Da Vinci - Coverage Requirements Discovery
2.2.0-ballot - STU 2.2 Ballot United States of America flag

This page is part of the Da Vinci Coverage Requirements Discovery (CRD) FHIR IG (v2.2.0-ballot: STU 2.2 Ballot) based on FHIR (HL7® FHIR® Standard) R4. This version is a pre-release. The current official version is 2.1.0. For a full list of available versions, see the Directory of published versions

: CRD Coverage Detail Categories Value Set - TTL Representation

Page standards status: Trial-use Maturity Level: 1

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:ValueSet ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "coverageDetailCategories"] ; # 
  fhir:text [
fhir:status [ fhir:v "extensions" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ValueSet coverageDetailCategories</b></p><a name=\"coverageDetailCategories\"> </a><a name=\"hccoverageDetailCategories\"> </a><ul><li>Include these codes as defined in <a href=\"CodeSystem-coverage-information-codes.html\"><code>http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes</code></a><table class=\"none\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td><a href=\"CodeSystem-coverage-information-codes.html#coverage-information-codes-cat-limitation\">cat-limitation</a></td><td style=\"color: #cccccc\">Coverage Limitation</td><td>The statement being made about coverage or authorization that are being constrained in scope in some way.  I.e. It is not safe to interpret the statements of 'this is covered' or 'this does not require prior auth' without looking at this detail.</td></tr><tr><td><a href=\"CodeSystem-coverage-information-codes.html#coverage-information-codes-cat-decisional\">cat-decisional</a></td><td style=\"color: #cccccc\">Decision Considerations</td><td>The statement does not qualify the coverage statement, however it does provide information that may be relevant to the patient &amp; caregiver decision of whether a therapy is appropriate/reasonable.</td></tr><tr><td><a href=\"CodeSystem-coverage-information-codes.html#coverage-information-codes-cat-other\">cat-other</a></td><td style=\"color: #cccccc\">Other Details</td><td>The statement does not limit the coverage statement being made and is unlikely to influence a decision to proceed with care.  For example, instructions on how to submit a claim, reference to to policy, etc.</td></tr></table></li></ul></div>"^^rdf:XMLLiteral
  ] ; # 
  fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm"^^xsd:anyURI ] ;
fhir:value [
a fhir:integer ;
fhir:v 1     ]
  ] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"^^xsd:anyURI ] ;
fhir:value [
a fhir:code ;
fhir:v "fm"     ]
  ] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"^^xsd:anyURI ] ;
fhir:value [
a fhir:code ;
fhir:v "trial-use" ;
      ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom"^^xsd:anyURI ] ;
fhir:value [
a fhir:canonical ;
fhir:v "http://hl7.org/fhir/us/davinci-crd/ImplementationGuide/davinci-crd"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/davinci-crd/ImplementationGuide/davinci-crd>         ]       ] )     ]
  ] ) ; # 
  fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageDetailCategories"^^xsd:anyURI] ; # 
  fhir:identifier ( [
fhir:system [ fhir:v "urn:ietf:rfc:3986"^^xsd:anyURI ] ;
fhir:value [ fhir:v "urn:oid:2.16.840.1.113883.4.642.40.18.48.23" ]
  ] ) ; # 
  fhir:version [ fhir:v "2.2.0-ballot"] ; # 
  fhir:name [ fhir:v "CRDCoverageDetailCategories"] ; # 
  fhir:title [ fhir:v "CRD Coverage Detail Categories Value Set"] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:experimental [ fhir:v false] ; # 
  fhir:date [ fhir:v "2025-08-06T17:27:13+00:00"^^xsd:dateTime] ; # 
  fhir:publisher [ fhir:v "HL7 International / Financial Management"] ; # 
  fhir:contact ( [
    ( fhir:telecom [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://www.hl7.org/Special/committees/fm" ]     ] )
  ] ) ; # 
  fhir:description [ fhir:v "Codes that define the type of coverage information detail being provided"] ; # 
  fhir:jurisdiction ( [
    ( fhir:coding [
fhir:system [ fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ] ;
fhir:code [ fhir:v "US" ]     ] )
  ] ) ; # 
  fhir:compose [
    ( fhir:include [
fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes"^^xsd:anyURI ] ;
      ( fhir:concept [
fhir:code [ fhir:v "cat-limitation" ]       ] [
fhir:code [ fhir:v "cat-decisional" ]       ] [
fhir:code [ fhir:v "cat-other" ]       ] )     ] )
  ] . #