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HCC

CMScript 13 of 2021: Hepatocellular carcinoma

As part of PMB level of care, medical schemes must fund the diagnosis and treatment of treatable Hepatocellular carcinoma HCC, which falls under DTP code 950G.

For those patients who are diagnosed with HCC that is not treatable according to the PMB Regulations, DTP code 260S may be applied dependent on the clinical case.

This DTP refers to “Imminent death regardless of diagnosis”. Treatment component specified for this DTP code is “Comfort care; pain relief; hydration”.

Treatable hepatocellular carcinoma is a prescribed minimum benefit (PMB) condition under the Diagnosis and Treatment Pair (DTP) code 950G. Treatable cancers are defined in the PMB regulations as:

  1. they involve only the organ of origin and have not spread to adjacent organs;
  2. there is no evidence of distant metastatic spread;
  3. they have not, by means of compression, infarction, or other means, brought about irreversible and irreparable damage to the organ within which they originated (for example brain stem compression caused by a cerebral tumour) or another vital organ;
  4. if points (i) to (iii) do not apply, there is a well demonstrated five-year survival rate of greater than 10% for the given therapy for the condition concerned.

The Council for Medical Schemes has published the Prescribed Minimum Benefit Guidelines for Hepatocellular carcinoma (HCC), and these provide detailed information on which tests and treatment options are PMB level of care and which ones are not.

Download the CMScript here

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