List of PMB conditions: Liver, Pancreas and Spleen

Table of Contents:

PMB list

Below is a list of the PMB condition treatment pairs for Brain and Nervous 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.

Liver, Pancreas and Spleen

CODE CONDITION TREATMENT
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

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.

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What does a “PMBs only” restriction mean?
In this case, the scheme will only pay for diagnosis, treatment and management of a claim for one of 270 pre-defined conditions (PMBs). Read more, and see full list of PMB conditions. 

What does “From Risk” mean?
The scheme will pay for this claim from its own funds, not from your savings or other day-to-day benefits. 

What is a DSP?
A Designated Service Provider. The scheme has a network of providers, and will often only pay claims in full if you use a DSP. If you choose another provider, you might have a co-payment, or even no cover. 

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