The Philippine Health Insurance Corporation (PhilHealth) is committed to making healthcare accessible and affordable for every Filipino. A key aspect of this commitment is its Relative Value Scale (RVS) code system, which standardizes the benefits provided for various medical procedures.
Understanding the RVS codes can help you maximize your PhilHealth benefits and reduce out-of-pocket expenses. To illustrate, let’s explore how these codes work and look at specific examples of procedures and their associated rates.
What is the RVS Code?
The RVS code is a classification system that assigns a unique code and value to medical procedures based on their complexity and resource requirements. This ensures consistent reimbursement rates for healthcare providers while making it easier for patients to estimate their medical expenses.
Each procedure has a predetermined case rate, which is divided into two components:
- Professional Fee (PF): The portion paid to the attending healthcare provider.
- Health Care Institution Fee (HCI): The portion paid to the hospital or clinic for facility use, supplies, and other services.
Examples of RVS Codes and Case Rates
Below are some common procedures, their RVS codes, and corresponding PhilHealth case rates:
| RVS Code | Description | Case Rate | Professional Fee | Health Care Institution Fee |
|---|---|---|---|---|
| 10060 | Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia) | ₱2,548 | ₱588 | ₱1,960 |
| 10080 | Incision and drainage of pilonidal cyst | ₱2,548 | ₱588 | ₱1,960 |
| 10120 | Incision and removal of foreign body, subcutaneous tissues | ₱2,548 | ₱588 | ₱1,960 |
| 10140 | Incision and drainage of hematoma, seroma, or fluid collection | ₱2,548 | ₱588 | ₱1,960 |
| 10160 | Puncture aspiration of abscess, hematoma, bulla, or cyst | ₱2,548 | ₱588 | ₱1,960 |
| 10180 | Incision and drainage, complex, postoperative wound infection | ₱3,892 | ₱882 | ₱3,010 |
| 11040 | Debridement; skin, partial thickness | ₱2,548 | ₱588 | ₱1,960 |
| 11041 | Debridement; skin, full thickness | ₱2,548 | ₱588 | ₱1,960 |
| 11042 | Debridement; skin and subcutaneous tissue | ₱3,976 | ₱1,176 | ₱2,800 |
CLICK HERE to see Philhealth full RVS Codes
How to Use the RVS Code
- Before Treatment: Ask your doctor or healthcare provider for the RVS code of any procedure you plan to undergo.
- Estimate Costs: Use the RVS code to determine the case rate and know how much PhilHealth will cover for the professional fee and healthcare institution fee.
- Avoid Financial Surprises: By understanding these rates, you can better prepare for any potential out-of-pocket expenses.
Maximize Your PhilHealth Benefits
The RVS code system is more than a technical tool—it’s a valuable resource for patients. Knowing the case rates and coverage details empowers you to make informed healthcare decisions.
Remember, every peso counts when it comes to medical expenses. By understanding PhilHealth’s RVS code system, you can take full advantage of your benefits and significantly reduce your healthcare costs.
Got questions or want to know more about specific procedures? Share them in the comments below!