CRD Coverage Detail Codes

{
  "description" : "Codes that describe additional details related to a coverage information assertion.  These live in THO rather than the CRD specification to support adding additional concepts without putting out a new CRD release.",
  "date" : "2025-10-16T00:00:00+00:00",
  "publisher" : "Health Level Seven International",
  "content" : "complete",
  "property" : [ {
    "type" : "boolean",
    "code" : "abstract",
    "uri" : "http://hl7.org/fhir/concept-properties#notSelectable"
  }, {
    "description" : "The concept identified is a child of the concept",
    "type" : "code",
    "code" : "child",
    "uri" : "http://hl7.org/fhir/concept-properties#child"
  }, {
    "description" : "The concept identified is a parent of the concept",
    "type" : "code",
    "code" : "parent",
    "uri" : "http://hl7.org/fhir/concept-properties#parent"
  } ],
  "name" : "CRDCoverageDetail",
  "copyright" : "This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license",
  "experimental" : false,
  "resourceType" : "CodeSystem",
  "title" : "CRD Coverage Detail Codes",
  "extension" : [ {
    "valueCode" : "fm",
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"
  }, {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 1
  }, {
    "extension" : [ {
      "valueString" : "concept",
      "url" : "path"
    }, {
      "url" : "count",
      "valueInteger" : 4
    } ],
    "url" : "http://health-samurai.io/extensions/excised-data"
  }, {
    "url" : "http://health-samurai.io/extensions/source",
    "valueCode" : "db"
  } ],
  "status" : "active",
  "language" : "en",
  "hierarchyMeaning" : "is-a",
  "id" : "crd-coverage-detail",
  "url" : "http://terminology.hl7.org/CodeSystem/crd-coverage-detail",
  "identifier" : [ {
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.5.177"
  } ],
  "caseSensitive" : true,
  "version" : "1.0.0",
  "contact" : [ {
    "telecom" : [ {
      "system" : "url",
      "value" : "http://hl7.org"
    }, {
      "system" : "email",
      "value" : "hq@HL7.org"
    } ]
  } ],
  "text" : {
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en\" lang=\"en\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem crd-coverage-detail</b></p><a name=\"crd-coverage-detail\"> </a><a name=\"hccrd-coverage-detail\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Language: en</p></div><p><b>Properties</b></p><p><b>This code system defines the following properties for its concepts</b></p><table class=\"grid\"><tr><td><b>Name</b></td><td><b>Code</b></td><td><b>URI</b></td><td><b>Type</b></td></tr><tr><td>Not Selectable</td><td>abstract</td><td>http://hl7.org/fhir/concept-properties#notSelectable</td><td>boolean</td></tr></table><p><b>Concepts</b></p><p>This case-sensitive code system <code>http://terminology.hl7.org/CodeSystem/crd-coverage-detail</code> defines the following codes in a Is-A hierarchy:</p><table class=\"codes\"><tr><td><b>Lvl</b></td><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td><td><b>Not Selectable</b></td></tr><tr><td>1</td><td style=\"white-space:nowrap\">_limitation<a name=\"crd-coverage-detail-_limitation\"> </a></td><td>Limitation details</td><td>Identifies detail codes that define limitations of coverage.  (Category should be 'cat-limitation')</td><td>true</td></tr><tr><td>2</td><td style=\"white-space:nowrap\">  allowed-quantity<a name=\"crd-coverage-detail-allowed-quantity\"> </a></td><td>Maximum quantity</td><td>Indicates limitations on the number of services/products allowed (possibly per time period).  Value should be a Quantity</td><td/></tr><tr><td>2</td><td style=\"white-space:nowrap\">  allowed-period<a name=\"crd-coverage-detail-allowed-period\"> </a></td><td>Maximum allowed period</td><td>Indicates the maximum period of time that can be covered in a single order.  Value should be a Period</td><td/></tr><tr><td>1</td><td style=\"white-space:nowrap\">_decisional<a name=\"crd-coverage-detail-_decisional\"> </a></td><td>Decisional details</td><td>Identifies detail codes that may impact patient and clinician decision making  (Category should be 'cat-decisional')</td><td>true</td></tr><tr><td>2</td><td style=\"white-space:nowrap\">  in-network-copay<a name=\"crd-coverage-detail-in-network-copay\"> </a></td><td>Copay for in-network</td><td>Indicates a percentage co-pay to expect if delivered in-network.  Value should be a Quantity.</td><td/></tr><tr><td>2</td><td style=\"white-space:nowrap\">  out-network-copay<a name=\"crd-coverage-detail-out-network-copay\"> </a></td><td>Copay for out-of-network</td><td>Indicates a percentage co-pay to expect if delivered out-of-network.  Value should be a Quantity.</td><td/></tr><tr><td>2</td><td style=\"white-space:nowrap\">  concurrent-review<a name=\"crd-coverage-detail-concurrent-review\"> </a></td><td>Concurrent review</td><td>Additional payer-defined documentation will be required prior to claim payment.  Value should be a boolean.</td><td/></tr><tr><td>2</td><td style=\"white-space:nowrap\">  appropriate-use-needed<a name=\"crd-coverage-detail-appropriate-use-needed\"> </a></td><td>Appropriate use</td><td>Payer-defined appropriate use process must be invoked to determine coverage.  Value should be a boolean.</td><td/></tr><tr><td>1</td><td style=\"white-space:nowrap\">_other<a name=\"crd-coverage-detail-_other\"> </a></td><td>Other details</td><td>Identifies detail codes that are generally not relevant to clinicians/patients  (Category should be 'cat-other')</td><td>true</td></tr><tr><td>2</td><td style=\"white-space:nowrap\">  policy-link<a name=\"crd-coverage-detail-policy-link\"> </a></td><td>Policy Link</td><td>A URL pointing to the specific portion of a payer policy, coverage agreement or similar authoritative document that provides a portion of the basis for the decision documented in the coverage-information.  Value should be a url.</td><td/></tr><tr><td>1</td><td style=\"white-space:nowrap\">instructions<a name=\"crd-coverage-detail-instructions\"> </a></td><td>Instructions</td><td>Information to display to the user that gives guidance about what steps to take in achieving the recommended actions identified by this coverage-information (e.g. special instructions about requesting authorization, details about information needed, details about data retention, etc.).  Value should be a string.  (Category may vary.)</td><td/></tr></table></div>",
    "status" : "generated"
  }
}