List of PMB conditions and their prescribed treatment

Below is a list of the Categories (Diagnosis and Treatment Pairs) constituting the Prescribed Minimum Benefits (PMB) Package under Section 29(1)(o) of the Medical Schemes Act (listed by Organ-System chapter).

IMPORTANT: For an explanation of general treatments (example: “Medical Management”) please click here

NOS means “not otherwise specified”.


For more in-depth explanation, click here
906A Acute generalised paralysis, including polio and Guillain-Barre Medical management; ventilation and plasmapheresis
341A Basal ganglia, extra-pyramidal disorders; other dystonias NOS Initial diagnosis; initiation of medical management
950A Benign and malignant brain tumours, treatable Medical and surgical management which includes radiation therapy and chemotherapy
49A Compound/ depressed fractures of skull Craniotomy/ craniectomy
213A Difficulty in breathing, eating, swallowing, bowel, or bladder control due to non-progressive neurological (including spinal) condition or injury Medical and surgical management; ventilation
83A Encephalocele; congenital hydrocephalus Shunt; surgery
902A Epilepsy (status epilepticus, initial diagnosis, candidate for neurosurgery) Medical management; ventilation; neurosurgery
211A Intraspinal and Intracranial abscess Medical and surgical management
905A Meningitis – acute and subacute Medical and surgical management
513A Myasthenia gravis; muscular dystrophy; neuro-myopathies NOS Initial diagnosis; initiation of medical management; therapy for acute complications and exacerbations
510A Peripheral nerve injury with open wound Neuroplasty
940A Reversible CNS abnormalities due to other systemic disease Medical and surgical management
1A Severe / moderate head injury: hematoma / oedema with loss of consciousness Medical and surgical management; ventilation
84A Spina Bifida Surgical management
941A Spinal cord compression, ischaemia or degenerative disease NOS Medical and surgical management
901A Stroke – due to hemorrhage, or ischaemia Medical management; surgery
28A Subarachnoid and intracranial hemorrhage / hematoma; compression of brain Medical and surgical management
305A Tetanus Medical management; ventilation
265A Transient cerebral ischaemia; life-threatening cerebrovascular conditions NOS Evaluation; medical management; surgery
109A Vertebral dislocations/ fractures, open or closed with injury to spinal cord Repair /reconstruction; medical management; inpatient rehabilitation up to 2 months
684A Viral meningitis, encephalitis, myelitis and encephalomyelitis Medical management


47B Acute orbital cellulitis Medical and surgical management
394B Angle-closure glaucoma Iridectomy; laser surgery; medical and surgical management
586B Bell’s palsy; exposure keratoconjunctivitis Tarsorrhaphy; medical and surgical management
950B Cancer of the eye and orbit – treatable Medical and surgical management, which includes radiation therapy and chemotherapy
901B Cataract; aphakia Extraction of cataract; lens implant
911B Corneal ulcer; Superficial injury of eye and adnexa Conjunctival flap; medical management
405B Glaucoma associated with disorders of the lens Surgical management
386B Herpes zoster & herpes simplex with ophthalmic complications Medical management
389B Hyphaema Removal of blood clot; observation
485B Inflammation of lacrimal passages Incision; medical management
909B Open wound of eyeball and other eye structures Medical and surgical management
407B Primary and open angle glaucoma with failed medical management Trabeculectomy; other surgery
419B Purulent endophthalmitis Vitrectomy
922B intraocular foreign body Surgical management
904B Retinal detachment, tear and other retinal disorders Vitrectomy; laser treatment; other surgery
906B Retinal vascular occlusion; central retinal vein occlusion Laser surgery
409B Sympathetic uveitis and degenerative disorders and conditions of globe; sight threatening thyroid optopathy Enucleation; medical management; surgery


33C Acute and chronic mastoiditis Mastoidectomy; medical management
482C Acute otitis media Medical and surgical management, including myringotomy
900C Acute upper airway obstruction, including croup, epiglottitis and acute laryngotracheitis Medical management; intubation; tracheostomy
950C Cancer of oral cavity, pharynx, nose, ear, and larynx – treatable Medical and surgical management, which includes chemotherapy and radiation therapy
241C Cancrum oris Medical and surgical management
38C Choanal atresia Repair of choanal atresia
133C Cholesteatoma Medical and surgical management
910C Chronic upper airway obstruction, resulting in cor pulmonale Medical and surgical management
901C Cleft palate and/or cleft lip without airway obstruction Repair
12C Deep open wound of neck, including larynx; fracture of larynx or trachea, open Medical and surgical management; ventilation
346C Epistaxis – not responsive to anterior packing Cautery / repair / control hemorrhage
521C Foreign body in ear and nose Removal of foreign body; and medical and surgical management
29C Foreign body in pharynx, larynx, trachea, bronchus & esophagus Removal of foreign body
339C Fracture of face bones, orbit, jaw; injury to optic and other cranial nerves Medical and surgical management
219C Leukoplakia of oral mucosa, including tongue Incision/excision; medical management
132C Life-threatening diseases of pharynx NOS, including retropharyngeal abscess Medical and surgical management
457C Open wound of ear-drum Tympanoplasty; medical management
240C Peritonsillar abscess Incision and drainage of abscess; tonsillectomy; medical management
347C Sialoadenitis; abscess / fistula of salivary glands Surgery
543C Stomatitis, cellulites and abscess of oral soft tissue; Vincent’s angina Incision and drainage; medical management


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


155E Myocarditis; cardiomyopathy; transposition of great vessels; hypoplastic left heart syndrome Medical and surgical management; cardiac transplant
108E Pericarditis Medical and surgical management
907E Acute and subacute ischemic heart disease, including myocardial infarction and unstable angina Medical management; surgery; percutaneous procedures
284E Acute pulmonary heart disease and pulmonary emboli Medical and surgical management
35E Acute rheumatic fever Medical management
908E Aneurysm of major artery of chest, abdomen, neck, – Unruptured or ruptured NOS Surgical management
26E Arterial embolism/thrombosis: abdominal aorta, thoracic aorta Medical and surgical management
204E Cardiac failure: acute or recent deterioration of chronic cardiac failure Medical treatment
98E Complete, corrected and other transposition of great vessels Repair
97E Coronary artery anomaly Anomalous coronary artery ligation
309E Diseases and disorders of aortic valve NOS Aortic valve replacement
210E Diseases of endocardium; endocarditis Medical management
314E Diseases of mitral valve Valvuloplasty; valve replacement; medical management
902E Disorders of arteries: visceral Bypass graft; surgical management
18E Dissecting or ruptured aortic aneurysm Surgical management
915E Gangrene; severe atherosclerosis of arteries of extremities; diabetes mellitus with peripheral circulatory disease Medical and surgical management including amputation
294E Giant cell arteritis, Kawasaki disease, hypersensitivity angiitis Medical management
450E Hereditary hemorrhagic telangiectasia Excision
901E Hypertension – acute life-threatening complications and malignant hypertension; renal artery stenosis and other curable hypertension Medical and surgical management
111E Injury to major blood vessels – trunk, head and neck, and upper limbs Repair
19E Injury to major blood vessels of extremities Ligation
903E Life-threatening cardiac arrhythmias Medical and surgical management, pacemakers, cardioversion
900E Life-threatening complications of elective cardiac and major vascular procedures Medical and surgical management
497E Multiple valvular disease Surgical management
355E Other aneurysm of artery – peripheral Surgical management
905E Other correctable congenital cardiac conditions Surgical repair; medical management
100E Patent ductus arteriosus; aortic pulmonary fistula – persistent Ligation
209E Phlebitis & thrombophlebitis, deep Ligation and division; medical management
914E Rheumatic pericarditis; rheumatic myocarditis Medical management
16E Rupture of papillary muscle Medical and surgical management
627E Shock / hypotension – life-threatening Medical management; ventilation
99E Tetralogy of Fallot (TOF) Total repair tetralogy
93E Ventricular septal defect – persistent Closure


920F Anal Fissure; Anal fistula Fissurectomy ; Fistulectomy; medical management
41F Abscess of intestine Drain abscess; medical management
489F Acquired hypertrophic pyloric stenosis and other disorders of the stomach and duodenum Surgical management
254F Acute diverticulitis of colon Medical and surgical management, including colon resection
124F Acute vascular insufficiency of intestine Colectomy
337F Amoebiasis; typhoid Medical management
264F Anal and rectal polyp Excision of polyp
9F Appendicitis Appendectomy
952F Cancer of retroperitoneum, peritoneum, omentum & mesentery – treatable Medical and surgical management, which includes chemotherapy and radiation therapy
950C Cancer of the gastro-intestinal tract, including oesophagus, stomach, bowel, rectum, anus – treatable Medical and surgical management, which includes chemotherapy and radiation therapy
95F Congenital anomalies of upper alimentary tract – excluding tongue Medical and surgical management
214F Oesophageal stricture Dilatation; surgery
516F Oesophageal varices Medical management; surgical shunt; sclerotherapy
902F Gastric or intestinal ulcers with hemorrhage or perforation Surgery; endoscopic diagnosis; medical management
901F Gastroenteritis and colitis with life-threatening haemorrhage or dehydration, regardless of cause Medical management
6F Hernia with obstruction and/or gangrene; uncomplicated hernias under age 18 Repair; bowel resection
20F Intestinal obstruction without mention of hernia; symptomatic foreign body in stomach, intestines, colon & rectum Excision; surgery; medical management
232F Paralytic ileus Medical management
498F Peritoneal adhesion Surgical management
3F Peritonitis, regardless of cause Medical and surgical management
555F Rectal prolapse Partial colectomy
292F Regional enteritis; idiopathic proctocolitis – acute exacerbations and complications only Medical and surgical management
900F Rupture of intra-abdominal organ Repair; splenectomy; resection
507F Thrombosed and complicated haemorrhoids Haemorrhoidectomy; incision


325G Acute necrosis of liver Medical management
327G Acute pancreatitis Medical management, and where appropriate, surgical management
36G Budd-Chiari syndrome, and other venous embolism and thrombosis Thrombectomy / ligation
910G Calculus of bile duct with cholecystitis Medical management; cholecystectomy; other open or closed surgery
950G Cancer of liver, biliary system and pancreas – treatable Medical and surgical management
255G Cyst and pseudocyst of pancreas Drainage of pancreatic cyst
156G Disorders of bile duct Excision; repair
910G Gallstone with cholecystitis and/or jaundice Medical management; cholecystectomy; other open or closed surgery
743G Hepatorenal syndrome Medical management
27G Liver abscess; pancreatic abscess Medical and surgical management
911G Liver failure; hepatic vascular obstruction; inborn errors of liver metabolism; biliary atresia Liver transplant, other surgery, medical management
231G Portal vein thrombosis Shunt


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


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
950J Cancer of breast – treatable Medical and surgical management, which includes chemotherapy and radiation therapy
954J Cancer of skin, excluding malignant melanoma – treatable
952J Cancer of soft tissue, including sarcomas and malignancies of the adnexa – treatable Medical and surgical management, which includes chemotherapy and radiation therapy
349J Cellulitis and abscesses with risk of organ or limb damage or septiceamia if untreated; necrotizing fasciitis Medical and surgical management
901J Disseminated bullous skin disease, including pemphigus, pemphigoid, epidermolysis bullosa, epidermolytic hyperkeratosis Medical management
951J Lethal midline granuloma Medical management, which includes radiation therapy
953J Malignant melanoma of skin – treatable Medical and surgical management, which includes radiation therapy
373J Non-superficial open wounds – non life-threatening Repair
356J Pyoderma; body, deep-seated fungal infections Medical management
112J Toxic epidermal necrolysis and staphylococcal scalded skin syndrome; Stevens-Johnson syndrome Medical management


331K Acute thyroiditis Medical management
951K Benign and malignant tumours of pituitary gland with/without hypersecretion syndromes Medical and surgical management; radiation therapy
30K Benign neoplasm of islets of Langerhans Excision of tumour; medical management
950K Cancer of endocrine system, excluding thyroid – treatable Medical and surgical management, which includes chemotherapy and radiation therapy
952K Cancer of thyroid – treatable; carcinoid syndrome Medical and surgical management, which includes chemotherapy and radiation therapy
61K Congenital hypothyroidism Medical management
902K Disorder of adrenal secretion NOS Medical management; adrenalectomy
447K Disorders of parathyroid gland; benign neoplasm of parathyroid gland Medical and surgical management
904K Hyper and hypothyroidism with life-threatening complications or requiring surgery Medical management, Surgery
31K Hypoglycemic coma; hyperglycemia; diabetic ketoacidosis Medical management
236K Iron deficiency; vitamin and other nutritional deficiencies – life-threatening Medical management
901K Life-threatening congenital abnormalities of carbohydrate, lipid, protein and amino acid metabolism Medical management
903K Life-threatening disorders of fluid and electrolyte balance, NOS Medical management


354L Abscess of prostate Turp; drain abscess
904L Acute and chronic pyelonephritis; renal and perinephric abscess Medical and surgical management
903L Acute glomerulonephritis and nephritic syndrome Medical management
954L Cancer of penis and other male genital organ – 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
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
906L Congenital anomalies of urinary system – symptomatic and life-threatening Nephrectomy / repair
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)
900L Hyperplasia of the prostate, with acute urinary retention or obstructive renal failure Transurethral resection; medical management
905L Obstruction of the urogenital tract, regardless of cause Catheterisation; surgery; endoscopic removal of obstructing agent: lithotripsy
436L Torsion of testis Orchidectomy; repair
43L Trauma to the urinary system including ruptured bladder Cystorrhaphy; suture; repair
289L Ureteral fistula (intestinal) Nephrostomy
359L Vesicoureteral reflux Medical management; replantation


539M Abscesses of Bartholin’s gland and vulva Incision and drainage; medical management
288M Acute pelvic inflammatory disease Medical and surgical management
954M Cancer of Cervix – treatable Medical and surgical management, which includes radiation therapy and chemotherapy
952M Cancer of ovary – treatable Medical and surgical management, which includes radiation therapy and chemotherapy
950M Cancer of uterus – treatable Medical and surgical management, which includes radiation therapy and chemotherapy
953M Cancer of vagina, vulva and other female genital organs NOS – treatable Medical and surgical management, which includes radiation therapy and chemotherapy
960M Cervical and breast cancer screening Cervical smears; periodic breast examination
645M Congenital abnormalities of the female genitalia Medical and surgical management
266M Dysplasia of cervix and cervical carcinoma-in-situ; cervical condylomata Medical and surgical management
53M Ectopic pregnancy Surgery
460M Fistula involving female genital tract Closure of fistula
951M Hydatidiform mole; choriocarcinoma D & C; hysterectomy; chemotherapy
902M Infertility (Explanatory Note 9 of Annexure A of Regulations) Medical and surgical management
528M Menopausal management, anomalies of ovaries, primary and secondary amenorrhoea, female sex hormones abnormalities NOS, including hirsutism Medical and surgical management, including hormone replacement therapy
434M Non-inflammatory disorders and benign neoplasms of ovary, fallopian tubes and uterus Salpingectomy; oophorectomy; hysterectomy; medical and surgical management
237M Sexual abuse, including rape Medical management; psychotherapy
903M Spontaneous abortion Medical and surgical manegment
435M Torsion of ovary Oophorectomy; ovarian cystectomy
530M Uterine prolapse; cystocele Surgical repair
296M Voluntary termination of pregnancy Induced abortion; medical and surgical management


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


50S Syphilis – congenital, secondary and tertiary Medical management
168S # HIV-infection # HIV voluntary counseling and testing
Co-trimoxazole as preventative therapy Screening and preventative therapy for TB, Diagnosis and treatment of sexually transmitted infections
Pain management in palliative care
Treatment of opportunistic infections, Prevention of mother-to-child transmission of HIV
Post-exposure prophylaxis following occupational exposure or sexual assault
Medical management and medication, including the provision of anti-retroviral therapy, and ongoing monitoring for medicine effectiveness and safety, to the extent provided for in the national guidelines applicable in the public sector
260S # Imminent death regardless of diagnosis # Comfort care; pain relief; hydration
113S Acquired haemolytic anaemias Medical management
901S Acute leukemias, lymphomas Medical management, which includes chemotherapy, radiation therapy, bone marrow transplantation
277S Anaerobic infections – life threatening Medical management; hyperbaric oxygen
48S Anaphylactic shock Medical management; ventilation
900S Aplastic anemia; agranulocytosis; other life-threatening hereditary immune deficiencies Bone marrow transplantation; medical management
197S Botulism Medical management
338S Cholera; rat-bite fever Medical management
196S Chronic Granulomatous disease Medical management, which includes radiation therapy
916S Coagulation defects Medical management
246S Cysticercosis; other systemic cestode infection Medical management
903S Deep-seated (excluding nail infections), disseminated and systemic fungal infections Medical management; surgery
44S Erysipelas Medical management
179S Hereditary angioedema; angioneurotic oedema Medical and surgical management
174S Hereditary haemolytic anaemias (e.g. sickle cell); dyserythropoietic anemia (congenital) Medical management
201S Herpetic encephalitis; Reye’s syndrome Medical management
913S Immune compromise NOS and associated life-threatening infections NOS Medical management
912S Leprosy and other systemic mycobacterial infections, Excluding tuberculosis Medical management
336S Leptospirosis; spirochaetal infections NOS Medical management
252S Life-threatening anaemia NOS Medical management; transfusion
908S Life-threatening conditions due to exposure to the elements, including hypo and hyperthermia; lighting strikes Medical management
907S Life-threatening rickettsial and other arthropod-borne diseases Medical management
172S Malaria; trypanosomiasis; other life-threatening parasitic disease Medical management
904S Metastatic infections; septiceamia Medical management
910S Multiple myeloma and chronic leukaemias Medical management which includes chemotherapy and radiation therapy
247S Poisoning by ingestion, injection, and non-medicinal agents Medical management
911S Sexually transmitted diseases with systemic involvement not elsewhere specified Medical management
128S Tetanus; anthrax; Whipple’s disease Medical management
122S Thalassemia and other haemoglobinopathies – treatable Medical management; bone marrow transplant
316S Toxic effect of gasses, fumes, and vapors Medical therapy
11S Tuberculosis Diagnosis and acute medical management; successful transfer to maintenance therapy in accordance to DOH guidelines
937S Tumour of internal organ (excludes skin): unknown whether benign or malignant Biopsy
15S Whooping cough, diptheria Medical management


182T Abuse or dependence on Psychoactive substance, including alcohol Hospital-based management up to 3 weeks/year
910T Acute delusional mood, anxiety, personality, perception disorders and organic mental disorder caused by drugs Hospital-based management up to 3 days
901T Acute stress disorder accompanied by recent significant trauma, including physical or sexual abuse Hospital admission for psychotherapy / counselling up to 3 days, or up to 12 outpatient psychotherapy / counselling contacts
910T Alcohol withdrawal delirium; alcohol intoxication delirium Hospital-based management up to 3 days leading to rehabilitation
908T Anorexia Nervosa and Bulimia Nervosa Hospital-based management up to 3 weeks/year or minimum of 15 outpatient contacts per year
903T Attempted suicide, irrespective of cause Hospital-based management up to 3 days or up to 6 outpatient contacts
184T Brief reactive psychosis Hospital-based management up to 3 weeks/year
910T Delirium: Amphetamine, Cocaine, or other psychoactive substance Hospital-based management up to 3 days
902T Major affective disorders, including unipolar and bipolar depression Hospital-based management up to 3 weeks/year (including inpatient electro-convulsive therapy and inpatient psychotherapy) or outpatient psychotherapy of up to 15 contacts
907T Schizophrenic and paranoid delusional disorders Hospital-based management up to 3 weeks/year
909T Treatable dementia Admission for initial diagnosis; management of acute psychotic symptoms – up to 1 week

Chronic PMB conditions

Addison’s Disease
Bipolar Mood Disorder
Cardiac Failure
Chronic Renal Disease
Chronic Obstructive Pulmonary Disease
Coronary Artery Disease
Crohn’s Disease
Diabetes Insipidus
Diabetes Mellitus Types 1 & 2
Multiple Sclerosis
Parkinson’s Disease
Rheumatoid Arthritis
Systemic Lupus Erythematosus
Ulcerative Colitis