CGHS NABH vs non-NABH rates: which one applies to your hospital, and how to tell when the wrong one is being billed
CGHS publishes two rates for the same procedure. The gap can be 15% or more. Here's how to figure out which one your hospital is entitled to, with worked examples for common surgeries.
Published · Jaanch
Pull up the CGHS rate sheet for any procedure and you'll see two columns side by side. One labelled NABH and one labelled non-NABH. For the same surgery, in the same city tier, on the same patient, the NABH column is usually 15% higher.
Most patients never notice. The hospital billing system picks a column, the bill prints, and that's that. The problem is that a meaningful fraction of bills, especially from mid-tier private hospitals chasing CGHS empanelment, use the NABH column when the hospital itself is not actually NABH-accredited.
This post is about how to check.
Where these numbers come from
CGHS — the Central Government Health Scheme — is the central-government employee health scheme. It maintains a list of empanelled hospitals across India and publishes the rates it will pay them for each procedure. These rates are revised periodically by the Ministry of Health and Family Welfare. The current schedule has roughly 1,800 procedure codes.
The two-column structure dates back to the 2014 revision. The reasoning was: NABH-accredited hospitals carry compliance costs that non-accredited hospitals don't. To maintain incentive to accredit, the CGHS rate sheet pays accredited hospitals more for the same procedure.
The reasonable figure is roughly a 15% premium, though it varies by procedure. For some technology-heavy surgeries (cardiac, oncology) the premium can be smaller. For routine procedures (cataract, dental) it's sometimes larger.
The schedule also has three city tiers:
- Tier 1 — Delhi NCR, Mumbai, Kolkata, Chennai, Bangalore, Hyderabad, Ahmedabad, Pune
- Tier 2 — other million-plus cities (Lucknow, Indore, Patna, etc.)
- Tier 3 — everything else
The same procedure costs more in Tier 1 than Tier 2, and more in Tier 2 than Tier 3. So the matrix any specific bill needs to anchor against is: (procedure, NABH or not, city tier).
A worked example: angioplasty in Mumbai
Take a standard percutaneous transluminal coronary angioplasty with one drug-eluting stent, in Mumbai (Tier 1).
| Rate sheet column | Tier 1 amount |
|---|---|
| NABH | ~Rs 91,000 (procedure) + stent cost |
| Non-NABH | ~Rs 79,000 (procedure) + stent cost |
The gap is around Rs 12,000 on the procedure line alone. If your bill shows the NABH figure but the hospital is not actually NABH-accredited, that gap is what you can ask back.
This is before you add the stent cost, which has its own NPPA ceiling (more on that in our post about stent prices).
The four common patterns
When we audit bills, the CGHS rate mismatches fall into four buckets.
The hospital is fully NABH and bills the NABH rate. Fine. No overcharge.
The hospital is fully NABH and bills the non-NABH rate by mistake. This is a rare case where the patient gets a small discount they didn't earn. We don't flag it as a defect, but it does sometimes get re-billed when the hospital catches it.
The hospital is non-NABH (or holds only entry-level certification) and bills the NABH rate. This is the overcharge. The most common single overcharge we see on CGHS-aligned bills. The difference is typically Rs 5,000 to Rs 50,000 depending on the procedure complexity.
The hospital was previously NABH-accredited, the certificate has lapsed, and the billing system has not been updated. Same overcharge as above, but with the wrinkle that the hospital may not realise the certificate has lapsed. Worth a polite ask rather than an accusation.
How to figure out which column applies
Three checks, in order.
The first is the NABH logo on the bill itself. If the bill prints "NABH Accredited" and a certificate number, the hospital is claiming full accreditation. Note the certificate number for later.
The second is the NABH public registry at nabh.co. Search the hospital name. The registry returns the current accreditation status and the certificate validity dates. Cross-check against the bill: is the certificate number on the bill the same as the one on the registry? Is the validity date in the future? If either fails, the hospital is not currently NABH-accredited.
The third is the discharge desk. Ask: "Could you confirm the hospital's current NABH accreditation status?" An accredited hospital answers immediately. A non-accredited hospital sometimes hedges.
A reasonable hospital might be entry-level NABH
This is where it gets nuanced. NABH has four tiers, and the rate-column question depends on tier.
- Full NABH → NABH column applies.
- Entry-level NABH → most CGHS interpretations still apply the non-NABH column. Entry-level is a stepping stone, not the full certification.
- Pre-accreditation NABH → non-NABH column.
- No NABH → non-NABH column.
So a hospital that is "NABH certified" at the entry level is not entitled to bill the NABH rate, even though it has a NABH-branded certificate. This is the most common confusion. The patient sees a NABH logo on the bill, assumes it's full accreditation, and doesn't check the tier. We've written a separate explainer on the four NABH tiers if you need to dig in further.
What about non-empanelled hospitals?
The CGHS rate schedule technically applies only to CGHS-empanelled hospitals serving CGHS beneficiaries (central government employees and pensioners, mostly). If you're a private patient at a non-CGHS hospital, the schedule doesn't bind the hospital at all.
But it still matters. Most large Indian health insurers use CGHS as their reference rate schedule. Star Health, HDFC ERGO, Bajaj Allianz, ICICI Lombard all peg their cashless tariffs to CGHS plus or minus a margin. So if your insurance settled a claim at the non-NABH rate but your bill assumed NABH, you've absorbed the gap as out-of-pocket.
The dispute, in that case, is with the hospital and not the insurer. The insurer applied its rate correctly. The hospital billed the wrong column.
Asking for a corrected bill
If you've spotted that the NABH column was used for a non-NABH (or only entry-level) hospital, the simplest written ask:
"Could you please confirm the NABH accreditation status used to determine the rate sheet column on this bill? My understanding is that [the hospital] currently holds [entry-level / no] NABH accreditation, which would mean the non-NABH column applies under the current CGHS rate schedule. Could the procedure rates please be reviewed and a corrected invoice issued?"
This is procedural language, not accusatory. The hospital can either confirm full NABH accreditation (and provide the certificate, which clears the dispute) or reissue at the lower rate.
If the desk pushes back, the escalation path covers the next steps. The CGHS rate sheet itself, with both columns visible, is the key document to attach to any written complaint.
What our audit engine does
The audit engine checks the hospital's NABH status against our bundled list at audit time. When the bill applies a CGHS-aligned rate that we can confidently identify, we surface both columns in the audit report along with the hospital's accreditation status. The patient sees: "Procedure rate billed: Rs 91,000. NABH-column rate for this procedure: Rs 91,000. Non-NABH-column rate: Rs 79,000. Hospital accreditation status per public registry: not currently NABH-accredited. Probable rate to use: non-NABH (Rs 79,000)."
This is the kind of comparison that's effectively impossible to do at the discharge counter without doing the lookup ourselves. Once it's visible side by side, the conversation with the billing desk is much shorter.
Sources: CGHS rate schedule, current revision; NABH public accreditation list; Ministry of Health and Family Welfare orders on CGHS rates. The rate examples are illustrative and should be verified against the current notified schedule before relying on them in a dispute.