CMScript 4 of 2024: Focus on Burns

A burn is a physical injury to the skin or other tissue in the body caused by heat, radiation, electricity, chemicals, or friction. Burn injuries may result in lifelong physical and psychological scarring, causing pain and influencing mental health, quality of life, ability to return to work, and death. Burns are common worldwide accounting for an estimated 180 000 deaths annually.  Almost 90% of burns occur in low- and middle-income countries. In South Africa, burns are a significant public health concern affecting both rural and urban populations. There is no specific data on burn occurrences in the country.

What is covered under the Prescribed Minimum Benefits (PMBs)?

“Burns, greater than 10% of body surface, or more than 5% involving head, neck, hands, perineum” are included in the Prescribed Minimum Benefits (PMBs) under Diagnosis and Treatment and Pair (DTP code) 900J. Treatment component specified for this DTP is “Debridement; free skin graft; medical management”. The diagnosis, treatment, and care costs in relation to these burns must be paid in line with the PMB regulations. The medical schemes must pay for in and out-of-hospital costs in full if the services were obtained from a designated service provider (DSP). In case of an emergency, healthcare services must be paid in full even if a non-DSP was used. The healthcare practitioner must assist the member in completing the forms to register for PMB benefits which must be funded by the medical scheme from the risk benefit. Funding of PMB claims from the Medical Savings Account (MSA) contravenes the Medical Schemes Act.

Download the full CMScript here