Patient Cost Transparency Implementation Guide
2.0.0-ballot - STU 2 Ballot US

This page is part of the Da Vinci Patient Cost Transparency Implementation Guide (v2.0.0-ballot: STU 2 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions

: PCT Subject-To-Medical-Management Reason Code System - XML Representation

Page standards status: Trial-use

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<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="PCTSubjectToMedicalMgmtReasonCS"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p>This case-sensitive code system <code>http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSubjectToMedicalMgmtReasonCS</code> 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">concurrent-review<a name="PCTSubjectToMedicalMgmtReasonCS-concurrent-review"> </a></td><td>Concurrent Review</td><td>Concurrent Review</td></tr><tr><td style="white-space:nowrap">prior-auth<a name="PCTSubjectToMedicalMgmtReasonCS-prior-auth"> </a></td><td>Prior Authorization</td><td>Prior Authorization</td></tr><tr><td style="white-space:nowrap">step-therapy<a name="PCTSubjectToMedicalMgmtReasonCS-step-therapy"> </a></td><td>Step Therapy</td><td>Step Therapy</td></tr><tr><td style="white-space:nowrap">fail-first<a name="PCTSubjectToMedicalMgmtReasonCS-fail-first"> </a></td><td>Fail-First</td><td>Fail-First</td></tr></table></div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="fm"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="trial-use">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
        <valueCanonical
                        value="http://hl7.org/fhir/us/davinci-pct/ImplementationGuide/hl7.fhir.us.davinci-pct"/>
      </extension>
    </valueCode>
  </extension>
  <url
       value="http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTSubjectToMedicalMgmtReasonCS"/>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.16.840.1.113883.4.642.40.4.16.16"/>
  </identifier>
  <version value="2.0.0-ballot"/>
  <name value="PCTSubjectToMedicalMgmtReasonCS"/>
  <title value="PCT Subject-To-Medical-Management Reason Code System"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2024-04-08T16:53:34+00:00"/>
  <publisher value="HL7 International / Financial Management"/>
  <contact>
    <name value="HL7 International / Financial Management"/>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/fm"/>
    </telecom>
    <telecom>
      <system value="email"/>
      <value value="fmlists@lists.hl7.org"/>
    </telecom>
  </contact>
  <description
               value="Defining codes for the classification of subject-to-medical-management reason types. This CodeSystem is currently defined by this IG, but is anticipated to be temporary. The concepts within are expected to be moved in a future version to a more central terminology specification such as THO, which will result in a code system url change and possibly modified codes and definitions."/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <copyright value="This CodeSystem is not copyrighted."/>
  <caseSensitive value="true"/>
  <content value="complete"/>
  <count value="4"/>
  <concept>
    <code value="concurrent-review"/>
    <display value="Concurrent Review"/>
    <definition value="Concurrent Review"/>
  </concept>
  <concept>
    <code value="prior-auth"/>
    <display value="Prior Authorization"/>
    <definition value="Prior Authorization"/>
  </concept>
  <concept>
    <code value="step-therapy"/>
    <display value="Step Therapy"/>
    <definition value="Step Therapy"/>
  </concept>
  <concept>
    <code value="fail-first"/>
    <display value="Fail-First"/>
    <definition value="Fail-First"/>
  </concept>
</CodeSystem>