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

ValueSet: Coverage Guidance Value Set

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

Coverage guidance

References

Logical Definition (CLD)

 

Expansion

This value set contains 5 concepts

Expansion based on Coverage Guidance Code System v1.1.0-ballot (CodeSystem)

All codes in this table are from the system http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverageGuidance

CodeDisplayDefinition
not-coveredNot coveredno coverage or possibility of coverage for this service)
coveredCoveredregular coverage applies
prior-authPrior authorizationcoverage is possible with prior authorization
clinicalClinicalclinical details are required to determine coverage/prior auth applicability - e.g. via DTR by clinician
adminAdminadministrative details are required to determine coverage/prior auth applicability - e.g. via DTR by clinician

Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
System 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)
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