Da Vinci - Coverage Requirements Discovery
1.1.0-ballot - STU 1.1 US

This page is part of the Da Vinci Coverage Requirements Discovery (CRD) FHIR IG (v1.1.0-ballot: STU 1.1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

CodeSystem: Coverage Guidance Code System

Official URL: http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverageGuidance Version: 1.1.0-ballot
Draft as of 2022-02-17 Computable Name: CoverageGuidance

Coverage guidance

This Code system is referenced in the content logical definition of the following value sets:

This code system http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverageGuidance defines the following codes:

CodeDisplayDefinition
not-covered Not coveredno coverage or possibility of coverage for this service)
covered Coveredregular coverage applies
prior-auth Prior authorizationcoverage is possible with prior authorization
clinical Clinicalclinical details are required to determine coverage/prior auth applicability - e.g. via DTR by clinician
admin Adminadministrative details are required to determine coverage/prior auth applicability - e.g. via DTR by clinician