Case Rate & RVS Mapping for Procedures Utilizing FlexiOss®
A friction-reducing reference for surgeons and a reassuring cost guide for patients — covering orthopedic, maxillofacial, otologic, and lateral skull-base / neurosurgical procedures.
Important: PhilHealth reimburses the surgical procedure, not a specific commercial brand of biomaterial. Codes below are presented as “Common PhilHealth RVS Codes for Procedures Utilizing FlexiOss®.” FlexiOss® is not directly reimbursed by PhilHealth.
How PhilHealth Coverage Works
The procedure is covered
PhilHealth reimburses the surgical procedure through a fixed Case Rate — not any specific commercial brand of biomaterial.
FlexiOss® is utilized
FlexiOss® is the synthetic bone-graft material the surgeon uses to fill or obliterate the defect during that covered procedure.
Out-of-pocket is reduced
The Total Case Rate is deducted from the hospital bill, lowering the patient’s out-of-pocket cost for the operation.
Common PhilHealth RVS Codes for Procedures Utilizing FlexiOss®
Indicative figures based on the latest PhilHealth Annex B (Procedure Case Rates) and Annex D (Second Case Rate). Professional Fee (PF) is the surgeon\u2019s share of the Total Case Rate. Values vary by facility tier, approach, and number of levels / sites.
Orthopedics & Trauma
Bone-defect filling, fracture fixation, and arthrodesis where FlexiOss® Ortho serves as the synthetic graft substitute within the covered procedure.
Oral, Maxillofacial & Implant Dentistry
Cyst / tumor enucleation, socket & ridge preservation, and alveolar defect filling where FlexiOss® Dent reconstructs the bony defect.
Otology & Mastoid ReconstructionCholesteatoma
Mastoid cavity obliteration and posterior canal-wall reconstruction after cholesteatoma removal, where FlexiOss® fills and obliterates the bony defect.
Lateral Skull Base & NeurosurgeryCPA Tumor
Reconstruction of the bony defect after acoustic neuroma / cerebellopontine angle (CPA) tumor excision — FlexiOss® helps prevent CSF leak and restore structural protection.
Cranioplasty & Structural Skull RepairSkull Defect
Secondary repair of a skull defect, using the biomaterial to patch and protect the cranium when performed separately from the tumor removal.
* Bone-graft components are typically claimed as a separate item, frequently under the “second case rate” when performed alongside a primary procedure in the same surgical session.
For Surgeons
- Map your operative report to the primary RVS code; claim the bone-graft component as a separate (often second-case) item.
- For multiple procedures in one session, sequence the highest-valued code first (100%), with others at 50%.
- Document defect size, indication, and graft utilization clearly to support the claim at adjudication.
- Verify current peso values against PhilHealth Annex B (Case Rates) & Annex D (Second Case Rate) for your facility tier.
For Patients
- Your PhilHealth Case Rate is automatically deducted from your total hospital bill.
- The benefit is split between the hospital (facility fee) and your surgeon (professional fee).
- Selected implants may be further subsidized under the PhilHealth Z-Benefit at contracted hospitals.
- Ask your hospital’s PhilHealth desk to confirm your final coverage before your procedure.
Frequently Asked Questions
Is FlexiOss® itself reimbursed by PhilHealth?
No. PhilHealth reimburses the surgical procedure via its Case Rate system. FlexiOss® is the biomaterial used by your surgeon during that procedure. This page maps the common RVS codes for the procedures in which FlexiOss® is utilized.
What is the difference between the Professional Fee and the Total Case Rate?
The Total Case Rate is the full PhilHealth benefit for the procedure. It is split into a Health-Facility Fee (paid to the hospital) and a Professional Fee (paid to the surgeon/physician).
What is a “Second Case Rate”?
When two or more covered procedures are performed in the same surgical session, PhilHealth typically pays 100% for the highest-valued procedure and 50% for the others. Bone-graft components are frequently claimed this way.
How do I confirm the exact amount?
Final values are confirmed by your hospital’s billing / PhilHealth section upon claim adjudication, based on the latest PhilHealth Annex B and Annex D for your facility tier.
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Disclaimer: The case rates and RVS codes listed on this page are provided as a general reimbursement mapping resource for healthcare professionals and patients. PhilHealth case rate allocations, professional fee shares, and approval rules are subject to change without prior notice depending on new PhilHealth Memorandums, Circulars, or departmental directives. Final coverage values are determined solely by PhilHealth upon formal hospital claim adjudication.
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