PhilHealth Surgery Case Rate Calculator
Estimate surgical case rate benefits, facility & doctor fees, and out-of-pocket balance
Updated with PC 2024-0037 Rates
1. Select Surgical Procedure
RVS: 44950
Add Secondary Surgical Procedure
Calculated at 50% under PhilHealth 2nd Case Rate policy
2. Hospital & Billing Details
3. Discounts & Secondary Coverage
Senior Citizen (RA 9994) / PWD (RA 10754)
Applies 12% VAT exemption + 20% statutory discount
Patient Billing Guide & Frequently Asked Questions
How does the PhilHealth Case Rate system work for surgeries?
PhilHealth uses an All-Case-Rate (ACR) system where each surgical procedure (identified by an RVS code) has a fixed predetermined coverage amount regardless of the length of hospital stay. This package is split between the Health Care Institution (HCI) Fee (covers operating room, hospital bed, standard medications, and supplies) and the Professional Fee (PF) (covers the surgeon and anesthesiologist).
What is the No Balance Billing (NBB) policy?
Under the No Balance Billing policy, accredited government and public hospitals are prohibited from charging qualified members (Indigent, Sponsored, Senior Citizens, and Kasambahay) any out-of-pocket costs when admitted in basic service ward beds for covered surgical procedures.
How are Senior Citizen and PWD discounts deducted with PhilHealth?
In accordance with Republic Act No. 9994 and Republic Act No. 10754, the statutory deduction sequence is:
1. Deduct 12% VAT (if applicable in private facilities).
2. Deduct the 20% Senior Citizen / PWD discount on eligible hospital charges and professional fees.
3. Deduct the fixed PhilHealth Case Rate benefit.
4. Any remaining balance is payable by the patient or their HMO.
1. Deduct 12% VAT (if applicable in private facilities).
2. Deduct the 20% Senior Citizen / PWD discount on eligible hospital charges and professional fees.
3. Deduct the fixed PhilHealth Case Rate benefit.
4. Any remaining balance is payable by the patient or their HMO.
What is the 50% Second Case Rate rule?
If a patient undergoes two distinct covered surgical operations during the same hospitalization, PhilHealth allows reimbursement of 100% of the case rate for the primary procedure (the one with the higher rate) plus 50% of the case rate for the allowed secondary procedure.
Has the 45-day confinement limit been removed?
Yes. Under PhilHealth Circular No. 2025-0007, the historical 45-day annual confinement limit rule has been lifted for medical and surgical cases under All Case Rates, ensuring continuous financial risk protection.