Benefits & Coverage

Is CT Scan Covered by PhilHealth for Outpatient? (2026)

Written by: PhilHealth Guide Last verified: October 2026, against PhilHealth Circulars 2025-0014, 2025-0027 and 2024-0033 (Annex A) Reading time: ~9 minutes

Mostly no. PhilHealth does not pay for a routine, doctor-ordered CT scan done as a walk-in outpatient. It pays in two narrow cases: a low-dose chest CT for lung cancer screening under YAKAP, at a ₱7,220 package rate (Circular 2025-0014), and a CT scan in an emergency department when you go home within 24 hours, at fixed fees of ₱3,175 to ₱19,929 (Circular 2024-0033). A CT scan during hospital admission is paid through the case rate. The first article I read while researching this said outpatient CT was coming “before the end of the year.” What PhilHealth actually issued is much narrower, and that gap is where people lose money.

Is CT Scan Covered by PhilHealth for Outpatient?

For everything else PhilHealth pays for, see our PhilHealth benefits guide.

Is a CT Scan Covered by YAKAP PhilHealth?

YAKAP covers exactly one CT scan: the low-dose chest CT (LDCT) used to screen for lung cancer. PhilHealth Circular 2025-0014 sets its package rate at ₱7,220, listed in Table 1 of the circular alongside five other cancer screening tests.

The package is a fixed, case-based payment to the facility. The circular says there is no co-payment and no balance billing for PhilHealth beneficiaries in public and private facilities, and that the rate covers equipment, supplies, staff costs and the reader’s or professional fees.

This is a screening benefit. Circular 2025-0027 defines screening as testing people who have no symptoms, so it does not pay for a CT scan ordered to investigate a cough, pain or a lump. The Philippine News Agency reported that the outpatient cancer screening benefit started on August 14, 2025, and was launched at Jose Reyes Memorial Medical Center, one of the accredited screening facilities.

Who Qualifies for the YAKAP Low-Dose Chest CT?

You qualify if you are an asymptomatic adult aged 50 to 80 and meet one of two risk criteria, according to PhilHealth Circular 2025-0027.

Criterion one: at least 30 pack-years, and you either smoke now or quit within the past 15 years. Pack-years are packs per day multiplied by years smoked, so 1.5 packs a day for 20 years equals 30.

Criterion two: a first-degree relative with lung cancer, plus a confirmed smoking history of your own.

The scan repeats every 12 months. Before it, your YAKAP physician must document the assessment and give pre-screening counseling that ends with your informed consent.

How Do I Get a PhilHealth-Covered Low-Dose Chest CT?

You choose a YAKAP clinic online, and every step after that happens in person. Use the Member Portal or the eGovPH app for step one.

1. Choose a YAKAP clinic online. Select your clinic in the eGovPH app or the PhilHealth Member Portal using your PIN, as PhilHealth Advisory 2025-0071 describes. Missing your number? See how to recover a lost PhilHealth number.
2. Do the First Patient Encounter and liveness check. The clinic records your health data and verifies you through the PhilHealth Check Utility. The encounter is not yet a consultation.
3. Sign the YAKAP Empanelment Slip. Since January 1, 2026, this signed slip confirms your empanelment so you keep receiving YAKAP benefits (Advisory 2025-0071).
4. Get assessed and counseled. The YAKAP physician checks your age, pack-years and family history, explains the test’s benefits and limits, and records your consent.
5. Collect the Screening Test Request Form. The physician fills out the form (Annex C of Circular 2025-0014) and hands it to you.
6. Visit an accredited cancer screening facility. Bring the form, a valid ID and your Member Data Record, which the Philippine Information Agency lists as required. The facility validates your request with your clinic. Sign the acknowledgement after the scan.
7. Return to your YAKAP clinic with the result. The facility sends the result to your clinic, PhilHealth and you. Your clinic handles follow-up and refers you onward if the result is positive.

What If the Facility Asks Me to Pay?

Under Circular 2025-0014, an accredited screening facility cannot charge a co-payment or balance bill you for the package. If you are asked to pay, check three things first. Is the facility accredited as a cancer screening facility, not just licensed as an imaging center? Did it validate your request form with your YAKAP clinic? Is the request for a low-dose chest CT specifically, with your assessment documented?

The circular also keeps first-time users eligible when the request came from a private, non-primary-care physician, provided you are referred to a YAKAP clinic after the result (Section V.C.7). Claims are denied when they overlap with a hospital confinement or duplicate a service under a Z Benefit, so schedule the scan outside any admission. Practice varies by facility. If you were charged, ask for a written explanation and raise it with your PhilHealth regional office.

Is a Head CT Scan Covered by PhilHealth for Outpatient?

A head CT scan is covered as an outpatient service only when you get it in an emergency department. Under the Outpatient Emergency Care Benefit (OECB), set by PhilHealth Circular 2024-0033 and effective January 1, 2025, severe headache is one of the listed cases. The fixed fee is ₱4,949 for a plain cranial CT and ₱8,918 for a cranial CT with contrast (Annex A, items 0033 and 0032).

Three conditions apply. You must be discharged within 24 hours of arriving at the ED, or die while seeking treatment. The facility must be OECB-accredited, because the circular says patients treated at non-accredited facilities pay out of pocket; the Inquirer reported in January 2025 that no facility list had been published yet. And the scan must be part of emergency care, not a scheduled appointment.

If your doctor orders a head CT at a clinic for recurring headaches, neither OECB nor YAKAP pays for it. If you are admitted, the scan falls under the case rate instead.

How Much Does PhilHealth Cover for a CT Scan?

PhilHealth’s fixed fees for emergency-department CT scans run from ₱3,175 to ₱19,929 per scan, depending on the body part and whether contrast is used. They come from Annex A of Circular 2024-0033, in the version updated as of February 14, 2025 (PhilHealth Advisory 2025-0009).

The only outpatient CT with its own package outside the ED is the YAKAP low-dose chest CT at ₱7,220 (Circular 2025-0014). Inpatient CT has no separate fee.

Is a CT Scan Covered by PhilHealth for Inpatient?

Yes. When you are admitted, the CT scan is part of your hospital course and is reimbursed through the case rate for your diagnosis, so PhilHealth sets no separate CT fee. The Daily Tribune reported in September 2024 that MRI, CT and PET scans were covered only as inpatient services, and PhilHealth’s own circular on emergency care says its All Case Rates cover procedures as part of an admitted patient’s hospital course (as quoted by the Inquirer, January 2025).

How much you receive depends on the diagnosis or procedure, not on the scan. Check the case rates guide for your condition, and see whether it has a Z Benefit package, which pays differently. A screening claim is also denied if its date falls inside a confinement period (Circular 2025-0014).

What Outpatient Services Does PhilHealth Cover?

PhilHealth’s outpatient coverage sits mainly in YAKAP and the emergency benefit, and it is narrower than most people assume.

• YAKAP primary care: consultations and selected laboratory and diagnostic tests at an accredited YAKAP clinic (Circular 2026-0007).
• GAMOT medicines: up to ₱20,000 a year from a 75-drug list for YAKAP-registered members and legal dependents (Philippine Information Agency, November 2025).
• Cancer screening: six tests under Circular 2025-0014, with the rates below.
• Emergency care (OECB): 342 outpatient emergency services, medicines and supplies on a fixed fee schedule (Philstar, February 2025, summarizing Circular 2024-0033).
• Other outpatient packages: day surgeries, radiotherapy, hemodialysis and blood transfusion (same Philstar summary).

Where Can I Get a Free CT Scan in the Philippines?

No single benefit makes every CT scan free, but three legitimate routes exist. First, the YAKAP low-dose chest CT carries no co-payment at an accredited facility if you meet the Circular 2025-0027 criteria.

Second, the DOH Medical Assistance for Indigent Patients (MAIP), delivered through Malasakit Centers, covers laboratory, imaging, radiological and other diagnostic services under Joint Administrative Order 2020-0001. A medical social worker at the host hospital assesses your eligibility.

Third, some public hospitals subsidize scans for indigent patients. The director of UP-PGH said its new PET-CT facility is free for indigent PGH patients (Inquirer). Rules and eligibility vary by hospital, so call the hospital’s social service office before you travel. Be wary of anyone who offers to arrange a “free PhilHealth CT scan” for a fee.

Why Do Older Articles Say Outpatient CT Is Coming Soon?

In September 2024, the Daily Tribune reported that PhilHealth planned to add outpatient MRI, CT and PET scans by the end of that year, based on a letter signed by Health Secretary Teodoro Herbosa and PhilHealth president Emmanuel Ledesma Jr. At that point these scans were covered only as inpatient services. That plan is why many pages still read as if outpatient CT is an upcoming benefit.

What PhilHealth actually issued was narrower. The Outpatient Emergency Care Benefit took effect on January 1, 2025 and covers CT in the emergency department (Circular 2024-0033). The YAKAP cancer screening package started on August 14, 2025 and covers one CT, the low-dose chest scan (Circular 2025-0014).

As of October 2026, I found no PhilHealth circular that pays for a routine, scheduled outpatient diagnostic CT, MRI or PET. That is a negative finding, not a guarantee. PhilHealth can add benefits by circular at any time, so check the circulars on philhealth.gov.ph before you pay.

What Mistakes Cost People the Most?

1. Trusting a 2024 headline. A plan to cover outpatient scans is not a circular. Read the circular number before you book.
2. Skipping the accreditation check. Both benefits pay only accredited facilities, and the emergency benefit leaves you paying out of pocket at a non-accredited one.
3. Expecting coverage for a symptom-driven CT outside the ED. Neither OECB nor YAKAP pays for it.
4. Skipping the empanelment slip. Advisory 2025-0071 says signing it is how you keep receiving YAKAP benefits from January 1, 2026.
5. Assuming age 50 alone qualifies. I made this mistake myself while researching: the Annex A wording in Circular 2025-0014 looked broad, and I only caught the stricter pack-year and family-history rules after reading Circular 2025-0027.

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