Revision of lists and rates of artificial appliances for CGHS/CS(MA) beneficiaries and general guidelines
Issued on 6-8-2014
No.S-11011/25/2014/CGHS-(P)
Government of India
Ministry of Health and Family Welfare
Department of Health and Family Welfare
****
Nirman 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-11011/5/95-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-1, 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-11: This contains the list, rates and specifications pertaining to the orthotics (i.e. callipers & braces) including lower extremity, upper extremity and spinal orthotics.(Annexure-11 has been divided into Annexure-IIA, IIB and IIC].
Annexure-111: 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-1, 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 & 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-II, based on the size of the appliances.
(viii)T. here 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 (H&FW) and concurrence of
Integrated Finance Division.
(Ravi Kant)
Under Secretary to the Government of India
------------------------------------------------
ANNEXURE-IA
LOWER EXTREMITY PROSTHETICS (Above 12
years)
Sl. No.
|
Name of Prosthesis
|
Approved Rate/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 Adapter Sleeve 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, 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. 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, 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. 51940/-
|
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/-
|
ANNEXURE-IB
LOWER EXTREMITY PROSTHETICS (CHILD
UPTO THE AGE OF 12 YEARS)
Sl. No.
|
Name of Prosthesis
|
Approved rate/Price (Child
7-12 years)
|
Approved rate/Price (Child
0-6 years)
|
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.18,140/-
|
Rs.5000/-
|
2.
|
Trans Tibial Prosthesis (Below Knee
Prosthesis) with silicone / PU liner
|
Rs. 35,140/-
|
Not applicable
|
2.a
|
Trans Tibial Prosthesis with silicone
/ PU liner with shuttle lock 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 ( Above Knee
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 ( Above Knee
Prosthesis) with Suction Valve
|
Rs.49980 + 3800=53,780/-
|
Not Applicable
|
7.
|
Trans Femoral Prosthesis (Above
Knee Prosthesis) with Silicon / PU liner
|
Rs.70,280/-
|
Not Applicable
|
7.a.
|
Trans Femoral Prosthesis ( Above Knee
Prosthesis) with Silicon/PU liner 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.
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
|
Approved Rate/Price (Above 12
years of age)
|
Approved Rate/Price CHILD (7-
12 Years)
|
Approved Rate/Price CHILD
(0-6) Years
|
1.
|
Transtibial prosthesis (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.
|
Trans tibial Prosthesis
(Below Knee Prosthesis) with silicone / PU liner
|
Rs.43700/-
|
Not Applicable
|
Not Applicable
|
3.
|
Trans tibial Prosthesis
(Below Knee Prosthesis) with silicone / PU liner with
shuttle lock mechanism
|
Rs.52200
|
Not Applicable
|
Not Applicable
|
4.
|
Trans Femoral Prosthesis
(Above Knee Prosthesis) (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.
|
Trans Femoral Prosthesis
(Above Knee Prosthesis) with Suction Valve
|
Rs.47540 + 3800=51,340/-
|
Not Applicable
|
Not Applicable
|
6.
|
Trans Femoral Prosthesis
(Above Knee Prosthesis) with Silicon / PU
liner
|
Rs.64,540/-
|
Not Applicable
|
Not Applicable
|
7
|
Trans Femoral Prosthesis
(Above Knee Prosthesis) with Silicon /
PU liner with shuttle lock mechanism
|
64540+ 8500=73040/-
|
Not Applicable
|
Not Applicable
|
8.
|
Knee Disarticulation Prosthesis
(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.
|
PARTIAL FOOT PROSTHESIS
|
|||
9a.
|
Shoe filler with carbon plate
|
Rs.9000/-
|
Rs.5000/-
|
Rs.3000/-
|
9b.
|
GREAT TOE SILICON PROSTHESIS
|
Rs.9000/-
|
Rs.5000/-
|
Rs.3000/-
|
9c.
|
Silicone Prosthesis For
Second 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.
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
|
Approved Rate/Price (Above 12
years of age)
|
Approved Rate/Price CHILD
(7-12 Years)
|
Approved Rate/Price CHILD
(0-6) Years
|
1.
|
Trans Radial or Below Elbow / Wrist
Disarticulation Passive Prosthesis
|
Rs.10,000/-
|
Rs.5000/-
|
Rs.2000/-
|
2.
|
Body Powered Prosthesis
(Trans Radial or Below Elbow / Wrist Disarticulation)
Its components includes trans radial kit
and socket
|
17000/-
|
12000/-
|
Not Applicable
|
3.
|
Trans Humeralor Above
Elbow / Elbow Disarticulation Passive Prosthesis
|
Rs.20,000/-
|
Rs.10,000/-
|
Rs.5,000/-
|
4.
|
Body Powered Prosthesis
(Trans Humeral or Above Elbow / Elbow
Disarticulation)
|
28000/-
|
22000/-
|
Not Applicable
|
5.
|
Shoulder Disarticulation Passive
Prosthesis
|
Rs.30,000/-
|
Rs.20,000/-
|
Rs.10,000/-
|
6.
|
Shoulder Disarticulation body
powered Prosthesis
|
Rs. 37,000/-
|
28000/-
|
Not Applicable
|
ANNEXURE-IE
HIGH END UPPER EXTREMITY
PROSTHETICS (ADULT)
Sl. No.
|
Name of Prosthesis
|
Approved Rate/Price (Above 12
years of age)
|
Approved Rate/Price CHILD (7-
12 Years)
|
Approved rate/Price CHILD
(0-6) Years
|
1.
|
Externally Powered below
elbow or Trans radial / Wrist Disarticulation
prosthesis (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.
|
Externally Powered Trans
Humeral / Elbow Disarticulation Prosthesis
(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.
|
Silicone Finger Prosthesis
each
|
Rs.7000/-
|
Rs.5000/-
|
Not Applicable
|
4.
|
Silicone Thumb Prosthesis
|
Rs.8000/-
|
Rs.6000/-
|
Not Applicable
|
5.
|
Silicone Partial Hand Prosthesis
|
Rs.35000/-
|
Rs.25000/-
|
Rs.10,000/-
|
ANNEXURE-IIA
SPINAL ORTHOTICS
Sl. No.
|
Name of Prosthesis
|
Approved Rate/Price (Above 12
years of age)
|
Approved Rate/Price CHILD (7-
12 Years)
|
Approved Rate/Price CHILD
(0-6) Years
|
1.
|
Soft / Semi rigid Cervical Collar
|
200/-
|
200/-
|
Not Applicable
|
2.
|
Philadelphia or Two post Cervical collar /
Head Cervical Orthosis (Moulded collar)
|
1500/-
|
1500/-
|
1200/-
|
3.
|
Soft L.S. corset / Belt
|
700/-
|
500/-
|
Not Applicable
|
4.
|
SOMI BRACE / Three Post Cervical Orthosis
|
2000/-
|
2000/-
|
Not Applicable
|
5.
|
Four Post Cervical Orthosis
|
1200/-
|
1000/-
|
800/-
|
6.
|
Rigid L.S.O / Chair Back Orthosis
|
1200/-
|
1000/-
|
Not Applicable
|
7.
|
Rigid TLSO / Taylor,s brace, Knight Taylor,s
brace, William,s brace
|
1500/-
|
1200/-
|
1000/-
|
8.
|
Hyperextension brace / ASH /
CASH / JEWETT BRACE
|
1200/-
|
1000/-
|
Not Applicable
|
9.
|
CTLSO ( MILWAUKEE BRACE)
|
5000/-
|
5000/-
|
Not Applicable
|
10.
|
Head Cervical Thoraco Orthosis (HCTO)
|
1500
|
1500/-
|
1200/-
|
11.
|
TLSO BI- Valve / Body Jacket
|
3000/-
|
3000/-
|
2500/-
|
12
|
UNDER ARM BRACE (Boston Brace / Miami
Brace / Wilmington Brace / 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
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
Sl. No.
|
Name of Prosthesis
|
Approved Rate/Price (Above 12
years of age)
|
Approved Rate/Price CHILD
(7-12 Years)
|
Approved Rate/Price CHILD
(0-6) Years
|
1.
|
Soft Heel Pad / M.T. Pad with
Insole ( One Piece)
|
200/-
|
200/-
|
Not Applicable
|
2.
|
Arch Support (Unilateral)
|
300/-
|
200/-
|
200/-
|
3.
|
Silicone / PU arch support (One Piece)
|
350/-
|
250/-
|
Not Applicable
|
4.
|
Medial / Lateral Wedge
|
100/-
|
100/-
|
100/-
|
5.
|
Soft Insole cross link polymer
(One Piece)
|
100/-
|
100/-
|
Not Applicable
|
6.
|
Soft Insole ( Plastozote) One
Piece
|
300/-
|
200/-
|
Not Applicable
|
7.
|
Silicone / PU Insole (One Piece)
|
500/-
|
Not Applicable
|
Not Applicable
|
8.
|
Silicone Heel Cushion (One Piece)
|
300/-
|
Not Applicable
|
Not Applicable
|
9.
|
Molded / customized Insole (One Piece)
|
600/-
|
500/-
|
400/-
|
10.
|
Silicone Toe separator (One Piece)
|
200/-
|
100/-
|
Not Applicable
|
11.
|
UCBL ( Unilateral)
|
800/-
|
600/-
|
500/-
|
12.
|
SMO without shoes (One Piece)
|
1200/-
|
1000/-
|
800/-
|
13
|
Flat Feet / CTEV Shoes Pair (Leather)
|
1200/-
|
800/-
|
700/-
|
14.
|
Molded Shoe ( Leather)- one side normal & one side
affected
|
2200/-
|
1600/-
|
Not Applicable
|
15.
|
Molded Shoe ( Leather)- both side affected
|
3000/-
|
2000/-
|
Not Applicable
|
16
|
Shoe Raise
|
Rs. 50 per ½ inch
|
Rs. 50 per ½ inch
|
Not Applicable
|
17.
|
Open toe shoes for paraplegic one pair
|
1500/-
|
-Not Applicable
|
Not Applicable
|
18.
|
D.B. Splint with / without shoe
|
Not Applicable
|
Not Applicable
|
800/-
|
19.
|
AFO Conventional (One Side)
|
2500/-
|
2000/-
|
1500/-
|
20.
|
AFO Conventional (Bilateral)
|
3500/-
|
2700/-
|
2000/-
|
Polypropylene / Customized A.F.O without shoes
|
1200/-
|
1000/-
|
800/-
|
|
22.
|
FRO (Floor Reaction Orthosis)
|
1800/-
|
Not Applicable
|
Not Applicable
|
23.
|
Pneumatic walker
|
3500/-
|
Not Applicable
|
Not Applicable
|
24.
|
Knee Orthosis Polypropylene (Valgum /Varus, immobilizer
etc.)
|
1500/-
|
1200/-
|
900/-
|
25.
|
P.T.B Brace without shoes
|
1800/-
|
1500/-
|
1200/-
|
26.
|
Knee Sleeve without hinge
|
500/-
|
500/-
|
Not Applicable
|
27.
|
Knee Sleeve with hinge
|
800/-
|
800/-
|
Not Applicable
|
28.
|
Off loader Knee Orthosis
|
17000/-
|
Not Applicable
|
Not Applicable
|
29.
|
KAFO conventional with shoe
(One side)
|
4000/-
|
3200/-
|
2000/-
|
30.
|
Bilateral KAFO conventional with shoe
|
5500/-
|
4500/-
|
4000/-
|
31.
|
KAFO custom molded without shoe (One side)
|
4000/-
|
3200/-
|
2000/-
|
32.
|
Femoral Fracture Brace Non
weight relieving
|
1500/-
|
1000/-
|
800/-
|
33.
|
Femoral Fracture Brace weight
relieving
|
4000/-
|
3200/-
|
2000/-
|
34.
|
HKAFO Conventional with shoes (One side)
|
5000/-
|
4000/-
|
3000/-
|
35.
|
Bilateral HKAFO Conventional with shoes
|
6500/-
|
5500/-
|
4500/-
|
36.
|
HKAFO Polyproxyline custom moulded without shoes (One
side)
|
5000/-
|
4000/-
|
3000/-
|
37.
|
Trilateral Orthosis
|
4000/-
|
3200/-
|
2000/-
|
38.
|
HIP Abduction Orthosis (Conventional)
|
Not Applicable
|
1000/-
|
1000/-
|
39.
|
Pavlik Harness for CDH
|
Not Applicable
|
Not Applicable
|
2500/-
|
40.
|
Hip Bracing (Immobilizer)
|
2000/-
|
1500/-
|
Not Applicable
|
41
|
SWASH Brace
|
Not Applicable
|
18000/-
|
18000/-
|
42
|
Reciprocating Gait Orthosis
|
32000/-
|
Not Applicable
|
Not Applicable
|
ANNEXURE-IIC
UPPER EXTREMITY ORTHOTICS
Sl. No.
|
Name of Prosthesis
|
Approved Rate/Price (Above 12 years of
age)
|
Approved Rate/Price CHILD (7-12 Years)
|
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
|
Approved Rate/Price (Above 12
years of age)
|
Approved Rate/Price CHILD (7-
12 Years)
|
Approved Rate/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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