Maharashtra fixes PET-CT scan rate at Rs 10,250 in government and PPP hospitals

The Maharashtra government has fixed the charge for PET-CT scans for cancer patients at Rs 10,250 in government hospitals and healthcare facilities run on the public-private partnership (PPP) model. To prevent varying bills, uniform rates have also been set for the contrast agents used in CT and MRI scans.

The state's medical education department has issued the order. According to it, the new PET-CT rate includes the FDG (fluorodeoxyglucose) radiotracer and, where required, the contrast agent. The amount was arrived at by giving a 50% discount on the Rs 20,500 package fixed under the Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) and the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY).

Patients not covered by these government health insurance schemes but who get the test done at government or PPP hospitals will also get this rate. Private hospitals and independent diagnostic labs have been kept outside the order.

A PET-CT scan is used to detect cancer, find out how far it has spread, determine the stage of the disease and monitor the effect of treatment. The decision is therefore expected to reduce diagnostic costs for cancer patients. It follows the government's decision of October 17 to include PET-CT tests under MJPJAY and PMJAY.

Rates for contrast agents have also been fixed. The charge for contrast used in CT scans will be Rs 420 for 50 ml and Rs 830 for 100 ml. Gadolinium-based contrast used in MRI tests has been priced at Rs 950 for 10 ml. This followed a concern raised by the Directorate of Medical Education and Research (DMER) about differences in contrast prices across hospitals.

The revised guidelines say that patients eligible for free services under the government order of July 4, 2017, will continue to get the test without payment. Beneficiaries of MJPJAY and PMJAY will also get eligible services free, while other patients will have to pay the fixed rate.

Hospitals have been directed to display the charges clearly in Marathi and English, maintain separate records of patients and start a digital monitoring dashboard. The quantity of contrast must be certified by the treating medical officer, and proportionate billing for partly used vials has been barred.

Private diagnostic operators working under PPP agreements will no longer be able to collect payment directly from patients. All transactions must be processed through the hospital's billing counter, and the operator must be paid every month. A violation will be treated as a breach of contract and action can be taken under the agreement.