PMB Conditions
Below is a list of all PMB Conditions
| PMB Code | PMB Description | |
|---|---|---|
| 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 | Retained 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 |
| EAR; NOSE; MOUTH AND THROAT | ||
| 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 |
| 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 |
| RESPIRATORY SYSTEM | ||
| 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 |
| HEART AND VASCULATURE | ||
| 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 |
| 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 |
| 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 |
| 99E | Tetralogy of Fallot (TOF) | Total repair tetralogy |
| 93E | Ventricular septal defect - persistent | Closure |
| GASTRO-INTESTINAL SYSTEM | ||
| 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 |
| 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 |
| 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 |
| MUSCULOSKELETAL SYSTEM; TRAUMA NOS | ||
| 353H | Abscess of bursa or tendon | Incision and drainage |
| 32H | Acute osteomyelitis | 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 |
| 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 |
| SKIN AND BREAST | ||
| 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 | If histologically confirmed; Medical and surgical management; which includes radiation therapy |
| 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 |
| 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 |
| 31K | Hypoglycemic coma; hyperglycemia; diabetic ketoacidosis | 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 |
| URINARY AND MALE GENITAL SYSTEM | ||
| 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 |
| FEMALE REPRODUCTIVE SYSTEM | ||
| 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 |
| PREGNANCY AND CHILDBIRTH | ||
| 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 |
| 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 |
| 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 |
| 906A | Acute generalised paralysis; including polio and Guillain-Barre | Medical management; ventilation and plasmapheresis |
| 913S | Immune compromise NOS and associated life-threatening infections NOS | Medical management |
| 341A | Basal ganglia; extra-pyramidal disorders; other dystonias NOS | Initial diagnosis; initiation of medical management |
| 912S | Leprosy and other systemic mycobacterial infections; Excluding tuberculosis | Medical management |
| 950A | Benign and malignant brain tumours; treatable | Medical and surgical management which includes radiation therapy and chemotherapy |
| 336S | Leptospirosis; spirochaetal infections NOS | Medical management |
| 49A | Compound/ depressed fractures of skull | Craniotomy/ craniectomy |
| 252S | Life-threatening anaemia NOS | Medical management; transfusion |
| 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 |
| 908S | Life-threatening conditions due to exposure to the elements; including hypo and hyperthermia; lighting strikes | Medical management |
| 83A | Encephalocele; congenital hydrocephalus | Shunt; surgery |
| 907S | Life-threatening rickettsial and other arthropod-borne diseases | Medical management |
| 902A | Epilepsy (status epilepticus; initial diagnosis; candidate for neurosurgery) | Medical management; ventilation; neurosurgery |
| 172S | Malaria; trypanosomiasis; other life-threatening parasitic disease | Medical management |
| 211A | Intraspinal and Intracranial abscess | Medical and surgical management |
| 904S | Metastatic infections; septiceamia | Medical management |
| 910S | Multiple myeloma and chronic leukaemias | Medical management which includes chemotherapy and radiation therapy |
| 513A | Myasthenia gravis; muscular dystrophy; neuro-myopathies NOS | Initial diagnosis; initiation of medical management; therapy for acute complications and exacerbations |
| 247S | Poisoning by ingestion; injection; and non-medicinal agents | Medical management |
| 510A | Peripheral nerve injury with open wound | Neuroplasty |
| 911S | Sexually transmitted diseases with systemic involvement not elsewhere specified | Medical management |
| 940A | Reversible CNS abnormalities due to other systemic disease | Medical and surgical management |
| 128S | Tetanus; anthrax; Whipple's disease | Medical management |
| 1A | Severe / moderate head injury: hematoma / oedema with loss of consciousness | Medical and surgical management; ventilation |
| 84A | Spina Bifida | Surgical management |
| 316S | Toxic effect of gasses; fumes; and vapors | Medical therapy |
| 941A | Spinal cord compression; ischaemia or degenerative disease NOS | Medical and surgical management |
| 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 |
| 28A | Subarachnoid and intracranial hemorrhage / hematoma; compression of brain | Medical and surgical management |
| 15S | Whooping cough; diptheria | Medical management |
| 305A | Tetanus | Medical management; ventilation |
| MENTAL ILLNESS | ||
| 265A | Transient cerebral ischaemia; life-threatening cerebrovascular conditions NOS | Evaluation; medical management; surgery |
| 182T | Abuse or dependence on Psychoactive substance; including alcohol | Hospital-based management up to 3 weeks/year |
| 109A | Vertebral dislocations/ fractures; open or closed with injury to spinal cord | Repair /reconstruction; medical management; inpatient rehabilitation up to 2 months |
| 910T | Acute delusional mood; anxiety; personality; perception disorders and organic mental disorder caused by drugs | Hospital-based management up to 3 days |
| 684A | Viral meningitis; encephalitis; myelitis and encephalomyelitis | Medical management |
| 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 |
| EYE | ||
| 910T | Alcohol withdrawal delirium; alcohol intoxication delirium | Hospital-based management up to 3 days leading to rehabilitation |
| 47B | Acute orbital cellulitis | Medical and surgical management |
| 908T | Anorexia Nervosa and Bulimia Nervosa | Hospital-based management up to 3 weeks/year or minimum of 15 outpatient contacts per year |
| 394B | Angle-closure glaucoma | Iridectomy; laser surgery; medical and surgical management |
| 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 |
| 950B | Cancer of the eye and orbit - treatable | Medical and surgical management; which includes radiation therapy and chemotherapy |
| 910T | Delirium: Amphetamine; Cocaine; or other psychoactive substance | Hospital-based management up to 3 days |
| 901B | Cataract; aphakia | Extraction of cataract; lens implant |
| 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 |
| 911B | Corneal ulcer; Superficial injury of eye and adnexa | Conjunctival flap; medical management |
| 907T | Schizophrenic and paranoid delusional disorders | Hospital-based management up to 3 weeks/year |
| 405B | Glaucoma associated with disorders of the lens | Surgical management |
| 909T | Treatable dementia | Admission for initial diagnosis; management of acute psychotic symptoms - up to 1 week |
| 386B | Herpes zoster & herpes simplex with ophthalmic complications | Medical management |
| 389B | Hyphaema | Removal of blood clot; observation |
| 177D | Covid 19 | Screening, Testing, Medical management including Ventilation, Rehabilitation. |