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.

Musculoskeletal System; Trauma Nos

14 matching indexed records

← All clinical categories

DTP code	Condition	Minimum treatment
147H	Crush injuries of trunk, upper limbs, lower limbs, including blood vessels	Surgical management; ventilation; acute renal dialysis
178H	Fracture of hip	Reduction; hip replacement
206H	Chronic osteomyelitis	Incision and drainage
32H	Acute osteomyelitis	Medical and surgical management
34H	Pyogenic arthritis	Medical and surgical management
353H	Abscess of bursa or tendon	Incision and drainage
445H	Injury to internal organs	Medical and surgical management
491H	Dislocations / fractures of vertebral column without spinal cord injury	Medical management; surgical stabilisation
500H	Disruptions of the achilles / quadriceps tendons	Repair
85H	Congenital dislocation of hip; coxa vara and valga; congenital clubfoot	Repair / reconstruction
900H	Open fracture / dislocation of bones and joints	Reduction / relocation; medical and surgical management
901H	Traumatic amputation of limbs, hands, feet, and digits	Replantation / amputation
902H	Closed fractures/ dislocations of limb bones / epiphyses – excluding fingers and toes	Reduction / relocation
950H	Cancer of bones - treatable	Medical and surgical management, which includes chemotherapy and radiation therapy

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.