This page is part of the National Directory of Healthcare Providers and Services (NDH) Implementation Guide (v1.0.0: STU1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions
| Official URL: http://hl7.org/fhir/us/ndh/ValueSet/BenefitTypeVS | Version: 1.0.0 | |||
| Standards status: Trial-use | Computable Name: BenefitTypeVS | |||
Codes for Insurance Benefit Type.
References
Generated Narrative: ValueSet BenefitTypeVS
http://terminology.hl7.org/CodeSystem/insurance-benefit-type| Code | Display | Definition |
| pcpov | Primary Care Visit to Treat an Injury or Illness | Benefit plan covers services rendered by a primary care physician during an office visit with the purpose to treat injury or illness, except for preventive care services. |
| specialistov | Specialist Office Visit | Covered healthcare service rendered to a patient by a specialty provider. |
| mlpov | Other Practitioner Office Visit (Nurse, Physician Assistant) - Mid Level Professional | Benefit plan covers covered health related services rendered by a practitioner other than MD or DO and referred to as other practitioner. |
| outpatient | Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | Benefit plan covers health related services rendered to patient at an outpatient facility, outside of a facility that requires a patient admission. |
| outpatstx | Outpatient Surgery Physician/Surgical Services | Benefit plan covers surgical services rendered to patient outside of a facility admission, referred to as outpatient. |
| hospserv | Hospice Services | Benefit plan covers hospice services. |
| routinedental | Routine Dental Services (Adult) | Benefit plan covers routine dental services. |
| infertilitytx | Infertility Treatment | Benefit plan covers eligible infertility treatment services. |
| ltnhc | Long-Term/Custodial Nursing Home Care | Long-Term/Custodial Nursing Home Care. |
| privatenurse | Private-Duty Nursing | Private-Duty Nursing. |
| routineeye | Routine Eye Exam (Adult) | Routine Eye Exam (Adult). |
| ucservice | Urgent Care Centers or Facilities | Urgent Care Centers or Facilities. |
| homehealth | Home Health | Home health services insurance coverage. |
| erservice | Emergency Room Services | Emergency Room Services. |
| ambulance | Emergency Room Services | Emergency Room Services. |
| inpatienthospital | Inpatient Hospital Services (e.g., Hospital Stay) | A person who is hospitalized for at least one night to receive treatment or participate in a study. |
| inpatientprovider | Inpatient Physician and Surgical Services | A healthcare provider who is delivering healthcare services in a hospital environment. |
| bariatricsurg | Bariatric Surgery | Bariatric surgery service Skilled nursing service (qualifier value). |
| cosmeticsurg | Cosmetic Surgery | Cosmetic surgery service Skilled nursing service (qualifier value). |
| skillednursing | Skilled Nursing Facility | Skilled nursing service (qualifier value). |
| ppnatalcare | Prenatal and Postnatal Care | Prenatal and Postnatal services. |
| maternitycare | Delivery and All Inpatient Services for Maternity Care | All maternity care services. |
| menthlthoutp | Mental/Behavioral Health Outpatient Services | Mental health service delivered in an outpatient setting. |
| menthlthinp | Mental/Behavioral Health Inpatient Services | Mental health service delivered in an hospital or inpatient facility setting. |
| sadoutp | Substance Abuse Disorder Outpatient Services | Substance abuse related services delivered in a outpatient setting. |
| sadinp | Substance Abuse Disorder Inpatient Services | Substance abuse related services delivered in a inpatient setting. |
| drggenric | Generic Drugs | Generic drugs eligible benefits. |
| drgbrand | Preferred Brand Drugs | Preferred brand drugs eligible benefits. |
| drgnonpreferred | Non-Preferred Brand Drugs | Non-Preferred drugs brands eligible benefits. |
| drgspecialty | Specialty Drugs | Benefit plan covers specialty drugs. |
| rehaboutp | Outpatient Rehabilitation Services | Benefit plan covers outpatient rehabilitation services. |
| servicehablitation | Habilitation Services | Habilitation Services. |
| chiro | Chiropractic Care | Benefit plan covers chiropractor eligible benefits. |
| dme | Durable Medical Equipment | Benefit plan covers Durable medical equipment eligible benefits. |
| hearingaids | Hearing Aids | Benefit plan covers hearing aids. |
| imgctpetmri | Imaging (CT/PET Scans, MRIs) | Benefit plan covers advances imaging techniques services (CT/PET Scans, MRIs) eligible services. |
| prev | Preventive Care/Screening/Immunization | Routine healthcare services to prevent health related problems eligible benefits. |
| rtnpod | Routine Foot Care | Routine Foot Care. |
| acupuncture | Acupuncture | Benefit plan covers acupuncture treatment. |
| weightloss | Weight Loss Programs | Benefit plan covers weight loss services eligible benefits. |
| rtneyechld | Routine Eye Exam for Children | Routine eye exam for children eligible benefits. |
| glasseschld | Eye Glasses for Children | Eye glasses children eligible benefits. |
| rtndntlchld | Dental Check-Up for Children | Dental Check-Up for Children. |
| speachthpy | Rehabilitative Speech Therapy | Benefit plan covers rehabilitative speech therapy eligible benefits. |
| rehaboccandpt | Rehabilitative Occupational and Rehabilitative Physical Therapy | Benefit plan covers rehabilitative occupational and rehabilitative physical eligible benefits. |
| wellbaby | Well Baby Visits and Care | Regularly scheduled, preventive care services, including immunizations, provided to children up to an age as specified by a health insurance company or mandated by a government agency. |
| laboutp | Laboratory Outpatient and Professional Services | Benefit plan covers laboratory testing and related professional services received as outpatient. |
| imagingdx | X-rays and Diagnostic Imaging | Benefit plan covers diagnostic imaging procedures that produce images of internal structures of the human body and uses radiation to diagnose and treat diseases. |
| dntlbaschld | Basic Dental Care - Child | Benefit plan covers diagnostic basic dental care. |
| orthochld | Orthodontia - Child | Benefit plan covers orthodontia for children. |
| dntlmajchld | Major Dental Care - Child | Benefit plan covers major dental care for children. |
| dntlbasadlt | Basic Dental Care - Adult | Benefit plan covers basic dental care for adults. |
| orthodadlt | Orthodontia - Adult | Benefits plan covers services provided that are required for orthodontic purposes for an adult. |
| dntlmajadlt | Major Dental Care - Adult | Benefit plan covers major dental care for adult. |
| abortion | Abortion for Which Public Funding is Prohibited | Benefit plan covers services for abortion for which public funding is prohibited. |
| transplant | Transplant | Benefit plan covers transplant related services. |
| accdntl | Accidental Dental | Benefit plan covers dental care services related to an accident. |
| dialysis | Dialysis | The plan benefit covers services used to treat end stage renal disease. |
| testallrgy | Allergy Testing | The plan benefits covers services for diagnostic procedures ordered or performed to evaluate whether a sensitivity to a substance is present. This test may be associated with specimen collection and/or substance administration challenge activities. |
| chemotherapy | Chemotherapy | The plan benefits cover services the use of drugs and approved chemicals to treat disease. |
| radiation | Radiation | The plan benefits cover services the use radiation to treat disease. |
| edudiab | Diabetes Education | The plan benefits cover services related to instruction or training that encourages behaviors most likely to optimize health potentials through information about diabetes; facilitates the prevention of diabetes. |
| prosthetic | Prosthetic Devices | Plan benefit covers services related to prosthesis devices. |
| infusiontx | Infusion Therapy | Plan benefit covers services related to infusion therapy. |
| tmjtx | Treatment for Temporomandibular Joint Disorders | Plan benefit covers services related to treatment of Temporomandibular Joint disorder. |
| nutrition | Nutritional Counseling | Nutritional Counseling. |
| reconsurg | Reconstructive Surgery | Plan benefit covers services related to reconstructive surgery. |
ValueSet
Expansion performed internally based on codesystem Insurance Benefit Type Code System v1.0.0 (CodeSystem)
This value set contains 67 concepts
| Code | System | Display (en-US) | Definition |
| pcpov | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Primary Care Visit to Treat an Injury or Illness | Benefit plan covers services rendered by a primary care physician during an office visit with the purpose to treat injury or illness, except for preventive care services. |
| specialistov | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Specialist Office Visit | Covered healthcare service rendered to a patient by a specialty provider. |
| mlpov | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Other Practitioner Office Visit (Nurse, Physician Assistant) - Mid Level Professional | Benefit plan covers covered health related services rendered by a practitioner other than MD or DO and referred to as other practitioner. |
| outpatient | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | Benefit plan covers health related services rendered to patient at an outpatient facility, outside of a facility that requires a patient admission. |
| outpatstx | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Outpatient Surgery Physician/Surgical Services | Benefit plan covers surgical services rendered to patient outside of a facility admission, referred to as outpatient. |
| hospserv | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Hospice Services | Benefit plan covers hospice services. |
| routinedental | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Routine Dental Services (Adult) | Benefit plan covers routine dental services. |
| infertilitytx | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Infertility Treatment | Benefit plan covers eligible infertility treatment services. |
| ltnhc | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Long-Term/Custodial Nursing Home Care | Long-Term/Custodial Nursing Home Care. |
| privatenurse | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Private-Duty Nursing | Private-Duty Nursing. |
| routineeye | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Routine Eye Exam (Adult) | Routine Eye Exam (Adult). |
| ucservice | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Urgent Care Centers or Facilities | Urgent Care Centers or Facilities. |
| homehealth | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Home Health | Home health services insurance coverage. |
| erservice | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Emergency Room Services | Emergency Room Services. |
| ambulance | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Emergency Room Services | Emergency Room Services. |
| inpatienthospital | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Inpatient Hospital Services (e.g., Hospital Stay) | A person who is hospitalized for at least one night to receive treatment or participate in a study. |
| inpatientprovider | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Inpatient Physician and Surgical Services | A healthcare provider who is delivering healthcare services in a hospital environment. |
| bariatricsurg | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Bariatric Surgery | Bariatric surgery service Skilled nursing service (qualifier value). |
| cosmeticsurg | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Cosmetic Surgery | Cosmetic surgery service Skilled nursing service (qualifier value). |
| skillednursing | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Skilled Nursing Facility | Skilled nursing service (qualifier value). |
| ppnatalcare | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Prenatal and Postnatal Care | Prenatal and Postnatal services. |
| maternitycare | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Delivery and All Inpatient Services for Maternity Care | All maternity care services. |
| menthlthoutp | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Mental/Behavioral Health Outpatient Services | Mental health service delivered in an outpatient setting. |
| menthlthinp | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Mental/Behavioral Health Inpatient Services | Mental health service delivered in an hospital or inpatient facility setting. |
| sadoutp | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Substance Abuse Disorder Outpatient Services | Substance abuse related services delivered in a outpatient setting. |
| sadinp | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Substance Abuse Disorder Inpatient Services | Substance abuse related services delivered in a inpatient setting. |
| drggenric | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Generic Drugs | Generic drugs eligible benefits. |
| drgbrand | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Preferred Brand Drugs | Preferred brand drugs eligible benefits. |
| drgnonpreferred | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Non-Preferred Brand Drugs | Non-Preferred drugs brands eligible benefits. |
| drgspecialty | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Specialty Drugs | Benefit plan covers specialty drugs. |
| rehaboutp | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Outpatient Rehabilitation Services | Benefit plan covers outpatient rehabilitation services. |
| servicehablitation | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Habilitation Services | Habilitation Services. |
| chiro | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Chiropractic Care | Benefit plan covers chiropractor eligible benefits. |
| dme | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Durable Medical Equipment | Benefit plan covers Durable medical equipment eligible benefits. |
| hearingaids | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Hearing Aids | Benefit plan covers hearing aids. |
| imgctpetmri | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Imaging (CT/PET Scans, MRIs) | Benefit plan covers advances imaging techniques services (CT/PET Scans, MRIs) eligible services. |
| prev | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Preventive Care/Screening/Immunization | Routine healthcare services to prevent health related problems eligible benefits. |
| rtnpod | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Routine Foot Care | Routine Foot Care. |
| acupuncture | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Acupuncture | Benefit plan covers acupuncture treatment. |
| weightloss | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Weight Loss Programs | Benefit plan covers weight loss services eligible benefits. |
| rtneyechld | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Routine Eye Exam for Children | Routine eye exam for children eligible benefits. |
| glasseschld | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Eye Glasses for Children | Eye glasses children eligible benefits. |
| rtndntlchld | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Dental Check-Up for Children | Dental Check-Up for Children. |
| speachthpy | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Rehabilitative Speech Therapy | Benefit plan covers rehabilitative speech therapy eligible benefits. |
| rehaboccandpt | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Rehabilitative Occupational and Rehabilitative Physical Therapy | Benefit plan covers rehabilitative occupational and rehabilitative physical eligible benefits. |
| wellbaby | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Well Baby Visits and Care | Regularly scheduled, preventive care services, including immunizations, provided to children up to an age as specified by a health insurance company or mandated by a government agency. |
| laboutp | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Laboratory Outpatient and Professional Services | Benefit plan covers laboratory testing and related professional services received as outpatient. |
| imagingdx | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | X-rays and Diagnostic Imaging | Benefit plan covers diagnostic imaging procedures that produce images of internal structures of the human body and uses radiation to diagnose and treat diseases. |
| dntlbaschld | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Basic Dental Care - Child | Benefit plan covers diagnostic basic dental care. |
| orthochld | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Orthodontia - Child | Benefit plan covers orthodontia for children. |
| dntlmajchld | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Major Dental Care - Child | Benefit plan covers major dental care for children. |
| dntlbasadlt | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Basic Dental Care - Adult | Benefit plan covers basic dental care for adults. |
| orthodadlt | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Orthodontia - Adult | Benefits plan covers services provided that are required for orthodontic purposes for an adult. |
| dntlmajadlt | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Major Dental Care - Adult | Benefit plan covers major dental care for adult. |
| abortion | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Abortion for Which Public Funding is Prohibited | Benefit plan covers services for abortion for which public funding is prohibited. |
| transplant | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Transplant | Benefit plan covers transplant related services. |
| accdntl | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Accidental Dental | Benefit plan covers dental care services related to an accident. |
| dialysis | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Dialysis | The plan benefit covers services used to treat end stage renal disease. |
| testallrgy | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Allergy Testing | The plan benefits covers services for diagnostic procedures ordered or performed to evaluate whether a sensitivity to a substance is present. This test may be associated with specimen collection and/or substance administration challenge activities. |
| chemotherapy | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Chemotherapy | The plan benefits cover services the use of drugs and approved chemicals to treat disease. |
| radiation | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Radiation | The plan benefits cover services the use radiation to treat disease. |
| edudiab | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Diabetes Education | The plan benefits cover services related to instruction or training that encourages behaviors most likely to optimize health potentials through information about diabetes; facilitates the prevention of diabetes. |
| prosthetic | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Prosthetic Devices | Plan benefit covers services related to prosthesis devices. |
| infusiontx | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Infusion Therapy | Plan benefit covers services related to infusion therapy. |
| tmjtx | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Treatment for Temporomandibular Joint Disorders | Plan benefit covers services related to treatment of Temporomandibular Joint disorder. |
| nutrition | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Nutritional Counseling | Nutritional Counseling. |
| reconsurg | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Reconstructive Surgery | Plan benefit covers services related to reconstructive surgery. |
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 |