LUNG CENTER OF THE PHILIPPINES

PHILHEALTH CASE RATES

MOST COMMON MEDICAL CASE RATES

ICD CODE DESCRIPTION CASE RATE PROF. FEE HCI FEE
J85.2 Lung Abscess 10,000 3,000 7,000
J86.9 Empyema Thoracis 10,000 3,000 7,000
J43.9 Emphysema 11,400 3,420 7,980
J93.1 Spontaneous Pneumothorax 15,300 4,590 10,710
J93.9 Pneumothorax 15,300 4,590 10,710
A15.0 PTB ( + sputum ) 9,800 2,940 6,860
A16.0 PTB bacteriology & histologically 9,800 2,940 6,860
negative
A16.2 PTB w/o mention of bacteriology 9,800 2,940 6,860
or histologically; Tuberculous
Bronchiectasis
A19.9 Miliary Tuberculosis 15,100 4,530 10,570
A15.1 MDRTB confirmed by Culture 9,800 2,940 6,860
A16.9 PTB 9,800 2,940 6,860
J44.1 COPD IN A.E 12,200 3,660 8,540
J44.9 COPD 12,200 3,660 8,540
J90 Pleural Effusion 14,200 4,260 9,940
J18.92 Pneumonia, Mod. Risk 15,000 4,500 10,500
J18.93 Pneumonia, High Risk 32,000 9,600 22,400
J18.99,Y95 Nosocomial Pneumonia 32,000 9,600 22,400
J69.0 Aspiration Pneumonia 14,700 4,410 10,290
J86.0 Pyothorax with fistula 10,000 3,000 7,000
J98.4 Pulmonary Mass 10,200 3,060 7,140
I26.9 Pulmonary Embolism 24,300 7,290 17,010
 I27.0 Pulmonary Hypertension 14,100 4,230 9,870
J45.90 Bronchial Asthma In A.E 9,000 2,700 6,300
J46 Status Asthmaticus 9,000 2,700 6,300
J45.00 Allergic Bronchitis, Allergic Asthma 9,000 2,700 6,300
Allergic Rhinitis
J98.1 Atelectasis 13,800 4,140 9,660
J96.0 Acute Respiratory Failure 32,000 9,600 22,400
J96.1 Chronic Respiratory Failure 32,000 9,600 22,400
J96.9 Respiratory Failure 32,000 9,600 22,400
A41.9 Sepsis 32,000 9,600 22,400
R57.0 Cardiogenic Shock 32,000 9,600 22,400
R57.1 Hypovolemic Shock 32,000 9,600 22,400
C15.9 Esophageal Carcinoma 14,200 4,260 9,940
C50.9 Breast Carcinoma 11,800 3,540 8,260
C18.9 Colon Carcinoma 14,200 4,260 9,940
C20 Rectal Carcinoma 14,200 4,260 9,940
C22.9 Liver Carcinoma 14,200 4,260 9,940
C22.0 Hepatocellular Carcinoma 14,200 4,260 9,940
C56 Carcinoma of the Ovary 11,400 3,420 7,980
C02.9 Tongue Carcinoma 11,500 3,450 8,050
C16.9 Gastric Carcinoma 14,200 4,260 9,940
C19 Colorectal Carcinoma 14,200 4,260 9,940
C53.9 Cervical Carcinoma 11,400 3,420 7,980
C11.9 Nasopharyngeal Carcinoma 11,500 3,450 8,050
C81.9 Hodgkins Lymphoma 13,900 4,170 9,730
C85.9 Non-Hodgkins Lumphoma 13,900 4,170 9,730
C61 Prostate Carcinoma 13,400 4,020 9,380
C34.9 Lung Carcinoma 14,600 4,380 10,220
C37 Thymic Carcinoma 14,600 4,380 10,220
C78.2 Malignant Pleural Effusion 14,600 4,380 10,220
C73 Thyroid Carcinoma 11,400 3,420 7,980
C79.5 Secondary Malignant of bone & bone marrow 16,500 4,950 11,550
C79.3 Secondary Malignant of brain & cerebral meninges 16,900 5,070 11,830
C78.0 Secondary Malignant of the Lung 14,600 4,380 10,220
D38.3 Neoplasm of uncertain or unknown 12,200 3,660 8,540
of Mediastinum
I49.9 Cardiac Arrhythmia 12,200 3,660 8,540
I42.0 Dilated Cardiomyopathy 13,400 4,020 9,380
I42.9 Cardiomyopathy 13,400 4,020 9,380
I50.0 Congestive Heart Failure 15,700 4,710 10,990
I09.9 Rheumatic Heart Disease 15,700 4,710 10,990
I10.9 Hypertension 9,000 2,700 6,300
I10.1 Hypertension St. II 9,000 2,700 6,300
I11.9 HCVD/ Hypertensive Atherosclerotic 9,000 2,700 6,300
Cardiovascular Disease
I21.9 Acute Myocardial Infarction 18,900 5,670 13,230
I25.9 Ischemic Heart Disease 12,000 3,600 8,400
I20.0 Unstable Angina 12,000 3,600 8,400
Acute Coronary Syndrome
I20.9 Angina 12,000 3,600 8,400
I64 Stroke 28,000 8,400 19,600
I63.9 Cerebral Infarction 28,000 8,400 19,600
G45.9 Transient Ischemic Attack 7,300 2,190 5,110
K76.0 Fatty Liver 11,800 3,540 8,260
K74.6 Liver Cirrhosis 15,100 4,530 10,570
L03.9 Cellulitis 9,600 2,880 6,720
N08.9 Chronic Renal failure 14,500 4,350 10,150
N18.0 End Stage Renal Disease 14,500 4,350 10,150
A90 Dengue 10,000 3,000 7,000
A91.1 Dengue Hemorrhagic Fever St. II 10,000 3,000 7,000
A91.3 Dengue Shock Syndrome 16,000 4,800 11,200
K80.2 Cholecystolithiasis 9,800 2,940 6,860
 Cholelithiasis
K80.5 Choledocholithiasis 9,800 2,940 6,860
I71.9 Aortic Aneurysm 13,100 3,930 9,170
E87.8 Electrolyte Imbalance 8,500 2,550 5,950
E87.5 Hyperkalemia 8,500 2,550 5,950
K21.9 GERD 6,100 1,830 4,270
E87.1 Hyponatremia 8,500 2,550 5,950
E87.6 Hypokalemia 8,500 2,550 5,950
N03.9 Chronic Renal Disease 10,000 3,000 7,000
G43.9 Migraine 5,500 1,650 3,850
I50.9 Heart Failure 15,700 4,710 10,990
J11.1 Influenza 6,600 1,980 4,620
E46 Malnutrition 11,700 3,510 8,190
K29.7 Gastritis 6,100 1,830 4,270
K29.1 Acute Gastritis 6,100 1,830 4,270
K29.5 Chronic Gastritis 6,100 1,830 4,270
N40 BPH 9,200 2,760 6,440
N39.0 Urinary Tract Infection 7,500 2,250 5,250
D56.9 Thallasemia 10,000 3,000 7,000
D64.9 Anemia 10,000 3,000 7,000
A09.9 Acute Gastroenteritis 6,000 1,800 4,200
A09.0 Infectious Diarrhea 6,000 1,800 4,200
M13.99 Arthritis 7,000 2,100 4,900
M06.99 Rheumatoid Arthritis 7,000 2,100 4,900