Is Complex CTO PCI Covered Under the Ayushman PMJAY Scheme?

Dear Ashish Kumar ji,

Yes, PCI/angioplasty for a coronary artery blockage is covered under Ayushman Bharat PM-JAY. The treatment is performed at a PM-JAY-empanelled hospital under the applicable package.

However, “Complex CTO PCI” (Chronic Total Occlusion PCI) is a specialised form of coronary intervention. Therefore, you should not assume that every hospital offering routine angioplasty will perform complex CTO PCI under PM-JAY. The hospital must confirm that the specific CTO-PCI procedure/package can be processed under PM-JAY and that the required interventional cardiology facilities are available.

The National Health Authority's PM-JAY package documentation includes cardiology and cardiothoracic/vascular procedures, with pre-authorisation requirements for applicable packages. 

What Is Complex CTO PCI?

CTO PCI is a procedure used to open a coronary artery that has been completely blocked for a prolonged period, generally referred to as a chronic total occlusion.

Because CTO procedures can be technically more challenging than routine angioplasty, they may require an experienced interventional cardiologist and specialised cath-lab equipment.

The cardiologist will first review the patient's coronary angiography and other cardiac reports to determine whether CTO PCI is appropriate.

How to Check an Ayushman Hospital for Complex CTO PCI

Before admission, follow these steps :

1. Open the official PM-JAY Hospital Search portal.

2. Select your State.

3. Select your District.

4. Search the exact hospital name.

5. Confirm that the hospital's PM-JAY empanelment is currently active.

6. Check that Cardiology services are available.

Documents Required

Carry all available medical records, including :

• Ayushman Bharat PM-JAY Card/e-card

• Aadhaar Card or valid government ID

• Cardiologist's prescription/recommendation

• Coronary angiography/CAG report and CD, if available

• ECG report

• 2D Echo report

• TMT report, if performed

• CT coronary angiography report, if performed

• Previous angioplasty/stent records

• Previous discharge summaries

• Recent blood-test reports

• Kidney function/creatinine report

• Current medicines list

• Previous cardiac medical records

Important

If the patient currently has severe or persistent chest pain, breathlessness, sweating, fainting, or pain spreading to the arm, shoulder, jaw or back, please seek emergency cardiac care immediately rather than waiting for Ayushman verification.

How HexaHealth Can Help

We can help you connect with experienced interventional cardiologists and suitable PM-JAY-empanelled partner hospitals. We can also assist with consultation, appointment coordination, documentation and treatment planning.

Please share your city, state and the hospital where Complex CTO PCI has been advised. We can guide you on what to verify with the hospital's Ayushman desk before admission.

Wishing you and your family good health always.
Warm regards,
Team HexaHealth