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

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: Coverage Guidance Code System - JSON Representation

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{
  "resourceType" : "CodeSystem",
  "id" : "coverageGuidance",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This code system http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverageGuidance defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\">not-covered<a name=\"coverageGuidance-not-covered\"> </a></td><td>Not covered</td><td>no coverage or possibility of coverage for this service)</td></tr><tr><td style=\"white-space:nowrap\">covered<a name=\"coverageGuidance-covered\"> </a></td><td>Covered</td><td>regular coverage applies</td></tr><tr><td style=\"white-space:nowrap\">prior-auth<a name=\"coverageGuidance-prior-auth\"> </a></td><td>Prior authorization</td><td>coverage is possible with prior authorization</td></tr><tr><td style=\"white-space:nowrap\">clinical<a name=\"coverageGuidance-clinical\"> </a></td><td>Clinical</td><td>clinical details are required to determine coverage/prior auth applicability - e.g. via DTR by clinician</td></tr><tr><td style=\"white-space:nowrap\">admin<a name=\"coverageGuidance-admin\"> </a></td><td>Admin</td><td>administrative details are required to determine coverage/prior auth applicability - e.g. via DTR by clinician</td></tr></table></div>"
  },
  "url" : "http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverageGuidance",
  "version" : "1.1.0-ballot",
  "name" : "CoverageGuidance",
  "title" : "Coverage Guidance Code System",
  "status" : "draft",
  "date" : "2022-02-17T08:05:13+00:00",
  "publisher" : "HL7 International - Financial Management Work Group",
  "contact" : [
    {
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/fm"
        }
      ]
    }
  ],
  "description" : "Coverage guidance",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US"
        }
      ]
    }
  ],
  "caseSensitive" : true,
  "content" : "complete",
  "concept" : [
    {
      "code" : "not-covered",
      "display" : "Not covered",
      "definition" : "no coverage or possibility of coverage for this service)"
    },
    {
      "code" : "covered",
      "display" : "Covered",
      "definition" : "regular coverage applies"
    },
    {
      "code" : "prior-auth",
      "display" : "Prior authorization",
      "definition" : "coverage is possible with prior authorization"
    },
    {
      "code" : "clinical",
      "display" : "Clinical",
      "definition" : "clinical details are required to determine coverage/prior auth applicability - e.g. via DTR by clinician"
    },
    {
      "code" : "admin",
      "display" : "Admin",
      "definition" : "administrative details are required to determine coverage/prior auth applicability - e.g. via DTR by clinician"
    }
  ]
}