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.

Haematological, Infectious And Miscellaneous Systemic Conditions

35 matching indexed records

← All clinical categories

DTP code	Condition	Minimum treatment
113S	Acquired haemolytic anaemias	Medical management
11S	Tuberculosis	Diagnosis and acute medical management; successful transfer to maintenance therapy in accordance to DOH guidelines
122S	Thalassemia and other haemoglobinopathies – treatable	Medical management; bone marrow transplant
128S	Tetanus; anthrax; Whipple's disease	Medical management
15S	Whooping cough, diptheria	Medical management
168S	# HIV-infection	# HIV voluntary counseling and testing Co-trimoxazole as preventative therapy Screening and preventative therapy for TB, Diagnosis and treatment of sexually transmitted infections Pain management in palliative care Treatment of opportunistic infections, Prevention of mother-to-child transmission of HIV Post-exposure prophylaxis following occupational exposure or sexual assault Medical management and medication, including the provision of anti-retroviral therapy, and ongoing monitoring for medicine effectiveness and safety, to the extent provided for in the national guidelines applicable in the public sector
172S	Malaria; trypanosomiasis; other life-threatening parasitic disease	Medical management
174S	Hereditary haemolytic anaemias (e.g. sickle cell); dyserythropoietic anemia (congenital)	Medical management
179S	Hereditary angioedema; angioneurotic oedema	Medical and surgical management
196S	Chronic Granulomatous disease	Medical management, which includes radiation therapy
197S	Botulism	Medical management
201S	Herpetic encephalitis; Reye’s syndrome	Medical management
246S	Cysticercosis; other systemic cestode infection	Medical management
247S	Poisoning by ingestion, injection, and non-medicinal agents	Medical management
252S	Life-threatening anaemia NOS	Medical management; transfusion
260S	# Imminent death regardless of diagnosis	# Comfort care; pain relief; hydration
277S	Anaerobic infections – life threatening	Medical management; hyperbaric oxygen
316S	Toxic effect of gasses, fumes, and vapors	Medical therapy
336S	Leptospirosis; spirochaetal infections NOS	Medical management
338S	Cholera; rat-bite fever	Medical management
44S	Erysipelas	Medical management
48S	Anaphylactic shock	Medical management; ventilation
50S	Syphilis - congenital, secondary and tertiary	Medical management
900S	Aplastic anemia; agranulocytosis; other life-threatening hereditary immune deficiencies	Bone marrow transplantation; medical management
901S	Acute leukemias, lymphomas	Medical management, which includes chemotherapy, radiation therapy, bone marrow transplantation
903S	Deep-seated (excluding nail infections), disseminated and systemic fungal infections	Medical management; surgery
904S	Metastatic infections; septiceamia	Medical management
907S	Life-threatening rickettsial and other arthropod-borne diseases	Medical management
908S	Life-threatening conditions due to exposure to the elements, including hypo and hyperthermia; lighting strikes	Medical management
910S	Multiple myeloma and chronic leukaemias	Medical management which includes chemotherapy and radiation therapy
911S	Sexually transmitted diseases with systemic involvement not elsewhere specified	Medical management
912S	Leprosy and other systemic mycobacterial infections, Excluding tuberculosis	Medical management
913S	Immune compromise NOS and associated life-threatening infections NOS	Medical management
916S	Coagulation defects	Medical management
937S	Tumour of internal organ (excludes skin): unknown whether benign or malignant	Biopsy

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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.