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.

Mental Illness

9 matching indexed records

← All clinical categories

DTP code	Condition	Minimum treatment
182T	Abuse or dependence on Psychoactive substance, including alcohol	Hospital-based management up to 3 weeks/year
184T	Brief reactive psychosis	Hospital-based management up to 3 weeks/year
901T	Acute stress disorder accompanied by recent significant trauma, including physical or sexual abuse	Hospital admission for psychotherapy / counselling up to 3 days, or up to 12 outpatient psychotherapy / counselling contacts
902T	Major affective disorders, including unipolar and bipolar depression	Hospital-based management up to 3 weeks/year (including inpatient electro-convulsive therapy and inpatient psychotherapy) or outpatient psychotherapy of up to 15 contacts
903T	Attempted suicide, irrespective of cause	Hospital-based management up to 3 days or up to 6 outpatient contacts
907T	Schizophrenic and paranoid delusional disorders	Hospital-based management up to 3 weeks/year
908T	Anorexia Nervosa and Bulimia Nervosa	Hospital-based management up to 3 weeks/year or minimum of 15 outpatient contacts per year
909T	Treatable dementia	Admission for initial diagnosis; management of acute psychotic symptoms - up to 1 week
910T	Delirium: Amphetamine, Cocaine, or other psychoactive substance	Hospital-based management up to 3 days

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.