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.

Urinary And Male Genital System

15 matching indexed records

← All clinical categories

DTP code	Condition	Minimum treatment
289L	Ureteral fistula (intestinal)	Nephrostomy
354L	Abscess of prostate	Turp; drain abscess
359L	Vesicoureteral reflux	Medical management; replantation
436L	Torsion of testis	Orchidectomy; repair
43L	Trauma to the urinary system including ruptured bladder	Cystorrhaphy; suture; repair
900L	Hyperplasia of the prostate, with acute urinary retention or obstructive renal failure	Transurethral resection; medical management
901L	End stage renal disease regardless of cause	Dialysis and renal transplant where Department of Health criteria are met only (see criteria published in GPS 004-9001)
903L	Acute glomerulonephritis and nephritic syndrome	Medical management
904L	Acute and chronic pyelonephritis; renal and perinephric abscess	Medical and surgical management
905L	Obstruction of the urogenital tract, regardless of cause	Catheterisation; surgery; endoscopic removal of obstructing agent: lithotripsy
906L	Congenital anomalies of urinary system - symptomatic and life-threatening	Nephrectomy / repair
950L	Cancer of testis - treatable	Medical and surgical management, which includes chemotherapy and radiation therapy
952L	Cancer of urinary system including kidney and bladder - treatable	Medical and surgical management, which includes chemotherapy and radiation therapy
953L	Cancer of prostate gland - treatable	Medical and surgical management, which includes chemotherapy and radiation therapy
954L	Cancer of penis and other male genital organ - treatable	Medical and surgical management, which includes chemotherapy and 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.