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.

Gastro-Intestinal System

24 matching indexed records

← All clinical categories

DTP code	Condition	Minimum treatment
124F	Acute vascular insufficiency of intestine	Colectomy
20F	Intestinal obstruction without mention of hernia; symptomatic foreign body in stomach, intestines, colon & rectum	Excision; surgery; medical management
214F	Oesophageal stricture	Dilatation; surgery
232F	Paralytic ileus	Medical management
254F	Acute diverticulitis of colon	Medical and surgical management, including colon resection
264F	Anal and rectal polyp	Excision of polyp
292F	Regional enteritis; idiopathic proctocolitis – acute exacerbations and complications only	Medical and surgical management
337F	Amoebiasis; typhoid	Medical management
3F	Peritonitis, regardless of cause	Medical and surgical management
41F	Abscess of intestine	Drain abscess; medical management
489F	Acquired hypertrophic pyloric stenosis and other disorders of the stomach and duodenum	Surgical management
498F	Peritoneal adhesion	Surgical management
507F	Thrombosed and complicated haemorrhoids	Haemorrhoidectomy; incision
516F	Oesophageal varices	Medical management; surgical shunt; sclerotherapy
555F	Rectal prolapse	Partial colectomy
6F	Hernia with obstruction and/or gangrene; uncomplicated hernias under age 18	Repair; bowel resection
900F	Rupture of intra-abdominal organ	Repair; splenectomy; resection
901F	Gastroenteritis and colitis with life-threatening haemorrhage or dehydration, regardless of cause	Medical management
902F	Gastric or intestinal ulcers with hemorrhage or perforation	Surgery; endoscopic diagnosis; medical management
920F	Anal Fissure; Anal fistula	Fissurectomy ; Fistulectomy; medical management
950C	Cancer of the gastro-intestinal tract, including oesophagus, stomach, bowel, rectum, anus - treatable	Medical and surgical management, which includes chemotherapy and radiation therapy
952F	Cancer of retroperitoneum, peritoneum, omentum & mesentery - treatable	Medical and surgical management, which includes chemotherapy and radiation therapy
95F	Congenital anomalies of upper alimentary tract – excluding tongue	Medical and surgical management
9F	Appendicitis	Appendectomy

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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.