![PhilHealth Coverage for Angioplasty in the Philippines [2026]: Rates & Out-of-Pocket Costs](/_next/image?url=https%3A%2F%2Fmedia.clinicfinderph.com%2Fblog%2Fbest-hmo-philippines.webp&w=3840&q=75)
PhilHealth Coverage for Angioplasty in the Philippines [2026]: Rates & Out-of-Pocket Costs
Quick Answer: When angioplasty (PCI) is done to treat a heart attack, PhilHealth pays a case rate of ₱523,853, up from just ₱30,300 before December 2024, under PhilHealth Circular No. 2024-0032. It's not a Z Benefit Package — it's a bundled case rate covering the stent, the cath lab, and both hospital and doctor's fees, with no copayment in ward accommodation. The catch: private-hospital bills often run higher than ₱523,853, leaving a real out-of-pocket gap.
About these figures: The case rates below come from PhilHealth Circular No. 2024-0032, "Benefits Package for Ischemic Heart Disease – Acute Myocardial Infarction (IHD-AMI)," signed by PhilHealth President and CEO Emmanuel R. Ledesma Jr. on December 18, 2024, and effective December 21, 2024 per PhilHealth's own announcement. This circular remains the governing policy as of September 2026. The procedure cost ranges further down are not from this circular — see the separate note before that table. Last checked: September 2026.
Table of Contents
- How Much Does PhilHealth Pay for Angioplasty in 2026?
- Is Angioplasty a PhilHealth Z Benefit Package?
- Does the ₱523,853 Rate Include the Stent?
- Is There a Split Between Hospital and Doctor's Fees?
- Who Is Eligible, and What Documents Do You Need?
- What About Angioplasty That Isn't for a Heart Attack?
- How Much Does Angioplasty Really Cost in the Philippines?
- Worked Example: What Would You Actually Pay Out of Pocket?
- Does HMO Cover What's Left?
- Frequently Asked Questions
- Conclusion
How Much Does PhilHealth Pay for Angioplasty in 2026?
PhilHealth pays ₱523,853 for percutaneous coronary intervention (PCI) — the medical term for angioplasty with stenting — when it's performed to treat an acute myocardial infarction (a heart attack). That's the current rate under Package Code IHD-AMI-A in PhilHealth Circular No. 2024-0032, and it replaced a previous case rate of just ₱30,300, a 1,629% increase.
The same circular also updated three related packages under the IHD-AMI benefit:
| Package Code | Description | 2026 Rate |
|---|---|---|
| IHD-AMI-A | Percutaneous Coronary Intervention (angioplasty with stent) | ₱523,853 |
| IHD-AMI-B | Fibrinolysis (clot-dissolving drugs, no angioplasty) | ₱133,500 |
| IHD-AMI-C | Emergency medical services with coordinated referral/transfer | ₱21,900 |
| IHD-AMI-D | Cardiac rehabilitation after PCI | ₱66,140 |
Source: PhilHealth Circular No. 2024-0032, Table 1.
This is a real change with real numbers behind it: PhilHealth's own report shows it released ₱227.5 million to the Philippine Heart Center alone for IHD-AMI claims covering 459 patients admitted between December 21, 2024 and July 18, 2025 — an average payout of roughly ₱495,000 per patient, close to the full ₱523,853 cap.
PCI is only reimbursed at accredited Level 1 to 3 health facilities with cath lab capability — PhilHealth counted 70 accredited cath labs nationwide as of early 2025. If you're diagnosed with a heart attack at a facility without one, expect a referral to a hospital that has one, which the emergency-transfer package (IHD-AMI-C) is specifically designed to help fund.
Is Angioplasty a PhilHealth Z Benefit Package?
No. Angioplasty for a heart attack is a case rate, not a Z Benefit Package — a distinction worth getting right before you plan your finances around it. Z Benefits are PhilHealth's separate mechanism for a short list of major surgeries, and angioplasty isn't on that list.
The heart-related procedures that are Z Benefits, as of PhilHealth's March 2025 expansion, are:
- Coronary Artery Bypass Graft (CABG) — ₱660,000–₱960,000
- Heart valve repair and replacement — ₱642,000–₱810,000
- Ventricular Septal Defect (VSD) closure — ₱498,000–₱614,000
- Tetralogy of Fallot (TOF) total correction — ₱614,000
Angioplasty runs through the case-based (DRG-transition) payment mechanism instead, under its own IHD-AMI package. Functionally, the effect is similar — a fixed, published amount reimbursed per case — but the eligibility rules, forms, and application process differ from Z Benefits. If your cardiologist is instead recommending bypass surgery rather than a stent, see our PhilHealth Z Benefit Packages guide for how that separate mechanism works.
Does the ₱523,853 Rate Include the Stent?
Yes. PhilHealth's case rate is defined as a bundled payment that covers "room and board, diagnostic imaging procedures, laboratory/chemistry tests, drugs, medicines, devices, supplies, operating room fees, infection control, healthcare worker salary, and other service fees" — and a coronary stent falls under devices/supplies in that definition. You are not billed separately for the stent itself as a line item outside the case rate.
That said, PhilHealth's own circular flags stent pricing as a specific area it monitors for abuse, warning against "unwarranted increases in hospital charges for coronary stents, angioplasty balloons, fibrinolytic agents" that push actual hospital costs above the published rate. In practice, this means: the rate is meant to include the stent, but a hospital billing well above ₱523,853 for the same case — often by marking up premium drug-eluting stents — is exactly the scenario that creates the out-of-pocket gap covered further down.
Is There a Split Between Hospital and Doctor's Fees?
No separate breakdown exists in your bill. Under the Universal Health Care Act (RA 11223, Chapter IV, Sec. 18[b]), PhilHealth does not differentiate between facility charges and professional fees for this package — the full ₱523,853 is credited as one payment to the accredited health facility's account. For private hospitals, that single payment already reflects both. For government hospitals, it's the hospital's internal responsibility to distribute the professional-fee portion to the attending cardiologist and staff.
This matters for the "hospital vs. doctor's fee" question that comes up a lot for other PhilHealth benefits (like the ₱6,000 facility / ₱350 professional split for dialysis): for angioplasty, there is no such published split. It's one number.
Who Is Eligible, and What Documents Do You Need?
Eligibility for this specific package is broader than you might expect. Circular 2024-0032 cites the Universal Health Care Act directly: "Every Filipino citizen shall be automatically included in the NHIP" — meaning you don't need to prove months of active contributions specifically for this benefit, and PhilHealth explicitly states that claims submission "does not require a printed copy of the member data record (MDR)."
In practice, here's what actually happens at admission:
- Give the hospital your PhilHealth number (PIN) at admission or as soon as possible — this is what lets the billing office identify you in the system.
- You don't file the claim yourself. The circular is explicit that "direct filing by members/beneficiaries is discouraged and not allowed." Your hospital files it on your behalf, using PhilHealth Claim Form 2 (with the IHD-AMI-A package code) and Claim Form 4, plus a certified true copy of your cardiac catheterization/operative report — within a 60-day window after discharge.
- PhilHealth deducts the benefit automatically from your total bill before you're asked to pay anything at discharge.
The only real "document" responsibility on your end is making sure your PhilHealth membership record has your correct PIN and, if applicable, your dependents are properly declared — everything else is the hospital's paperwork, not yours.
What About Angioplasty That Isn't for a Heart Attack?
This is the gap we want to be upfront about. Circular 2024-0032's ₱523,853 rate is scoped specifically to angioplasty performed for acute myocardial infarction — it's tied to ICD-10 codes I21.0 through I22.9 (all heart-attack diagnosis codes). If your angioplasty is elective — a stent placed for stable angina or a narrowed artery found on a routine work-up, with no active heart attack — a different, and almost certainly smaller, PhilHealth case rate applies instead, since it falls outside this circular's scope.
We could not confirm the current published amount for elective (non-AMI) PCI from a numbered PhilHealth circular. Several third-party sites cite specific figures (and one attributes them to "Circular 2021-0013"), but we checked that circular directly against PhilHealth's own archive and it's actually titled "Temporary Suspension of Payment of Claims" — unrelated to angioplasty rates. Rather than repeat an unverified number, our advice: if your procedure is elective, ask your hospital's PhilHealth desk to confirm the exact case rate code and peso amount for your ICD-10 diagnosis before your admission, not after.
How Much Does Angioplasty Really Cost in the Philippines?
About this guide: No single source publishes a standardized, nationwide angioplasty price list — costs vary too much by hospital, stent brand, and number of vessels treated. The range below is compiled from Philippine hospital cost-estimator pages and one hospital's own posted package price. It's budgeting guidance, not a quote — always get a written cost estimate from your specific hospital before the procedure. Last checked: September 2026.
| Scenario | Estimated Range (2026) |
|---|---|
| Facility-only package, stent and doctor's fees excluded (e.g., St. Elizabeth Hospital's posted angioplasty package) | Starts at ₱107,000 |
| All-in, single bare-metal stent, private hospital | Roughly ₱250,000–₱500,000 |
| All-in, single drug-eluting stent, private hospital | Roughly ₱400,000–₱700,000+ |
| Multiple stents or complex/multi-vessel PCI | Can exceed ₱700,000–₱1,000,000 |
The wide spread exists because "angioplasty cost" bundles several variable line items: the cath lab and OR fee, the cardiologist's professional fee, anesthesia, days of confinement, and — the biggest swing factor — how many stents you need and whether they're drug-eluting. St. Elizabeth Hospital's own posted package illustrates this well: its ₱107,000 starting price is explicitly for the facility portion only, with the page noting "professional fees and stents are not included" — the stent and doctor's fee are added on top of that base figure, which is exactly why all-in totals land so much higher.
Worked Example: What Would You Actually Pay Out of Pocket?
Here's how the numbers actually play out for a heart-attack angioplasty, using a mid-range private-hospital bill:
| Item | Amount |
|---|---|
| Total hospital bill (1 drug-eluting stent, ward accommodation, private hospital) | ₱650,000 |
| PhilHealth IHD-AMI-A case rate (Circular 2024-0032) | –₱523,853 |
| Remaining balance before HMO | ₱126,147 |
| HMO reimbursement (assuming a ₱300,000 annual cardiac limit, no pre-existing exclusion) | –₱126,147 |
| Out-of-pocket after PhilHealth + HMO | ≈₱0 |
Without HMO, that same patient pays roughly ₱126,147 out of pocket — the gap between what the hospital billed and what PhilHealth's fixed case rate covers. This is the mechanism the circular itself describes: costs "in excess of payments made through the reimbursement rates for IHD-AMI shall be subject to cross-subsidization... or out-of-pocket spending."
The gap shrinks dramatically at public hospitals. Philippine Heart Center's own claims data — ₱227.5 million paid across 459 patients, averaging about ₱495,000 per case — suggests many patients treated at a public tertiary cardiac center in ward accommodation end up with bills close to or within the ₱523,853 cap itself, leaving little to no out-of-pocket balance. Private hospitals, with higher device markups and room-rate structures, are where the real gap tends to open up.
Does HMO Cover What's Left?
Yes, and by design — PhilHealth's own rules require HMO and private insurance to apply after PhilHealth deductions, not instead of them. Circular 2024-0032 states plainly: "Benefits from private health insurance (PHI), health maintenance organizations (HMO), or employee benefits shall be applied after PhilHealth deductions and complement the PhilHealth benefits packages."
Two things worth checking before you assume your HMO closes the gap entirely:
- Annual or per-illness limits. Many HMO plans cap cardiac-related claims well below what a full angioplasty bill can reach, especially with multiple stents.
- Pre-existing condition clauses. If you were diagnosed with coronary artery disease before your HMO plan started (or within its exclusion period), cardiac claims can be denied outright — this is one of the most common reasons HMO claims for heart procedures get rejected.
For a fuller comparison of how PhilHealth and HMO interact — including which pays first and what typically isn't covered by either — see our PhilHealth vs. HMO comparison guide.
Frequently Asked Questions
Does PhilHealth cover angioplasty in the Philippines?
Yes. PhilHealth pays a case rate of ₱523,853 for angioplasty (PCI) performed to treat a heart attack, under Circular No. 2024-0032. This is paid automatically as a deduction from your hospital bill — you don't file a separate claim yourself.
Is angioplasty covered under PhilHealth's Z Benefit Package?
No. Angioplasty is covered as a case rate, not a Z Benefit. PhilHealth's Z Benefits for heart conditions are reserved for coronary artery bypass graft (CABG), heart valve repair/replacement, and a small list of other major cardiac surgeries — angioplasty isn't among them.
Does the PhilHealth case rate for angioplasty include the stent?
Yes. PhilHealth defines its case rate as covering devices and supplies alongside room and board, diagnostics, drugs, and OR fees — a coronary stent falls under that definition. You shouldn't see the stent billed as a separate line item outside the case rate, though hospitals billing well above the case rate for premium stents is what creates the out-of-pocket gap in practice.
How much out-of-pocket will I pay for angioplasty with PhilHealth?
It depends entirely on your hospital's actual bill versus the ₱523,853 PhilHealth pays. At public hospitals in ward accommodation, many patients end up close to fully covered. At private hospitals, where bills can run ₱600,000–₱1,000,000+ depending on the stent and number of vessels treated, a real gap of ₱100,000 or more is common before any HMO applies.
Do I need to file the PhilHealth claim myself?
No. PhilHealth Circular 2024-0032 explicitly states that direct filing by members or beneficiaries is discouraged and not allowed. Your hospital files the claim using your PhilHealth number, deducts the benefit from your bill, and only asks you to settle what remains.
Is there a copayment for angioplasty done for a heart attack?
Not for care within basic or ward accommodation, and within what's covered under the package's minimum standards of care. Choosing a private room, a physician outside the standard arrangement, or services unrelated to your heart-attack treatment shifts those specific charges to out-of-pocket, separate from the case rate itself.
Does PhilHealth cover angioplasty that isn't for a heart attack?
Some coverage likely applies, but we could not verify the current case rate amount for elective (non-heart-attack) angioplasty against a numbered PhilHealth circular — the ₱523,853 rate in this guide is specific to heart-attack cases. Confirm the applicable case rate code and amount with your hospital's PhilHealth desk before an elective procedure.
Can PhilHealth and HMO both pay for my angioplasty?
Yes. PhilHealth pays first, and any HMO or private health insurance is applied afterward to cover what remains — PhilHealth's own circular requires this order. Check your HMO's annual cardiac limit and any pre-existing condition clause beforehand, since both can leave a gap even after PhilHealth's payment.
Which hospitals can perform PhilHealth-covered angioplasty?
Only PhilHealth-accredited Level 1 to 3 health facilities with cath lab capability — PhilHealth counted 70 accredited cath labs nationwide as of early 2025. If you're first brought to a hospital without one, expect a referral to a facility that has it, which PhilHealth's emergency-transfer package is designed to help fund.
Conclusion
PhilHealth's coverage for angioplasty changed dramatically in December 2024 — from a case rate that covered a fraction of the real cost to one that, at public hospitals especially, can come close to covering the whole bill. But "₱523,853" isn't the same as "free": it's a heart-attack-specific case rate, private-hospital bills routinely exceed it, and elective angioplasty runs on a different, unconfirmed number entirely. Know which scenario you're in before you count on a figure.
For the full picture of what PhilHealth pays across other conditions, see our PhilHealth Benefits & Coverage Guide. If your admission involves a longer hospital stay beyond the cardiac procedure itself, our PhilHealth hospitalization benefits guide covers how that separate limit works alongside this one.
Looking for a cardiac-capable hospital near you? Search ClinicFinderPH to compare hospitals by location and confirm PhilHealth accreditation before you're admitted.