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PhilHealth Circular 2014: New Medical Rates

This document from the Philippine Health Insurance Corporation outlines new policies and guidelines regarding case rates for hospital admissions and procedures. It adds several new medical conditions to the list of reimbursable case rates for all hospital levels. It also clarifies rules around indicating laterality for cataract procedures and using ICD or RVS codes instead of case rate codes on claims forms. New lower rates are established for some case rates in primary care facilities.

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100% found this document useful (1 vote)
55 views2 pages

PhilHealth Circular 2014: New Medical Rates

This document from the Philippine Health Insurance Corporation outlines new policies and guidelines regarding case rates for hospital admissions and procedures. It adds several new medical conditions to the list of reimbursable case rates for all hospital levels. It also clarifies rules around indicating laterality for cataract procedures and using ICD or RVS codes instead of case rate codes on claims forms. New lower rates are established for some case rates in primary care facilities.

Uploaded by

Amanda Jones
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION


Citystate Centre Building, 709 Shaw Boulevard, Pasig City
Healthline 441-7444 [Link]
PHILHEALTH CIRCULAR
No. 009 s. 2014
TO : ALL PHILHEALTH MEMBERS, ACCREDITED HEALTH CARE PROVIDERS, PHILHEALTH REGIONAL
OFFICES (PROs), AND ALL OTHERS CONCERNED
SUBJECT : ACR POLICY NO. 3 --- ADDITIONAL LIST OF MEDICAL CONDITIONS FOR HOSPITALS, NEW
RATES FOR SELECTED CASE RATES IN PRIMARY CARE FACILITIESINFIRMARIES/DISPENSARIES,
AND CLARIFICATION OF EXISTING RULES ON ALL CASE RATES
I. INTRODUCTION
New policies have been implemented recently as part of the road to universal health care. Some of the signifcant changes include
the revision of PhilHealth categories of health care institutions (HCI) found in PhilHealth Circular 14, s. 2013, the shift in payment
mechanism to All Case Rates (PC 31 and 35, s. 2013) and the exemption of cataract surgery from the rule on single period of
confnement (PC 17, s. 2013).
In order to facilitate implementation of the aforementioned issuances and further explain certain policies, additional guidelines and
clarifcations are hereby issued.
II. SPECIFIC GUIDELINES
A. Primary Care Facility Rates
1. As contained in PhilHealth Circular (PC) 14, s. 2013 and PC 35, s. 2013, rates for the following six (6) case rates shall be paid at
70% of the rates stipulated in PC 35, s. 2013 for admissions from January 1, 2014 onwards in primary care facilitiesinfrmaries/
dispensaries:
Table 1. New Rates for Selected Case Rates in Primary Care FacilitiesInfrmaries/Dispensaries
Group Old Case Rate New Case Rate
i. Dengue Fever 10,000 7,000
ii. Pneumonia Moderate Risk 15,000 10,500
iii. Hypertensive Emergency/Urgency 9,000 6,300
iv. Acute Gastroenteritis 6,000 4,200
v. Asthma in Acute Exacerbation 9,000 6,300
vi. Typhoid Fever 10,000 7,000
2. Annex 5 of PC 35, s. 2013 is hereby amended. The complete list of medical case rates for primary care facilitiesinfrmaries/
dispensaries is in Annex 1 of this Circular.
3. Annex 6 of PC 35, s. 2013, List of Procedure Case Rates for Primary Care Facilities Infrmaries/Dispensaries shall still be
used as basis for reimbursement of claims for procedure case rates in primary care facilitiesinfrmaries/dispensaries.
B. Laterality of Procedures
The succeeding rules shall be applicable to all health care institutions that are allowed to claim for cataract package procedures:
1. An additional character shall no longer be required for Relative Value Scale (RVS) codes of cataract package procedures (RVS
66983, 66984 and 66987). Instead, the laterality of the procedure shall be indicated by checking the appropriate box in the
laterality column of item 7 of Claim Form 2 (CF2) (see Figure 1).
2. However, an additional character shall still be required for the International Statistical Classifcation of Diseases and Related
Health Problems 10th Revisions (ICD 10) codes for cataract cases as provided in PC 17, s. 2013.
7. Discharge Diagnosis/es (Use additional CF2 if necessary):
Diagnosis
ICD-10
Code/s
Related Procedure/s (If
theres any)
RVS Code Date of Procedure Laterality (Check above boxes)
a. Cataract, OS H25.20 i. phacoemulsifcation 66987 01-06-2014 Left Right Both
ii. Left Right Both
b. iii. Left Right Both
i. Left Right Both
Figure 1. Item 7 of CF 2 showing the portion (encircled) where laterality of procedure is indicated.
C. Case Rate Code
The following shall apply to all claims:
1. Clarifcation on item ii of Part IV.I.1.d. of PC 35, s. 2013: Instead of indicating the case rate codes as stated in the aforementioned
Circular, the referral (receiving) hospital shall indicate the appropriate ICD 10 or RVS code/s in the frst and second (if applicable)
case rate feld/s in Claim Form 2 (Part II, item 9).
2. There shall be no instance where the case rate codes are to be used in any of the claims. Only the appropriate ICD 10, RVS
or package codes are required for reimbursement.
D. Addendum to List of Medical Case Rates (Annex 1 of PC 35, s. 2013)
The following medical conditions in Table 2 shall be added to the List of Medical Case Rates that are reimbursable among all levels
of hospitals. These case rates shall be available as frst case rate only.
Table 2. Additional List of Medical Case Rates (Annex 1 of PC 35, s. 2013)
ICD Code Description
FIRST CASE RATE
Case Rate
Professional
Fee
Health Care
Institution Fee
Group: DIABETES MELLITUS WITH COMPLICATIONS OTHER THAN COMA AND KETOSIS
E10.2+ N08.3* Insulin-dependent diabetes mellitus with renal complications;
Glomerular disorders in diabetes mellitus
12,600 3,780 8,820
E11.2+ N08.3* Non-insulin-dependent diabetes mellitus with renal complications;
Glomerular disorders in diabetes mellitus
12,600 3,780 8,820
E12.2+ N08.3* Malnutrition-related diabetes; Glomerular disorders in diabetes
mellitus
12,600 3,780 8,820
E13.2+ N08.3* Other specifed diabetes mellitus; Glomerular disorders in
diabetes mellitus
12,600 3,780 8,820
E14.2+ N08.3* Unspecifed diabetes mellitus; Glomerular disorders in diabetes
mellitus
12,600 3,780 8,820
Group: MALIGNANT NEOPLASMS OF LYMPHOID, HEMATOPOIETIC AND RELATED TISSUE
C91.0 Acute lymphoblastic leukemia; Acute lymphocytic leukemia 13,900 4,170 9,730
Group: INFLAMMATORY DISEASE OF THE CENTRAL NERVOUS SYSTEM
B05.0+ G05.1* Measles complicated by encephalitis; Encephalitis, myelitis and
encephalomyelitis in viral diseases classifed elsewhere
21,600 6,480 15,120
Group: MENINGITIS
B05.1+ G02.0* Measles complicated by meningitis; Meningitis in viral diseases
classifed elsewhere
25,700 7,710 17,990
Group: OTITIS MEDIA
B05.3+ H67.1* Measles complicated by otitis media; Otitis media in viral diseases
classifed elsewhere
7,800 2,340 5,460
Group: INTESTINAL DISORDERS
B05.4 Measles with intestinal complications 9,500 2,850 6,650
Group: VIRAL INFECTION (ADMISSIBLE)
B05.8 Measles with other complications 7,700 2,310 5,390
B05.9 Measles without complications 7,700 2,310 5,390
Group: FLUID AND ELECTROLYTE DISTURBANCES
E87.0 Hyperosmolality and hypernatraemia; Sodium [Na] excess;
Sodium [Na] overload
8,500 2,550 5,950
Group: VIRAL INFECTION WITHOUT COMPLICATIONS
B01.9 Varicella [chickenpox] without complication 4,000 1,200 2,800
B06.8 Rubella with other complications 4,000 1,200 2,800
B06.9 Rubella without complication 4,000 1,200 2,800
B09 Viral exanthem 4,000 1,200 2,800
B34.1 Echovirus infection NOS 4,000 1,200 2,800
B34.2 Coronavirus infection, unspecifed 4,000 1,200 2,800
B34.3 Parvovirus infection, unspecifed 4,000 1,200 2,800
B34.4 Papovavirus infection, unspecifed 4,000 1,200 2,800
B34.8 Other viral infections of unspecifed site 4,000 1,200 2,800
B34.9 Viral infection, unspecifed; 4,000 1,200 2,800
Group: MALARIA WITHOUT COMPLICATIONS
B50.9 Plasmodium falciparum malaria 4,000 1,200 2,800
B51.9 Plasmodium vivax malaria without complications 4,000 1,200 2,800
B52.9 Plasmodium malariae malaria without complications 4,000 1,200 2,800
Group: PARASITIC INFECTION WITHOUT COMPLICATIONS
B65.1 Schistosomiasis due to Schistosoma mansoni [intestinal
schistosomiasis]
4,000 1,200 2,800
B65.2 Schistosomiasis due to Schistosoma japonicum 4,000 1,200 2,800
B65.3 Cercarial dermatitis; Swimmers itch 4,000 1,200 2,800
B65.8 Infection due to Schistosoma intercalatum, Schistosoma
mattheei, Schistosoma mekongi
4,000 1,200 2,800
B65.9 Schistosomiasis, unspecifed 4,000 1,200 2,800
B77.9 Ascariasis 4,000 1,200 2,800
B82.0 Intestinal helminthiasis, unspecifed 4,000 1,200 2,800
B82.9 Intestinal parasitism, unspecifed 4,000 1,200 2,800
Group: DIABETES MELLITUS WITHOUT COMPLICATIONS
E10.9 Non-insulin-dependent diabetes mellitus without complications 4,000 1,200 2,800
E14.9 Insulin dependent diabetes mellitus without complications 4,000 1,200 2,800
Group: HYPOGLYCEMIA
E16.2 Hypoglycemia 4,000 1,200 2,800
Group: DEHYDRATION
E86.1 Moderate dehydration 4,000 1,200 2,800
E86.2 Severe dehydration 4,000 1,200 2,800
ICD Code Description
FIRST CASE RATE
Case Rate
Professional
Fee
Health Care
Institution Fee
Group: CHRONIC HEART DISEASES WITHOUT COMPLICATIONS
I25.0 Atherosclerotic cardiovascular disease, so described 4,000 1,200 2,800
I25.1 Atherosclerotic heart disease; Coronary artery atheroma;
Coronary artery atherosclerosis; Coronary artery disease;
Coronary artery sclerosis
4,000 1,200 2,800
I25.3 Aneurysm of heart; Mural aneurysm; Venticular aneurysm 4,000 1,200 2,800
I25.4 Coronary artery aneurysm; Coronary arteriovenous fstula,
acquired
4,000 1,200 2,800
Group: UPPER RESPIRATORY TRACT INFECTION
J03.0 Streptococcal tonsillitis 4,000 1,200 2,800
J03.8 Acute tonsillitis due to other specifed organisms 4,000 1,200 2,800
J03.9 Acute tonsillitis, unspecifed; Acute tonsillitis NOS; Acute Follicular
tonsillitis; Acute Gangrenous tonsillitis; Acute Infective tonsillitis;
Acute Ulcerative tonsillitis
4,000 1,200 2,800
J06.0 Acute laryngopharyngitis 4,000 1,200 2,800
J06.8 Other acute upper respiratory infections of multiple sites 4,000 1,200 2,800
J06.9 Acute upper respiratory infection, unspecifed; Acute upper
respiratory disease; Upper respiratory infection NOS
4,000 1,200 2,800
J20.0 Acute bronchitis due to Mycoplasma pneumoniae 4,000 1,200 2,800
J20.1 Acute bronchitis due to Haemophilus infuenzae 4,000 1,200 2,800
J20.2 Acute bronchitis due to streptococcus 4,000 1,200 2,800
J20.3 Acute bronchitis due to coxsackievirus 4,000 1,200 2,800
J20.4 Acute bronchitis due to parainfuenza virus 4,000 1,200 2,800
J20.5 Acute bronchitis due to respiratory syncytial virus 4,000 1,200 2,800
J20.6 Acute bronchitis due to rhinovirus 4,000 1,200 2,800
J20.7 Acute bronchitis due to echovirus 4,000 1,200 2,800
J20.8 Acute bronchitis due to other specifed organisms 4,000 1,200 2,800
J20.9 Acute bronchitis, unspecifed 4,000 1,200 2,800
J22 Unspecifed acute lower respiratory infection 4,000 1,200 2,800
J40 Bronchitis, not specifed as acute or chronic 4,000 1,200 2,800
Group: DENTAL DISORDERS
K04.0 Pulpitis; Pulpal abscess; Pulpal polyp; Acute pulpitis; Hyperplastic
chronic pulpitis; Ulcerative chronic pulpitis; Suppurative pulpitis
4,000 1,200 2,800
K04.1 Necrosis of pulp; Pulpal gangrene 4,000 1,200 2,800
K04.2 Pulp degeneration; Denticles; Pulpal calcifcations; Pulpal stones 4,000 1,200 2,800
K04.3 Abnormal hard tissue formation in pulp; Secondary or irregular
dentine
4,000 1,200 2,800
K04.4 Acute apical periodontitis of pulpal origin; Acute apical
periodontitis NOS
4,000 1,200 2,800
K04.5 Chronic apical periodontitis; Apical or periapical granuloma;
Apical periodontitis NOS
4,000 1,200 2,800
K04.6 Periapical abscess with sinus; Dental abscess with sinus;
Dentoalveolar abscess with sinus
4,000 1,200 2,800
K04.7 Periapical abscess without sinus; Dental abscess NOS;
Dentoalveolar abscess NOS; Periapical abscess NOS
4,000 1,200 2,800
K04.8 Radicular cyst; Periodontal apical cyst; Periapical cyst; Residual
radicular cyst
4,000 1,200 2,800
K04.9 Other and unspecifed diseases of pulp and periapical tissues 4,000 1,200 2,800
Group: BOWEL MOVEMENT DISORDERS
K30 Dyspepsia 4,000 1,200 2,800
K31.0 Acute dilatation of stomach; Acute distension of stomach 4,000 1,200 2,800
K31.9 Disease of stomach and duodenum, unspecifed 4,000 1,200 2,800
K59.0 Constipation 4,000 1,200 2,800
Group: SKIN INFECTIONS
L02.0 Cutaneous abscess, furuncle and carbuncle of face 4,000 1,200 2,800
L02.1 Cutaneous abscess, furuncle and carbuncle of neck 4,000 1,200 2,800
L02.2
Cutaneous abscess, furuncle and carbuncle of trunk; cutaneous
abscess, furuncle and carbuncle of abdominal wall; cutaneous
abscess, furuncle and carbuncle of back [any part, except
buttock]; cutaneous abscess, furuncle and carbuncle of chest
wall; cutaneous abscess, furuncle and carbuncle of groin;
cutaneous abscess, furuncle and carbuncle of perineum;
cutaneous abscess, furuncle and carbuncle of umbilicus
4,000 1,200 2,800
L02.3
Cutaneous abscess, furuncle and carbuncle of buttock; cutaneous
abscess, furuncle and carbuncle of gluteal region
4,000 1,200 2,800
L02.4
Cutaneous abscess, furuncle and carbuncle of limb, axilla, hip
& shoulder
4,000 1,200 2,800
L02.8
Cutaneous abscess, furuncle and carbuncle of other sites: head
[any part, except face]; scalp
4,000 1,200 2,800
L02.9
Cutaneous abscess, furuncle and carbuncle, unspecifed;
Furunculosis NOS
4,000 1,200 2,800
Group: CUTANEOUS CYSTS
L72.0 Epidermal cyst 4,000 1,200 2,800
L72.1 Trichilemmal cyst; Pilar cyst; Sebaceous cyst 4,000 1,200 2,800
L72.2 Steatocystoma multiplex 4,000 1,200 2,800
L72.8 Other follicular cysts of skin and subcutaneous tissue 4,000 1,200 2,800
L72.9 Follicular cyst of skin and subcutaneous tissue, unspecifed 4,000 1,200 2,800
Group: UROLITHIASIS
N20.0 Calculus of kidney; Nephrolithiasis NOS; Renal calculus or stone;
Staghorn calculus; Stone in kidney
4,000 1,200 2,800
N20.1 Calculus of ureter; Ureteric stone 4,000 1,200 2,800
N20.2 Calculus of kidney with calculus of ureter 4,000 1,200 2,800
N20.9 Urinary calculus, unspecifed; Calculous pyelonephritis 4,000 1,200 2,800
Group: IRRADIATION CYSTITIS
N30.4 Irradiation cystitis 4,000 1,200 2,800
Group: URINARY TRACT INFECTION IN PREGNANCY
O23.1 Infections of bladder in pregnancy 4,000 1,200 2,800
O23.2 Infections of urethra in pregnancy 4,000 1,200 2,800
O23.4 Unspecifed infection of urinary tract in pregnancy 4,000 1,200 2,800
O23.5 Infections of the genital tract in pregnancy 4,000 1,200 2,800
O23.9 Other and unspecifed genitourinary tract infection in pregnancy;
Genitourinary tract infection in pregnancy NOS
4,000 1,200 2,800
Group: SUPERFICIAL INJURIES
S00.0 Superfcial injury of scalp 4,000 1,200 2,800
S00.1 Contusion of eyelid and periocular area; Black eye 4,000 1,200 2,800
S00.2 Other superfcial injuries of eyelid and periocular area 4,000 1,200 2,800
S00.3 Superfcial injury of nose 4,000 1,200 2,800
S00.4 Superfcial injury of ear 4,000 1,200 2,800
S00.5 Superfcial injury of lip and oral cavity 4,000 1,200 2,800
S00.7 Multiple superfcial injuries of head 4,000 1,200 2,800
S00.8 Superfcial injury of other parts of head 4,000 1,200 2,800
S00.9 Superfcial injury of head, part unspecifed 4,000 1,200 2,800
S01.0 Open wound of scalp 4,000 1,200 2,800
S01.1 Open wound of eyelid and periocular area 4,000 1,200 2,800
S01.2 Open wound of nose 4,000 1,200 2,800
S01.3 Open wound of ear 4,000 1,200 2,800
S01.4 Open wound of cheek and temporomandibular area 4,000 1,200 2,800
S01.5 Open wound of lip and oral cavity 4,000 1,200 2,800
S01.7 Multiple open wounds of head 4,000 1,200 2,800
S01.8 Open wound of other parts of head 4,000 1,200 2,800
S01.9 Open wound of head, part unspecifed 4,000 1,200 2,800
S61.0 Open wound of fnger(s) without damage to nail; Open wound of
fnger(s) NOS
4,000 1,200 2,800
S61.1 Open wound of fnger(s) with damage to nail 4,000 1,200 2,800
S61.7 Multiple open wounds of wrist and hand 4,000 1,200 2,800
S61.8 Open wound of other parts of wrist and hand 4,000 1,200 2,800
S61.9 Open wound of wrist and hand part, part unspecifed 4,000 1,200 2,800
S81.0 Open wound of knee 4,000 1,200 2,800
S81.7 Multiple open wounds of lower leg 4,000 1,200 2,800
S81.8 Open wound of other parts of lower leg 4,000 1,200 2,800
S81.9 Open wound of lower leg, part unspecifed 4,000 1,200 2,800
S91.0 Open wound of ankle 4,000 1,200 2,800
S91.1 Open wound of toe(s) without damage to nail; open wound of toe
(s) NOS
4,000 1,200 2,800
S91.2 Open wound of toe(s) with damage to nail 4,000 1,200 2,800
S91.3 Open wound of other parts of foot; open wound of foot NOS 4,000 1,200 2,800
S91.7 Multiple open wounds of ankle and foot 4,000 1,200 2,800
T00.0 Superfcial injuries involving head with neck 4,000 1,200 2,800
a
ICD Code Description
FIRST CASE RATE
Case
Rate
Professional
Fee
Health Care
Institution
Fee
T00.1 Superfcial injuries
involving thorax with
abdomen lower back
and pelvis
4,000 1,200 2,800
T00.2 Superfcial injuries
involving multiple
regions of upper limb(s)
4,000 1,200 2,800
T00.3 Superfcial injuries
involving multiple
regions of lower limb(s)
4,000 1,200 2,800
T00.6 Superfcial injuries
involving multiple
regions of upper limb(s)
with lower limb(s)
4,000 1,200 2,800
T00.8 Superfcial injuries
involving other
combinations of body
regions
4,000 1,200 2,800
T00.9 Multiple superfcial
injuries, unspecifed;
Multiple abrasions NOS;
Multiple non thermal
blisters NOS; Multiple
bruises NOS; Multiple
contusions NOS;
Multiple haematomas
NOS; Multiple
nonvenomous insect
bite NOS
4,000 1,200 2,800
*Note : Please refer to the International Statistical Classifcation of Diseases and
Related Health Problems 10th Revision (ICD 10), and Philippine ICD-10
Modifcations, October 2008 for the complete descriptions of the ICD 10
codes

E. Extension of Deadline for Return to Sender
Return to sender (RTS) of claims for correction/revision/completion shall be
allowed for claims with admission dates on or before June 30, 2014.
F. Resuscitation Package
1. As contained in the implementing guidelines of Republic Act (RA) 10606
otherwise known as the National Health Insurance Act of 2013, claims for
confnements of less than 24 hours shall be compensated if the patient
expired even if beyond the service capability of the HCI. The health care
institution shall be reimbursed a fxed rate of 4,000 pesos with HCI fee
and professional fee (PF) computed at 70% and 30% respectively.
2. For purely medical cases and cases where a procedure has been started
but not completed, the HCI shall utilize the code P00000 as the frst
case rate code and write this on item 9 (PhilHealth Benefts) of CF2. The
complete and fnal diagnosis/es shall still be refected in item 7 of CF2.
For cases where a procedure was completed or where confnement is
more than 24 hours, existing rules shall still apply.
3. P00000 cannot be used as a second case rate. Also, second case rate
may not be claimed along with code P00000.
4. P00000 shall be available for all health care institutions. Along with the
usual requirements for fling of claims, the HCI shall also provide proof
that resuscitative measures were done to the patient in the form of a
certifed true copy of the doctors and nurses notes.
5. Claims for P00000 shall be subject to post-audit monitoring and
evaluation.
G. The time of death shall be the basis of the time of discharge in determining the
number of confnement days.
H. Chemotherapy
Only one (1) cycle of chemotherapy shall be claimed in the claim form 2. The
HCI shall follow the guidelines on chemotherapy found in Annex 11 of PC 35
s. 2013.
I. Photocopy of records of anesthesia and surgical or operative techniques shall
be accepted in lieu of original or certifed true copy. Records of anesthesia
shall be required for the management of all general and spinal anesthesia.
J. Special Consideration for Direct Filing of Claims for Selected Cases that
were either Denied or Not Filed and Adjustment of Reimbursement
1. Direct fling of members shall be allowed for all medical conditions listed
in Table 2-Additional List of Medical Case Rates (Annex 1 of PC 35 s.
2013) for all hospital admissions starting January 1, 2014 until March 20,
2014. Starting March 21, 2014, direct fling shall no longer be allowed.
Hence, the correct case rate amount shall be deducted by the health care
institutions prior to the discharge of the patient.
2. Direct fling shall also be allowed for admissions starting January 1, 2014
to March 20, 2014 for confnements of less than 24 hours where the
patient expired including confnements beyond service capability. The
member shall be reimbursed a fxed rate of 4,000 pesos.
3. The case rate amounts for the following medical conditions are adjusted
in primary care facilitiesinfrmaries/dispensaries:
Description From To
1
Measles complicated by otitis media;
Otitis media in viral diseases classifed
elsewhere
2,800 5,460
2 Measles with intestinal complications 2,800 6,650
3 Measles without complications 2,800 5,390
4
Hyperosmolality and hypernatraemia;
Sodium [Na] excess; Sodium [Na] over-
load
2,800 5,950
The complete breakdown (including HCI fee and PF) is found in Annex 1 (Revised
Annex 5 of PC 35 s. 2013) of this Circular.
Patients who were admitted in primary care facilities for these four medical
conditions shall be allowed to claim for adjustment of reimbursement.
Requirements for fling of adjustment for reimbursement include offcial receipts
or its equivalent and a completely flled-out adjustment form.
4. All claims for special consideration shall be processed subject to existing
rules of the Corporation.
K. Single Period of Confnement
The reckoning for the single period of confnement (SPC) shall be refreshed
for all admissions starting January 1, 2014. For example, a hospital claim
for pneumonia MR admitted on January 1, 2014 shall be paid regardless of
history of previous admissions.
L. The Newborn Care Package (NCP) shall be included in the list of case rates
allowed as second case rate for hospitals with admissions starting January
1, 2014.
Table 3. Additional List of Medical Conditions and Procedures Allowed as
Second Case Rates (Annex 3 of PC 35, s. 2013)
RVS
Code
Description
SECOND CASE RATE
Case
Rate
Professional
Fee
Health Care
Institution Fee
99432
Normal
Newborn Care
Package
1,750 500 1,250
III. REPEALING CLAUSE
All provisions of previous issuances that are inconsistent with any provisions of
this Circular are hereby amended/modifed/or repealed accordingly.
IV. SEPARABILITY CLAUSE
In the event that a part or provision of this Circular is declared unauthorized or
rendered invalid by any Court of Law or competent authority, those provisions not
affected by such declaration shall remain valid and effective.
V. EFFECTIVITY
This Circular shall take effect for all admissions starting January 1, 2014. It shall
be published in any newspaper of general circulation and shall be deposited
thereafter with the National Administrative Register at the University of the
Philippines Law Center.
VI. ANNEXES
Annex 1: List of Medical Case Rates for Primary Care Facilities-Infrmaries/
Dispensaries (Revised Annex 5 of PC 35, s. 2013) (refer to [Link].
ph)
ALEXANDER A. PADILLA
President and CEO
Date Signed: February 20, 2014

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