ENT PROCEDURE	RVS	Rate
Otoscopy	PART OF OUT PATIENT CONSULTATION
Anterior Rhinoscopy	PART OF OUT PATIENT CONSULTATION
Oral and Oropharyngeal Direct Examination	PART OF OUT PATIENT CONSULTATION
Head and Neck Direct Examination	PART OF OUT PATIENT CONSULTATION
Procedures not listed will have additional charges:
ENT PROCEDURE	RVS	Rate (inclusive of consultation fee)
Ear Suctioning and/or Ear cleaning	RUV 10	1,000
Aural irrigation	RUV 10	1,000
Removal of Cerumen	RUV 12	1,200
Removal of Foreign Bodies (Ear)	RUV 12	1,200
Tuning Fork Testing	RUV 8	800
Nasal Decongestion with Suctioning	RUV 10	1,000
Intranasal irrigation	RUV 10	1,000
Removal of Foreign Bodies (Nose)	RUV 12	1,000
Trans-illumination of sinuses	RUV 10	1,000
Posterior Rhinoscopy	RUV 12	1,200
Indirect Laryngoscopy w/ defogging solution	RUV 12	2,000
Cauterization of Aphthous Ulcers	RUV 8	800
Video Otoscopy / Pneumatic otoscopy		2,000
Test for Smell and Taste		2,000
Repositioning Maneuver for BPPV		2,000
Test for Vertigo		1,500
OTHER ENT PROCEDURES
ENT PROCEDURE	RVS	Rate
Acne Surgery	10060 = 10 units	1,200
Application of Lidocaine to Mouth Sores		Part of Consult
Application of Oral Antiseptic		Part of Consult
Aspiration of Infected Pre-auricular Cyst	12 units	1,440
Aspiration of Thrombus		1,500
Audiogram for both ears		450
Audiometry		350
Audiometry Brainstem Response		1,400
Aural Toilet		600
Brandt Daroff Maneuver, Vestibular Rehabilitation and Cervical Exercise		1,500
Cleaning of Tracheostomy Tube		Part of Consult
Control of Nasal Bleeding/Hemorrhage	30905 = 30 units	3,600
Dermatoscopy		1500-2000
Direct Laryngoscopy	20 units	2,400
Ear Packing	10 units	1,200
Ear wick		500
Endoscopic-Guided Removal of Fish Bone	30 units	3,600
Esophagogastroduodenoscopy	43235 = 60 units	7,200
Eustachian Tube Insufflation	69400 = 18 units	2,160
Excision of post auricular cyst	20 units	2,400
Extraction of FB Nostril		1,000
Eye Flushing	10 units/eye	1200/eye
FESS Functional Endoscopic Sinus Surgery	31256 = 100 units	12,000
Fiber Optic Laryngoscopy	31575 = 80 units	9,600
Flexible Endoscopy		1,200
FNAB of Thyroid	60100 = 40 units	4,800
FNAB Parotid Mass	42400 = 15 units	1,800
Gram Stain		Part of Consult
Head Turn Maneuver		2,000
Hypopharyngoscopy	12 units	1,440
Instrument Fee for Ear Cleaning/Ear Suctioning		600
Instrument Fee for Removal of Tonsiloliths		2,000
Intranasal Removal of Debris Bilateral Nostril (General Anesthesia)	30310 = 30 units	3,600
Lacrimal Apparatus Irrigation		200
Lacrimal Apparatus Probing		200
Lacrimal Irrigation		600
Lubrican Drops		Part of Consult
Membrane Peeling		500
Menthol Inhalation		Part of Consult
Micro Otoscopy		Part of Consult
Nasal Decongestion		500
Nasal Decongestion alone		500
Nasal Decongestion w/ polymerization		1,000
Nasal Drainage of Mucopath with Pneumatizatio of Eustachian Tube	10 units	1,200
Nasal Endoscopy	31231 = 60 units	7,200
Nasal Packing		1,000
Nasal Polypectomy	30110 = 30 units	3,600
Nasal Rigid Light Source		1,200
Nasal Saline Washing		Part of Consult
Nasal Stent		1,500
Nasal Suctioning		500
Nasal Toilet		250
Nasopharyngeal scoping		1,200
Nystagmography	10 units	1,200
Oral Lavage		500
Oral Spray		Part of Consult
Oropharyngeal washing		500
Otoendoscopy		1,000
Otowich Insertion		500
Pan-retinal photocoagulation (dx: branch retinal vein occlusion)	67107 = 300 units	36,000
Patch Test for Perforated Tympanic Membrane		1,000
Pneumatoscopy/Pneumatic Otoscopy		Part of Consult
Politzer Test		Part of Consult
Positional Nystamography		1,500
Positioning Test		1,500
Posturography		2,000
Radio Frequency Simul-assisted Turbinoplasty	30801 = 50 units	6,000
Release of tongue tie		1,800
Removal of Aural Pack		600
Removal of Foreign Body in General Anesthesia – Unilateral / Bilateral (EARS)	69200 = 25 units	3,000
Removal of Foreign Body in General Anesthesia – Unilateral / Bilateral (NOSTRILS)	30310 = 30 units	3,600
Removal of Nasal Crust		Part of Consult
Removal of Nasal Pack		Part of Consult
Removal of Nasal Scabs with Suctioning		Part of Consult
Removal of Nasal Vestibular Hair		Part of Consult
Removal of Tonsillar Mass via Cauterization	42808/ 42860 = 30 units	3,600
Removal of Tonsilolith & Cautery		1,000
Repositioning maneuver for BPPV (Regardless whether 2 or more maneuvers are performed, apply only one rate) - Vestibular rehabilitation - Brandt-Daroff maneuver	20 units	2,400
RF Turbninoplasty & Palatoplasty	150 units	18,000
Rhinopharyngoscopy		1,600
Rhinoscopy w/ cauterization of nasal vestibulitis (2-4 LESIONS)	11051 = 15 units	1,800
Rhinoscopy w/ cauterization of nasal vestibulitis (MORE THAN 4 LESIONS)	11052 = 20 units	2,400
Rhinoscopy w/ cauterization of nasal vestibulitis (SINGLE LESION)	11050 = 10 units	1,200
Romberg Test		Part of Consult
Simon's Maneuver for BPPV		Part of Consult
Sinus irrigation	31000 = 25 units	3,000
Sinus Surgery	31070 = 80 units	9,600
Suctioning of Nasopharynx		500
Suctioning of Tonsil Keratosis under Topical Anesthesia	10 units	1,200
Suspension Laryngoscopy		7,500
Suturing Inner Lips		500
Throat Swab		650-1000
Tonsilectomy	42825 = 100 units	12,000
Toynbee Maneuver		400 (Consult fee)
Tympanogram		400
Tympanometry		400
Uvulo Palato Pharyngoplasty	42145 = 150 units	18,000
Vestibular Exercise		250
Video Laryngoscopy/ Laryngoscopy	31525 = 30 units	3,600
Videonystagmoscopy (+ audiometry)		1,500

OPHTHALMOLOGY PROCEDURE	RVS	Rate	Remarks
Complete History	PART OF OUT PATIENT CONSULTATION
Visual Acuity Determination / Visual Acuity Assessment	PART OF OUT PATIENT CONSULTATION
Gross Examination	PART OF OUT PATIENT CONSULTATION
Extraocular Muscle Testing / Extraoccular Muscle Exam	PART OF OUT PATIENT CONSULTATION
Pupillary Examination	PART OF OUT PATIENT CONSULTATION
Digital Palpation	PART OF OUT PATIENT CONSULTATION
Direct Ophthalmoscopy	PART OF OUT PATIENT CONSULTATION
2. The following procedures are indicated to the basic ophthalmic exam but requires additional skills, equipment and supplies. They shall be considered PREAPPROVED.
OPHTHALMOLOGY PROCEDURE	RVS	Rate	Remarks
Slit Lamp Examination		100
Manifest Refraction		100
Diital Tonometry		50
3. The following are additional procedures that may be needed to complete a specialized exam. For approval by coordinator.
OPHTHALMOLOGY PROCEDURE	RVS	Rate	Remarks
Schirmer’s Test / Dry Eye Test / Tear Break Up Time (TBUT)		50
Vital Dye Staining		50
Stereo Testing		50
Color Testing		50
Prism Testing		50
Hertel’s Exophthalmometry		50
Cycloplegic Refraction / Objective Refraction		150
Gonioscopy		100
Dilated Fundus Exam / Funduscopy		100
OTHER OPHTHA PROCEDURES				F
OPHTHALMOLOGY PROCEDURE	RVS	Rate	Calamba Eye Center Rate	Remarks
90 degree Macular Exam		100
A-Scan		350
ABA Stain Injection for Retinal Neovascularization/ Retinopathy		6,500
Accommodation Test		Part of Consult
AFT (Ophtha Procedure)	67228 = 80 units	9,600		Procedure and PF
Amsler Grid		400 (Consult fee)
Ant. Segment reconstruction, lens reconstruction , Ant. Viterectomy	140 units	16,800
Anterior Chamber Reformation (trabeculectomy)	66172 = 180 units	21,600
Anterior Orbitotomy (Sebaceous Cyst-eye)	67415 = 300 units	36,000		Doc May 03.19.09
Anterior Segment Staining		500
Antibiotic treatment and Eyepatch ( ointment )		Part of Consult
Applanation Tonometry		180	450
Argon Laser treatment	67228 = 80 units	9,600	2500
Aspiration of eyelid	67835 = 25 units	3,000
Automated Perimetry		1,200
Automated Refraction		BIOMISC
Automated Visual Field		1,200
B-Scan		1,500		emailed by Ms. Dang 12.02.09
Basal Tear Test		Part of Schirmer's Test
Biometry	1 / both eyes	300	577.50
Biomicroscopy		100		Dr. Sheila / New AMOPHI 12/16/10
Color Vision Test (Farnsworth Hue Test)			625
Concretion of eye	67840 = 15 units	1,800
Confrontation Test		Part of Consult
Confrontation Test		Part of Consult
Conjunctival Scraping	68110 = 10 units	1,200
Corneal Anesthesia Test (both eye)		50
Corneal Repair	65285 = 150 units	18,000
Corneal Staining with Flourescein Dye Test		500 (procedure and consult)		emailed by Ms. Emmylou Fajutagana 09.23.10
Corneal Topography/ Photokeratoscopy / Videokeratography		700/eye
Corneal Ulcer for culture & sensitivity		150 for both eyes
Cover/Uncover Test		100
Densitometry		Part of Consult
Depth Perception Test		Part of Consult
Dilated Retinal Exam		500/eye
Disc Photo		750
Diurnal Intraoccular Pressure Test		300/hour
Diurnal Intraocular Pressure Test		300/hour
Drainage of canaliculitis	67700 = 20 units	2,400
Dye Disappearance Test		180
Electroepilation		250
Electroretinography (Adult)		2,056
Entropion Repair	67930 = 50 units	6,000
Epilation		400 ( adult ) / 600 ( pedia )
Excision and Repair if Lid over 1/4 of Lid Margin	67966 = 180 units	21,600
Expression of meibomian gland		600
Extermal Ocular Photography		Part of Consult
Eye Exam		Part of Consult
Eye irrigation		600/eye
Eye Pressure Determination Tono-Pen		50
FA (Flourescein Angiography)		2,100	2887.50
FDT – Frequency doubling technique		1000 for both eyes
FDT – Frequency doubling technique	11400-11406 = 10 units	1,200
Flourescein disappearance		150
Flourescein Dye Test / Flourescein Staining		Part of Consult
Focal Laserphotocoagulation		10,000/eye
Frequency Doubling Technique (optha)		150/eye		doc may (10/23/09)
Frequency Doubling Technology Perimetry		1,200
Fundus Disc Photos		750	1155
Fundus Fluorescein Angiogram		2,100
Fundus Photography		750
Glacouma/Retinal Screening		500/eye
Gonioplasty	65855 = 80 units	9,600
Heidelberg Retinal Tomography		300
Heidelberg retinal Tomography(HRT)		2200 for both eyes
High Myopic Screening		600
Hirschberg Test		100
Incision & Drainage of Hordeolum	67800 = 20 units	2,400	4500
Incision and Curettage of Chalazion aka Meibomian Cyst	67700 = 20 units	2,400	4000
Incision and Curettage of Hordeolum	67700 = 20 units	2,400
Indirect Opthalmoscopy		300/eye	475
Intra Occular Pressure Measurement		4,000
Intraocular Pressure Monitoring		50
Ishihara Test		Part of Consult
Keratectomy	65400 = 40 units	4,800
Keratometry		800		verified by maya 05.12.10
Lacrimal Apparatus Irrigation		800	500
Lacrimal Apparatus Probing		800
Lensometry		200
Lenstar Biometry		300
Levato Function Test		50
Lid Eversion		Part of Consult
Lid Scrubbing / Eye Scrubbing		200 (both eyes)
Lissamine Green Test		Part of Consult
Macular Exam		100
Marginal Reflex Distance Measurement		Part of Consult
Measurement of Central Corneal Thickness		700
Meibomian Cyst Excision		1,000
Motility Test		Part of Consult
Nasolacrimal Duct probing		2000/side
Near point accom.		Part of Consult
Near point accom.		Part of Consult	2500
Octopus Perimetry		1,400
Optic Nerve Exam		100
Orbital Ultrasound		500
Pachymetry		1,200
Pachymetry		700
Pan Optic Opthalmoscopy		300/eye
Panretinal Pathology		1,400
Panretinal photocoagulation		7,500
Pars Plana Vitrectomy	67036 = 300 units	36,000
PCIOL posterior chamber IOL exchange (dx:corneal steepening)		7,800
Perimetry		1,200	2310
Phenylephrine Provocation		1,500
Phoria test		400
Pinhole Test		Part of Consult
Posterior Capsulectomy	66830 = 80 units	9,600
Posterior Vitrectomy	67005 = 250 units	30,000
Potential Acuity Meter (PAM)		400 (Consult fee)
Pterygium Excision with grafting	65426 = 50 units	6,000	4300/eye
Quantel Biometry		300
Release of Synechia	30560 = 40 units	4,800
Removal of Bandage Contact Lens		Part of Consult
Removal of Conjunctival Membrane	68110 = 10 units	1,200
Removal of conjunctival stone		1,000
Removal of Discharge for Bacterial Conjunctivitis/ Removal of Membrane		500
Removal of Drain Disc	10 units	1,200
Removal of Filament on the Corneal	65210 = 30 units	3,600
Removal of Foreign Body ( Corneal / Conjunctiva )	65205 = 10 units	1,200	575
Removal of Trichiasis/Eyelashes	6 units	720
Repair of Entropion	67921 = 20 units	2,400
Repositioning of Intraocular Lens Prosthesis	66825 = 100 units	12,000
Retinal Exam		500/eye
Retinoscopy / Subject Refraction		300
Rose Bengal Staining		200
Rose-Bengal Staining		Part of Consult
Seidel Test		500
Sensorimotor Exam of Strabismus Test		1,000
Spectacle Refraction		100
Specular Microscopy		300
Squint Surgery	67311 = 55 units	6,600	5500
Strabismus Measurements		1,500
Streak Retinoscopy		300
Sweeping of Fornices		Part of Consult
Titmus Fly Test		50
Tonometry Monitoring	5 hours or more	4,000
Ultrasound Biomicroscopy		2,500
Videostroboscopy	31579 = 80 units	9,600
Visual Evoked Response (Adult)		2,164
Visual Field		1,200
Watzke Allen Test		200
Wide Meinster Contact Lens		Part of Consult
Yag Lase			2200

TYPE	Effective August 1, 2024
CONSULTATION RATE	600
CP CLEARANCE	1,150
READER'S FEE	AS CHARGED
CLINIC-SETTING	130 / AS CHARGED

DOCTOR	RATE
PATHOLOGIST'S FEE	AS CHARGED
INSTRUMENT FEE	AS CHARGED

INTRA-OPERATIVE MONITORING

1,800

ROOM/TYPE	DAILY VISIT PER DAY	RVS MULTIPLIER
WARD	900	140
SEMI PRIVATE	1100	145
PRIVATE	1200	150
SUITE	1600	155
ICU	1800	155
OPD-OR	N/A	130

 

DOCTOR	COMPUTATION
ANESTHESIOLOGIST	50% OF SURGEON'S FEE
ASSIST SURGEON	25% OF SURGEON'S FEE

DOCTOR	NOTES
ANESTHESIOLOGIST	UNLESS OTHERWISE STATED IN SOB / MINIMUM PF IS 2K
ASSIST SURGEON	APPLICABLE ONLY IF THE PROCEDURE IS LAPCHOLE OR 250 UNITS AND ABOVE

COMPUTATION FOR MULTIPLE PROCEDURES (FROM HIGHEST TO SMALLEST RVS UNITS)
100%
50%
25% FOR THE SUCCEEDING RVS
BUT IF THE PROCEDURES HAVE DIFFERENT ENTRY POINT, COMPUTE PF 100% EACH PROCEDURE

COMMON EXAMPLE IS EGD AND COLONOSCOPY
EGD - 60 UNITS
COLONOSCOPY - 80 UNITS

DIFFERENT SCENARIO COMPUTATION:

- 2 PROCEDURES DONE WITH DIFFERENT SURGEON BUT THE SAME DAY
100% COMPUTATION FOR THE HIGHEST RVS CODE UNIT EQUIVALENT; 80% FOR THE SECOND SURGEON

- 2 PROCEDURES DONE WITH DIFFERENT SURGEON BUT DIFFERENT DAY
COMPUTATION FOR BOTH SURGEONS ARE 100%

- PATIENT WAS ADMITTED FOR A LONG TIME WITH PROCEDURE DONE
COMPUTATION FOR PF IS PROCEDURE PLUS VISIT 2 DAYS BEFORE AND 5DAYS AFTER THE PROCEDURE

RVS CODE

IRR

 

SIMPLE (PO) Php 1,500.00	INTERMEDIATE Php 3,500.00	COMPLEX (VESICANT) Php 8,000.00	HIGHLY COMPLEX Php 10,000.00-15,000.00
PROTOTYPE REGIMENS:	PROTOTYPE REGIMENS:	DACTINOMYCIN (ACTINOMYCIN-D)	CARBOPLATIN (PARAPLATIN)
TAMOXIFEN FOR BREAST CA	5-FLUOROURACIL (5-FU)	DAUNORUBICIN (CERUBIDINE)	CARMUSTINE (BCNU OR BICNU)
MELPHALAN AND PREDNISONE FOR MULTIPLE MYOMA	DOCETAXWL (TAXOTERE)	DOXORUBICIN (ADRIAMYCIN)	CETUXIMAB
B-MERCAPTOPURINE AND METHOTREXATE FOR ACUTE LYMPHOCYTIC LEUKEMIA	ZOLADEX (GOSERELIN) FOR PROSTATE CANCER	MECHLORETHAMINE (NITROGEN MUSTARD)	CISPLATIN (IF >20ml OF 0.5 mg/ml)(PLATINOL; CDDP)
FLUTAMIDE FOR PROSTATE CANCER	LEUCOVORIN	MITOMYCIN-C (MUTAMYCIN)	DACARBAZINE (DTIC)
URACIL-TEGAFUR (UFT OR UFTORAL) FOR GI MALIGNANCIES	UROMITEXAN	VINBLASTINE (VELBAN)	ETOPOSIDE (VP-16 OR VePesid)
	CYCLOPHOSPHAMIDE-METHOTREXATE-5-FU FOR BREAST CANCER	VINCRISTINE (ONCOVIN)	IFOSFAMIDE (IFEX)
		VINORELBINE (NAVELBINE)	IRINOTE CAN (CPT-11 OR CAMPTOTHECIN)
			OXALIPLATIN
		PROTOTYPE REGIMENS:	PACLITAXEL (TAXOL)
		CAF (CYCLOPHOSPHAMIDE-DOXORUBICIN-5FU) FOR BREAST CANCER	STREPTOZOCIN (ZANOSAR)
		CEF (CYCLOPHOSPHAMIDE-EPIRUBICIN-5FU) FOR BREAST CANCER	TOPOTECAN (HYACAMTIN)
		CHOP (CYCLOPHOSPHAMIDE-DOXORUBICIN-VINCRISTINE-PREDNISONE) FOR NON-HODGKIN'S LYMPHOMA
		MOPP (MUSTURGEN-VINCRISTINE-PROCARBAZINE-PREDNISONE) FOR HODGKIN'S LYMPHOMA	PROTOTYPE REGIMENS:
		VINCRISTINE INJECTIONS FOR ACUTE LYMPHOCYTIC LEUKEMIA & EWING'S SARCOMA	CISPLATIN CONTAINING REGIMENS
		MITOMYCIN C CONTAINING REGIMENS	CETUXIMAB CONTAINING REGIMENS
		MITOXANTRONE CONTAINING REGIMENS	CARBOPLATIN CONTAINING REGIMENS
			IFOSFAMIDE CONTAINING REGIMENS
			OXALIPLATIN CONTAINING REGIMENS
			PACLITAXEL CONTAINING REGIMENS
			ETOPOSIDE CONTAINING REGIMENS

RADIOACTIVE IODINE
10 mci (OP)	3,000.00 - 3,500.00
10-20 mci (OP)	3,500.00 - 4,000.00
10-20 mci (IP)	4,000.00 - 4,500.00
20-30 mci (IP)	4,800.00 - 5,000.00
greater than 30 mci (IP)	5,400.00 - 6,300.00