SchemeBook / Covered conditions

Find a PMB condition or minimum treatment

Search the Diagnosis Treatment Pair (DTP) directory by condition, DTP code or minimum treatment, or browse by clinical category. This is a SchemeBook guide to the CMS PMB source set — not a quote, diagnosis or individual benefit decision.

Prescribed Minimum Benefits

266 DTP records currently indexed

The Council for Medical Schemes describes a limited set of 271 medical conditions defined through Diagnosis Treatment Pairs. SchemeBook currently indexes 266 parsed DTP records from the current CMS source material. The remaining difference is being reconciled before SchemeBook describes the catalogue as complete.

A DTP links a diagnosis to a minimum treatment entitlement. It does not by itself tell you which provider to use, what a provider will charge, whether authorisation is required, or the exact amount your option will pay.

Browse by clinical category

Brain And Nervous System

38 indexed conditions

Haematological, Infectious And Miscellaneous Systemic Conditions

35 indexed conditions

Heart And Vasculature

33 indexed conditions

Gastro-Intestinal System

24 indexed conditions

Female Reproductive System

20 indexed conditions

Ear, Nose, Mouth And Throat

19 indexed conditions

Urinary And Male Genital System

15 indexed conditions

Musculoskeletal System; Trauma Nos

14 indexed conditions

Endocrine, Metabolic And Nutritional

13 indexed conditions

Respiratory System

12 indexed conditions

Skin And Breast

12 indexed conditions

Liver, Pancreas And Spleen

11 indexed conditions

Pregnancy And Childbirth

11 indexed conditions

Mental Illness

9 indexed conditions

Using this with SchemeBook

Plan costs

Ask the provider and your scheme for current fees, codes, network rules and likely member payments.

Explore care

Start with a general healthcare service or procedure concept if you do not know the DTP code.

Ask SchemeBook

Choose your medical scheme and see what SchemeBook can verify from the available source layer.

Authoritative source

Council for Medical Schemes — Prescribed Minimum Benefits ↗ · CMS PMB conditions list ↗

Annexure A to the Medical Schemes Act regulations is the legal source. CMS notes that its coded PMB conditions list is a guideline and the regulatory condition definition prevails if there is a conflict.