ANNEX 5.

LIST OF MEDICAL CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES ICD CODE
A00.0 A00.1 A00.9 A01.0 A01.0+ J17.0* A01.1 A01.2 A01.3 A01.4 A02.0 A02.1 A02.2 A02.2+ J17.0* A02.8 A02.9 A03.0 A03.1 A03.2 A03.3 A03.8 A03.9 A04.0 A04.1 A04.2 A04.3 A04.4 A04.5 A04.6 A04.7 A04.8 A04.9 A05.0 A05.2

DESCRIPTION
Cholera due to Vibrio cholerae 01, biovar cholerae Cholera due to Vibrio cholerae 01, biovar eltor Cholera, unspecified Typhoid fever Pneumonia in typhoid fever Paratyphoid fever A Paratyphoid fever B Paratyphoid fever C Paratyphoid fever, unspecified; Infection due to Salmonella paratyphi NOS Salmonella enteritis; Salmonellosis Salmonella septicaemia Localized salmonella infections Pneumonia in salmonella infection Other specified salmonella infections Salmonella infection, unspecified Shigellosis due to Shigella dysenteriae; Group A shigellosis [Shiga-Kruse dysentery] Shigellosis due to Shigella flexneri;Group B shigellosis Shigellosis due to Shigella boydii; Group C shigellosis Shigellosis due to Shigella sonnei; Group D shigellosis Other shigellosis Shigellosis, unspecified; ; Bacillary dysentery NOS Enteropathogenic Escherichia coli infection Enterotoxigenic Escherichia coli infection Enteroinvasive Escherichia coli infection Enterohaemorrhagic Escherichia coli infection Other intestinal Escherichia coli infections Campylobacter enteritis Enteritis due to Yersinia enterocolitica Enterocolitis due to Clostridium difficile; Foodborne intoxication by Clostridium difficile; Pseudomembranous colitis Other specified bacterial intestinal infections Bacterial intestinal infection, unspecified. Bacterial enteritis NOS Foodborne staphylococcal intoxication Foodborne Clostridium perfringens [Clostridium welchii] intoxication. Enteritis necroticans. Pig-bel

Case Rate
6,000 6,000 6,000 10,000 15,000 10,000 10,000 10,000 10,000 10,000 10,000 10,000 15,000 10,000 10,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000

Professional Fee
1,800 1,800 1,800 3,000 4,500 3,000 3,000 3,000 3,000 3,000 3,000 3,000 4,500 3,000 3,000 1,800 1,800 1,800 1,800 1,800 1,800 1,800 1,800 1,800 1,800 1,800 1,800 1,800 1,800 1,800 1,800 1,800 1,800

Health Care Institution Fee

4,200 4,200 4,200 7,000 10,500 7,000 7,000 7,000 7,000 7,000 7,000 7,000 10,500 7,000 7,000 4,200 4,200 4,200 4,200 4,200 4,200 4,200 4,200 4,200 4,200 4,200 4,200 4,200 4,200 4,200 4,200 4,200 4,200

Page 1 of 22

ANNEX 5. LIST OF MEDICAL CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES ICD CODE
A05.3 A05.4 A05.8 A05.9 A06.1 A06.2 A07.0 A07.1 A07.2 A07.3

DESCRIPTION
Foodborne Vibrio parahaemolyticus intoxication Foodborne Bacillus cereus intoxication Other specified bacterial foodborne intoxications Bacterial foodborne intoxication, unspecified Chronic intestinal amoebiasis Amoebic nondysenteric colitis Balantidiasis; Balantidial dysentery Giardiasis [lambliasis] Cryptosporidiosis Isosporiasis; Infection due to Isospora belli and Isospora hominis; Intestinal coccidiosis; Isosporosis Other specified protozoal intestinal diseases; Intestinal trichomoniasis; Sarcocystosis; Sarcosporidiosis Protozoal intestinal disease, unspecified;Flagellate diarrhoea; Protozoal colitis; Protozoal diarrhoea; Protozoal dysentery Rotaviral enteritis Acute gastroenteropathy due to Norwalk agent; Small round structured virus enteritis Adenoviral enteritis Other viral enteritis Viral intestinal infection, unspecified; Viral enteritis NOS; Viral gastroenteritis NOS; Viral gastroenteropathy NOS Other specified intestinal infections Infectious diarrhea Acute gastroenteritis Tuberculosis of lung, confirmed by sputum microscopy with or without culture; Tuberculous Bronchiectasis, confirmed by sputum microscopy with or without culture; Tuberculous fibrosis of lung, confirmed by sputum microscopy with or without culture; Tuberculous pneumonia, confirmed by sputum microscopy with or without culture; Tuberculous pneumothorax, confirmed by sputum microscopy with or without culture

Case Rate
6,000 6,000 6,000 6,000 4,200 4,200 6,000 6,000 6,000 6,000

Professional Fee
1,800 1,800 1,800 1,800 2,940 2,940 1,800 1,800 1,800 1,800

Health Care Institution Fee 4,200 4,200 4,200 4,200 1,260 1,260 4,200 4,200 4,200 4,200

A07.8

6,000

1,800

4,200

A07.9 A08.0 A08.1 A08.2 A08.3 A08.4 A08.5 A09.0 A09.9

6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000

1,800 1,800 1,800 1,800 1,800 1,800 1,800 1,800 1,800

4,200 4,200 4,200 4,200 4,200 4,200 4,200 4,200 4,200

A15.0

6,860

2,058

4,802

Page 2 of 22

ANNEX 5. LIST OF MEDICAL CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES ICD CODE DESCRIPTION
Tuberculosis of lung, confirmed by culture only; Tuberculous Bronchiectasis, confirmed by culture only; Tuberculous fibrosis of lung, confirmed by culture only; Tuberculous pneumonia, confirmed by culture only; Tuberculous pneumothorax, confirmed by cul Tuberculosis of lung, confirmed histologically only; Tuberculous Bronchiectasis, confirmed histologically only; Tuberculous fibrosis of lung, confirmed histologically only; Tuberculous pneumonia, confirmed histologically only; Tuberculous pneumothorax Tuberculosis of lung, confirmed by unspecified means; Tuberculous Bronchiectasis, confirmed but unspecified whether bacteriologically or histologically; Tuberculous fibrosis of lung, confirmed but unspecified whether bacteriologically or histologically Tuberculosis of intrathoracic lymph nodes, confirmed bacteriologically & histologicaly; Tuberculosis of hilar lymph nodes, confirmed bacteriologically & histologicaly; Tuberculosis of mediastinal, lymph nodes, confirmed bacteriologically & histologicaly; Tuberculosis of larynx, trachea and bronchus, confirmed bacteriologically and histologically ; Tuberculosis of bronchus,confirmed bacteriologically and histologically; Tuberculosis of glottis, confirmed bacteriologically and histologically; Tuberculo Tuberculous pleurisy, confirmed bacteriologically and histologically [Tuberculosis of pleura, confirmed bacteriologically and histologically; Tuberculous empyema, confirmed bacteriologically & histologically Primary respiratory tuberculosis, confirmed bacteriologically and histologically Other respiratory tuberculosis, confirmed bacteriologically and histologically; Mediastinal tuberculosis, confirmed bacteriologically and histologically; Nasopharyngeal tuberculosis, confirmed bacteriologically and histologically; Tuberculosis of nose,

Case Rate

Professional Fee

Health Care Institution Fee

A15.1

6,860

2,058

4,802

A15.2

6,860

2,058

4,802

A15.3

6,860

2,058

4,802

A15.4

8,330

2,499

5,831

A15.5

8,330

2,499

5,831

A15.6

8,330

2,499

5,831

A15.7

6,860

2,058

4,802

A15.8

8,330

2,499

5,831

Page 3 of 22

ANNEX 5. LIST OF MEDICAL CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES ICD CODE
A15.9

DESCRIPTION
Respiratory tuberculosis unspecified, confirmed bacteriologically and histologically Tuberculosis of lung, bacteriologically and histologically negative; Tuberculous Bronchiectasis , bacteriologically and histologically negative; Tuberculous fibrosis of lung, bacteriologically and histologically negative; Tuberculous pneumonia, bac Tuberculosis of lung, bacteriological and histological examination not done; Tuberculous Bronchiectasis, bacteriological and histological examination not done; Tuberculous fibrosis of lung, bacteriological and histological examination not done; Tuberculo Tuberculosis of lung, NOS, without mention of bacteriological or histological confirmation; Tuberculous bronchiectasis, NOS, without mention of bacteriological or histological confirmation; Tuberculous fibrosis of lung, NOS, without mention of bact Tuberculosis of intrathoracic lymph nodes, without mention of bacteriological or histological confirmation; Tuberculosis of hilar lymph nodes NOS without mention of bacteriological or histological confirmation; Tuberculosis of intrathoracic lymph nodes, Tuberculosis of bronchus, NOS, without mention of bacteriological or histological onfirmation; Tuberculosis of glottis, NOS, without mention of bacteriological or histological onfirmation; Tuberculosis of larynx, NOS, without mention of bacteriologic Tuberculous pleurisy, without mention of bacteriological or histological confirmation; Tuberculosis of pleura, NOS, without mention of bacteriological or histological confirmation; Tuberculous empyema, NOS, without mention of bacteriological or his Primary respiratory tuberculosis without mention of bacteriological or histological confirmation; Primary respiratory tuberculosis NOS; Primary tuberculous complex

Case Rate

Professional Fee

Health Care Institution Fee

6,860

2,058

4,802

A16.0

6,860

2,058

4,802

A16.1

6,860

2,058

4,802

A16.2

6,860

2,058

4,802

A16.3

8,330

2,499

5,831

A16.4

8,330

2,499

5,831

A16.5

8,330

2,499

5,831

A16.7

6,860

2,058

4,802

Page 4 of 22

ANNEX 5. LIST OF MEDICAL CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES ICD CODE DESCRIPTION
Other respiratory tuberculosis, without mention of bacteriological or histological confirmation; Mediastinal tuberculosis, NOS without mention of bacteriological or histological confirmation; Nasopharyngeal tuberculosis, NOS without mention of bacteriolog Respiratory tuberculosis unspecified, without mention of bacteriological or histological confirmation; Respiratory tuberculosis NOS; Tuberculosis NOS Pneumonia in tularemia Pneumonia in anthrax Pulmonary mycobacterial infection; Infection due to Mycobacterium avium, Mycobacterium intracellulare [Battey bacillus]; Mycobacterium kansasii Whooping cough due to Bordetella pertussis Pneumonia in whooping cough due to Bordatella pertusis Whooping cough due to Bordetella parapertussis Pneumonia in whooping cough due to Bordatella parapertusis Whooping cough due to other Bordetella species Pneumonia in whooping cough due to Bordatella species other than pertusis or parapertusis Whooping cough, unspecified Pneumonia in whooping cough Pneumonia in actinomycoses Legionnaires' disease Pneumonia in nocardiosis Pneumonia in gonorrhea Pneumonia in spirochaetal Pneumonia in ornithosis Pneumonia in Q fever Dengue without warning signs Dengue with warning signs Pneumonia in varicella Varicella [chickenpox] without complication Pneumonia in measles Measles complicated by Otitis Media Measles with intestinal complications Measles without complications Rubella with other complications Pneumonia in rubella Rubella without complications Viral exanthem

Case Rate

Professional Fee

Health Care Institution Fee

A16.8

8,330

2,499

5,831

A16.9 A21.2+ J17.0* A22.1+ J17.0* A31.0

6,860 15,000 15,000 15,000

2,058 4,500 4,500 4,500

4,802 10,500 10,500 10,500

A37.0 A37.0+ J17.0* A37.1 A37.1+ J17.0* A37.8 A37.8+ J17.0* A37.9 A37.9+ J17.0* A42.0+ J17.0* A48.1 A53.0+ J17.0* A54.8+ J17.0* A69.8+ J17.8* A70+ J17.8* A78+ J17.8* A90 A91.1 B01.2+ J17.1* B01.9 B05.2+ J17.1* B05.3+H76.1* B05.4 B05.9 B06.8 B06.8+ J17.1* B06.9 B09

7,420 15,000 7,420 15,000 7,420 15,000 7,420 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 10,000 10,000 15,000 2,800 15,000 2,800 2,800 2,800 2,800 15,000 2,800 2,800

2,226 4,500 2,226 4,500 2,226 4,500 2,226 4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 3,000 3,000 4,500 840 4,500 840 840 840 840 4,500 840 840

5,194 10,500 5,194 10,500 5,194 10,500 5,194 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500 7,000 7,000 10,500 1,960 10,500 1,960 1,960 1,960 1,960 10,500 1,960 1,960

Page 5 of 22

ANNEX 5. LIST OF MEDICAL CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES ICD CODE
B15.9 B16.1 B16.9 B25.0+ J17.1* B34.1 B34.2 B34.3 B34.4 B34.8 B34.9 B37.1+ J17.2* B38.0+ J17.2* B38.1+ J17.2* B38.2+ J17.2* B39.0+ J17.2* B39.1+ J17.2* B39.2+ J17.2* B39.9+ J17.2* B44.0+ J17.2* B44.1+ J17.2* B50.9 B51.9 B52.9 B58.3+ J17.3* B65.0+ J17.3* B65.1 B65.1+ J17.3* B65.2 B65.2+ J17.3* B65.3 B65.8

DESCRIPTION
ACUTE HEPATITIS A WITHOUT HEPATIC COMA; HEPATITIS A (ACUTE)(VIRAL) NOS ACUTE HEPATITIS B WITH DELTA-AGENT (COINFECTION) WITHOUT HEPATIC COMA ACUTE HEPATITIS B WITHOUT DELTA-AGENT AND WITHOUT HEPATIC COMA; HEPATITIS B (ACUTE)(VIRAL) NOS Pneumonia in cytomegalovirus disease Echovirus infection NOS Coronavirus infection, unspecified Parvovirus infection, unspecified Papovavirus infection, unspecified Other viral infections of unspecified site Viral infection, unspecified; Pneumonia in candidiasis Pneumonia in acute pulmonary coccidiomycosis Pneumonia in chronic pulmonary coccidiomycosis Pneumonia in pulmonary coccidioidomycosis Pneumonia in acute pulmonary histoplasmosis capsulati Pneumonia in chronic pulmonary histoplasmosis capsulati Pneumonia in pulmonary histoplasmosis capsulati Pneumonia in histoplasmosis Pneumonia in invasive pulmonary aspergillosis Pneumonia in other pulmonary aspergillosis Plasmodium falciparum malaria Plasmodium vivax malaria without complications Plasmodium malariae malaria without complications Pneumonia in taxoplasmosis Pneumonia in schistosomiasis due to Schistosoma hematobium Schistosomiasis due to Schistosoma mansoni [intestinal schistosomiasis] Pneumonia in schistosomiasis due to Schistosoma mansoni Schistosomiasis due to Schistosoma japonicum Pneumonia in schistosomiasis due to Schistosoma japonicum Cercarial dermatitis; Swimmer's itch Infection due to Schistosoma intercalatum, Schistosoma mattheei , Schistosoma mekongi

Case Rate
8,260 8,260 8,260 15,000 2,800 2,800 2,800 2,800 2,800 2,800 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 2,800 2,800 2,800 15,000 15,000 2,800 15,000 2,800 15,000 2,800 2,800

Professional Fee
2,478 2,478 2,478 4,500 840 840 840 840 840 840 4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 840 840 840 4,500 4,500 840 4,500 840 4,500 840 840

Health Care Institution Fee 5,782 5,782 5,782 10,500 1,960 1,960 1,960 1,960 1,960 1,960 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500 1,960 1,960 1,960 10,500 10,500 1,960 10,500 1,960 10,500 1,960 1,960

Page 6 of 22

ANNEX 5. LIST OF MEDICAL CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES ICD CODE
B65.8+ J17.3* B65.9 B65.9+ J17.3* B77.8+ J17.3* B77.9 B82.0 B82.9 E10.9 E14.9 E16.0 E16.2 E40 E41 E43 E44.1 E86.1 E86.2 E87.0 E87.1 E87.2 E87.3 E87.4 E87.5 E87.6 E87.7

DESCRIPTION
Pneumonia in schistosomiasis due to Schistosoma intercalatum; mattheei; mekongi Schistosomiasis, unspecified Pneumonia in schistosomiasis Pneumonia in ascariasis Ascariasis Intestinal helminthiasis, unspecified Intestinal parasitism, unspecified Non-insulin-dependent diabetes mellitus without complications Insulin dependent diabetes mellitus without complications Drug-induced hypoglycaemia without coma Hypoglycemia Kwashiorkor Nutritional marasmus; Severe malnutrition with marasmus Unspecified severe protein-energy malnutrition Mild protein-energy malnutrition moderate dehydration severe dehydration Hyperosmolality and hypernatraemia; Sodium [Na] excess; Sodium [Na] overload Hypo-osmolality and hyponatraemia Acidosis; Acidosis NOS; Lactic Acidosis; Metabolic Acidosis; Respiratory Acidosis Alkalosis; Alkalosis NOS; Metabolic Alkalosis; Respiratory Alkalosis Mixed disorder of acid-base balance Hyperkalaemia; Potassium [K] excess; Potassium [K] overload Hypokalaemia; Potassium [K] deficiency Fluid overload Other disorders of electrolyte and fluid balance, not elsewhere classified; Electrolyte imbalance NOS; Hyperchloraemia; Hypochloraemia; Other metabolic disorders Migraine without aura [common migraine] Migraine with aura [classical migraine]; Migraine aura without headache; Migraine, basilar; Migraine equivalents; Familial hemiplegic Migraine; Migraine with acuteonset aura; Migraine with prolonged aura; Migraine with typical aura Status migrainosus

Case Rate

Professional Fee

Health Care Institution Fee

15,000 2,800 15,000 15,000 2,800 2,800 2,800 2,800 2,800 5,670 2,800 8,190 8,190 8,190 8,190 2,800 2,800 2,800 5,950 5,950 5,950 5,950 5,950 5,950 5,950

4,500 840 4,500 4,500 840 840 840 840 840 1,701 840 2,457 2,457 2,457 2,457 840 840 840 1,785 1,785 1,785 1,785 1,785 1,785 1,785

10,500 1,960 10,500 10,500 1,960 1,960 1,960 1,960 1,960 3,969 1,960 5,733 5,733 5,733 5,733 1,960 1,960 1,960 4,165 4,165 4,165 4,165 4,165 4,165 4,165

E87.8

5,950

1,785

4,165

G43.0

3,850

1,155

2,695

G43.1

3,850

1,155

2,695

G43.2

3,850

1,155

2,695

Page 7 of 22

ANNEX 5. LIST OF MEDICAL CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES ICD CODE
G43.3 G43.8 G43.9 G44.0 G44.1 G44.2 G44.3 G44.4 G44.8 H60.1 H60.2 H60.3 H60.4 H66.9 H81.0 H81.1 H81.2 H81.3 H81.4 H81.8 H81.9 H83.1 H83.2

DESCRIPTION
Complicated migraine Other migraine; Ophthalmoplegic migraine; Retinal migraine Migraine, unspecified Cluster headache syndrome; Chronic paroxysmal hemicrania; Chronic cluster headache; Episodic Cluster headache Vascular headache, not elsewhere classified; Vascular headache NOS Tension-type headache; Chronic tension-type headache; Episodic tension headache; Tension headache NOS Chronic post-traumatic headache Drug-induced headache, not elsewhere classified Other specified headache syndromes Cellulitis of external ear; Cellulitis of auricle; Cellulitis of external auditory canal Malignant otitis externa Other infective otitis externa; diffuse Otitis externa ; Haemorrhagic Otitis externa ; Swimmer's ear Cholesteatoma of external ear; Keratosis obturans of external ear (canal) Otitis media, unspecified; Otitis media NOS; Acute Otitis media NOS; Chronic Otitis media NOS Mnire's disease; Labyrinthine hydrops; Mnire's syndrome or vertigo Benign paroxysmal vertigo Vestibular neuronitis Other peripheral vertigo; Lermoyez' syndrome; Aural Vertigo ; Otogenic Vertigo; Peripheral NOS Vertigo Vertigo of central origin; Central positional nystagmus Other disorders of vestibular function Disorder of vestibular function, unspecified; Vertiginous syndrome NOS Labyrinthine fistula Labyrinthine dysfunction; Hypersensitivity of labyrinth; Hypofunction of labyrinth; Loss of function Of labyrinth Rheumatic fever without mention of heart involvement; Arthritis, rheumatic, acute or subacute involvement Pneumonia in rheumatic fever Hypertension, stage II Essential Hypertension; malignant hypertension

Case Rate
3,850 3,850 3,850 3,850 3,850 3,850 3,850 3,850 3,850 6,300 6,300 6,300 6,300 5,460 3,990 3,990 3,990 3,990 3,990 3,990 3,990 3,990 3,990

Professional Fee
1,155 1,155 1,155 1,155 1,155 1,155 1,155 1,155 1,155 1,890 1,890 1,890 1,890 1,638 1,197 1,197 1,197 1,197 1,197 1,197 1,197 1,197 1,197

Health Care Institution Fee 2,695 2,695 2,695 2,695 2,695 2,695 2,695 2,695 2,695 4,410 4,410 4,410 4,410 3,822 2,793 2,793 2,793 2,793 2,793 2,793 2,793 2,793 2,793

I00 I00+ J17.8* I10.1 I10.9

7,070 15,000 9,000 9,000

2,121 4,500 2,700 2,700

4,949 10,500 6,300 6,300

Page 8 of 22

ANNEX 5. LIST OF MEDICAL CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES ICD CODE
I11.0

DESCRIPTION
Hypertensive heart disease with (congestive) heart failure; Hypertensive heart failure Hypertensive heart disease without (congestive) heart failure; Hypertensive heart disease NOS Hypertensive renal disease with renal failure; Hypertensive renal failure Hypertensive renal disease without renal failure; Hypertensive renal disease NOS Hypertensive heart and renal disease with (congestive) heart failure Hypertensive heart and renal disease with renal failure Hypertensive heart and renal disease with both (congestive) heart failure and renal failure Hypertensive heart and renal disease, unspecified Renovascular hypertension Hypertension secondary to other renal disorders Hypertension secondary to endocrine disorders Other secondary hypertension Secondary hypertension, unspecified Atherosclerotic cardiovasculardisease, so described Atherosclerotic hear tdisease; Coronary artery atheroma; Coronary artery atherosclerosis; Coronary artery disease; Coronary artery sclerosis Aneurysm of heart; Mural aneurysm; Venticular aneurysm Coronary artery aneurysm; Coronary arteriovenous fistula, acquired Ischaemic cardiomyopathy Silent myocardial ischaemia Other forms of chronic ischaemic heart disease Chronic ischaemic heart disease, unspecified; Chronic Ischaemic heart disease NOS Streptococcal tonsillitis Acute tonsillitis due to other specified organisms

Case Rate

Professional Fee

Health Care Institution Fee

9,000

2,700

6,300

I11.9 I12.0 I12.9 I13.0 I13.1 I13.2 I13.9 I15.0 I15.1 I15.2 I15.8 I15.9 I25.0

9,000 9,000 9,000 9,000 9,000 9,000 9,000 9,000 9,000 9,000 9,000 9,000 2,800

2,700 2,700 2,700 2,700 2,700 2,700 2,700 2,700 2,700 2,700 2,700 2,700 840

6,300 6,300 6,300 6,300 6,300 6,300 6,300 6,300 6,300 6,300 6,300 6,300 1,960

I25.1

2,800

840

1,960

I25.3 I25.4 I25.5 I25.6 I25.8 I25.9 J03.0 J03.8

2,800 2,800 8,400 8,400 8,400 8,400 2,800 2,800

840 840 2,520 2,520 2,520 2,520 840 840

1,960 1,960 5,880 5,880 5,880 5,880 1,960 1,960

Page 9 of 22

ANNEX 5. LIST OF MEDICAL CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES ICD CODE DESCRIPTION
Acute tonsillitis, unspecified; Acute tonsillitis NOS; Acute Follicular tonsillitis; Acute Gangrenous tonsillitis; Acute Infective tonsillitis; Acute Ulcerative tonsillitis Acute laryngopharyngitis Other acute upper respiratory infections of multiple sites Acute upper respiratory infection, unspecified; Acute upper respiratory disease; Upper respiratory infection NOS Influenza with pneumonia, virus not identified; Influenzal (broncho) pneumonia, unspecified or specific virus not identified Influenza with other respiratory manifestations, virus not identified; Influenza NOS; Influenzal Acute upper respiratory infection, unspecified or specific virus not identified; Influenzal laryngitis, unspecified or specific virus not identified; Influen Influenza with other manifestations, virus not identified; Encephalopathy due to influenza, unspecified or specific virus not identified; Influenzal gastroentiritis, unspecified or specific virus not identified; Acute influenzal myocarditis, unspecified o Adenoviral pneumonia, moderate risk Respiratory syncytial virus pneumonia, moderate risk Parainfluenza virus pneumonia, moderate risk Human metapneumovirus pneumonia, moderate risk Viral pneumonia, moderate risk Pneumonia [bronchopneumonia] due to Streptococcus pneumoniae, moderate risk Pneumonia [bronchopneumonia]due to Haemophilus influenzae, moderate risk Pneumonia due to Klebsiella pneumoniae, moderate risk Pneumonia due to Pseudomonas, moderate risk Pneumonia due to staphylococcus, moderate risk Pneumonia due to streptococcus, group B, moderate risk Pneumonia due to other streptococci, moderate risk

Case Rate

Professional Fee

Health Care Institution Fee

J03.9

2,800

840

1,960

J06.0 J06.8 J06.9

2,800 2,800 2,800

840 840 840

1,960 1,960 1,960

J11.0

4,620

1,386

3,234

J11.1

4,620

1,386

3,234

J11.8

4,620

1,386

3,234

J12.02 J12.12 J12.22 J12.32 J12.92 J13.2 J14.2 J15.02 J15.12 J15.22 J15.32 J15.42

15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000

4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500

10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500

Page 10 of 22

ANNEX 5. LIST OF MEDICAL CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES ICD CODE
J15.52 J15.62 J15.72 J15.92 J16.02 J18.02 J18.12 J18.22

DESCRIPTION
Pneumonia due to Escherichia coli, moderate risk Pneumonia due to other aerobic Gramnegative bacteria; Pneumonia due to Serratia marcescens, moderate risk Pneumonia due to Mycoplasma pneumoniae, moderate risk Bacterial pneumonia [bronchopneumonia], moderate risk Chlamydial pneumonia, moderate risk Bronchopneumonia, moderate risk Lobar pneumonia, moderate risk Hypostatic pneumonia, moderate risk Community-acquired pneumonia III (This classification utilized the American Thoracic Society recommendation. This is equivalent to CAP, moderate risk in the Philippine Clinical Practice Guidelines on the Diagnosis, Empiric Management, and Prevention of Community- acquired Pneumonia in Immunocompetent Adults, 2010 update) Acute bronchitis due to Mycoplasma pneumoniae Acute bronchitis due to Haemophilus influenzae Acute bronchitis due to streptococcus Acute bronchitis due to coxsackievirus Acute bronchitis due to parainfluenza virus Acute bronchitis due to respiratory syncytial virus Acute bronchitis due to rhinovirus Acute bronchitis due to echovirus Acute bronchitis due to other specified organisms Acute bronchitis, unspecified Unspecified acute lower respiratory infection Bronchitis, not specified as acute or chronic Predominantly allergic asthma; Allergic bronchitis NOS; Allergic rhinitis with asthma; Atopic asthma; Extrinsic allergic asthma; Hay fever with asthma; in Acute Exacerbation Nonallergic asthma; Idiosyncratic asthma; Intrinsic nonallergic asthma, in Acute Exacerbation Mixed asthma, in Acute Exacerbation Bronchial Asthma in Acute Exacerbation Status asthmaticus; Acute severe asthma

Case Rate
15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000

Professional Fee
4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500

Health Care Institution Fee 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500

J18.92

15,000

4,500

10,500

J20.0 J20.1 J20.2 J20.3 J20.4 J20.5 J20.6 J20.7 J20.8 J20.9 J22 J40

2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800

840 840 840 840 840 840 840 840 840 840 840 840

1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960

J45.00

9,000

2,700

6,300

J45.10 J45.80 J45.90 J46

9,000 9,000 9,000 9,000

2,700 2,700 2,700 2,700

6,300 6,300 6,300 6,300

Page 11 of 22

ANNEX 5. LIST OF MEDICAL CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES ICD CODE DESCRIPTION
Pulpitis; Pulpal abscess; Pulpal polyp; Acute pulpitis; Hyperplastic chronic pulpitis; Ulcerative chronic pulpitis; Supparative pulpitis Necrosis of pulp; Pulpal gangrene Pulp degeneration; Denticles; Pulpal calcifications; Pulpal stones Abnormal hard tissue formation in pulp; Secondary or irregular dentine Acute apical periodontitis of pulpal origin; Acute apical periodontitis NOS Chronic apical periodontitis; Apical or periapical granuloma; Apical periodontitis NOS Periapical abscess with sinus; Dental abscess with sinus; Dentoalveolar abscess with sinus Periapical abscess without sinus; Dental abscess NOS; Dentoalveolar abscess NOS; Periapical abscess NOS Radicular cyst; Periodontal apical cyst; Periapical cyst; Residual radicular cyst Other and unspecified diseases of pulp and periapical tissues Sialoadenitis Gastro-oesophageal reflux disease with oesophagitis; Reflux oesophagitis Gastro-oesophageal reflux disease without oesophagitis; Oesophageal reflux NOS Gastric ulcer, acute / Acute erosion of stomach/ Pylorus peptic ulcer / Stomach peptic ulcer without haemorrhage or perforation Acute Peptic/ Gastroduodenal ulcer, site unspecified, without haemorrhage or perforation Chronic or unspecified Peptic/ Gastroduodenal ulcer, site unspecified, with both haemorrhage and perforation Peptic/ Gastroduodenal ulcer, unspecified as acute or chronic, without haemorrhage or perforation Other acute gastritis Alcoholic gastritis Chronic superficial gastritis Chronic atrophic gastritis; Gastric atrophy

Case Rate

Professional Fee

Health Care Institution Fee

K04.0 K04.1 K04.2 K04.3 K04.4 K04.5

2,800 2,800 2,800 2,800 2,800 2,800

840 840 840 840 840 840

1,960 1,960 1,960 1,960 1,960 1,960

K04.6

2,800

840

1,960

K04.7 K04.8 K04.9 K11.2 K21.0 K21.9

2,800 2,800 2,800 5,810 4,270 4,270

840 840 840 1,743 1,281 1,281

1,960 1,960 1,960 4,067 2,989 2,989

K25.3

4,270

1,281

2,989

K27.3

4,270

1,281

2,989

K27.6

8,960

2,688

6,272

K27.9 K29.1 K29.2 K29.3 K29.4

4,270 4,270 4,270 4,270 4,270

1,281 1,281 1,281 1,281 1,281

2,989 2,989 2,989 2,989 2,989

Page 12 of 22

ANNEX 5. LIST OF MEDICAL CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES ICD CODE
K29.5 K29.6 K29.7 K29.8 K30 K31.0 K31.1 K31.2 K31.3 K31.4 K31.5

DESCRIPTION
Chronic gastritis, unspecified; Chronic Antral gastritis; Chronic Fundal gastritis Other gastritis; Giant hypertrophic gastritis; Granulomatous gastritis; Menetrier's disease Gastritis, unspecified Duodenitis Dyspepsia Acute dilatation of stomach; Acute distension of stomach Adult hypertrophic pyloric stenosis; Pyloric stenosis NOS Hourglass stricture and stenosis of stomach Pylorospasm, not elsewhere classified Gastric diverticulum Obstruction of duodenum; Constriction of duodenum; Stenosis of duodenum; Stricture of duodenum; Chronic duodenal ileus Fistula of stomach and duodenum; Gastrocolic fistula; Gastrojejunocolic fistula Polyp of stomach and duodenum Other specified diseases of stomach and duodenum; Achlorhydria; Gastroptosis; Hourglass contraction of stomach Disease of stomach and duodenum, unspecified Gastroenteritis and colitis due to radiation Toxic gastroenteritis and colitis Allergic and dietetic gastroenteritis and colitis; Food hypersensitivity gastroenteritis or colitis Other specified noninfective gastroenteritis and colitis; Eosinophilic gastritis or gastroenteritis Noninfective gastroenteritis and colitis, unspecified; Diarrhoea specified as noninfective, or NOS in countries where the conditions can be presumed to be of noninfectious origin; Enteritis specified as noninfective, or NOS in countries where the conditio Paralytic ileus; Paralysis of bowel; Paralysis of colon; Paralysis of intestine Irritable bowel syndrome with diarrhoea Constipation Hepatic fibrosis

Case Rate
4,270 4,270 4,270 4,270 2,800 2,800 4,620 4,620 4,620 4,620 4,620

Professional Fee
1,281 1,281 1,281 1,281 840 840 1,386 1,386 1,386 1,386 1,386

Health Care Institution Fee 2,989 2,989 2,989 2,989 1,960 1,960 3,234 3,234 3,234 3,234 3,234

K31.6 K31.7 K31.8 K31.9 K52.0 K52.1 K52.2

4,620 4,620 4,620 2,800 6,000 6,000 6,000

1,386 1,386 1,386 840 1,800 1,800 1,800

3,234 3,234 3,234 1,960 4,200 4,200 4,200

K52.8

6,000

1,800

4,200

K52.9

6,000

1,800

4,200

K56.0 K58.0 K59.0 K74.0

7,070 6,000 2,800 10,570

2,121 1,800 840 3,171

4,949 4,200 1,960 7,399

Page 13 of 22

ANNEX 5. LIST OF MEDICAL CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES ICD CODE
K74.1 K74.2 K74.3 K74.4 K74.5

DESCRIPTION
Hepatic sclerosis Hepatic fibrosis with hepatic sclerosis Primary biliary cirrhosis; Chronic nonsupparative destructive cholangitis Secondary biliary cirrhosis Biliary cirrhosis, unspecified Other and unspecified cirrhosis of liver; Cirrhosis of liver NOS; Cryptogenic cirrhosis of liver; Macronodular cirrhosis of liver; Micronodular cirrhosis of liver; Mixed type cirrhosis of liver; Portal cirrhosis of liver; Postnecrotic cirrhosis of liver; Cutaneous abscess, furuncle and carbuncle of face Cutaneous abscess, furuncle and carbuncle of neck Cutaneous abscess, furuncle and carbuncle of trunk; Cutaneous abscess, furuncle and carbuncle of Abdominal wall; Cutaneous abscess, furuncle and carbuncle of Back [any part, except buttock]; Cutaneous abscess, furuncle and carbuncle of Chest wall; Cutaneous abscess, furuncle and carbuncle of Groin; Cutaneous abscess, furuncle and carbuncle of Perineum; Cutaneous abscess, furuncle and carbuncle of Umbilicus Cutaneous abscess, furuncle and carbuncle of buttock; Cutaneous abscess, furuncle and carbuncle of Gluteal region Cutaneous abscess, furuncle and carbuncle of limb, Axilla, Hip & Shoulder Cutaneous abscess, furuncle and carbuncle of other sites: Head [any part, except face]; Scalp Cutaneous abscess, furuncle and carbuncle, unspecified; Furunculosis NOS Cellulitis of finger and toe; Infection of nail; Onychia; Paronychia; Perionychia Cellulitis of other parts of limb, Axilla; Cellulitis of Hip;Cellulitis of Shoulder Cellulitis of face Cellulitis of trunk;Cellulitis of Abdominal wall;Cellulitis of Back [any part]; Cellulitis of Chest wall;Cellulitis of Groin;Cellulitis of Perineum;Cellulitis of Umbilicus

Case Rate
8,260 10,570 9,240 6,860 6,860

Professional Fee
2,478 3,171 2,772 2,058 2,058

Health Care Institution Fee 5,782 7,399 6,468 4,802 4,802

K74.6

10,570

3,171

7,399

L02.0 L02.1

2,800 2,800

840 840

1,960 1,960

L02.2

2,800

840

1,960

L02.3 L02.4 L02.8 L02.9 L03.0 L03.1 L03.2

2,800 2,800 2,800 2,800 6,720 6,720 6,720

840 840 840 840 2,016 2,016 2,016

1,960 1,960 1,960 1,960 4,704 4,704 4,704

L03.3

6,720

2,016

4,704

Page 14 of 22

ANNEX 5. LIST OF MEDICAL CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES ICD CODE
L03.8 L03.9 L72.0 L72.1 L72.2 L72.8 L72.9 M00.16 M00.19 M00.29 M00.82 M00.90

DESCRIPTION
Cellulitis of other sites; Cellulitis of Head [any part, except face];Cellulitis of Scalp Cellulitis, unspecified Epidermal cyst Trichilemmal cyst; Pilar cyst; Sebaceous cyst Steatocystoma multiplex Other follicular cysts of skin and subcutaneous tissue Follicular cyst of skin and subcutaneous tissue, unspecified Pneumococcal arthritis and polyarthritis, Lower leg Pneumococcal arthritis and polyarthritis, Site unspecified Other streptococcal arthritis and polyarthritis, Site unspecified Arthritis and polyarthritis due to other specified bacterial agents upper arm Pyogenic arthritis, unspecified; Infective arthritis NOS multiple sites Pyogenic arthritis, unspecified; Infective arthritis NOS shoulder region Pyogenic arthritis, unspecified; Infective arthritis NOS forearm Pyogenic arthritis, unspecified; Infective arthritis NOS hand Pyogenic arthritis, unspecified; Infective arthritis NOS pelvic region and thigh Pyogenic arthritis, unspecified; Infective arthritis NOS lower leg Pyogenic arthritis, unspecified; Infective arthritis NOS ankle and foot Pyogenic arthritis, unspecified; Infective arthritis NOS other sites Pyogenic arthritis, unspecified; Infective arthritis NOS site unspecified Seronegative rheumatoid arthritis, shoulder region Seronegative rheumatoid arthritis, site unspecified Adult-onset Still's disease, site unspecified

Case Rate
6,720 6,720 2,800 2,800 2,800 2,800 2,800 6,790 6,790 6,790 6,790 6,790

Professional Fee
2,016 2,016 840 840 840 840 840 2,037 2,037 2,037 2,037 2,037

Health Care Institution Fee 4,704 4,704 1,960 1,960 1,960 1,960 1,960 4,753 4,753 4,753 4,753 4,753

M00.91

6,790

2,037

4,753

M00.93

6,790

2,037

4,753

M00.94

6,790

2,037

4,753

M00.95

6,790

2,037

4,753

M00.96

6,790

2,037

4,753

M00.97

6,790

2,037

4,753

M00.98

6,790

2,037

4,753

M00.99 M06.01 M06.09 M06.19

6,790 4,900 4,900 6,790

2,037 1,470 1,470 2,037

4,753 3,430 3,430 4,753

Page 15 of 22

ANNEX 5. LIST OF MEDICAL CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES ICD CODE
M06.36 M06.45 M06.49 M06.81 M06.86 M06.87 M06.89 M06.90 M06.91 M06.93 M06.94 M06.95 M06.96 M06.97 M06.98 M06.99 M10.00 M10.01 M10.02 M10.03 M10.04 M10.05 M10.06 M10.07 M10.08 M10.09 M10.10 M10.29 M10.30 M10.36 M10.39

DESCRIPTION
Rheumatoid nodule, lower leg Inflammatory polyarthropathy, pelvic region and thigh Inflammatory polyarthropathy, site unspecified Other specified rheumatoid arthritis, shoulder region Other specified rheumatoid arthritis, lower leg Other specified rheumatoid arthritis, ankle and foot Other specified rheumatoid arthritis, site unspecified Rheumatoid arthritis, unspecified, multiple sites Rheumatoid arthritis, unspecified, shoulder region Rheumatoid arthritis, unspecified, forearm Rheumatoid arthritis, unspecified, hand Rheumatoid arthritis, unspecified, pelvic region and thigh Rheumatoid arthritis, unspecified, lower leg Rheumatoid arthritis, unspecified, ankle and foot Rheumatoid arthritis, unspecified, other sites Rheumatoid arthritis, unspecified, site unspecified Idiopathic gout; Gouty bursitis; Primary gout multiple sites Urate tophus of heart shoulder region Urate tophus of heart upper arm Idiopathic gout; Gouty bursitis; Primary gout forearm Urate tophus of heart hand Urate tophus of heart pelvic region and thigh Idiopathic gout; Gouty bursitis; Primary gout lower leg Urate tophus of heart ankle and foot Urate tophus of heart other sites Urate tophus of heart site unspecified Lead-induced gout multiple sites Drug-induced gout site unspecified Gout due to impairment of renal function multiple sites Gout due to impairment of renal function lower leg Gout due to impairment of renal function site unspecified

Case Rate
4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900

Professional Fee
1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470

Health Care Institution Fee 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430

Page 16 of 22

ANNEX 5. LIST OF MEDICAL CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES ICD CODE
M10.40 M10.49 M10.90 M10.91 M10.92 M10.93 M10.94 M10.96 M10.97 M10.98 M10.99 M19.00 M19.02 M19.05 M19.06 M19.08 M19.09 M19.10

DESCRIPTION
Other secondary gout multiple sites Other secondary gout site unspecified Gout, unspecified multiple sites Gout, unspecified shoulder region Gout, unspecified upper arm Gout, unspecified forearm Gout, unspecified hand Gout, unspecified lower leg Gout, unspecified ankle and foot Gout, unspecified other sites Gout, unspecified site unspecified Primary arthrosis of other joints; Primary arthrosis NOSmultiple sites Primary arthrosis of other joints; Primary arthrosis NOSupper arm Primary arthrosis of other joints; Primary arthrosis NOSpelvic region and thigh Primary arthrosis of other joints; Primary arthrosis NOSlower leg Primary arthrosis of other joints; Primary arthrosis NOSother sites Primary arthrosis of other joints; Primary arthrosis NOSsite unspecified Post-traumatic arthrosis of other joints; Posttraumatic arthrosis NOS multiple sites Post-traumatic arthrosis of other joints; Posttraumatic arthrosis NOS shoulder region Post-traumatic arthrosis of other joints; Posttraumatic arthrosis NOS upper arm Post-traumatic arthrosis of other joints; Posttraumatic arthrosis NOS site unspecified Other secondary arthrosis; Secondary arthrosis NOS shoulder region Other secondary arthrosis; Secondary arthrosis NOS site unspecified Other specified arthrosis shoulder region Other specified arthrosis lower leg Other specified arthrosis ankle and foot Other specified arthrosis other sites Other specified arthrosis site unspecified Arthrosis, unspecified shoulder region Arthrosis, unspecified upper arm Arthrosis, unspecified forearm Arthrosis, unspecified hand Arthrosis, unspecified pelvic region and thigh Arthrosis, unspecified lower leg Arthrosis, unspecified ankle and foot Arthrosis, unspecified other sites

Case Rate
4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900

Professional Fee
1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470

Health Care Institution Fee 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430

M19.11 M19.12 M19.19 M19.21 M19.29 M19.81 M19.86 M19.87 M19.88 M19.89 M19.91 M19.92 M19.93 M19.94 M19.95 M19.96 M19.97 M19.98

4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900 4,900

1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470 1,470

3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430 3,430

Page 17 of 22

ANNEX 5. LIST OF MEDICAL CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES ICD CODE
M19.99 N20.0 N20.1 N20.2 N20.9 N30.0 N30.1 N30.2 N30.3 N30.4 N30.8 N30.9 N39.0

DESCRIPTION
Arthrosis, unspecified site unspecified Calculus of kidney; Nephrolithiasis NOS; Renal calculus or stone; Staghorn calculus; Stone in kidney Calculus of ureter; Ureteric stone Calculus of kidney with calculus of ureter Urinary calculus, unspecified; Calculous pyelonephritis Acute cystitis Chronic Interstitial cystitis Other chronic cystitis Trigonitis; Urethrotrigonitis Irradiation cystitis Other cystitis; Abscess of bladder Cystitis, unspecified Urinary tract infection, site not specified Hyperplasia of prostate; Adenofibromatous hypertrophy of prostate; Adenoma (benign)of prostate ; Enlargement of prostate (benign); Fibroadenoma of prostate; Fibroma of prostate; Hypertrophy of prostate (benign); Myoma of prostate; Median bar (prostate), Orchitis, epididymitis and epididymo-orchitis with abscess; Abscess of epididymis or testis Orchitis, epididymitis and epididymo-orchitis without abscess; Epididymitis NOS; Orchitis NOS Redundant prepuce, phimosis and paraphimosis; Adherent prepuce; Tight foreskin Inflammatory disorders of breast; Acute abscess of non puerperal areola; Acute abscess nonpuerperal breast; Chronic abscess of nonpuerperal areola; Chronic abscess of nonpuerperal breast; Carbuncle of breast; Acute mastitis nonpuerperal, NOS; Acute inf Acute parametritis and pelvic cellulitis; Acute abcess of broad ligament; Acute abscess of parametrium; Acute pelvic cellulitis, female Chronic parametritis and pelvic cellulitis Spontaneous abortion, complete or unspecified, without complication Threatened abortion; Haemorrhage specified as due to threatened abortion

Case Rate
4,900 2,800 2,800 2,800 2,800 5,250 5,250 5,250 5,250 2,800 9,730 5,250 5,250

Professional Fee
1,470 840 840 840 840 1,575 1,575 1,575 1,575 840 2,919 1,575 1,575

Health Care Institution Fee 3,430 1,960 1,960 1,960 1,960 3,675 3,675 3,675 3,675 1,960 6,811 3,675 3,675

N40

6,440

1,932

4,508

N45.0

5,530

1,659

3,871

N45.9

5,530

1,659

3,871

N47

4,480

1,344

3,136

N61

5,530

1,659

3,871

N73.0 N73.1 O03.9 O20.0

6,300 6,300 3,500 4,760

1,890 1,890 1,050 1,428

4,410 4,410 2,450 3,332

Page 18 of 22

ANNEX 5. LIST OF MEDICAL CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES ICD CODE DESCRIPTION
Mild hyperemesis gravidarum; Hyperemesis gravidarum, mild or unspecified, starting before the end of the 22nd week of gestation Hyperemesis gravidarum with metabolic disturbance; Hyperemesis gravidarum, starting before the end of the 22nd week of gestation, with metabolic disturbance such as carbohydrate depletion, dehydration, elctrolyte imbalance Late vomiting of pregnancy; Excessive vomiting starting after 22 completed weeks of gestation Other vomiting complicating pregnancy; Vomiting due to disease classified elsewhere, complicating pregnancy Vomiting of pregnancy, unspecified Infections of kidney in pregnancy Infections of bladder in pregnancy Infections of urethra in pregnancy Infections of other parts of urinary tract in pregnancy Unspecified infection of urinary tract in pregnancy Infections of the genital tract in pregnancy Other and unspecified genitourinary tract infection in pregnancy; Genitourinary tract infection in pregnancy NOS Preterm labor, not resulting to delivery Anaemia complicating pregnancy, childbirth and the puerperium Other diseases of the blood and bloodforming organs and certain disorders involving the immune mechanism complicating pregnancy, childbirth and the puerperium Endocrine, nutritional and metabolic diseases complicating pregnancy, childbirth and the puerperium Mental disorders and diseases of the nervous system complicating pregnancy, childbirth and the puerperium Diseases of the circulatory system complicating pregnancy, childbirth and the puerperium Diseases of the respiratory system complicating pregnancy, childbirth and the puerperium Diseases of the digestive system complicating pregnancy, childbirth and the puerperium

Case Rate

Professional Fee

Health Care Institution Fee

O21.0

4,760

1,428

3,332

O21.1

4,760

1,428

3,332

O21.2

4,760

1,428

3,332

O21.8 O21.9 O23.0 O23.1 O23.2 O23.3 O23.4 O23.5 O23.9 O60.0 O99.0

4,760 4,760 4,760 2,800 2,800 4,760 2,800 2,800 2,800 4,760 4,760

1,428 1,428 1,428 840 840 1,428 840 840 840 1,428 1,428

3,332 3,332 3,332 1,960 1,960 3,332 1,960 1,960 1,960 3,332 3,332

O99.1

4,760

1,428

3,332

O99.2

4,760

1,428

3,332

O99.3

4,760

1,428

3,332

O99.4

4,760

1,428

3,332

O99.5

4,760

1,428

3,332

O99.6

4,760

1,428

3,332

Page 19 of 22

ANNEX 5. LIST OF MEDICAL CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES ICD CODE
O99.7

DESCRIPTION
Diseases of the skin and subcutaneous tissue complicating pregnancy, childbirth and the puerperium Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium Post-term infant, not heavy for gestational age; Fetus or infant with gestation period of 42 completed weeks or more (294 days or more), not heavy- or large-for-dates; Postmaturity NOS Dizziness and giddiness; Light-headedness; Vertigo NOS Headache; Facial pain NOS Febrile convulsions Other and unspecified convulsions; Fit NOS; Seizure (convulsive) NOS Superficial injury of scalp Contusion of eyelid and periocular area; Black eye Other superficial injuries of eyelid and periocular area Superficial injury of nose Superficial injury of ear Superficial injury of lip and oral cavity Multiple superficial injuries of head Superficial injury of other parts of head Superficial injury of head, part unspecified Open wound of scalp Open wound of eyelid and periocular area Open wound of nose Open wound of ear Open wound of cheek and temporomandibular area Open wound of lip and oral cavity Multiple open wounds of head Open wound of other parts of head Open wound of head, part unspecified Open wound of finger(s) without damage to nail; Open wound of finger(s) NOS Open wound of finger(s) with damage to nail Multiple open wounds of wrist and hand Open wound of other parts of wrist and hand Open wound of wrist and hand part, part unspecified Open wound of knee Multiple open wounds of lower leg

Case Rate

Professional Fee

Health Care Institution Fee

4,760

1,428

3,332

O99.8

4,760

1,428

3,332

P08.2

5,250

1,575

3,675

R42 R51 R56.0 R56.8 S00.0 S00.1 S00.2 S00.3 S00.4 S00.5 S00.7 S00.8 S00.9 S01.0 S01.1 S01.2 S01.3 S01.4 S01.5 S01.7 S01.8 S01.9 S61.0 S61.1 S61.7 S61.8 S61.9 S81.0 S81.7

3,990 3,850 4,900 4,900 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800

1,197 1,155 1,470 1,470 840 840 840 840 840 840 840 840 840 840 840 840 840 840 840 840 840 840 840 840 840 840 840 840 840

2,793 2,695 3,430 3,430 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960

Page 20 of 22

ANNEX 5. LIST OF MEDICAL CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES ICD CODE
S81.8 S81.9 S91.0 S91.1 S91.2 S91.3 S91.7 T00.0 T00.1 T00.2 T00.3 T00.6 T00.8

DESCRIPTION
Open wound of other parts of lower leg Open wound of lower leg, part unspecified Open wound of ankle Open wound of toe(s) without damage to nail; open wound of toe (s) NOS Open wound of toe(s) with damage to nail Open wound of other parts of foot; open wound of foot NOS Multiple open wounds of ankle and foot Superficial injuries involving head with neck Superficial injuries involving thorax with abdomen lower back and pelvis Superficial injuries involving multiple regions of upper limb(s) Superficial injuries involving multiple regions of lower limb(s) Superficial injuries involving multiple regions of upper limb(s) with lower limb(s) Superficial injuries involving other combinations of body regions Multiple superficial injuries, unspecified; Multiple abrassions NOS; Mulitple nonthermal blisters NOS; Multiple bruises NOS; Mutiple contussions NOS; Multiple haematomas NOS; Mutiple nonvenomous insect bite NOS Anaphylactic shock due to adverse food reaction Other adverse food reactions, not elsewhere classified Anaphylactic shock, unspecified; Allergic shock NOS; Anaphylactic reaction NOS; Anaphylaxis NOS Angioneurotic oedema; Giant urticaria; Quinke's oedema Allergy, unspecified; Allergic reaction NOS; Hypersensitivity NOS; Idiosyncracy NOS Other adverse effects, not elsewhere classified Adverse effect, unspecified Post-traumatic wound infection, not elsewhere classified

Case Rate
2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800 2,800

Professional Fee
840 840 840 840 840 840 840 840 840 840 840 840 840

Health Care Institution Fee 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960 1,960

T00.9

2,800

840

1,960

T78.0 T78.1 T78.2 T78.3 T78.4 T78.8 T78.9 T79.3

5,320 4,340 5,320 4,340 4,340 4,340 4,340 6,510

1,596 1,302 1,596 1,302 1,302 1,302 1,302 1,953

3,724 3,038 3,724 3,038 3,038 3,038 3,038 4,557

Page 21 of 22

ANNEX 5. LIST OF MEDICAL CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES ICD CODE DESCRIPTION
Unspecified adverse effect of drug or medicament; Adverse effect of correct drug or medicament properly administered; Allergic reactiion to correct drug or medicament properly administered; Hypersensitivity to correct drug or medicament properly administe Care and examination immediately after delivery

Case Rate

Professional Fee

Health Care Institution Fee

T88.7

4,340

1,302

3,038

Z39.0

2,000

600

1,400

Page 22 of 22