Release 5 Ballot

This page is part of the FHIR Specification (v5.0.0-ballot: R5 Ballot - see ballot notes). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4

4.4.1.222 ValueSet http://hl7.org/fhir/ValueSet/ex-benefitcategory

Financial Management icon

Work Group

Maturity Level: 1

Draft

Use Context: Not Intended for Production use, Not Intended for Production use

This is a value set defined by the FHIR project.

Summary

Defining URL: http://hl7.org/fhir/ValueSet/ex-benefitcategory

Version: 5.0.0-ballot

Name: BenefitCategoryCodes

Title: Benefit Category Codes

Status: draft

Definition:

This value set includes examples of Benefit Category codes.

Committee: Financial Management Work Group

OID: 2.16.840.1.113883.4.642.3.1174 (for OID based terminology systems)

Copyright:

This is an example set.

Flags: Experimental

This value set is used in the following places:

Resource: CoverageEligibilityResponse.insurance.item.category (CodeableConcept / Example)
Resource: ExplanationOfBenefit.item.category (CodeableConcept / Example)
Resource: ExplanationOfBenefit.item.detail.category (CodeableConcept / Example)
Resource: ExplanationOfBenefit.item.detail.subDetail.category (CodeableConcept / Example)
Resource: ExplanationOfBenefit.benefitBalance.category (CodeableConcept / Example)
Resource: Coverage.costToBeneficiary.category (CodeableConcept / Example)
Resource: CoverageEligibilityRequest.item.category (CodeableConcept / Example)
Resource: Claim.item.category (CodeableConcept / Example)
Resource: Claim.item.detail.category (CodeableConcept / Example)
Resource: Claim.item.detail.subDetail.category (CodeableConcept / Example)

4.4.1.222.1 Content Logical Definition

Include all codes defined in http://terminology.hl7.org/CodeSystem/ex-benefitcategory

4.4.1.222.2 Expansion

This expansion generated 10 Sep 2022

This value set contains 28 concepts

Expansion based on Benefit Category Codes v0.1.0 (CodeSystem) icon

Code	System	Display	Definition
1	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Medical Care	Medical Care.
2	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Surgical	Surgical.
3	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Consultation	Consultation.
4	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Diagnostic XRay	Diagnostic XRay.
5	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Diagnostic Lab	Diagnostic Lab.
14	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Renal Supplies	Renal Supplies excluding Dialysis.
23	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Diagnostic Dental	Diagnostic Dental.
24	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Periodontics	Periodontics.
25	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Restorative	Restorative.
26	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Endodontics	Endodontics.
27	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Maxillofacial Prosthetics	Maxillofacial Prosthetics.
28	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Adjunctive Dental Services	Adjunctive Dental Services.
30	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Health Benefit Plan Coverage	Health Benefit Plan Coverage.
35	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Dental Care	Dental Care.
36	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Dental Crowns	Dental Crowns.
37	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Dental Accident	Dental Accident.
49	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Hospital Room and Board	Hospital Room and Board.
55	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Major Medical	Major Medical.
56	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Medically Related Transportation	Medically Related Transportation.
61	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	In-vitro Fertilization	In-vitro Fertilization.
62	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	MRI Scan	MRI Scan.
63	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Donor Procedures	Donor Procedures such as organ harvest.
69	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Maternity	Maternity.
76	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Renal Dialysis	Renal dialysis.
F1	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Medical Coverage	Medical Coverage.
F3	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Dental Coverage	Dental Coverage.
F4	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Hearing Coverage	Hearing Coverage.
F6	http://terminology.hl7.org/CodeSystem/ex-benefitcategory	Vision Coverage	Vision Coverage.

See the full registry of value sets defined as part of FHIR.

Explanation of the columns that may appear on this page:

Lvl

A few code lists that FHIR defines are hierarchical - each code is assigned a level. For value sets, levels are mostly used to organize codes for user convenience, but may follow code system hierarchy - see Code System for further information

Source

The source of the definition of the code (when the value set draws in codes defined elsewhere)

Code

The code (used as the code in the resource instance). If the code is in italics, this indicates that the code is not selectable ('Abstract')

Display

The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application

Definition

An explanation of the meaning of the concept

Comments

Additional notes about how to use the code