If your CGHS medical reimbursement claims have ever been queried or delayed over follow-up tests and consultations, this clarification explains exactly why. The Union Public Service Commission issued an Office Memorandum on 11 August 2026, passing on fresh guidance from CGHS Headquarters after repeated confusion during claim scrutiny — and it directly affects where you can get follow-up tests done and what needs prior approval.
Why This Clarification Was Issued
UPSC's Administration-IV Section noticed a recurring problem: staff submitting medical reimbursement claims kept running into issues during processing, specifically because the existing CGHS guidelines weren't clear enough on certain points. Rather than keep resolving these case by case, UPSC took the issues directly to CGHS Headquarters for clarification. This OM passes on CGHS HQ's response.
It builds on three earlier CGHS documents:
- CGHS OM No. Z/15025/19/2024/DIR/CGHS/EHS, dated 28 June 2024
- SOP dated 2 September 2024
- CGHS OM No. 5-16/CGHS(HQ)/HEC/2024(Part-I), dated 3 October 2025
The Core Rule: Follow-Up Care Stays at the Same Hospital
This is the headline clarification, and it's worth understanding in full: subsequent follow-up consultations, investigations, and minor procedures can only be done at the same empanelled hospital where you had your primary consultation. You can't simply choose a different empanelled hospital for your follow-up just because it's more convenient.
Three specific sub-rules flesh this out:
i. Tests up to ₹3,000 must be done at the same hospital If a specialist at an empanelled hospital or HCO prescribes any investigation or test costing up to ₹3,000 (per test/investigation), that test must be done at that same hospital — not somewhere else, even if the other facility is also CGHS-empanelled.
ii. Want a different facility? Get a referral first If you'd rather get your tests or investigations done at a different CGHS empanelled hospital, HCO, or diagnostic centre, you need prior referral/endorsement from your CGHS Wellness Centre before doing so. You can't just walk into a different empanelled facility and expect the claim to process smoothly without this step.
iii. Big-ticket scans always need a referral, regardless of hospital For high-cost investigations specifically — CT Scan, MRI Scan, PET Scan, and anything else costing over ₹3,000 — a CGHS referral/endorsement is required, period. This applies even if you're staying at the same hospital, based on how the OM frames it as a separate, standalone requirement from rule (i).
Three More Rules Worth Knowing
Consultation validity is 7 days, same specialty only A single consultation is considered valid for 7 days, but only if any follow-up or related activity within that window pertains to the same specialty. Step outside that specialty, and the 7-day validity doesn't carry over.
Eye consultation fees are bundled If you're going for an eye consultation, the fee already includes refraction, tonometry, and fundus examination — these aren't billed or claimed as separate line items.
Unlisted procedures need Department permission first If a specialist at a CGHS empanelled hospital recommends an investigation or procedure that isn't on the standard list, you need prior permission from your Department/Office before undergoing it. Skipping this step and getting the procedure done first is likely to create reimbursement problems later.
What This Means for Your Next CGHS Claim
- If your specialist prescribes a test costing up to ₹3,000, get it done at the same hospital where you consulted — don't shop around for a different empanelled facility without a referral
- For anything over ₹3,000, or for CT/MRI/PET scans specifically, get your CGHS Wellness Centre referral sorted before the test, not after
- If you're bouncing between specialties, don't assume your last consultation's 7-day window still applies — it only carries over within the same specialty
- If a specialist recommends something not on the standard list, loop in your Department for permission before going ahead, even if it feels like an unnecessary delay at the time
- Eye check-ups: don't expect to claim refraction, tonometry, or fundus exams separately from the consultation fee — they're bundled together
Following this sequence — same hospital for routine follow-ups, referral for anything bigger or elsewhere, Department permission for unlisted procedures — is genuinely the difference between a smooth reimbursement and a delayed or rejected one.
Who Issued This and the Formal Basis
The OM is signed by Subhasis Roy, Under Secretary (Admn.), Union Public Service Commission, and issued with the approval of the Competent Authority. All UPSC staff and officials have been specifically advised to follow these CGHS Headquarters guidelines for hassle-free medical reimbursement — though the underlying clarification comes from CGHS HQ itself, so it's relevant to CGHS beneficiaries more broadly, not just UPSC staff.
For the broader CGHS framework these rules sit within, our CGHS complete guide and CGHS empanelled hospitals finder are useful references. If you're tracking other recent CGHS developments, our coverage of the CGHS hospital empanelment extension and the CGHS Pensioner Card integration with Bhavishya Portal covers related updates from the same system.
For more official CGHS and Central Government circulars like this, follow our government news section.