This page is part of the US Drug Formulary (v1.1.0: STU 1) based on FHIR R4. The current version which supercedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

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: Codes for qualifier of copay amount - JSON Representation

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{
  "resourceType" : "CodeSystem",
  "id" : "usdf-CopayOptionCS",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This code system http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CopayOptionCS 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\">after-deductible<a name=\"usdf-CopayOptionCS-after-deductible\"> </a></td><td>After Deductible</td><td>The consumer first pays the deductible, and after the deductible is met, the consumer is responsible only for the copay (this indicates that this benefit is subject to the deductible).</td></tr><tr><td style=\"white-space:nowrap\">before-deductible<a name=\"usdf-CopayOptionCS-before-deductible\"> </a></td><td>Before Deductible</td><td>The consumer first pays the copay, and any net remaining allowed charges accrue to the deductible (this indicates that this benefit is subject to the deductible).</td></tr><tr><td style=\"white-space:nowrap\">no-charge<a name=\"usdf-CopayOptionCS-no-charge\"> </a></td><td>No Charge</td><td>No cost sharing is charged (this indicates that this benefit is not subject to the deductible).</td></tr><tr><td style=\"white-space:nowrap\">no-charge-after-deductible<a name=\"usdf-CopayOptionCS-no-charge-after-deductible\"> </a></td><td>No Charge After Deductible</td><td>The consumer first pays the deductible, and after the deductible is met, no copayment is charged (this indicates that this benefit is subject to the deductible).</td></tr><tr><td style=\"white-space:nowrap\">charge<a name=\"usdf-CopayOptionCS-charge\"> </a></td><td>Charge</td><td>The consumer always pays just the copay and the issuer pays the remainder of allowed charges (this indicates that this benefit is not subject to the deductible).</td></tr><tr><td style=\"white-space:nowrap\">not-applicable<a name=\"usdf-CopayOptionCS-not-applicable\"> </a></td><td>Not Applicable</td><td>Deductible is not applicable: Zero-deductible cost sharing represented by a co-pay value of 'Not applicable' and co-insurance value of 'No charge'.</td></tr></table></div>"
  },
  "url" : "http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CopayOptionCS",
  "version" : "1.1.0",
  "name" : "CopayOptionCS",
  "title" : "Codes for qualifier of copay amount",
  "status" : "active",
  "date" : "2021-10-15T15:46:55+00:00",
  "publisher" : "HL7 Pharmacy Working Group",
  "contact" : [
    {
      "name" : "HL7 Pharmacy Working Group",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/medication"
        },
        {
          "system" : "email",
          "value" : "pharmacy@lists.HL7.org"
        }
      ]
    }
  ],
  "description" : "Codes for qualifier of copay amount",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US"
        }
      ]
    }
  ],
  "content" : "complete",
  "count" : 6,
  "concept" : [
    {
      "code" : "after-deductible",
      "display" : "After Deductible",
      "definition" : "The consumer first pays the deductible, and after the deductible is met, the consumer is responsible only for the copay (this indicates that this benefit is subject to the deductible)."
    },
    {
      "code" : "before-deductible",
      "display" : "Before Deductible",
      "definition" : "The consumer first pays the copay, and any net remaining allowed charges accrue to the deductible (this indicates that this benefit is subject to the deductible)."
    },
    {
      "code" : "no-charge",
      "display" : "No Charge",
      "definition" : "No cost sharing is charged (this indicates that this benefit is not subject to the deductible)."
    },
    {
      "code" : "no-charge-after-deductible",
      "display" : "No Charge After Deductible",
      "definition" : "The consumer first pays the deductible, and after the deductible is met, no copayment is charged (this indicates that this benefit is subject to the deductible)."
    },
    {
      "code" : "charge",
      "display" : "Charge",
      "definition" : "The consumer always pays just the copay and the issuer pays the remainder of allowed charges (this indicates that this benefit is not subject to the deductible)."
    },
    {
      "code" : "not-applicable",
      "display" : "Not Applicable",
      "definition" : "Deductible is not applicable: Zero-deductible cost sharing represented by a co-pay value of 'Not applicable' and co-insurance value of 'No charge'."
    }
  ]
}