Compensation Guidelines for Surgical Missions

Services performed during medical/surgical missions are presumed covered and paid for by sponsors or donors.
PhilHealth will manage claims according to this presumption to avoid double payment.

Surgical procedures done during medical missions in private facilities are not compensable.
Examples include cataract extraction (Phacoemulsification), cleft palate repair (Cheiloplasty), removal of ingrown toenail, and circumcisions.

Surgical procedures during medical missions sponsored by the National Government or Local Government Units are compensable if done in PhilHealth-accredited government facilities.
Covered facilities include Ambulatory Surgical Care Clinics, and Level II, III, and IV hospitals.
Professional fees must be pooled and distributed among facility personnel according to Rule VIII Section 7 of the Implementing Rules and Regulations of RA 7875, as amended by RA 9241.

Foreign doctors participating in surgical medical missions are prohibited from filing claims for reimbursement for PhilHealth members or their dependents.
Violation will be reported to the Department of Health and Professional Regulatory Commission for action.

PhilHealth will conduct regular utilization reviews and validate admissions.
Evaluation aims to monitor quality of care and proper adherence to policies concerning medical missions.
Detection of claims fraudulently represented as part of a medical mission results in withholding of reimbursement pending validation.

Claims confirmed as part of medical missions but submitted improperly will be denied.
Healthcare providers must refund payments from previously paid claims related to the same mission or have these charges applied to future claims.
Legal sanctions may be imposed.
Claims proven not to be related to medical missions will be processed normally.

All inconsistent previous issuances are repealed or modified.
The Circular takes effect fifteen (15) days after publication in the official gazette and newspapers of general circulation.