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.

Pregnancy And Childbirth

11 matching indexed records

← All clinical categories

DTP code	Condition	Minimum treatment
52N	Pregnancy	Antenatal and obstetric care necessitating hospitalisation, including delivery
54N	Necrotizing enterocolitis in newborn	Medical and surgical management
56N	Respiratory conditions of newborn	Medical management; ventilation
67N	# Low birth weight (under 1000g) with respiratory difficulties	# Medical management not including ventilation
71N	Birth trauma for baby	Medical management; surgery
74N	Neonatal and infant GIT abnormalities and disorders, including malrotation and atresia	Medical and surgical management
901N	Congenital systemic infections affecting the newborn	Medical management, ventilation
902N	Neonatal endocrine, metabolic and toxin-induced conditions	Medical management
903N	Neurological abnormalities in the newborn	Medical management
904N	Haematological disorders of the newborn	Medical management
967N	# Low birth weight (under 2500 grams & > 1000g) with respiratory difficulties	# Medical management, including ventilation; intensive care therapy

Using this with SchemeBook

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Start with a general healthcare service or procedure concept if you do not know the DTP code.

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Choose your medical scheme and see what SchemeBook can verify from the available source layer.

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.