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

 

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