This page is part of the Validated Healthcare Directory FHIR IG (v0.2.0: STU 1 Ballot 2) based on FHIR v3.5.0. . For a full list of available versions, see the Directory of published versions 
JSON Format: ValueSet-valueset-benefit-type
Raw json
{
"resourceType" : "ValueSet",
"id" : "valueset-benefit-type",
"text" : {
"status" : "generated",
"div" : "<div xmlns="http://www.w3.org/1999/xhtml"><h2>VhDir Benefit Type</h2><div><p>This value set defines a set of codes that indicate the type of benefit in a product/plan.</p>
</div><p>This value set includes codes from the following code systems:</p><ul><li>Include these codes as defined in <a href="CodeSystem-codesystem-payercharacteristics.html"><code>http://hl7.org/fhir/uv/vhdir/CodeSystem/codesystem-payercharacteristics</code></a><table class="none"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-pcpov">pcpov</a></td><td>Primary Care Visit to Treat an Injury or Illness</td><td>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.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-specialistov">specialistov</a></td><td>Specialist Office Visit</td><td>Covered healthcare service rendered to a patient by a specialty provider.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-mlpov">mlpov</a></td><td>Other Practitioner Office Visit (Nurse, Physician Assistant) - Mid Level Professional</td><td>Benefit plan covers covered health related services rendered by a practioner other than MD or DO and referred to as other practitioner.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-outpatient">outpatient</a></td><td>Outpatient Facility Fee (e.g., Ambulatory Surgery Center)</td><td>Benefit plan covers health related services rendered to patient at an outpatient facility, outside of a facility that requires a patient admission.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-outpatstx">outpatstx</a></td><td>Outpatient Surgery Physician/Surgical Services</td><td>Benefit plan covers surgical services rendered to patient outside of a facility admission, referred to as outpatient.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-hospserv">hospserv</a></td><td>Hospice Services</td><td>Benefit plan covers hospice services.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-routinedental">routinedental</a></td><td>Routine Dental Services (Adult)</td><td>Benefit plan covers routine dental services.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-infertilitytx">infertilitytx</a></td><td>Infertility Treatment</td><td>Benefit plan covers eligible infertility treatment services.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-ltnhc">ltnhc</a></td><td>Long-Term/Custodial Nursing Home Care</td><td>Long-Term/Custodial Nursing Home Care.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-privatenurse">privatenurse</a></td><td>Private-Duty Nursing</td><td>Private-Duty Nursing.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-routineeye">routineeye</a></td><td>Routine Eye Exam (Adult)</td><td>Routine Eye Exam (Adult).</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-ucservice">ucservice</a></td><td>Urgent Care Centers or Facilities</td><td>Urgent Care Centers or Facilities.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-homehealth">homehealth</a></td><td>Home Health</td><td>Home health services insurance coverage.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-erservice">erservice</a></td><td>Emergency Room Services</td><td>Emergency Room Services.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-ambulance">ambulance</a></td><td>Emergency Room Services</td><td>Emergency Room Services.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-inpatienthospital">inpatienthospital</a></td><td>Inpatient Hospital Services (e.g., Hospital Stay)</td><td>A person who is hospitalized for at least one night to receive treatment or participate in a study.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-inpatientprovider">inpatientprovider</a></td><td>Inpatient Physician and Surgical Services</td><td>A healthcare provider who is delivering healthcare services in a hospital environment.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-bariatricsurg">bariatricsurg</a></td><td>Bariatric Surgery</td><td>Bariatric surgery service Skilled nursing service (qualifier value).</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-cosmeticsurg">cosmeticsurg</a></td><td>Cosmetic Surgery</td><td>Cosmetic surgery service Skilled nursing service (qualifier value).</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-skillednursing">skillednursing</a></td><td>Skilled Nursing Facility</td><td>Skilled nursing service (qualifier value).</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-ppnatalcare">ppnatalcare</a></td><td>Prenatal and Postnatal Care</td><td>Prenatal and Postnatal services.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-maternitycare">maternitycare</a></td><td>Delivery and All Inpatient Services for Maternity Care</td><td>All maternity care services.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-menthlthoutp">menthlthoutp</a></td><td>Mental/Behavioral Health Outpatient Services</td><td>Mental health service delivered in an outpatient setting.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-menthlthinp">menthlthinp</a></td><td>Mental/Behavioral Health Inpatient Services</td><td>Mental health service delivered in an hospital or inpatient facility setting.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-sadoutp">sadoutp</a></td><td>Substance Abuse Disorder Outpatient Services</td><td>Substance abuse related services delivered in a outpatient setting.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-sadinp">sadinp</a></td><td>Substance Abuse Disorder Inpatient Services</td><td>Substance abuse related services delivered in a inpatient setting.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-drggenric">drggenric</a></td><td>Generic Drugs</td><td>Generic drugs eligible benefits.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-drgbrand">drgbrand</a></td><td>Preferred Brand Drugs</td><td>Preferred brand drugs eligible benefits.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-drgnonpreferred">drgnonpreferred</a></td><td>Non-Preferred Brand Drugs</td><td>Non-Preferred drugs brands eligible benefits.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-drgspecialty">drgspecialty</a></td><td>Specialty Drugs</td><td>Benefit plan covers specialty drugs.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-rehaboutp">rehaboutp</a></td><td>Outpatient Rehabilitation Services</td><td>Benefit plan covers outpatient rehabilitation services.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-servicehablitation">servicehablitation</a></td><td>Habilitation Services</td><td>Habilitation Services.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-chiro">chiro</a></td><td>Chiropractic Care</td><td>Benefit plan covers chiropractor eligible benefits.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-dme">dme</a></td><td>Durable Medical Equipment</td><td>Benefit plan covers Durable medical equipment eligible benefits.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-hearingaids">hearingaids</a></td><td>Hearing Aids</td><td>Benefit plan covers hearing aids.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-imgctpetmri">imgctpetmri</a></td><td>Imaging (CT/PET Scans, MRIs)</td><td>Benefit plan covers advances imaging techniques services (CT/PET Scans, MRIs) eligible services.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-prev">prev</a></td><td>Preventive Care/Screening/Immunization</td><td>Routine healthcare services to prevent health related problems eligible benefits.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-rtnpod">rtnpod</a></td><td>Routine Foot Care</td><td>Routine Foot Care.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-acupuncture">acupuncture</a></td><td>Acupuncture</td><td>Benefit plan covers acupuncture treatment.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-weightloss">weightloss</a></td><td>Weight Loss Programs</td><td>Benefit plan covers weight loss services eligible benefits.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-rtneyechld">rtneyechld</a></td><td>Routine Eye Exam for Children</td><td>Routine eye exam for children eligible benefits.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-glasseschld">glasseschld</a></td><td>Eye Glasses for Children</td><td>Eye glasses children eligible benefits.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-rtndntlchld">rtndntlchld</a></td><td>Dental Check-Up for Children</td><td>Dental Check-Up for Children.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-speachthpy">speachthpy</a></td><td>Rehabilitative Speech Therapy</td><td>Benefit plan covers rehabilitative speech therapy eligible benefits.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-rehaboccandpt">rehaboccandpt</a></td><td>Rehabilitative Occupational and Rehabilitative Physical Therapy</td><td>Benefit plan covers rehabilitative occupational and rehabilitative physical eligible benefits.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-wellbaby">wellbaby</a></td><td>Well Baby Visits and Care</td><td>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.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-laboutp">laboutp</a></td><td>Laboratory Outpatient and Professional Services</td><td>Benefit plan covers laboratory testing and related professional services received as outpatient.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-imagingdx">imagingdx</a></td><td>X-rays and Diagnostic Imaging</td><td>Benefit plan covers diagnostic imaging procedures that produce images of internal structures of the human body and uses radiation to diagnose and treat diseases.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-dntlbaschld">dntlbaschld</a></td><td>Basic Dental Care – Child</td><td>Benefit plan covers diagnostic basic dental care.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-orthochld">orthochld</a></td><td>Orthodontia – Child</td><td>Benefit plan covers orthodontia for children.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-dntlmajchld">dntlmajchld</a></td><td>Major Dental Care – Child</td><td>Benefit plan covers major dental care for children.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-dntlbasadlt">dntlbasadlt</a></td><td>Basic Dental Care – Adult</td><td>Benefit plan covers basic dental care for adults.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-orthodadlt">orthodadlt</a></td><td>Orthodontia – Adult</td><td>Benefits plan covers services provided that are required for orthodontic purposes for an adult.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-dntlmajadlt">dntlmajadlt</a></td><td>Major Dental Care – Adult</td><td>Benefit plan covers major dental care for adult.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-abortion">abortion</a></td><td>Abortion for Which Public Funding is Prohibited</td><td>Benefit plan covers services for abortion for which public funding is prohibited.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-transplant">transplant</a></td><td>Transplant</td><td>Benefit plan covers transplant related services.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-accdntl">accdntl</a></td><td>Accidental Dental</td><td>Benefit plan covers dental care services related to an accident.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-dialysis">dialysis</a></td><td>Dialysis</td><td>The plan benefit covers services used to treat end stage renal disease.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-testallrgy">testallrgy</a></td><td>Allergy Testing</td><td>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.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-chemotherapy">chemotherapy</a></td><td>Chemotherapy</td><td>The plan benefits cover services the use of drugs and approved chemicals to treat disease.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-radiation">radiation</a></td><td>Radiation</td><td>The plan benefits cover services the use radiation to treat disease.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-edudiab">edudiab</a></td><td>Diabetes Education</td><td>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.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-prosthetic">prosthetic</a></td><td>Prosthetic Devices</td><td>Plan benefit covers services related to prosthesis devices.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-infusiontx">infusiontx</a></td><td>Infusion Therapy</td><td>Plan benefit covers services related to infusion therapy.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-tmjtx">tmjtx</a></td><td>Treatment for Temporomandibular Joint Disorders</td><td>Plan benefit covers services related to treatment of Temporomandibular Joint disorder.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-nutrition">nutrition</a></td><td>Nutritional Counseling</td><td>Nutritional Counseling.</td></tr><tr><td><a href="CodeSystem-codesystem-payercharacteristics.html#codesystem-payercharacteristics-reconsurg">reconsurg</a></td><td>Reconstructive Surgery</td><td>Plan benefit covers services related to reconstructive surgery.</td></tr></table></li></ul></div>"
},
"url" : "http://hl7.org/fhir/uv/vhdir/ValueSet/valueset-benefit-type",
"version" : "0.2.0",
"name" : "VhDirBenefitType",
"title" : "VhDir Benefit Type",
"status" : "active",
"date" : "2018-02-21",
"publisher" : "HL7 International",
"contact" : [
{
"telecom" : [
{
"system" : "other",
"value" : "http://hl7.org/fhir"
}
]
}
],
"description" : "This value set defines a set of codes that indicate the type of benefit in a product/plan.",
"compose" : {
"include" : [
{
"system" : "http://hl7.org/fhir/uv/vhdir/CodeSystem/codesystem-payercharacteristics",
"concept" : [
{
"code" : "pcpov"
},
{
"code" : "specialistov"
},
{
"code" : "mlpov"
},
{
"code" : "outpatient"
},
{
"code" : "outpatstx"
},
{
"code" : "hospserv"
},
{
"code" : "routinedental"
},
{
"code" : "infertilitytx"
},
{
"code" : "ltnhc"
},
{
"code" : "privatenurse"
},
{
"code" : "routineeye"
},
{
"code" : "ucservice"
},
{
"code" : "homehealth"
},
{
"code" : "erservice"
},
{
"code" : "ambulance"
},
{
"code" : "inpatienthospital"
},
{
"code" : "inpatientprovider"
},
{
"code" : "bariatricsurg"
},
{
"code" : "cosmeticsurg"
},
{
"code" : "skillednursing"
},
{
"code" : "ppnatalcare"
},
{
"code" : "maternitycare"
},
{
"code" : "menthlthoutp"
},
{
"code" : "menthlthinp"
},
{
"code" : "sadoutp"
},
{
"code" : "sadinp"
},
{
"code" : "drggenric"
},
{
"code" : "drgbrand"
},
{
"code" : "drgnonpreferred"
},
{
"code" : "drgspecialty"
},
{
"code" : "rehaboutp"
},
{
"code" : "servicehablitation"
},
{
"code" : "chiro"
},
{
"code" : "dme"
},
{
"code" : "hearingaids"
},
{
"code" : "imgctpetmri"
},
{
"code" : "prev"
},
{
"code" : "rtnpod"
},
{
"code" : "acupuncture"
},
{
"code" : "weightloss"
},
{
"code" : "rtneyechld"
},
{
"code" : "glasseschld"
},
{
"code" : "rtndntlchld"
},
{
"code" : "speachthpy"
},
{
"code" : "rehaboccandpt"
},
{
"code" : "wellbaby"
},
{
"code" : "laboutp"
},
{
"code" : "imagingdx"
},
{
"code" : "dntlbaschld"
},
{
"code" : "orthochld"
},
{
"code" : "dntlmajchld"
},
{
"code" : "dntlbasadlt"
},
{
"code" : "orthodadlt"
},
{
"code" : "dntlmajadlt"
},
{
"code" : "abortion"
},
{
"code" : "transplant"
},
{
"code" : "accdntl"
},
{
"code" : "dialysis"
},
{
"code" : "testallrgy"
},
{
"code" : "chemotherapy"
},
{
"code" : "radiation"
},
{
"code" : "edudiab"
},
{
"code" : "prosthetic"
},
{
"code" : "infusiontx"
},
{
"code" : "tmjtx"
},
{
"code" : "nutrition"
},
{
"code" : "reconsurg"
}
]
}
]
}
}
