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
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
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
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:
. Nephrology Center