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.

Female Reproductive System

20 matching indexed records

← All clinical categories

DTP code	Condition	Minimum treatment
237M	Sexual abuse, including rape	Medical management; psychotherapy
266M	Dysplasia of cervix and cervical carcinoma-in-situ; cervical condylomata	Medical and surgical management
288M	Acute pelvic inflammatory disease	Medical and surgical management
296M	Voluntary termination of pregnancy	Induced abortion; medical and surgical management
434M	Non-inflammatory disorders and benign neoplasms of ovary, fallopian tubes and uterus	Salpingectomy; oophorectomy; hysterectomy; medical and surgical management
435M	Torsion of ovary	Oophorectomy; ovarian cystectomy
460M	Fistula involving female genital tract	Closure of fistula
528M	Menopausal management, anomalies of ovaries, primary and secondary amenorrhoea, female sex hormones abnormalities NOS, including hirsutism	Medical and surgical management, including hormone replacement therapy
530M	Uterine prolapse; cystocele	Surgical repair
539M	Abscesses of Bartholin's gland and vulva	Incision and drainage; medical management
53M	Ectopic pregnancy	Surgery
645M	Congenital abnormalities of the female genitalia	Medical and surgical management
902M	Infertility (Explanatory Note 9 of Annexure A of Regulations)	Medical and surgical management
903M	Spontaneous abortion	Medical and surgical manegment
950M	Cancer of uterus - treatable	Medical and surgical management, which includes radiation therapy and chemotherapy
951M	Hydatidiform mole; choriocarcinoma	D & C; hysterectomy; chemotherapy
952M	Cancer of ovary - treatable	Medical and surgical management, which includes radiation therapy and chemotherapy
953M	Cancer of vagina, vulva and other female genital organs NOS - treatable	Medical and surgical management, which includes radiation therapy and chemotherapy
954M	Cancer of Cervix - treatable	Medical and surgical management, which includes radiation therapy and chemotherapy
960M	Cervical and breast cancer screening	Cervical smears; periodic breast examination

Using this with SchemeBook

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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.