FHIR Cross-Version Extensions package for FHIR R4 from FHIR R5 - Version 0.0.1-snapshot-2. See the Directory of published versions
| Page standards status: Informative | Maturity Level: 0 |
<ValueSet xmlns="http://hl7.org/fhir">
<id value="R5-v3-ActInvoiceDetailGenericCode-for-R4"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: ValueSet R5-v3-ActInvoiceDetailGenericCode-for-R4</b></p><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4"> </a><a name="hcR5-v3-ActInvoiceDetailGenericCode-for-R4"> </a><p>This value set expansion contains 25 concepts.</p><table class="codes"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>System</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-COIN"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-COIN">COIN</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>coinsurance</td><td><div><p>That portion of the eligible charges which a covered party must pay for each service and/or product. It is a percentage of the eligible amount for the service/product that is typically charged after the covered party has met the policy deductible. This amount represents the covered party's coinsurance that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-COPAYMENT"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-COPAYMENT">COPAYMENT</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>patient co-pay</td><td><div><p>That portion of the eligible charges which a covered party must pay for each service and/or product. It is a defined amount per service/product of the eligible amount for the service/product. This amount represents the covered party's copayment that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-DEDUCTIBLE"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-DEDUCTIBLE">DEDUCTIBLE</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>deductible</td><td><div><p>That portion of the eligible charges which a covered party must pay in a particular period (e.g. annual) before the benefits are payable by the adjudicator. This amount represents the covered party's deductible that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-PAY"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-PAY">PAY</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>payment</td><td><div><p>The guarantor, who may be the patient, pays the entire charge for a service. Reasons for such action may include: there is no insurance coverage for the service (e.g. cosmetic surgery); the patient wishes to self-pay for the service; or the insurer denies payment for the service due to contractual provisions such as the need for prior authorization.</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-SPEND"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-SPEND">SPEND</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>spend down</td><td><div><p>That total amount of the eligible charges which a covered party must periodically pay for services and/or products prior to the Medicaid program providing any coverage. This amount represents the covered party's spend down that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-COINS"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-COINS">COINS</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>co-insurance</td><td><div><p>The covered party pays a percentage of the cost of covered services.</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-AFTHRS"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-AFTHRS">AFTHRS</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>non-normal hours</td><td><div><p>Premium paid on service fees in compensation for practicing outside of normal working hours.</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-ISOL"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-ISOL">ISOL</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>isolation allowance</td><td><div><p>Premium paid on service fees in compensation for practicing in a remote location.</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-OOO"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-OOO">OOO</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>out of office</td><td><div><p>Premium paid on service fees in compensation for practicing at a location other than normal working location.</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-CANCAPT"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-CANCAPT">CANCAPT</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>cancelled appointment</td><td><div><p>A charge to compensate the provider when a patient cancels an appointment with insufficient time for the provider to make another appointment with another patient.</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-DSC"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-DSC">DSC</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>discount</td><td><div><p>A reduction in the amount charged as a percentage of the amount. For example a 5% discount for volume purchase.</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-ESA"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-ESA">ESA</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>extraordinary service assessment</td><td><div><p>A premium on a service fee is requested because, due to extenuating circumstances, the service took an extraordinary amount of time or supplies.</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-FFSTOP"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-FFSTOP">FFSTOP</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>fee for service top off</td><td><div><p>Under agreement between the parties (payor and provider), a guaranteed level of income is established for the provider over a specific, pre-determined period of time. The normal course of business for the provider is submission of fee-for-service claims. Should the fee-for-service income during the specified period of time be less than the agreed to amount, a top-up amount is paid to the provider equal to the difference between the fee-for-service total and the guaranteed income amount for that period of time. The details of the agreement may specify (or not) a requirement for repayment to the payor in the event that the fee-for-service income exceeds the guaranteed amount.</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-FNLFEE"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-FNLFEE">FNLFEE</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>final fee</td><td><div><p>Anticipated or actual final fee associated with treating a patient.</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-FRSTFEE"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-FRSTFEE">FRSTFEE</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>first fee</td><td><div><p>Anticipated or actual initial fee associated with treating a patient.</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-MARKUP"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-MARKUP">MARKUP</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>markup or up-charge</td><td><div><p>An increase in the amount charged as a percentage of the amount. For example, 12% markup on product cost.</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-MISSAPT"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-MISSAPT">MISSAPT</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>missed appointment</td><td><div><p>A charge to compensate the provider when a patient does not show for an appointment.</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-PERFEE"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-PERFEE">PERFEE</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>periodic fee</td><td><div><p>Anticipated or actual periodic fee associated with treating a patient. For example, expected billing cycle such as monthly, quarterly. The actual period (e.g. monthly, quarterly) is specified in the unit quantity of the Invoice Element.</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-PERMBNS"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-PERMBNS">PERMBNS</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>performance bonus</td><td><div><p>The amount for a performance bonus that is being requested from a payor for the performance of certain services (childhood immunizations, influenza immunizations, mammograms, pap smears) on a sliding scale. That is, for 90% of childhood immunizations to a maximum of $2200/yr. An invoice is created at the end of the service period (one year) and a code is submitted indicating the percentage achieved and the dollar amount claimed.</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-RESTOCK"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-RESTOCK">RESTOCK</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>restocking fee</td><td><div><p>A charge is requested because the patient failed to pick up the item and it took an amount of time to return it to stock for future use.</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-TRAVEL"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-TRAVEL">TRAVEL</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>travel</td><td><div><p>A charge to cover the cost of travel time and/or cost in conjuction with providing a service or product. It may be charged per kilometer or per hour based on the effective agreement.</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-URGENT"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-URGENT">URGENT</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>urgent</td><td><div><p>Premium paid on service fees in compensation for providing an expedited response to an urgent situation.</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-FST"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-FST">FST</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>federal sales tax</td><td><div><p>Federal tax on transactions such as the Goods and Services Tax (GST)</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-HST"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-HST">HST</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>harmonized sales Tax</td><td><div><p>Joint Federal/Provincial Sales Tax</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-ActInvoiceDetailGenericCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-PST"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-PST">PST</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActCode</td><td>provincial/state sales tax</td><td><div><p>Tax levied by the provincial or state jurisdiction such as Provincial Sales Tax</p>
</div></td></tr></table></div>
</text>
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value="http://hl7.org/fhir/5.0/ValueSet/R5-v3-ActInvoiceDetailGenericCode-for-R4"/>
<version value="0.0.1-snapshot-2"/>
<name value="R5_v3_ActInvoiceDetailGenericCode_for_R4"/>
<title
value="Cross-version VS for R5.ActInvoiceDetailGenericCode for use in FHIR R4"/>
<status value="active"/>
<experimental value="false"/>
<date value="2025-09-01T22:37:04.900546+10:00"/>
<publisher value="FHIR Infrastructure"/>
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<description
value="This cross-version ValueSet represents concepts from http://terminology.hl7.org/ValueSet/v3-ActInvoiceDetailGenericCode|2.0.0 for use in FHIR R4. Concepts not present here have direct `equivalent` mappings crossing all versions from R5 to R4."/>
<jurisdiction>
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<system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
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<display value="World"/>
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<compose>
<include>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<concept>
<code value="COIN"/>
<display value="coinsurance"/>
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<concept>
<code value="COPAYMENT"/>
<display value="patient co-pay"/>
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<concept>
<code value="DEDUCTIBLE"/>
<display value="deductible"/>
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<concept>
<code value="PAY"/>
<display value="payment"/>
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<concept>
<code value="SPEND"/>
<display value="spend down"/>
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<concept>
<code value="COINS"/>
<display value="co-insurance"/>
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<concept>
<code value="AFTHRS"/>
<display value="non-normal hours"/>
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<concept>
<code value="ISOL"/>
<display value="isolation allowance"/>
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<concept>
<code value="OOO"/>
<display value="out of office"/>
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<concept>
<code value="CANCAPT"/>
<display value="cancelled appointment"/>
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<concept>
<code value="DSC"/>
<display value="discount"/>
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<concept>
<code value="ESA"/>
<display value="extraordinary service assessment"/>
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<concept>
<code value="FFSTOP"/>
<display value="fee for service top off"/>
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<concept>
<code value="FNLFEE"/>
<display value="final fee"/>
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<concept>
<code value="FRSTFEE"/>
<display value="first fee"/>
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<concept>
<code value="MARKUP"/>
<display value="markup or up-charge"/>
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<concept>
<code value="MISSAPT"/>
<display value="missed appointment"/>
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<concept>
<code value="PERFEE"/>
<display value="periodic fee"/>
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<concept>
<code value="PERMBNS"/>
<display value="performance bonus"/>
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<concept>
<code value="RESTOCK"/>
<display value="restocking fee"/>
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<concept>
<code value="TRAVEL"/>
<display value="travel"/>
</concept>
<concept>
<code value="URGENT"/>
<display value="urgent"/>
</concept>
<concept>
<code value="FST"/>
<display value="federal sales tax"/>
</concept>
<concept>
<code value="HST"/>
<display value="harmonized sales Tax"/>
</concept>
<concept>
<code value="PST"/>
<display value="provincial/state sales tax"/>
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</include>
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<expansion>
<timestamp value="2025-09-01T22:37:04.90054+10:00"/>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="COIN"/>
<display value="coinsurance"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="COPAYMENT"/>
<display value="patient co-pay"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="DEDUCTIBLE"/>
<display value="deductible"/>
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<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="PAY"/>
<display value="payment"/>
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<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="SPEND"/>
<display value="spend down"/>
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<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="COINS"/>
<display value="co-insurance"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="AFTHRS"/>
<display value="non-normal hours"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="ISOL"/>
<display value="isolation allowance"/>
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<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="OOO"/>
<display value="out of office"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="CANCAPT"/>
<display value="cancelled appointment"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="DSC"/>
<display value="discount"/>
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<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="ESA"/>
<display value="extraordinary service assessment"/>
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<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="FFSTOP"/>
<display value="fee for service top off"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="FNLFEE"/>
<display value="final fee"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="FRSTFEE"/>
<display value="first fee"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="MARKUP"/>
<display value="markup or up-charge"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="MISSAPT"/>
<display value="missed appointment"/>
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<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="PERFEE"/>
<display value="periodic fee"/>
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<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="PERMBNS"/>
<display value="performance bonus"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="RESTOCK"/>
<display value="restocking fee"/>
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<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="TRAVEL"/>
<display value="travel"/>
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<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="URGENT"/>
<display value="urgent"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="FST"/>
<display value="federal sales tax"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="HST"/>
<display value="harmonized sales Tax"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<version value="8.0.0"/>
<code value="PST"/>
<display value="provincial/state sales tax"/>
</contains>
</expansion>
</ValueSet>