- M.B.B.S.
- M.S. Orthopaedics
- Fellow in Knee and Hip Replacement, Mumbai
- Fellow In Knee and Hip Surgery, Germany
- Fellow in Knee and Hip Surgery, NHS, Singapore
- Fellowship in Complex and revesion knee and Hip replacement, London, Lancaster, UK
For eligible patients across Central India, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) – has made joint replacement surgery genuinely accessible.Procedures that once cost ₹2-3 lakh in private hospitals are now available cashless at empanelled facilities. For patients from rural Vidarbha, Madhya Pradesh and Chhattisgarh, this has changed what’s possible.
This guide explains how to use the scheme practically for knee or hip replacement in Nagpur – eligibility, the process, what’s covered, what’s not and the realities families navigate.
Who Is Eligible?
Ayushman Bharat PM-JAY covers families identified through the Socio-Economic Caste Census (SECC) database. Eligibility is based on:
- Rural families: Identified through deprivation criteria including kuccha house, no adult earning member, SC/ST status, female-headed households with no adult male, disability-affected families, manual scavengers and several other categories.
- Urban families: Identified through occupational categories including domestic workers, street vendors, construction workers, sanitation workers, security guards and similar.
- Maharashtra-specific extension: The Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) covers additional families beyond the central PM-JAY list, including all government white-card holders and yellow ration card holders.
- Other state-level schemes: Patients from Chhattisgarh, MP and other states with valid state Ayushman cards may also be covered, depending on inter-state portability arrangements.
To check eligibility:
- Visit the official PM-JAY website (pmjay.gov.in) and use the “Am I Eligible?” tool
- Call the toll-free helpline: 14555 or 1800-111-565
- Visit any Common Service Centre (CSC) with Aadhaar and ration card
- Check directly at the hospital admission desk – Varunam Hospital can verify eligibility from the central database
What's Covered for Joint Replacement?
Under PM-JAY, knee and hip replacement are covered as part of the orthopaedics package. The standard inclusions:
- Pre-operative investigations (X-rays, blood tests, ECG, anaesthesia consultation)
- Surgery and operating theatre charges
- Implant (standard quality, from approved manufacturers)
- Anaesthesia and pharmacy
- 4-5 day hospital stay (general ward)
- Post-operative physiotherapy during hospitalisation
- 2-3 follow-up visits in the first 3 months
The package rate for single knee replacement is approximately ₹80,000-₹90,000; for hip replacement, ₹85,000-₹1,10,000. This is the rate paid to the hospital by the government — it’s fully cashless for the eligible patient.
What's Not Covered (and Common Top-Ups)?
Honest discussion: while the standard package covers a complete, clinically appropriate knee or hip replacement, some patients choose to upgrade specific elements. Top-up payments at most empanelled hospitals allow this without losing the basic scheme coverage:
- Implant upgrade — switching from standard implant to a high-flexion or imported premium implant adds ₹40,000-₹1,00,000
- Robotic or computer-assisted surgery — adds ₹80,000-₹1,50,000 (where available)
- Room category upgrade — from general ward to semi-private or private room adds ₹2,000-₹5,000 per day
- Extended stay — beyond the package’s 4-5 day allowance, if medically required
- Bilateral surgery — single-sitting bilateral knee replacement may require partial top-up, as PM-JAY packages are typically structured per knee
The key point: top-up is optional. The standard package provides a clinically complete, safe surgery with good outcomes. Many eligible patients undergo replacement entirely cashless, with zero out-of-pocket spending.
Not sure if you qualify or how much top-up applies to your case?
Send your Ayushman/MJPJAY card details and X-rays on WhatsApp — the Varunam team will check eligibility and give you a clear total cost picture upfront.
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The Process Step by Step
For eligible patients, the typical process is:
- Initial consultation — Bring your Ayushman/MJPJAY card, Aadhaar and any existing X-rays/reports. The orthopaedic consultation confirms whether surgery is appropriate and which procedure is needed.
- Eligibility verification — The hospital’s PM-JAY desk verifies your details in the central database. This happens within 1-2 hours typically.
- Pre-authorisation — The hospital submits a pre-authorisation request to the state Ayushman authority with diagnosis, planned procedure and supporting documents. Approval typically comes within 24-72 hours.
- Surgery scheduling — Once pre-authorisation is approved, surgery is scheduled. Pre-operative investigations are done.
- Admission and surgery — Admission for surgery is fully cashless under the scheme. The hospital handles all billing directly with PM-JAY.
- Discharge and follow-up — Discharge typically on day 4-5. Two to three follow-up visits in the first 12 weeks are included.
The whole process from first consultation to surgery typically takes 2-4 weeks, depending on pre-operative preparation needs.
Why Varunam Hospital Specifically?
Varunam Super Speciality Hospital is empanelled under both PM-JAY and Maharashtra’s MJPJAY. The orthopaedic department performs joint replacement surgeries regularly under these schemes, which means:
- The administrative process is streamlined — the hospital’s PM-JAY desk handles documentation
- Surgeons are familiar with package-rate workflow and patient counselling
- The hospital infrastructure (NABH-grade OT, post-op care) is the same whether you’re using Ayushman or paying cash
- Dr. Utsav specifically performs Ayushman knee and hip replacements regularly — your surgery is not a “lesser” experience because you’re using the scheme
This last point matters. Some hospitals empanelled under PM-JAY effectively run a two-tier system — cash patients get the senior surgeons, Ayushman patients get junior staff. At Varunam, this is not the case. The same fellowship-trained joint replacement specialists perform your surgery regardless of payment mode.
Common Concerns and Misconceptions
Is the implant used in Ayushman surgery inferior?
No. PM-JAY approved implants are from major manufacturers (Zimmer, DePuy, Smith & Nephew, Stryker, Meril and others) — the same brands used for cash patients. The specific SKU may differ — typically the standard, well-proven implant rather than the premium variant — but clinical outcomes for patients in the typical 60-75 age range are equivalent.
Will I get rushed through with poor care?
At a reputable hospital, no. The package covers a 4-5 day stay, full physiotherapy and proper post-op monitoring. If your hospital is rushing you out at day 2-3, that’s a hospital quality issue, not a scheme limitation.
Can I get a second opinion before deciding?
Absolutely. Take time, get multiple opinions, choose the hospital and surgeon you trust. Ayushman eligibility doesn’t expire and the surgery can be planned at your pace.
What if I’m not eligible but my income is still modest?
For middle-income families who don’t qualify for PM-JAY, options include:
- Mahatma Jyotirao Phule scheme (MJPJAY) — broader eligibility in Maharashtra
- ECHS for ex-servicemen
- CGHS for central government employees
- ESI for organised sector workers
- Private insurance cashless
- Hospital EMI plans for cash-paying patients
A Note on Out-of-State Patients
Patients from Chhattisgarh, Madhya Pradesh and other states with valid Ayushman cards can use them at empanelled hospitals in Maharashtra under inter-state portability rules. The process is essentially the same as for Maharashtra patients. For MP patients especially, Nagpur is often more accessible than reaching empanelled hospitals within MP, making it a practical choice for joint replacement surgery.
FAQ
For eligible patients at empanelled hospitals, yes the standard package is fully cashless. If you choose implant upgrades or room category upgrades, the difference is paid out of pocket.
PM-JAY is the central scheme. MJPJAY is Maharashtra’s state scheme, which extends coverage to additional families. Both can be used at empanelled hospitals, though the procedures and rates may differ slightly.
Yes, PM-JAY supports inter-state portability. Patients from MP, CG and other states can use their cards at empanelled hospitals in Maharashtra.
Visit any Common Service Centre (CSC), Ayushman Bharat Kendra, or PMJAY-empanelled hospital with your Aadhaar and ration card. The card is issued free of charge.
No specific age limit for orthopaedic procedures. Coverage is based on family eligibility, not individual age.
Typically 24-72 hours. Emergency cases can be processed faster. Elective surgeries are usually scheduled 1-2 weeks after pre-authorisation is approved.
Want to confirm your eligibility?
Send your card details on WhatsApp and the Varunam team will check eligibility, explain what’s covered for your specific case and schedule a consultation with Dr. Utsav.
Call: +91 7447799000