CGHS Tests Clarification 2026: Rules for Medical Reimbursement in Empaneled Hospitals | Department of Posts OM No.CA-30/14/2025-CA/PB-DOP dated 22/01/2026

F.No.CA-30/14/2025-CA/PB-DOP 

Government of India 

Ministry of Communications 

Department of Posts (C&A/PB Section)

Dak Bhavan, Sansad Marg, New Delhi-110001 

Dated:22-01-2026

OFFICE MEMORANDUM

Subject: Clarification in respect of tests/investigations under CGHS- regarding.

The undersigned is directed to refer to CGHS OM No. Z/15025/19/2024/DIR/CGHS/EHS dated 28.06.2024, SOP dated 02.09.2024 and clarification received from CGHS (HQ) dated 08.01.2026 and to say that many cases have come to notice/received in this Office wherein tests/investigations have been undertaken from empaneled center/hospital other than the empaneled center/hospital, where the primary consultation has been undertaken.

In this regard, all Officers/Officials are advised to follow the guidelines issued by Ministry of Health & Family Welfare and CGHS for hassle-free medical reimbursement. The following guidelines may be referred:

i. A CGHS beneficiary except aged more than 70 years must obtain referral from CGHS Wellness Center for taking consultation from any CGHS empaneled HCO.

ii. If any investigation(s)/test(s) [except MRI, CT Scan [for which separate endorsement/permission is required]] amounting to less than Rs. 3000/- (each tests) are prescribed by the Specialist of an empaneled HCO/Centre, these investigation(s)/test(s) must be undertaken in the same HCO/Centre, where primary consultation has been taken.

iii. If the beneficiary wants to get the tests/investigations done from any other CGHS empaneled HCO/Centre/Lab, He/She has to take prior endorsement from CGHS Wellness Center.

2.1 For instance, if a beneficiary has consulted in Max Super Specialty Hospital, New Delhi, after obtaining referral from CGHS Wellness Center wherein the treating specialist has prescribed some tests except CT scan & MRI (for which separate endorsement/permission is required) amounting less than Rs. 3000/-, no endorsement will be required for undertaking the tests from Max Super Specialty Hospital. However, prior endorsement/permission will be required, if the beneficiary wants to get these tests/investigations done from any other CGHS empaneled HCO/Center.

To 

All Officer(s)/Official(s) of D/o Posts through e-office Notice Board.

The Department of Posts has issued a clarification regarding the rules for undergoing medical tests under the Central Government Health Scheme (CGHS). The memo is a reminder to all employees to follow existing CGHS guidelines strictly to avoid issues with medical reimbursements.

Key Guidelines Clarified:

Mandatory Referral: All CGHS beneficiaries (except those aged over 70) must get a referral from a CGHS Wellness Center before consulting any empaneled private hospital.

Where to Get Tests Done:

• If a doctor at an empaneled hospital prescribes tests (excluding MRI and CT Scan) costing less than ₹3,000 each, the patient must get them done at the same hospital where the consultation happened. No extra permission is needed.
• If the patient wants to get these same tests done at a different empaneled lab or hospital, they must obtain prior endorsement (permission) from the CGHS Wellness Center first.
• MRI & CT Scans: Separate prior permission/endorsement from CGHS is always required for MRI and CT scans, regardless of cost.

Purpose: This directive aims to prevent reimbursement claims from being rejected because tests were conducted at a facility different from the consulting hospital without proper prior authorization from CGHS.