Philhealth Coverage for Chemotherapy

Here are Philhealth coverage amounts for Chemotherapy.

Chemotherapy is the use of chemicals or medications to kill cancer cells. 
Most chemotherapy is delivered intravenously.

Code 96408
Chemotherapy administration

Coverage for hospital expense:  5,600 pesos
Coverage for professional fee (PF):  1,680 pesos
Total coverage:  7,280 pesos

Code 96440
Chemotherapy administration into pleural cavity, requiring and including thoracentesis

Coverage for hospital expense:  4,300
Coverage for professional fee (PF):  1,260
Total coverage:  5,560

Code 96445
Chemotherapy administration into peritoneal cavity, requiring and including peritoneocentesis

Coverage for hospital expense:  5,500
Coverage for professional fee (PF):  2,520
Total coverage:  8,020

Code 96450
Chemotherapy administration into CNS, requiring and including spinal puncture

Coverage for hospital expense:  4,300
Coverage for professional fee (PF):  1,260
Total coverage:  5,560

Code 96542
Chemotherapy injection, subarachnoid or interventricular via subcutaneous reservoir

Coverage for hospital expense:  2,800
Coverage for professional fee (PF):  840
Total coverage:  3,640

Code 36640
Arterial catheterization for prolonged infusion therapy (chemotherapy), cutdown

Coverage for hospital expense:  2,800
Coverage for professional fee (PF):  840
Total coverage:  3,640

Source:
Philhealth Circular No. 35 s. 2013, effective January 1, 2014
Annex 2.  List of Procedure Case Rates

Rules on Chemotherapy Coverage:

Chemotherapy (RVS 96408)

a. The case rate amount for chemotherapy is equivalent to one cycle of chemotherapy.

b. One cycle of chemotherapy is equivalent to 2 days deduction from the 45 days benefit allowance.

c. Chemotherapy may be claimed as inpatient or outpatient.

i. If claimed as inpatient and in the same hospital, the chemotherapy package may be claimed as first or second case rate.

ii. Multiple cycles may be claimed in one claim form for both inpatient and outpatient chemotherapy. The dates of each cycle claimed shall be indicated in the space provided in Claim Form 2.

Source: Philhealth Circular No. 0035 s. 2013 — ACR Policy No. 2 — Implementing Guidelines on Medical and Procedure Case Rates

 

Disclaimer:  This site is not administered by Philhealth.

Related Post:
Philhealth Coverage for Non-Hodgkin’s Lymphoma

50 Comments

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  1. Good AM. Sir/Ma’am, ask lang po ako alin po dito yung babayaran ang case po ay chemo for breast cancer? May mga packages po ba?

    1. Hi flora mae, if the breast cancer is newly diagnosed and the patient has not yet undergone chemo, find a hospital that can help you apply to Philhealth under the Z package (if approved, total cost of treatment is 100k).

  2. good day…

    im an an ofw april 2012-april 2013

    I am diagnosed with Cancer April 2013- and just now aug i paid for the philiphealth 2400 Pesos..can i claim my benifits..100k ? i was in hospital and i cant pay so i jsut put payment now aug 2013

    please advise and im am still dubai how can i process to claim my benefits its very expensive here fo the hospital
    thanks

  3. Good day…

    Tanong ko lang po kung pwede i refund sa philhealth yung mga na gastos namin sa ct scan, histopath, 2d echo, bone scan at laboratory?… breast cancer po yung sakit ng tita ko last july lang na diagnose yung sakit nya…

    1. Hi Philip, sad to say, what I know is that outpatient diagnostic procedures are not covered. Since this is a new diagnosis, you can ask Philhealth about how to apply for their Z program for breast cancer, so you can get better coverage.

  4. Hi Nora firstly thanks for taking time to answer all the questions & here’s mine. My sister is currently on chemo, I think she is on her 2nd session. We sent 100K pesos last August & asked for more. She is a member of Philhealth. She has breast cancer stage 4. My question is, is she covered for the Z package?. She told me that Philhealth only covers hospital fee but she is outpatient & that chemo, ct scan, xray, medicines & other requirements are not covered. Can you throw any light on this subject. Thanks

  5. Gud pm. Po… My mother undergone a explore lap procedure last august 2013 to treat her colon cancer… The doctors cut her intestine having cyst.. She has now a colostomy.. After the operation she advise to undergo a chemo theraphy… But due to financial problem she refuse.. Last week she was confined again due the pain in her intestine again… The doctors said that cancer cell recur.. They advise to have a chemo first before the operation… Suddenly the hospital has no medicine for the said chemo… So we decided to go home since nothing will happen since we dont have enough money to buy medicine outside.. She was a lifetime member of philhealth and shes now 63 years old… Is it posible to send her again into other hospital with medicine for chemo? How much will becovered by philhealth? Thanks…

    1. Hi Ali, the coverage for regular chemo is 7,280 (5,600 pesos for hospital expense and 1,680 for PF). Ask the hospital about cost. If you have chemo prescription and medical papers, you can ask PCSO for assistance for meds. Your hospital’s social welfare can help you with papers.

  6. Hi This is Janice, I would like to ask what are the coverage that philhealth can provide us, my mother got breast cancer stage III-B. Prior to her operation she was advised that chemo therapy is needed, as well as after the surgery. We will be spending a lot of money which includes laboratories. Professional Fees, Inpatient accommodation etc. Now we need to know how to lessen the expenses to make sure that we can support her until such time that she is all clear.

    1. Hi Janice, sad to say that Philhealth’s special 100k package for breast cancer is for early-stage-cancer patients only. But you should ask your hospital if you can avail of this package. If not, the regular chemo administration coverage is 7280 pesos per session. Coverage for mastectomy is 22k per breast. If 2 breasts in one surgery, coverage is 33k. If separate operations, 22k per operation. Philhealth gave an example in its website of chemo of 2 cycles plus radiotherapy (LINAC) of 2 sessions — the coverage is 20,560. Talk to the hospital about costs so you’ll be prepared.

  7. hello, I have bone tumor and my doctor advised me to undergo denosumab xgeva. I take medication monthly by injection; the cost of the injection is 20,250 per vial a month. I’m a philheath member since april 2014. What can philhealth do for my case. thanks. good day!

  8. Hello. What philhealth coverage can my mother use? She was diagnosed last week with cervical cancer stage IIb. She’s a beneficiary of my father. please help

    1. Hi elean, go to the nearest Philhealth with your mother’s medical papers, ID and your father’s Philhealth no. and your father’s authorization to process Philhealth papers and ask about applying for Z Benefit Package for Cervical Cancer.

    2. Mam nora, hello po ulit. Nag aaply na po si father ko sa benefit na pede gamitin ni mama. z package po ung sinabi s philhealth taz po s pgh dw po ang pede hospital. Ask ko po ulit if papanu po ang proseso nUn. Kpg inchemo n po b si mama at radiation dirct charge na po ba un sa z package ng philhealth? Nabasa ko din po sa circular ng philhealth n 15% ng package e ibibigay s professional fee. thank you po and more power…

  9. My husband has stage 3b rectal cancer. He had surgery nov 8, 2014 and stayed inthe hospital for 8 days then he had radiotherapy (RT) for 25 days. We were able to claim for philhealth for these. He needs 6 cycles intravenous and oral chemotherapy starting feb 23 and he will be confined overnight. The next 5 will be done outpatient. We were told we will buy the medicines from the doctor. Can we file for philhealth benefits even for outpatient service?

    1. Hi grace, yes, chemotherapy administration is covered, even if done as outpatient, but ask the hospital so that the chemo benefit is deducted from the bill.

  10. Hi miss nora. My mother was diagnosed cervical cancer stage 2b on january 25,2015. And i immediately applied her for philhealth voluntary because she’s only 57 years old and is not covered as dependent in my philhealth. I already paid for the first 6 months contribution. Can we already use the philhealth? And avail the radiotherapy and chemotherapy in the hospital we are taking medication already?thank you

  11. Good day. Ask ko lang mam kc at this time ang minimum days na pag stay ko sa hospital ay 6 days, naeextend pa po kapag sinalinan ako ng dugo, same po ba ang maavail ko sa chemotheraphy benifits.

  12. Ang concern ko po ung no. of days kada chemo kasi minimum of 6 days po ako at ang ibinibigay sa akin ay for 1 chemo benifits lang 6 days or more din po ba ang ibabawas sa akin sa 45 days na ibinibigay ng philhealth per year. Salamat po and more power.

  13. Hi po. Who are qualified to avail the Z package? ex.if suffering from colon cancer stage111. Can all paying members avail or only indigent? Can the Z package used in a private hospital?

    1. Hi Jam, yes, every member can avail as long as the cancer is newly diagnosed. Cannot be used in any hospital. Must be in a contracted hospital. No list yet for colon cancer, but I’ll email you a list of hospitals for other Z packages. You can ask these hospitals if they’re offering Z benefit for colon cancer.

  14. Hi Ms Nora,newly diagnosed po c lolo ng lung cancer stage IV..covered po ba ng phil health ang chemo therapy nya?salamat po

  15. Hi Ms. Nora. Tanong ko lng. Diagnosed po ang mother ko ng Cervix cancer and required po ng radiation therapy and chemo therapy. pero nagamit na po namin phil health namin nung surgery po ng mother ko sa PGH. tanong ko lng po kung nauubos po ba ang laman ng phil health at kung mggmt pa ba namin un sa chemo and radiation nya? thanks po.

    1. Hi Jason, 45 days ang allotment per member per calendar year. If she spent 4 or 5 days in the hospital, she still has 40 days left for 2016. Puede pang gamitin for radiotherapy and chemotherapy (1 cycle of radiotherapy = 1 day; 1 cycle of chemotherapy = 2 days). Exempted from the 90-day-same-treatment rule ang chemo at radio, so puede siyang sunud-sunod.

      1. Bali ibig sbhn po pag naubos ko na ung 45 days, magbabayad na po ako ng cash na wlng discount from phil health?

        1. Hi Jason, yes, pag naubos na ang 45 days, cash na. Mag-umpisa uli ang new allocation of 45 days sa year Jan 2017. Puede kang mag-apply for assistance from PCSO or the Office of the Vice President. Research mo na lang mga required docs online, pati mga suggestions.

          1. Thanks Ms. Nora, Madami ka pa po sana matulungan sa mga katulad kong may mga katanungan. Godbless!

  16. gud eve p.my father was diagnosed with stge3b colon cancer he is a member of philhealth since he’an ofw and regularly contributing to the institution.what help can philhealth provide him for his chemo treatment via iv?

    1. Hi yojann, is your father’s cancer newly diagnosed? If newly diagnosed, he can avail of the Z benefit package. It is offered at the UP-PGH. The Z benefit package for colon cancer is a full treatment package but he must first be seen by a doctor there. When you get there, ask for the cancer department and ask about Z benefit package.

  17. Hi Ms. Nora, My dad was diagnosed last July 31, 2016 of colon cancer stage 4. May I know if covered siya ng Z Package of philhealth? If you can refer me to a link maam much appreciated. Mahal po kasi now ng gastusin. Besides PCSO maam, ano po kayang organizations that can help with our cost? Thank you Ms. Nora hulog ka po ng langit for helping so many of us in our questions.

    1. Hi boy, it’s sad that the Z package covers colon cancer only up to Stage 3. Here are links: Colon Cancer FAQs at UP-PGH. Isang hospital pa lang (UP-PGH) ang nabasa kong contracted for colon cancer Z package. Pero kahit stage 3 na, puede pa namang magpunta sa UP-PGH to ask. Puede kayong lumapit sa mga offices doon sa Senate and Congress, at Vice President at sa Malacanang. Puede rin sa offices sa mismong munisipyo nio (councillors, mayor, vice mayor). Bring medical documents and receipts, photos of your father, your IDs and your birth cert (to prove relationship with your father). Thanks for appreciating my blog. Means a lot. Keep praying for strength. You’re a good son — you’ll be blessed. I’ll get back to you halimbawa lang I see a foundation helping colon cancer patients.

  18. good day..can i ask po i already using ź benefits package for breast cancer stage2b. if i already consumminated the package..can i avail regular package for chemotherapy as a individually paying member out patient po aq s accredited hospital..thank you po possible response..god bless

    1. Hi jorrina, I think you can avail if you have not yet consumed your annual allowance of 45 days. I have read in a Philhealth PDF that the Z package is counted as 5 days, so this means you have 40 days more to use. One chemotherapy cycle is counted as 2 days. To be sure, ask your hospital about this. You can also ask for assistance from PCSO. Ask about documents from your hospital’s social services dept. Take care

      1. Hi ms nora,tanong ko lang po member po ako ng philhealth pero nung nawala nako sa company ko hindi nako nakahulog,so gusto ko sya icontinue as voluntary,if end of this month mag hulog ako,how much and kelan ko pa po sya pwede magamit!?if ever mag pa colonoscopy po ako sa pgh magagamit ko po ba sya!?thanks po po Godbless,

        1. Hi Tin, pay ASAP for July to Sep (600 pesos) so you can use it this September for colonoscopy. Find a Philhealth-accredited doctor and hospital. God bless too.

  19. Wat if the case if after operation and biopsy the doctors said its positive, stage 3-C. how much coverd ng philhealth? My mother is a govt employee. Thank you

    1. Hi Jhaz, kapag breast cancer or colon cancer, and newly diagnosed as cancer, ask your doctor if your mother qualifies for Philhealth Z benefit. This benefit has bigger coverage.

  20. Hi miss nora, ask ko lng po if pwede po maging dependent ang parent below 60years old newley diagnos with lung cancer stage 4.. At ano po requirments at mga magkano po maleless sa bill? Hindi po kc kmi mklabas sa ospital sa laki po ng bill.. 190k na po ang bill. Salamat po

    1. Hi John, puede siyang maconsider kapag i-accept ng Philhealth na ang condition siya is permanent disability. Dapat mapa-register mo as your dependent before discharge. Bring a “detailed Medical Certificate issued by attending physician stating the diagnosis, extent of disability and the date when the disability was acquired.” Puede kayong mag-ask ng assistance sa social services dept ng hospital so you can ask help from PCSO. Pag PCSO, dapat hindi pa paid yong bill or konti pa lang ang nabayaran.

  21. Hi,po.Ask ko lng po kc 1mo post mastectomy ako at sa wed po 1st chemo ko dhil sa invasive ductal carcinoma.sa ust hosp po.pwede po b dun ung z package o ibbawas lng ung philhealth?mgkno po ang mddiscount ko?

  22. Good day sir/mam. Ang father ko po ay non hodgkin’s lymphoma patient. He is 71 yrs old. So obviously hindi na po sya nag work. Lahat po ba ng chemo sessions niya ay covered sa philhealth?

    1. Hi Cristina, sorry hindi. Merong allocation na 45 days per Philhealth member per year. One cycle of chemotherapy is equivalent to 2 days deduction from the 45 days benefit allowance. Puede kayong lumapit sa PCSO for the other chemotherapies.

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