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.

Skin And Breast

12 matching indexed records

← All clinical categories

DTP code	Condition	Minimum treatment
112J	Toxic epidermal necrolysis and staphylococcal scalded skin syndrome; Stevens-Johnson syndrome	Medical management
349J	Cellulitis and abscesses with risk of organ or limb damage or septiceamia if untreated; necrotizing fasciitis	Medical and surgical management
356J	Pyoderma; body, deep-seated fungal infections	Medical management
373J	Non-superficial open wounds – non life-threatening	Repair
465J	Acute lymphadenitis	Incision and drainage; medical management
900J	Burns, greater than 10% of body surface, or more than 5% involving head, neck, hands, perineum	Debridement; free skin graft; medical management
901J	Disseminated bullous skin disease, including pemphigus, pemphigoid, epidermolysis bullosa, epidermolytic hyperkeratosis	Medical management
950J	Cancer of breast - treatable	Medical and surgical management, which includes chemotherapy and radiation therapy
951J	Lethal midline granuloma	Medical management, which includes radiation therapy
952J	Cancer of soft tissue, including sarcomas and malignancies of the adnexa - treatable	Medical and surgical management, which includes chemotherapy and radiation therapy
953J	Malignant melanoma of skin - treatable	Medical and surgical management, which includes radiation therapy
954J	Cancer of skin, excluding malignant melanoma - treatable	If histologically confirmed, Medical and surgical management, which includes radiation therapy

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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.