SchemeBook / Covered conditions / 213A
Difficulty in breathing, eating, swallowing, bowel, or bladder control due to non-progressive neurological (including spinal) condition or injury
DTP code 213A · Brain And Nervous System
What the DTP says
Minimum treatment
Medical and surgical management; ventilation
What this record tells you
Diagnosis / condition
Difficulty in breathing, eating, swallowing, bowel, or bladder control due to non-progressive neurological (including spinal) condition or injury
Clinical category
Brain And Nervous System
Minimum treatment descriptor
Medical and surgical management; ventilation
What it does not settle on its own
- Whether your exact clinical presentation satisfies the PMB descriptor.
- Which designated service provider or network rules apply to your option.
- Whether pre-authorisation, referral or clinical motivation is required.
- The provider's current charge, the scheme tariff, or your final out-of-pocket amount.
- How an individual dispute will be decided.
Questions to ask your scheme
- Does my diagnosis meet this DTP descriptor for PMB purposes?
- What treatment and public-sector protocol are you applying?
- Which DSP or network provider should I use, and when may I use another provider?
- What authorisation, referral, motivation or supporting records do you need?
- Please confirm the funding decision and any member payment in writing.
Plan the care and cost side separately
The DTP describes minimum PMB treatment; it is not a provider quote. For planned care, ask the provider what will be billed and ask your scheme how it will fund the exact service, codes, facility and providers involved.
Source and legal context
Council for Medical Schemes — PMBs ↗ · CMS PMB conditions list ↗