.7500/-each | Rs.4000/- | Not Applicable |
RECOMMENDED CRITERIA FOR HIGH END PROSTHESIS
1. Dynamic foot can be prescribed only for Military, paramilitary, commando persons / police personals sustaining amputation in saddle and likely go back to active and strenuous work.
2. Dynamic foot can also be prescribed for young / children and dynamic athletes of University, cultural activities, State/ National or international level.
3. Shoe filler with carbon plate can be prescribed only for Military, paramilitary, commando persons / police personals sustaining amputation in saddle and likely go back to active and strenuous work.
4. Shoe filler with carbon plate can also be prescribed for young / children and dynamic athletes of University, Participating in cultural activities, at State / National or international level.
5. In case of Bilateral Upper Limb amputation, Externally Powered Prosthesis /Myoelectric Prosthesis may be prescribed for one side and body powered Prosthesis or Passive Prosthesis for the other side.
ANNEXURE-ID
UPPER EXTREMITY PROSTHETICS
| Sl.No. | Name of Prosthesis | ApprovedRate/Price (Above 12 years of age) | ApprovedRate/Price CHILD (7-12 Years) | ApprovedRate/Price CHILD (0-6) Years |
| 1. | Trans Radial or BelowElbow/WristDisarticulationPassive Prosthesis | Rs.10,000/- | Rs.5000/- | Rs.2000/- |
| 2. | BodyPoweredProsthesis(TransRadial or BelowElbow/WristDisarticulation)Itscomponentsincludestransradialkit and socket | 17000/- | 12000/- | Not Applicable |
| 3. | TransHumeralorAbove Elbow /ElbowDisarticulationPassive Prosthesis | Rs.20,000/- | Rs.10,000/- | Rs.5,000/- |
| 4. | BodyPoweredProsthesis(TransHumeralorAboveElbow/ElbowDisarticulation) | 28000/- | 22000/- | Not Applicable |
| 5. | ShoulderDisarticulationPassive Prosthesis | Rs.30,000/- | Rs.20,000/- | Rs.10,000/- |
| 6. | ShoulderDisarticulationbodypowered Prosthesis | Rs. 37,000/- | 28000/- | Not Applicable |
ANNEXURE-IE
HIGH END UPPER EXTREMITY PROSTHETICS (ADULT)
| Sl.No. | Name of Prosthesis | ApprovedRate/Price (Above 12 years of age) | ApprovedRate/Price CHILD (7- 12 Years) | Approvedrate/Price CHILD (0-6) Years |
| 1. | ExternallyPoweredbelowelboworTransradial/WristDisarticulationprosthesis (It includes:- Hand, Lithium ion Battery (one pair) with cover, Electrodes, Wrist Unit Battery Charger & Transformer, Electrode cable, Connector block cable Silicone Glove, Flexible inner Liner and socket, etc) | Rs.1,29,500/- | Not Applicable | Not Applicable |
| 2. | ExternallyPoweredTransHumeral/ElbowDisarticulationProsthesis (It includes:- Hand, Lithium ion Battery (one pair) with cover, Electrodes, Wrist Unit, Mechanical Elbow, Battery Charger & Transformer, Electrode cable, Connector block cable Silicone Glove, Flexible inner Liner and sockets, etc) | Rs.1,76,500/- | Not Applicable | Not Applicable |
| 3. | SiliconeFingerProsthesis each | Rs.7000/- | Rs.5000/- | Not Applicable |
| 4. | SiliconeThumbProsthesis | Rs.8000/- | Rs.6000/- | Not Applicable |
| 5. | Silicone PartialHandProsthesis | Rs.35000/- | Rs.25000/- | Rs.10,000/- |
ANNEXURE-IIA
SPINAL ORTHOTICS
| Sl.No. | Name of Prosthesis | ApprovedRate/Price (Above 12 years of age) | ApprovedRate/Price CHILD (7- 12 Years) | ApprovedRate/Price CHILD (0-6) Years |
| 1. | Soft / Semi rigidCervical Collar | 200/- | 200/- | Not Applicable |
| 2. | Philadelphia or Twopost Cervical collar /Head Cervical Orthosis(Moulded collar) | 1500/- | 1500/- | 1200/- |
| 3. | Soft L.S. corset / Belt | 700/- | 500/- | Not Applicable |
| 4. | SOMI BRACE / ThreePost Cervical Orthosis | 2000/- | 2000/- | Not Applicable |
| 5. | Four Post CervicalOrthosis | 1200/- | 1000/- | 800/- |
| 6. | Rigid L.S.O / ChairBack Orthosis | 1200/- | 1000/- | Not Applicable |
| 7. | Rigid TLSO / Taylor,sbrace, Knight Taylor,sbrace, William,s brace | 1500/- | 1200/- | 1000/- |
| 8. | Hyperextension brace /ASH / CASH / JEWETTBRACE | 1200/- | 1000/- | Not Applicable |
| 9. | CTLSO ( MILWAUKEEBRACE) | 5000/- | 5000/- | Not Applicable |
| 10. | Head Cervical ThoracoOrthosis (HCTO) | 1500 | 1500/- | 1200/- |
| 11. | TLSO BI- Valve / BodyJacket | 3000/- | 3000/- | 2500/- |
| 12 | UNDER ARM BRACE(Boston Brace / MiamiBrace / WilmingtonBrace / NYOH Brace ) | 3500/- | 3500/- | Not Applicable |
| 13. | HALO BRACE | 15000/- | Not Applicable | Not Applicable |
Abbreviations:
1. L.S.O--- Lumbo Sacral Orthosis
2. ASH- Anterior Spinal Hyperextension Brace
3. CASH-- Cruciform Anterior Spinal Hyperextension
4. TLSO---- Thoraco Lumbo Sacral Orthosis
5. CTLSO----- Cervical Thoraco Lumbo Sacral Orthosis
ANNEXURE-IIB
LOWER EXTREMITY ORTHOTICS
ANNEXURE-IIC
UPPER EXTREMITY ORTHOTICS
| Sl. No. | Name of Prosthesis | Approved Rate/Price (Above 12years of age) | Approved Rate/Price CHILD (7-12Years) | Approved Rate/Price CHILD(0-6) Years |
| 1. | Finger orthosis static ( One Piece) | 150/- | 100/- | 100/- |
| 2. | Finger orthosis dynamic ( One Piece) | 200/- | 100/- | 100/- |
| 3. | Hand Orthosis | 400/- | 300/- | 300/- |
| 4. | Thumb Spica / stabilizer | 300/- | 200/- | 200/- |
| 5. | Knuckle bender | 500/- | 350/- | Not Applicable |
| 6. | Wrist Hand Orthosis( Static) P.P | 700/- | 500/- | 400/- |
| 7. | Wrist Hand Orthosis (dynamic) | 1000/- | 700/- | 500/- |
| 8. | Elastic Wrist Hand Orthosis | 400/- | 300/- | 200/- |
| 9. | Tennis Elbow support | 200/- | 200/- | Not Applicable |
| 10. | Adjustable arm sling | 300/- | 300/- | Not Applicable |
| 11. | Elbow orthosis (static) | 900/- | 700/- | 500/- |
| 12. | Elbow orthosis (Dynamic) | 1000/- | 800/- | 600/- |
| 13. | Fracture Brace ( Below Elbow) | 1200/- | 800/- | 700/- |
| 14. | shoulder brace (Immobilizer) | 1000/- | 800/- | 700/- |
| 15. | Gun slinger shoulder orthosis | 1000/- | Not Applicable | Not Applicable |
| 16. | Humeral fracture brace without elbow hinge and forearm support | 1200/- | 800/- | 800/- |
| 17. | Humeral fracture brace with elbow hinge and forearm support | 1600/- | 1200/- | 1000/- |
| 18. | Shoulder Elbow Wrist Hand Orthosis ( Air plane splint) | 2200/- | 1600/- | 1400/- |
ANNEXURE-III
MOBILITY AIDS
| S.N0. | NAME OF ORTHOSIS | ApprovedRate/Price (Above 12 years of age) | ApprovedRate/Price CHILD (7- 12 Years) | ApprovedRate/Price CHILD (0-6) Years |
| 1. | Walking Stick (Adjustable) Aluminium | 350/- | 350/- | Not Applicable |
| 2. | Tripod / Quadripod walking stick Aluminium | 750/- | Not Applicable | Not Applicable |
| 3. | Auxillary Crutch / Elbow crutch (Aluminum) Adjustable | 850/- | 650/- | Not Applicable |
| 4. | Walker/Rollator (Aluminium) | 1500/- | 1200/- | 900/- |
| 5. | C.P.Chair / C.P.Stand | Not applicable | 7300/- | 7000/- |
| 6. | Commode Chair | 2500/- | 2500/- | Not Applicable |
| 7. | Wheel Chair Folding( Chrome Plated) | 7000/- | 4000/- | Not Applicable |
| 8. | Motorized Wheel chair | |||
| (i) Quadriplegic wheel chair with Chin and Head Control | 1,10,000/- | Not Applicable | Not Applicable | |
| (ii) Quadriplegic wheel chair with joy stick | 60,000/- | Not Applicable | Not Applicable | |
| (iii) Motorized wheel chair (Handle driven) | 35,000/- | Not Applicable | Not Applicable | |
| 9. | Tricycle Hand Propelled | 6000/- | Not Applicable | Not Applicable |
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