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.

Ear, Nose, Mouth And Throat

19 matching indexed records

← All clinical categories

DTP code	Condition	Minimum treatment
12C	Deep open wound of neck, including larynx; fracture of larynx or trachea, open	Medical and surgical management; ventilation
132C	Life-threatening diseases of pharynx NOS, including retropharyngeal abscess	Medical and surgical management
133C	Cholesteatoma	Medical and surgical management
219C	Leukoplakia of oral mucosa, including tongue	Incision/excision; medical management
240C	Peritonsillar abscess	Incision and drainage of abscess; tonsillectomy; medical management
241C	Cancrum oris	Medical and surgical management
29C	Foreign body in pharynx, larynx, trachea, bronchus & esophagus	Removal of foreign body
339C	Fracture of face bones, orbit, jaw; injury to optic and other cranial nerves	Medical and surgical management
33C	Acute and chronic mastoiditis	Mastoidectomy; medical management
346C	Epistaxis – not responsive to anterior packing	Cautery / repair / control hemorrhage
347C	Sialoadenitis; abscess / fistula of salivary glands	Surgery
38C	Choanal atresia	Repair of choanal atresia
457C	Open wound of ear-drum	Tympanoplasty; medical management
482C	Acute otitis media	Medical and surgical management, including myringotomy
521C	Foreign body in ear and nose	Removal of foreign body; and medical and surgical management
543C	Stomatitis, cellulites and abscess of oral soft tissue; Vincent’s angina	Incision and drainage; medical management
900C	Acute upper airway obstruction, including croup, epiglottitis and acute laryngotracheitis	Medical management; intubation; tracheostomy
901C	Cleft palate and/or cleft lip without airway obstruction	Repair
910C	Chronic upper airway obstruction, resulting in cor pulmonale	Medical and surgical management

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.