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.

Respiratory System

12 matching indexed records

← All clinical categories

DTP code	Condition	Minimum treatment
125D	Adult respiratory distress syndrome; inhalation and aspiration pneumonias	Medical management; ventilation
157D	Acute asthmatic attack; pneumonia due to respiratory syncytial virus in persons under age 3	Medical management
158D	# Respiratory failure, regardless of cause	# Medical management; oxygen; ventilation
170D	Empyema and abscess of lung	Medical and surgical management
203D	Hypoplasia and dysplasia of lung	Medical and surgical management
315D	Atelectasis (collapse of lung)	Medical and surgical management; ventilation
340D	Benign neoplasm of respiratory and intrathoracic organs	Biopsy; lobectomy; Medical management; radiation therapy
5D	Pneumothorax and haemothorax	Tube thoracostomy / thoracotomy
900D	Open fracture of ribs and sternum; multiple rib fractures; flail chest	Medical and surgical management, ventilation
903D	Bacterial, viral, fungal pneumonia	Medical management, ventilation
934D	Frank haemoptysis	Medical and surgical management
950D	Cancer of lung, bronchus, pleura, trachea, mediastinum & other respiratory organs - treatable	Medical and surgical management, which includes chemotherapy and radiation therapy

Using this with SchemeBook

Plan costs

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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.