Philhealth Coverage for Hemodialysis

Updated January 7, 2017

The Philhealth coverage amount for hemodialysis has been reduced to 2,600 pesos per session, effective September 2015.

But the number of hemodialysis sessions covered per year has been increased from 45 sessions per year to 90 sessions per year.

Hemodialysis procedure (Code 90935)

Total coverage amount: 2,600 pesos

No. of sessions covered per calendar year:  90 sessions

Find a Philhealth-accredited hemodialysis center and ask for their Philhealth hemodialysis packages. Packages range from zero cash payment to lower-cost payment to higher-cash-payment.

Philhealth documents required by hemodialysis facilities:

1.  Signed Philhealth Claim Form 1

2.  Receipt of applicable premium payments

3.  Updated and clear copy of Philhealth MDR

4.  Philhealth ID, or Philhealth card, or valid ID (orig and copy)

B.  Medical papers required (may vary depending on the facility)

1.  Hemodialysis prescription from nephrologist
2.  Medical abstract
3.  Results of recent diagnostic exams
(less than 1 month old)
4. Hepatitis profile: HBsAG, Anti-HBS, Anti HCV
(less than 3 months old)
5.  Copies of reports for the last 3 treatment sessions
6.  Signed consent form for hemodialysis treatment
7.  Signed conforme to the policies of the facility

Rules:

1. Outpatient hemodialysis is excluded from the 90-day single-period-of-confinement rule.

It can be availed of on a per session basis, such as twice or thrice a week, up to 90 sessions per year.

2. This coverage covers both inpatient and outpatient hemodialysis procedures, including emergency dialysis procedures for acute renal failure.

3. Coverage include payment for use of the dialysis machine and health care institution, drugs and medicines, supplies and others on per session basis.

4. If hemodialysis sessions are done while confined, whether in the same facility or not, only the total number of confinement days, not the number of hemodialysis sessions, shall be deducted from the 90 days total allotment.

4. Creation of fistula shall be reimbursed using a different case rate but in accredited health care institutions only.

5. Multiple sessions may be claimed in one claim form for both inpatient and outpatient hemodialysis. The dates of each session claimed shall be indicated in the space provided in Claim Form 2.

6. If an admitted patient is sent to another health care institution (HCI) for hemodialysis, a separate claim shall be filed by the HCI that performed the dialysis.

7.  Claims must be filed by the facility with Philhealth within 60 days from dates of dialysis service.

8.  The hemodialysis facility should have a DOH license to perform hemodialysis, whether it is a hospital, freestanding dialysis clinic or hemodialysis center.

9.  The medical director or head of a hemodialysis center should handle only up to 3 hemodialysis centers.

 

Philhealth Coverage for Insertion of Catheter or Cannula

Codes 36488, 36810, and 36815
Placement of central venous catheter for hemodialysis
or Insertion of cannula for hemodialysis (arteriovenous, either external revision/closure or external Scribner-type)

Total coverage amount: 9,700 pesos
PF: 4,200 pesos
Hospital and meds/supplies cost: 5,500 pesos
Code 36800
Insertion of cannula for hemodialysis; vein to vein
Total coverage amount: 9,300 pesos
PF: 2,100 pesos
Hospital, Meds/Supplies Cost: 7,200 pesos

 

Sources:

Philhealth News on philhealth.gov.ph:  PhilHealth Extends Dialysis Coverage to 90 Days, June 26, 2015

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

Annex 2. List of Procedure Case Rates

Philhealth Circular No. 0021 s 2013 — Clarification on the Reimbursement of Radiotherapy and Hemodialysis

 

Hemodialysis centers recommended by Evelyn in the Comments section:

. Clinica Antipolo

. Genesis in San Juan

. Metro in Lemery, Batangas

Subsidized Hemodialysis offered by the Valenzuela City Emergency Hospital, as described by author Nathaniel R. Melican in his May 26, 2013 Philippine Daily Inquirer article.

Other dialysis centers recommended:

. Hemotek
. Nephrology Center

List of Philhealth-Accredited Dialysis Centers in Metro Manila

10 Comments

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  1. Good day! can u pls provide me info regarding hemodialysis? I started out-patient dialysis last DEc 01, 2014 for 3x session per week, according to philhealth rules the maximum session per calendar year is 45 days only but at the end of 2014 i consumed only 12 days.. can i use the remaining 33 days of 2014 for 2015 plus the 45 days fo the year 2015? your kind assistance is highly appreciated…many thanks…claro

    1. Hi claro, sad to say, the 33 days cannot be carried over into 2015; so for this year, you can use only 45 days. Some people I know and read about who are having dialysis, they complement Philhealth coverage by asking assistance from PCSO and they’re able to get 10,000 pesos per request.

  2. Hello Ms. Nora, Thank you for the helpful article. You mentioned in your comment that other people compliment their PhilHealth coverage by asking assistance from PCSO. Does PCSO provide assistance even if you still have the 45 sessions from PhilHealth? And how can we avail of the process? Thanks in advance.

    1. Hi Mickey, yes, you can. I think PCSO does not require that you first use up your Philhealth allotment. I think they don’t even ask, although I’m not sure. But I know someone that uses Philhealth and PCSO nearly alternately. For PCSO, you will get at least 4 documents from your doctor/hemodialysis center, so it’s best if you first ask your hemo center about PCSO. For the requirements, see this: http://www.healthphilippines.net/2015/01/pcso-medical-assistance-for-hemodialysis/ and this: http://pinoylifewithpkd.blogspot.com/2014/01/steps-in-getting-pcso-financial.html

  3. Hi! I would like to ask if more than 1 family member has philheath can they use it after the 45 session already consume? Ex my dad is having his dialysis and currently a dependent of my mom. I am also a philhealth member, can i use my philheath for my dad? Thank you

  4. my mother is undergoing dialysis at bghmc, 3 times a week…and she has already used up 50 sessions thru her phil health, she was informed by bghmc that since she has already used up 45 sessions, if ever she will be confined/admitted we are already going to cash out since the last 45 sessions are strictly for dialysis. is this correct? how abt if my mother will undergo surgery re: fistula, can she still use her philhealth? will philhealth cover it despite the fact that she has already used up 50 sessiond?

    1. Hi divina, sorry, hindi na, kasi your mother has used up the 45-day allocation for 2016. What others do, hindi agad-agad ginagamit yong 45 para merong para sa confinement or procedure, in case it’s needed. Ask others too. You can ask for assistance from PCSO; ask help from the hospital’s social service dept. Meron ding medical assistance ang Vice-President’s office.

  5. ano ano po ba ang expenses for dialysis na covered ng philhealth, meron po ako pamangkin ngda dialysis, pero hirap pa din po kasi may binibili pa din sila ng pang injection dialyzer dw po worth 900 hnd po ba ito covered ng philhealth

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