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.

Brain And Nervous System

38 matching indexed records

← All clinical categories

DTP code	Condition	Minimum treatment
109A	Vertebral dislocations/ fractures, open or closed with injury to spinal cord	Repair /reconstruction; medical management; inpatient rehabilitation up to 2 months
1A	Severe / moderate head injury: hematoma / oedema with loss of consciousness	Medical and surgical management; ventilation
211A	Intraspinal and Intracranial abscess	Medical and surgical management
213A	Difficulty in breathing, eating, swallowing, bowel, or bladder control due to non-progressive neurological (including spinal) condition or injury	Medical and surgical management; ventilation
265A	Transient cerebral ischaemia; life-threatening cerebrovascular conditions NOS	Evaluation; medical management; surgery
28A	Subarachnoid and intracranial hemorrhage / hematoma; compression of brain	Medical and surgical management
305A	Tetanus	Medical management; ventilation
341A	Basal ganglia, extra-pyramidal disorders; other dystonias NOS	Initial diagnosis; initiation of medical management
386B	Herpes zoster & herpes simplex with ophthalmic complications	Medical management
389B	Hyphaema	Removal of blood clot; observation
394B	Angle-closure glaucoma	Iridectomy; laser surgery; medical and surgical management
405B	Glaucoma associated with disorders of the lens	Surgical management
407B	Primary and open angle glaucoma with failed medical management	Trabeculectomy; other surgery
409B	Sympathetic uveitis and degenerative disorders and conditions of globe; sight threatening thyroid optopathy	Enucleation; medical management; surgery
419B	Purulent endophthalmitis	Vitrectomy
47B	Acute orbital cellulitis	Medical and surgical management
485B	Inflammation of lacrimal passages	Incision; medical management
49A	Compound/ depressed fractures of skull	Craniotomy/ craniectomy
510A	Peripheral nerve injury with open wound	Neuroplasty
513A	Myasthenia gravis; muscular dystrophy; neuro-myopathies NOS	Initial diagnosis; initiation of medical management; therapy for acute complications and exacerbations
586B	Bell’s palsy; exposure keratoconjunctivitis	Tarsorrhaphy; medical and surgical management
684A	Viral meningitis, encephalitis, myelitis and encephalomyelitis	Medical management
83A	Encephalocele; congenital hydrocephalus	Shunt; surgery
84A	Spina Bifida	Surgical management
901A	Stroke – due to hemorrhage, or ischaemia	Medical management; surgery
901B	Cataract; aphakia	Extraction of cataract; lens implant
902A	Epilepsy (status epilepticus, initial diagnosis, candidate for neurosurgery)	Medical management; ventilation; neurosurgery
904B	Retinal detachment, tear and other retinal disorders	Vitrectomy; laser treatment; other surgery
905A	Meningitis – acute and subacute	Medical and surgical management
906A	Acute generalised paralysis, including polio and Guillain-Barre	Medical management; ventilation and plasmapheresis
906B	Retinal vascular occlusion; central retinal vein occlusion	Laser surgery
909B	Open wound of eyeball and other eye structures	Medical and surgical management
911B	Corneal ulcer; Superficial injury of eye and adnexa	Conjunctival flap; medical management
922B	Retained intraocular foreign body	Surgical management
940A	Reversible CNS abnormalities due to other systemic disease	Medical and surgical management
941A	Spinal cord compression, ischaemia or degenerative disease NOS	Medical and surgical management
950A	Benign and malignant brain tumours, treatable	Medical and surgical management which includes radiation therapy and chemotherapy
950B	Cancer of the eye and orbit - treatable	Medical and surgical management, which includes radiation therapy and chemotherapy

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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.