{ "resourceType" : "ValueSet", "id" : "R5-v3-ActInvoiceDetailGenericCode-for-R4", "text" : { "status" : "generated", "div" : "

Generated Narrative: ValueSet R5-v3-ActInvoiceDetailGenericCode-for-R4

This value set expansion contains 29 concepts.

SystemVersionCodeDisplayDefinition
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0AFTHRSnon-normal hours

Premium paid on service fees in compensation for practicing outside of normal working hours.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0CANCAPTcancelled appointment

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.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0COINcoinsurance

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.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0COINSco-insurance

The covered party pays a percentage of the cost of covered services.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0COPAYMENTpatient co-pay

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.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0DEDUCTIBLEdeductible

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.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0DSCdiscount

A reduction in the amount charged as a percentage of the amount. For example a 5% discount for volume purchase.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0ESAextraordinary service assessment

A premium on a service fee is requested because, due to extenuating circumstances, the service took an extraordinary amount of time or supplies.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0FFSTOPfee for service top off

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.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0FNLFEEfinal fee

Anticipated or actual final fee associated with treating a patient.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0FRSTFEEfirst fee

Anticipated or actual initial fee associated with treating a patient.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0FSTfederal sales tax

Federal tax on transactions such as the Goods and Services Tax (GST)

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0HSTharmonized sales Tax

Joint Federal/Provincial Sales Tax

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0ISOLisolation allowance

Premium paid on service fees in compensation for practicing in a remote location.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0MARKUPmarkup or up-charge

An increase in the amount charged as a percentage of the amount. For example, 12% markup on product cost.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0MISSAPTmissed appointment

A charge to compensate the provider when a patient does not show for an appointment.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0OOOout of office

Premium paid on service fees in compensation for practicing at a location other than normal working location.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0PAYpayment

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.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0PERFEEperiodic fee

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.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0PERMBNSperformance bonus

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.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0PSTprovincial/state sales tax

Tax levied by the provincial or state jurisdiction such as Provincial Sales Tax

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0RESTOCKrestocking fee

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.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0SPENDspend down

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

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0TRAVELtravel

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.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0URGENTurgent

Premium paid on service fees in compensation for providing an expedited response to an urgent situation.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0_ActInvoiceDetailGenericAdjudicatorCodeActInvoiceDetailGenericAdjudicatorCode

The billable item codes to identify adjudicator specified components to the total billing of a claim.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0_ActInvoiceDetailGenericModifierCodeActInvoiceDetailGenericModifierCode

The billable item codes to identify modifications to a billable item charge. As for example after hours increase in the office visit fee.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0_ActInvoiceDetailGenericProviderCodeActInvoiceDetailGenericProviderCode

The billable item codes to identify provider supplied charges or changes to the total billing of a claim.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0_ActInvoiceDetailTaxCodeActInvoiceDetailTaxCode

The billable item codes to identify modifications to a billable item charge by a tax factor applied to the amount. As for example 7% provincial sales tax.

\n
" }, "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg", "valueCode" : "fhir" }, { "extension" : [{ "url" : "packageId", "valueId" : "hl7.fhir.uv.xver-r5.r4" }, { "url" : "version", "valueString" : "0.1.0" }, { "url" : "uri", "valueUri" : "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r5.r4" }], "url" : "http://hl7.org/fhir/StructureDefinition/package-source" }, { "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm", "valueInteger" : 0, "_valueInteger" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom", "valueCanonical" : "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r5.r4" }] } }, { "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode" : "trial-use", "_valueCode" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom", "valueCanonical" : "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r5.r4" }] } }], "url" : "http://hl7.org/fhir/uv/xver/ValueSet/R5-v3-ActInvoiceDetailGenericCode-for-R4", "version" : "0.1.0", "name" : "R5V3ActInvoiceDetailGenericCodeForR4", "title" : "Cross-version ValueSet R5.ActInvoiceDetailGenericCode for use in FHIR R4", "status" : "active", "experimental" : false, "date" : "2026-03-17T21:02:03.8104715+00:00", "publisher" : "FHIR Infrastructure", "contact" : [{ "name" : "FHIR Infrastructure", "telecom" : [{ "system" : "url", "value" : "http://www.hl7.org/Special/committees/fiwg" }] }], "description" : "This cross-version ValueSet represents content from `http://terminology.hl7.org/ValueSet/v3-ActInvoiceDetailGenericCode|2.0.0` for use in FHIR R4.", "jurisdiction" : [{ "coding" : [{ "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm", "code" : "001", "display" : "World" }] }], "purpose" : "This value set is part of the cross-version definitions generated to enable use of the\r\nvalue set `http://terminology.hl7.org/ValueSet/v3-ActInvoiceDetailGenericCode|2.0.0` as defined in FHIR R5\r\nin FHIR R4.\r\n\r\nThe source value set is bound to the following FHIR R5 elements:\r\n* \r\n\r\nNote that all concepts are included in this cross-version definition because no concepts have compatible representations\r\n\r\nFollowing are the generation technical comments:\r\n\nFHIR ValueSet `http://terminology.hl7.org/ValueSet/v3-ActInvoiceDetailGenericCode|2.0.0`, defined in FHIR R5 does not have any mapping to FHIR R4", "compose" : { "include" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "concept" : [{ "code" : "AFTHRS", "display" : "non-normal hours" }, { "code" : "CANCAPT", "display" : "cancelled appointment" }, { "code" : "COIN", "display" : "coinsurance" }, { "code" : "COINS", "display" : "co-insurance" }, { "code" : "COPAYMENT", "display" : "patient co-pay" }, { "code" : "DEDUCTIBLE", "display" : "deductible" }, { "code" : "DSC", "display" : "discount" }, { "code" : "ESA", "display" : "extraordinary service assessment" }, { "code" : "FFSTOP", "display" : "fee for service top off" }, { "code" : "FNLFEE", "display" : "final fee" }, { "code" : "FRSTFEE", "display" : "first fee" }, { "code" : "FST", "display" : "federal sales tax" }, { "code" : "HST", "display" : "harmonized sales Tax" }, { "code" : "ISOL", "display" : "isolation allowance" }, { "code" : "MARKUP", "display" : "markup or up-charge" }, { "code" : "MISSAPT", "display" : "missed appointment" }, { "code" : "OOO", "display" : "out of office" }, { "code" : "PAY", "display" : "payment" }, { "code" : "PERFEE", "display" : "periodic fee" }, { "code" : "PERMBNS", "display" : "performance bonus" }, { "code" : "PST", "display" : "provincial/state sales tax" }, { "code" : "RESTOCK", "display" : "restocking fee" }, { "code" : "SPEND", "display" : "spend down" }, { "code" : "TRAVEL", "display" : "travel" }, { "code" : "URGENT", "display" : "urgent" }, { "code" : "_ActInvoiceDetailGenericAdjudicatorCode", "display" : "ActInvoiceDetailGenericAdjudicatorCode" }, { "code" : "_ActInvoiceDetailGenericModifierCode", "display" : "ActInvoiceDetailGenericModifierCode" }, { "code" : "_ActInvoiceDetailGenericProviderCode", "display" : "ActInvoiceDetailGenericProviderCode" }, { "code" : "_ActInvoiceDetailTaxCode", "display" : "ActInvoiceDetailTaxCode" }] }] }, "expansion" : { "timestamp" : "2026-03-17T21:02:03.8104715+00:00", "contains" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "AFTHRS", "display" : "non-normal hours" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "CANCAPT", "display" : "cancelled appointment" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "COIN", "display" : "coinsurance" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "COINS", "display" : "co-insurance" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "COPAYMENT", "display" : "patient co-pay" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "DEDUCTIBLE", "display" : "deductible" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "DSC", "display" : "discount" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "ESA", "display" : "extraordinary service assessment" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "FFSTOP", "display" : "fee for service top off" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "FNLFEE", "display" : "final fee" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "FRSTFEE", "display" : "first fee" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "FST", "display" : "federal sales tax" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "HST", "display" : "harmonized sales Tax" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "ISOL", "display" : "isolation allowance" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "MARKUP", "display" : "markup or up-charge" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "MISSAPT", "display" : "missed appointment" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "OOO", "display" : "out of office" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "PAY", "display" : "payment" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "PERFEE", "display" : "periodic fee" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "PERMBNS", "display" : "performance bonus" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "PST", "display" : "provincial/state sales tax" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "RESTOCK", "display" : "restocking fee" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "SPEND", "display" : "spend down" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "TRAVEL", "display" : "travel" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "URGENT", "display" : "urgent" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "_ActInvoiceDetailGenericAdjudicatorCode", "display" : "ActInvoiceDetailGenericAdjudicatorCode" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "_ActInvoiceDetailGenericModifierCode", "display" : "ActInvoiceDetailGenericModifierCode" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "_ActInvoiceDetailGenericProviderCode", "display" : "ActInvoiceDetailGenericProviderCode" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "_ActInvoiceDetailTaxCode", "display" : "ActInvoiceDetailTaxCode" }] } }