Tuesday, December 23, 2014

Revision of ceiling rates for Intra Ocular Lenses (IOL): ECHS Order

Central Organisation, ECHS
Adjutant General‘s Branch
Integrated Headquarters
Ministry of Defence (Army)
Maude Lines
Delhi Cantt-110010
19 Dec 2014

1. Refer this office letters:-
(a) B/49773/AG/ECHS/Rates/Policy dt 10 Jan 2011.
(b) B/49773/AG/ECHS/Rates/Policy dt 28 Oct 2014.
(c) B/49773/AG/ECHS/Rates/Policy dt 24 Nov 2014.

2. The following ceiling rates for IOL are hereby made at para 16 of Appx ‘C’ of above mentioned letter on the basis of CGHS OM No 536/2012/R & H/CGHS dt 21 Aug 14 and even no of dt 11 Nov 2014:-

(i)Hydrophobic Foldable IOL
(Multi-piece/Single piece Aspheric)
Rs. 5,800/-
(ii)Hydrophilic Acrylic IOLRs. 4,500/-
(iii)PMMA IOL (AC/PC)Rs. 500/-
(iv)Scleral Fixated IOLRs. 3,500/-

3. Reimbursement for LASIK Surgery and INTACS Rings is not recommended.

4. Therapeutic and Bandage contact Lenses for Keratoconus of Corneal Ulcers can be considered on a case to case basis.

5. Further, reimbursement for IOL Implants will be limited to ceiling rates or'actual, whichever is less and will be reimbursable in addition to the package rates for cataract surgery procedure. The reimbursement at the above mentioned ceiling rates will be done as per the rates fixed for the various types of IOL mentioned above and the IOL actually used in the surgery. It is mandatory for the operating surgeon of all private empanelled hospital/ECHS beneficiaries to attach the empty IOL sticker, bearing the signature and stamp of the operating surgeon on it, along with the bill in support of type of IOL used, containing its batch number. In the event of the private empanelled hospital not giving the batch number and/or empty IOL sticker, then the beneficiary will be required to obtain the same from the hospital before the competent authority finally settles the claim for reimbursement.

6. Beneficiaries undergoing IOL Implantation: This office has been receiving numerous queries regarding the cost of IOL which is in addition to the cost, of surgery as mentioned in our earlier ECHS letter under ref. Once again it is clarified that the cost of lens (IOL) would be reimbursable in addition to package charges for treatment procedures. The same has also been clarified by CGHS at para 3 of their Office Memorandum No 5-11045/36/2012 dt 26 Nov 2014 In addition it is clarified that if a beneficiary had been implanted Hydrophilic IOL in one. eye earlier and now requires IOL in other eye, then in such a case Hydrophilic IOL would be permitted as per old rates of 2008. In all such cases prior permission by competent authority permitting use of Hydrophilic IOL based on advice of specialist would be required.

7. Para 16,17 & 18 of Appx ‘C’ of this office letter No 8/49773/AG/ECHS/Rates/Policy dt 10 Jan 2011, B/49773/AG/ECHS/Rates/Policy dt 28 Oct 2014 & even no of dt 24 Nov 2014 are hereby cancelled.

(Vijay Anand)
Dir (Med)

Source: http://echs.gov.in/images/pdf/med/med120.pdf

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