Extensions for Using Data Elements from FHIR R4 in FHIR STU3
0.1.0 - STU
Extensions for Using Data Elements from FHIR R4 in FHIR STU3
0.1.0 - STU
Extensions for Using Data Elements from FHIR R4 in FHIR STU3 - Downloaded Version null See the Directory of published versions
| Page standards status: Trial-use | Maturity Level: 0 |
Definitions for the ext-R4-ExplanationOfBenefit.add.det.subDetail extension.
Guidance on how to interpret the contents of this table can be foundhere
| 0. Extension | |
| Definition | R4: Optional Extension Element - found in all resources. |
| Short | R4: Insurer added line items (new)Optional Extensions Element |
| Comments | Element |
| Control | 0..* This element is affected by the following invariants: ele-1 |
| Is Modifier | false |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists())ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists()) |
| 2. Extension.extension | |
| Definition | An Extension May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
| Short | ExtensionAdditional Content defined by implementations |
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
| Control | 10..* |
| Type | Extension |
| Alternate Names | extensions, user content |
| Slicing | This element introduces a set of slices on Extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 4. Extension.extension:productOrService | |
| Slice Name | productOrService |
| Definition | R4: |
| Short | R4: Billing, service, product, or drug code (new)Additional Content defined by implementations |
| Comments | Element |
| Control | 10..1* |
| Type | Extension |
| Requirements | Necessary to state what was provided or done. Element |
| 6. Extension.extension:productOrService.url | |
| Definition | Source of the definition for the extension code - a logical name or a URL. |
| Short | identifies the meaning of the extension |
| Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. |
| Control | 1..1 |
| Type | uri |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| Fixed Value | productOrService |
| 8. Extension.extension:productOrService.value[x] | |
| Definition | When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). |
| Short | Billing, service, product, or drug codeValue of extension |
| Comments | If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. |
| Control | 10..1 |
| Binding | For example codes, see For codes, see USCLS Codes (example to http://hl7.org/fhir/ValueSet/service-uscls|3.0.2)Allowable service and product codes. |
| Type | CodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal |
| [x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
| 10. Extension.extension:modifier | |
| Slice Name | modifier |
| Definition | R4: |
| Short | R4: Service/Product billing modifiers (new)Additional Content defined by implementations |
| Comments | Element |
| Control | 0..* |
| Type | Extension |
| Requirements | To support inclusion of the item for adjudication or to charge an elevated fee. Element |
| 12. Extension.extension:modifier.url | |
| Definition | Source of the definition for the extension code - a logical name or a URL. |
| Short | identifies the meaning of the extension |
| Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. |
| Control | 1..1 |
| Type | uri |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| Fixed Value | modifier |
| 14. Extension.extension:modifier.value[x] | |
| Definition | Item typification or modifiers codes to convey additional context for the product or service. Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). |
| Short | Service/Product billing modifiersValue of extension |
| Comments | For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. |
| Control | 0..1 |
| Binding | For example codes, see For codes, see Modifier type Codes (example to http://hl7.org/fhir/ValueSet/claim-modifiers|3.0.2)Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. |
| Type | CodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal |
| [x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
| 16. Extension.extension:quantity | |
| Slice Name | quantity |
| Definition | R4: |
| Short | R4: Count of products or services (new)Additional Content defined by implementations |
| Comments | Element |
| Control | 0..1* |
| Type | Extension |
| Requirements | Required when the product or service code does not convey the quantity provided. Element |
| 18. Extension.extension:quantity.url | |
| Definition | Source of the definition for the extension code - a logical name or a URL. |
| Short | identifies the meaning of the extension |
| Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. |
| Control | 1..1 |
| Type | uri |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| Fixed Value | quantity |
| 20. Extension.extension:quantity.value[x] | |
| Definition | The number of repetitions of a service or product. Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). |
| Short | Count of products or servicesValue of extension |
| Control | 0..1 |
| Type | Quantity(SimpleQuantity), date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept |
| [x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
| 22. Extension.extension:unitPrice | |
| Slice Name | unitPrice |
| Definition | R4: |
| Short | R4: Fee, charge or cost per item (new)Additional Content defined by implementations |
| Comments | Element |
| Control | 0..1* |
| Type | Extension |
| Requirements | The amount charged to the patient by the provider for a single unit. Element |
| 24. Extension.extension:unitPrice.url | |
| Definition | Source of the definition for the extension code - a logical name or a URL. |
| Short | identifies the meaning of the extension |
| Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. |
| Control | 1..1 |
| Type | uri |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| Fixed Value | unitPrice |
| 26. Extension.extension:unitPrice.value[x] | |
| Definition | If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). |
| Short | Fee, charge or cost per itemValue of extension |
| Control | 0..1 |
| Type | Money, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept |
| [x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
| 28. Extension.extension:factor | |
| Slice Name | factor |
| Definition | R4: |
| Short | R4: Price scaling factor (new)Additional Content defined by implementations |
| Comments | Element |
| Control | 0..1* |
| Type | Extension |
| Requirements | When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. Element |
| 30. Extension.extension:factor.url | |
| Definition | Source of the definition for the extension code - a logical name or a URL. |
| Short | identifies the meaning of the extension |
| Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. |
| Control | 1..1 |
| Type | uri |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| Fixed Value | factor |
| 32. Extension.extension:factor.value[x] | |
| Definition | A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). |
| Short | Price scaling factorValue of extension |
| Comments | To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). |
| Control | 0..1 |
| Type | decimal, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, CodeableConcept |
| [x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 34. Extension.extension:net | |
| Slice Name | net |
| Definition | R4: |
| Short | R4: Total item cost (new)Additional Content defined by implementations |
| Comments | Element |
| Control | 0..1* |
| Type | Extension |
| Requirements | Provides the total amount claimed for the group (if a grouper) or the line item. Element |
| 36. Extension.extension:net.url | |
| Definition | Source of the definition for the extension code - a logical name or a URL. |
| Short | identifies the meaning of the extension |
| Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. |
| Control | 1..1 |
| Type | uri |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| Fixed Value | net |
| 38. Extension.extension:net.value[x] | |
| Definition | The quantity times the unit price for an additional service or product or charge. Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). |
| Short | Total item costValue of extension |
| Comments | For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. |
| Control | 0..1 |
| Type | Money, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept |
| [x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
| 40. Extension.extension:noteNumber | |
| Slice Name | noteNumber |
| Definition | R4: |
| Short | R4: Applicable note numbers (new)Additional Content defined by implementations |
| Comments | Element |
| Control | 0..* |
| Type | Extension |
| Requirements | Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. Element |
| 42. Extension.extension:noteNumber.url | |
| Definition | Source of the definition for the extension code - a logical name or a URL. |
| Short | identifies the meaning of the extension |
| Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. |
| Control | 1..1 |
| Type | uri |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| Fixed Value | noteNumber |
| 44. Extension.extension:noteNumber.value[x] | |
| Definition | The numbers associated with notes below which apply to the adjudication of this item. Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). |
| Short | Applicable note numbersValue of extension |
| Control | 0..1 |
| Type | positiveInt, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept |
| [x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 46. Extension.extension:adjudication | |
| Slice Name | adjudication |
| Definition | R4: |
| Short | R4: Added items adjudication (new)Additional Content defined by implementations |
| Comments | Element |
| Control | 0..* |
| Type | Extension |
| Requirements | Element |
| 48. Extension.extension:adjudication.url | |
| Definition | Source of the definition for the extension code - a logical name or a URL. |
| Short | identifies the meaning of the extension |
| Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. |
| Control | 1..1 |
| Type | uri |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| Fixed Value | http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication |
| 50. Extension.extension:adjudication.value[x] | |
| Definition | Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). |
| Short | Value of extension |
| Control | 0..01 |
| Type | Choice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 52. Extension.url | |
| Definition | Source of the definition for the extension code - a logical name or a URL. |
| Short | identifies the meaning of the extension |
| Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. |
| Control | 1..1 |
| Type | uri |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| Fixed Value | http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail |
| 54. Extension.value[x] | |
| Definition | Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). |
| Short | Value of extension |
| Control | 0..01 |
| Type | Choice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
Guidance on how to interpret the contents of this table can be foundhere
| 0. Extension | |
| Definition | R4: |
| Short | R4: Insurer added line items (new) |
| Comments | Element |
| Control | 0..* |
| Is Modifier | false |
| 2. Extension.extension | |
| Control | 1..* |
| Slicing | This element introduces a set of slices on Extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 4. Extension.extension:productOrService | |
| Slice Name | productOrService |
| Definition | R4: |
| Short | R4: Billing, service, product, or drug code (new) |
| Comments | Element |
| Control | 1..1 |
| Requirements | Necessary to state what was provided or done. Element |
| 6. Extension.extension:productOrService.url | |
| Control | 1..1 |
| Fixed Value | productOrService |
| 8. Extension.extension:productOrService.value[x] | |
| Definition | When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. |
| Short | Billing, service, product, or drug code |
| Comments | If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. |
| Control | 1..1 |
| Binding | For example codes, see USCLS Codes (example to http://hl7.org/fhir/ValueSet/service-uscls|3.0.2)Allowable service and product codes. |
| Type | CodeableConcept |
| [x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
| 10. Extension.extension:modifier | |
| Slice Name | modifier |
| Definition | R4: |
| Short | R4: Service/Product billing modifiers (new) |
| Comments | Element |
| Control | 0..* |
| Requirements | To support inclusion of the item for adjudication or to charge an elevated fee. Element |
| 12. Extension.extension:modifier.url | |
| Control | 1..1 |
| Fixed Value | modifier |
| 14. Extension.extension:modifier.value[x] | |
| Definition | Item typification or modifiers codes to convey additional context for the product or service. |
| Short | Service/Product billing modifiers |
| Comments | For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. |
| Control | 0..1 |
| Binding | For example codes, see Modifier type Codes (example to http://hl7.org/fhir/ValueSet/claim-modifiers|3.0.2)Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. |
| Type | CodeableConcept |
| [x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
| 16. Extension.extension:quantity | |
| Slice Name | quantity |
| Definition | R4: |
| Short | R4: Count of products or services (new) |
| Comments | Element |
| Control | 0..1 |
| Requirements | Required when the product or service code does not convey the quantity provided. Element |
| 18. Extension.extension:quantity.url | |
| Control | 1..1 |
| Fixed Value | quantity |
| 20. Extension.extension:quantity.value[x] | |
| Definition | The number of repetitions of a service or product. |
| Short | Count of products or services |
| Control | 0..1 |
| Type | Quantity(SimpleQuantity) |
| [x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
| 22. Extension.extension:unitPrice | |
| Slice Name | unitPrice |
| Definition | R4: |
| Short | R4: Fee, charge or cost per item (new) |
| Comments | Element |
| Control | 0..1 |
| Requirements | The amount charged to the patient by the provider for a single unit. Element |
| 24. Extension.extension:unitPrice.url | |
| Control | 1..1 |
| Fixed Value | unitPrice |
| 26. Extension.extension:unitPrice.value[x] | |
| Definition | If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. |
| Short | Fee, charge or cost per item |
| Control | 0..1 |
| Type | Money |
| [x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
| 28. Extension.extension:factor | |
| Slice Name | factor |
| Definition | R4: |
| Short | R4: Price scaling factor (new) |
| Comments | Element |
| Control | 0..1 |
| Requirements | When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. Element |
| 30. Extension.extension:factor.url | |
| Control | 1..1 |
| Fixed Value | factor |
| 32. Extension.extension:factor.value[x] | |
| Definition | A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. |
| Short | Price scaling factor |
| Comments | To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). |
| Control | 0..1 |
| Type | decimal |
| [x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 34. Extension.extension:net | |
| Slice Name | net |
| Definition | R4: |
| Short | R4: Total item cost (new) |
| Comments | Element |
| Control | 0..1 |
| Requirements | Provides the total amount claimed for the group (if a grouper) or the line item. Element |
| 36. Extension.extension:net.url | |
| Control | 1..1 |
| Fixed Value | net |
| 38. Extension.extension:net.value[x] | |
| Definition | The quantity times the unit price for an additional service or product or charge. |
| Short | Total item cost |
| Comments | For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. |
| Control | 0..1 |
| Type | Money |
| [x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
| 40. Extension.extension:noteNumber | |
| Slice Name | noteNumber |
| Definition | R4: |
| Short | R4: Applicable note numbers (new) |
| Comments | Element |
| Control | 0..* |
| Requirements | Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. Element |
| 42. Extension.extension:noteNumber.url | |
| Control | 1..1 |
| Fixed Value | noteNumber |
| 44. Extension.extension:noteNumber.value[x] | |
| Definition | The numbers associated with notes below which apply to the adjudication of this item. |
| Short | Applicable note numbers |
| Control | 0..1 |
| Type | positiveInt |
| [x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 46. Extension.extension:adjudication | |
| Slice Name | adjudication |
| Definition | R4: |
| Short | R4: Added items adjudication (new) |
| Comments | Element |
| Control | 0..* |
| Requirements | Element |
| 48. Extension.extension:adjudication.url | |
| Control | 1..1 |
| Fixed Value | http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication |
| 50. Extension.extension:adjudication.value[x] | |
| Control | 0..0 |
| 52. Extension.url | |
| Control | 1..1 |
| Fixed Value | http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail |
| 54. Extension.value[x] | |
| Control | 0..0 |
Guidance on how to interpret the contents of this table can be foundhere
| 0. Extension | |
| Definition | R4: |
| Short | R4: Insurer added line items (new) |
| Comments | Element |
| Control | 0..* This element is affected by the following invariants: ele-1 |
| Is Modifier | false |
| Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))ext-1: Must have either extensions or value[x], not both ( extension.exists() != value.exists()) |
| 2. Extension.id | |
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
| Short | xml:id (or equivalent in JSON) |
| Control | 0..1 |
| Type | string |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| 4. Extension.extension | |
| Definition | An Extension |
| Short | Extension |
| Control | 1..* |
| Type | Extension |
| Slicing | This element introduces a set of slices on Extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 6. Extension.extension:productOrService | |
| Slice Name | productOrService |
| Definition | R4: |
| Short | R4: Billing, service, product, or drug code (new) |
| Comments | Element |
| Control | 1..1 |
| Type | Extension |
| Requirements | Necessary to state what was provided or done. Element |
| 8. Extension.extension:productOrService.id | |
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
| Short | xml:id (or equivalent in JSON) |
| Control | 0..1 |
| Type | string |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| 10. Extension.extension:productOrService.extension | |
| Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
| Short | Additional Content defined by implementations |
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
| Control | 0..* |
| Type | Extension |
| Alternate Names | extensions, user content |
| Slicing | This element introduces a set of slices on Extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 12. Extension.extension:productOrService.url | |
| Definition | Source of the definition for the extension code - a logical name or a URL. |
| Short | identifies the meaning of the extension |
| Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. |
| Control | 1..1 |
| Type | uri |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| Fixed Value | productOrService |
| 14. Extension.extension:productOrService.value[x] | |
| Definition | When the value is a group code then this item collects a set of related claim details, otherwise this contains the product, service, drug or other billing code for the item. |
| Short | Billing, service, product, or drug code |
| Comments | If this is an actual service or product line, i.e. not a Group, then use code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI). If a grouping item then use a group code to indicate the type of thing being grouped e.g. 'glasses' or 'compound'. |
| Control | 1..1 |
| Binding | For example codes, see USCLS Codes (example to http://hl7.org/fhir/ValueSet/service-uscls|3.0.2)Allowable service and product codes. |
| Type | CodeableConcept |
| [x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
| 16. Extension.extension:modifier | |
| Slice Name | modifier |
| Definition | R4: |
| Short | R4: Service/Product billing modifiers (new) |
| Comments | Element |
| Control | 0..* |
| Type | Extension |
| Requirements | To support inclusion of the item for adjudication or to charge an elevated fee. Element |
| 18. Extension.extension:modifier.id | |
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
| Short | xml:id (or equivalent in JSON) |
| Control | 0..1 |
| Type | string |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| 20. Extension.extension:modifier.extension | |
| Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
| Short | Additional Content defined by implementations |
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
| Control | 0..* |
| Type | Extension |
| Alternate Names | extensions, user content |
| Slicing | This element introduces a set of slices on Extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 22. Extension.extension:modifier.url | |
| Definition | Source of the definition for the extension code - a logical name or a URL. |
| Short | identifies the meaning of the extension |
| Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. |
| Control | 1..1 |
| Type | uri |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| Fixed Value | modifier |
| 24. Extension.extension:modifier.value[x] | |
| Definition | Item typification or modifiers codes to convey additional context for the product or service. |
| Short | Service/Product billing modifiers |
| Comments | For example, in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours. |
| Control | 0..1 |
| Binding | For example codes, see Modifier type Codes (example to http://hl7.org/fhir/ValueSet/claim-modifiers|3.0.2)Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen. |
| Type | CodeableConcept |
| [x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
| 26. Extension.extension:quantity | |
| Slice Name | quantity |
| Definition | R4: |
| Short | R4: Count of products or services (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension |
| Requirements | Required when the product or service code does not convey the quantity provided. Element |
| 28. Extension.extension:quantity.id | |
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
| Short | xml:id (or equivalent in JSON) |
| Control | 0..1 |
| Type | string |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| 30. Extension.extension:quantity.extension | |
| Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
| Short | Additional Content defined by implementations |
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
| Control | 0..* |
| Type | Extension |
| Alternate Names | extensions, user content |
| Slicing | This element introduces a set of slices on Extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 32. Extension.extension:quantity.url | |
| Definition | Source of the definition for the extension code - a logical name or a URL. |
| Short | identifies the meaning of the extension |
| Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. |
| Control | 1..1 |
| Type | uri |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| Fixed Value | quantity |
| 34. Extension.extension:quantity.value[x] | |
| Definition | The number of repetitions of a service or product. |
| Short | Count of products or services |
| Control | 0..1 |
| Type | Quantity(SimpleQuantity) |
| [x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
| 36. Extension.extension:unitPrice | |
| Slice Name | unitPrice |
| Definition | R4: |
| Short | R4: Fee, charge or cost per item (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension |
| Requirements | The amount charged to the patient by the provider for a single unit. Element |
| 38. Extension.extension:unitPrice.id | |
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
| Short | xml:id (or equivalent in JSON) |
| Control | 0..1 |
| Type | string |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| 40. Extension.extension:unitPrice.extension | |
| Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
| Short | Additional Content defined by implementations |
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
| Control | 0..* |
| Type | Extension |
| Alternate Names | extensions, user content |
| Slicing | This element introduces a set of slices on Extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 42. Extension.extension:unitPrice.url | |
| Definition | Source of the definition for the extension code - a logical name or a URL. |
| Short | identifies the meaning of the extension |
| Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. |
| Control | 1..1 |
| Type | uri |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| Fixed Value | unitPrice |
| 44. Extension.extension:unitPrice.value[x] | |
| Definition | If the item is not a group then this is the fee for the product or service, otherwise this is the total of the fees for the details of the group. |
| Short | Fee, charge or cost per item |
| Control | 0..1 |
| Type | Money |
| [x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
| 46. Extension.extension:factor | |
| Slice Name | factor |
| Definition | R4: |
| Short | R4: Price scaling factor (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension |
| Requirements | When discounts are provided to a patient (example: Senior's discount) then this must be documented for adjudication. Element |
| 48. Extension.extension:factor.id | |
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
| Short | xml:id (or equivalent in JSON) |
| Control | 0..1 |
| Type | string |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| 50. Extension.extension:factor.extension | |
| Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
| Short | Additional Content defined by implementations |
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
| Control | 0..* |
| Type | Extension |
| Alternate Names | extensions, user content |
| Slicing | This element introduces a set of slices on Extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 52. Extension.extension:factor.url | |
| Definition | Source of the definition for the extension code - a logical name or a URL. |
| Short | identifies the meaning of the extension |
| Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. |
| Control | 1..1 |
| Type | uri |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| Fixed Value | factor |
| 54. Extension.extension:factor.value[x] | |
| Definition | A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount. |
| Short | Price scaling factor |
| Comments | To show a 10% senior's discount, the value entered is: 0.90 (1.00 - 0.10). |
| Control | 0..1 |
| Type | decimal |
| [x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 56. Extension.extension:net | |
| Slice Name | net |
| Definition | R4: |
| Short | R4: Total item cost (new) |
| Comments | Element |
| Control | 0..1 |
| Type | Extension |
| Requirements | Provides the total amount claimed for the group (if a grouper) or the line item. Element |
| 58. Extension.extension:net.id | |
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
| Short | xml:id (or equivalent in JSON) |
| Control | 0..1 |
| Type | string |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| 60. Extension.extension:net.extension | |
| Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
| Short | Additional Content defined by implementations |
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
| Control | 0..* |
| Type | Extension |
| Alternate Names | extensions, user content |
| Slicing | This element introduces a set of slices on Extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 62. Extension.extension:net.url | |
| Definition | Source of the definition for the extension code - a logical name or a URL. |
| Short | identifies the meaning of the extension |
| Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. |
| Control | 1..1 |
| Type | uri |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| Fixed Value | net |
| 64. Extension.extension:net.value[x] | |
| Definition | The quantity times the unit price for an additional service or product or charge. |
| Short | Total item cost |
| Comments | For example, the formula: quantity * unitPrice * factor = net. Quantity and factor are assumed to be 1 if not supplied. |
| Control | 0..1 |
| Type | Money |
| [x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
| 66. Extension.extension:noteNumber | |
| Slice Name | noteNumber |
| Definition | R4: |
| Short | R4: Applicable note numbers (new) |
| Comments | Element |
| Control | 0..* |
| Type | Extension |
| Requirements | Provides a condensed manner for associating human readable descriptive explanations for adjudications on the line item. Element |
| 68. Extension.extension:noteNumber.id | |
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
| Short | xml:id (or equivalent in JSON) |
| Control | 0..1 |
| Type | string |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| 70. Extension.extension:noteNumber.extension | |
| Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
| Short | Additional Content defined by implementations |
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
| Control | 0..* |
| Type | Extension |
| Alternate Names | extensions, user content |
| Slicing | This element introduces a set of slices on Extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 72. Extension.extension:noteNumber.url | |
| Definition | Source of the definition for the extension code - a logical name or a URL. |
| Short | identifies the meaning of the extension |
| Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. |
| Control | 1..1 |
| Type | uri |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| Fixed Value | noteNumber |
| 74. Extension.extension:noteNumber.value[x] | |
| Definition | The numbers associated with notes below which apply to the adjudication of this item. |
| Short | Applicable note numbers |
| Control | 0..1 |
| Type | positiveInt |
| [x] Note | SeeChoice of Data Typesfor further information about how to use [x] |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 76. Extension.extension:adjudication | |
| Slice Name | adjudication |
| Definition | R4: |
| Short | R4: Added items adjudication (new) |
| Comments | Element |
| Control | 0..* |
| Type | Extension |
| Requirements | Element |
| 78. Extension.extension:adjudication.id | |
| Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. |
| Short | xml:id (or equivalent in JSON) |
| Control | 0..1 |
| Type | string |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| 80. Extension.extension:adjudication.extension | |
| Definition | May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. |
| Short | Additional Content defined by implementations |
| Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
| Control | 0..* |
| Type | Extension |
| Alternate Names | extensions, user content |
| Slicing | This element introduces a set of slices on Extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators: |
| 82. Extension.extension:adjudication.url | |
| Definition | Source of the definition for the extension code - a logical name or a URL. |
| Short | identifies the meaning of the extension |
| Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. |
| Control | 1..1 |
| Type | uri |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| Fixed Value | http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.item.adjudication |
| 84. Extension.extension:adjudication.value[x] | |
| Definition | Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). |
| Short | Value of extension |
| Control | 0..0 |
| Type | Choice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 86. Extension.url | |
| Definition | Source of the definition for the extension code - a logical name or a URL. |
| Short | identifies the meaning of the extension |
| Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. |
| Control | 1..1 |
| Type | uri |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| XML Format | In the XML format, this property is represented as an attribute. |
| Fixed Value | http://hl7.org/fhir/4.0/StructureDefinition/extension-ExplanationOfBenefit.addItem.detail.subDetail |
| 88. Extension.value[x] | |
| Definition | Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list). |
| Short | Value of extension |
| Control | 0..0 |
| Type | Choice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
IG © 2025+ FHIR Infrastructure. Package hl7.fhir.uv.xver-r4.r3#0.1.0 based on FHIR 3.0.2. Generated 2026-03-20
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