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.

Heart And Vasculature

33 matching indexed records

← All clinical categories

DTP code	Condition	Minimum treatment
100E	Patent ductus arteriosus; aortic pulmonary fistula - persistent	Ligation
108E	Pericarditis	Medical and surgical management
111E	Injury to major blood vessels - trunk, head and neck, and upper limbs	Repair
155E	Myocarditis; cardiomyopathy; transposition of great vessels; hypoplastic left heart syndrome	Medical and surgical management; cardiac transplant
16E	Rupture of papillary muscle	Medical and surgical management
18E	Dissecting or ruptured aortic aneurysm	Surgical management
19E	Injury to major blood vessels of extremities	Ligation
204E	Cardiac failure: acute or recent deterioration of chronic cardiac failure	Medical treatment
209E	Phlebitis & thrombophlebitis, deep	Ligation and division; medical management
210E	Diseases of endocardium; endocarditis	Medical management
26E	Arterial embolism/thrombosis: abdominal aorta, thoracic aorta	Medical and surgical management
284E	Acute pulmonary heart disease and pulmonary emboli	Medical and surgical management
294E	Giant cell arteritis, Kawasaki disease, hypersensitivity angiitis	Medical management
309E	Diseases and disorders of aortic valve NOS	Aortic valve replacement
314E	Diseases of mitral valve	Valvuloplasty; valve replacement; medical management
355E	Other aneurysm of artery – peripheral	Surgical management
35E	Acute rheumatic fever	Medical management
450E	Hereditary hemorrhagic telangiectasia	Excision
497E	Multiple valvular disease	Surgical management
627E	Shock / hypotension – life-threatening	Medical management; ventilation
900E	Life-threatening complications of elective cardiac and major vascular procedures	Medical and surgical management
901E	Hypertension – acute life-threatening complications and malignant hypertension; renal artery stenosis and other curable hypertension	Medical and surgical management
902E	Disorders of arteries: visceral	Bypass graft; surgical management
903E	Life-threatening cardiac arrhythmias	Medical and surgical management, pacemakers, cardioversion
905E	Other correctable congenital cardiac conditions	Surgical repair; medical management
907E	Acute and subacute ischemic heart disease, including myocardial infarction and unstable angina	Medical management; surgery; percutaneous procedures
908E	Aneurysm of major artery of chest, abdomen, neck, - Unruptured or ruptured NOS	Surgical management
914E	Rheumatic pericarditis; rheumatic myocarditis	Medical management
915E	Gangrene; severe atherosclerosis of arteries of extremities; diabetes mellitus with peripheral circulatory disease	Medical and surgical management including amputation
93E	Ventricular septal defect - persistent	Closure
97E	Coronary artery anomaly	Anomalous coronary artery ligation
98E	Complete, corrected and other transposition of great vessels	Repair
99E	Tetralogy of Fallot (TOF)	Total repair tetralogy

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.