PMB list
Below is a list of the PMB condition treatment pairs for Gastro interstinal System.. Your medical aid has to pay for the treatment, and cannot use funds from your savings, even if the treatment is given out-of-hospital.
To see the rest of the 270 PMB conditions, please see our “List of PMBs” page.
For an explanation of general treatments (example: “Medical Management”) please read our explainer.
Gastro interstinal system
| CODE | CONDITION | TREATMENT |
|---|---|---|
| 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 |
To see the rest of the 270 PMB conditions, please see our “List of PMBs” page.
How does your medial aid plan cover this benefit?
What you see above is the minimum level of cover for each condition. Medical aids can offer more benefits than the limits above.To see how your plan pays out for a condition, find your plan here, and view your plan’s full benefits.
You can also compare any two medical aid plans side by side, to see which one suits your needs best.
Remember, a medical aid can still impose conditions on how PMBs are treated. For example, the scheme can impose network service providers (DSPs), a medicine formulary or even require that you be treated in a state hospital. You can read a full explanation on how medical aids must pay for PMBs here.
