Question & AnswerQ&A (PHIC PHILHEALTH CIRCULAR NO. 31, S. 2009)
The compensable anesthesia services are: a) General anesthesia administered as inhaled or injected anesthetics, b) Regional anesthesia including spinal, epidural, or peripheral nerve blocks, and c) Sedation given via injection, mouth, rectum or nasal route.
No, the professional fee for local anesthesia through infiltration, drops, spray, or ointment is non-compensable. However, claims for the local anesthetic agent itself may be reimbursed under drugs and medicines subject to guidelines.
MAC is a physician service by an anesthesiologist involving local anesthesia with or without sedation and analgesia, where the anesthesiologist monitors and manages the patient’s vital signs and anesthesia depth, adjusting or converting to general anesthesia as needed.
MAC includes preoperative visit, intraoperative care, and postoperative anesthesia management.
Reimbursement is allowed if: i) MAC is performed to facilitate certain PhilHealth-covered procedures, and ii) The patient's clinical condition justifies MAC presence, such as extreme age, cognitive or psychological impairments, extreme anxiety disorders, systemic diseases, or critical illness.
No, MAC professional fees for diagnostic procedures and services with no relative value units shall not be reimbursed.
No, MAC services for cataract surgery paid via case payment (RVS codes 66983, 66984, 66987) are not covered by PhilHealth.
A properly accomplished Anesthesia Record must be attached to the PhilHealth Claim Forms along with the Operative Technique documentation.
The circular took effect for all claims with admission dates starting September 1, 2009.
Yes, as long as their provisions are not inconsistent with this circular, previous issuances remain in effect.