Benefit Type Value Set

{
  "description" : "Codes for Insurance Benefit Type.",
  "compose" : {
    "exclude" : [ ],
    "include" : [ {
      "system" : "http://terminology.hl7.org/CodeSystem/insurance-benefit-type",
      "extension" : [ {
        "extension" : [ {
          "valueString" : "concept",
          "url" : "path"
        }, {
          "url" : "count",
          "valueInteger" : 67
        } ],
        "url" : "http://health-samurai.io/extensions/excised-data"
      } ]
    } ]
  },
  "date" : "2025-04-10T13:37:10+00:00",
  "publisher" : "HL7 International / Patient Administration",
  "jurisdiction" : [ {
    "coding" : [ {
      "system" : "urn:iso:std:iso:3166",
      "code" : "US",
      "display" : "United States of America"
    } ]
  } ],
  "name" : "BenefitTypeVS",
  "experimental" : false,
  "resourceType" : "ValueSet",
  "title" : "Benefit Type Value Set",
  "extension" : [ {
    "valueCode" : "pa",
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"
  }, {
    "valueCode" : "trial-use",
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "_valueCode" : {
      "extension" : [ {
        "valueCanonical" : "http://hl7.org/fhir/us/ndh/ImplementationGuide/hl7.fhir.us.ndh",
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom"
      } ]
    }
  }, {
    "url" : "http://health-samurai.io/extensions/source",
    "valueCode" : "db"
  } ],
  "status" : "active",
  "id" : "BenefitTypeVS",
  "url" : "http://hl7.org/fhir/us/ndh/ValueSet/BenefitTypeVS",
  "version" : "1.0.0",
  "contact" : [ {
    "name" : "HL7 International / Patient Administration",
    "telecom" : [ {
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/pafm"
    }, {
      "system" : "email",
      "value" : "pafm@lists.hl7.org"
    } ]
  } ],
  "text" : {
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ValueSet BenefitTypeVS</b></p><a name=\"BenefitTypeVS\"> </a><a name=\"hcBenefitTypeVS\"> </a><a name=\"BenefitTypeVS-en-US\"> </a><ul><li>Include these codes as defined in <a href=\"CodeSystem-insurance-benefit-type.html\"><code>http://terminology.hl7.org/CodeSystem/insurance-benefit-type</code></a><table class=\"none\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-pcpov\">pcpov</a></td><td>Primary Care Visit to Treat an Injury or Illness</td><td>Benefit plan covers services rendered by a primary care physician during an office visit with the purpose to treat injury or illness, except for preventive care services.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-specialistov\">specialistov</a></td><td>Specialist Office Visit</td><td>Covered healthcare service rendered to a patient by a specialty provider.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-mlpov\">mlpov</a></td><td>Other Practitioner Office Visit (Nurse, Physician Assistant) - Mid Level Professional</td><td>Benefit plan covers covered health related services rendered by a practitioner other than MD or DO and referred to as other practitioner.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-outpatient\">outpatient</a></td><td>Outpatient Facility Fee (e.g., Ambulatory Surgery Center)</td><td>Benefit plan covers health related services rendered to patient at an outpatient facility, outside of a facility that requires a patient admission.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-outpatstx\">outpatstx</a></td><td>Outpatient Surgery Physician/Surgical Services</td><td>Benefit plan covers surgical services rendered to patient outside of a facility admission, referred to as outpatient.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-hospserv\">hospserv</a></td><td>Hospice Services</td><td>Benefit plan covers hospice services.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-routinedental\">routinedental</a></td><td>Routine Dental Services (Adult)</td><td>Benefit plan covers routine dental services.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-infertilitytx\">infertilitytx</a></td><td>Infertility Treatment</td><td>Benefit plan covers eligible infertility treatment services.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-ltnhc\">ltnhc</a></td><td>Long-Term/Custodial Nursing Home Care</td><td>Long-Term/Custodial Nursing Home Care.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-privatenurse\">privatenurse</a></td><td>Private-Duty Nursing</td><td>Private-Duty Nursing.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-routineeye\">routineeye</a></td><td>Routine Eye Exam (Adult)</td><td>Routine Eye Exam (Adult).</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-ucservice\">ucservice</a></td><td>Urgent Care Centers or Facilities</td><td>Urgent Care Centers or Facilities.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-homehealth\">homehealth</a></td><td>Home Health</td><td>Home health services insurance coverage.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-erservice\">erservice</a></td><td>Emergency Room Services</td><td>Emergency Room Services.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-ambulance\">ambulance</a></td><td>Emergency Room Services</td><td>Emergency Room Services.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-inpatienthospital\">inpatienthospital</a></td><td>Inpatient Hospital Services (e.g., Hospital Stay)</td><td>A person who is hospitalized for at least one night to receive treatment or participate in a study.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-inpatientprovider\">inpatientprovider</a></td><td>Inpatient Physician and Surgical Services</td><td>A healthcare provider who is delivering healthcare services in a hospital environment.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-bariatricsurg\">bariatricsurg</a></td><td>Bariatric Surgery</td><td>Bariatric surgery service Skilled nursing service (qualifier value).</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-cosmeticsurg\">cosmeticsurg</a></td><td>Cosmetic Surgery</td><td>Cosmetic surgery service Skilled nursing service (qualifier value).</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-skillednursing\">skillednursing</a></td><td>Skilled Nursing Facility</td><td>Skilled nursing service (qualifier value).</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-ppnatalcare\">ppnatalcare</a></td><td>Prenatal and Postnatal Care</td><td>Prenatal and Postnatal services.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-maternitycare\">maternitycare</a></td><td>Delivery and All Inpatient Services for Maternity Care</td><td>All maternity care services.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-menthlthoutp\">menthlthoutp</a></td><td>Mental/Behavioral Health Outpatient Services</td><td>Mental health service delivered in an outpatient setting.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-menthlthinp\">menthlthinp</a></td><td>Mental/Behavioral Health Inpatient Services</td><td>Mental health service delivered in an hospital or inpatient facility setting.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-sadoutp\">sadoutp</a></td><td>Substance Abuse Disorder Outpatient Services</td><td>Substance abuse related services delivered in a outpatient setting.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-sadinp\">sadinp</a></td><td>Substance Abuse Disorder Inpatient Services</td><td>Substance abuse related services delivered in a inpatient setting.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-drggenric\">drggenric</a></td><td>Generic Drugs</td><td>Generic drugs eligible benefits.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-drgbrand\">drgbrand</a></td><td>Preferred Brand Drugs</td><td>Preferred brand drugs eligible benefits.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-drgnonpreferred\">drgnonpreferred</a></td><td>Non-Preferred Brand Drugs</td><td>Non-Preferred drugs brands eligible benefits.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-drgspecialty\">drgspecialty</a></td><td>Specialty Drugs</td><td>Benefit plan covers specialty drugs.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-rehaboutp\">rehaboutp</a></td><td>Outpatient Rehabilitation Services</td><td>Benefit plan covers outpatient rehabilitation services.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-servicehablitation\">servicehablitation</a></td><td>Habilitation Services</td><td>Habilitation Services.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-chiro\">chiro</a></td><td>Chiropractic Care</td><td>Benefit plan covers chiropractor eligible benefits.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-dme\">dme</a></td><td>Durable Medical Equipment</td><td>Benefit plan covers Durable medical equipment eligible benefits.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-hearingaids\">hearingaids</a></td><td>Hearing Aids</td><td>Benefit plan covers hearing aids.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-imgctpetmri\">imgctpetmri</a></td><td>Imaging (CT/PET Scans, MRIs)</td><td>Benefit plan covers advances imaging techniques services (CT/PET Scans, MRIs) eligible services.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-prev\">prev</a></td><td>Preventive Care/Screening/Immunization</td><td>Routine healthcare services to prevent health related problems eligible benefits.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-rtnpod\">rtnpod</a></td><td>Routine Foot Care</td><td>Routine Foot Care.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-acupuncture\">acupuncture</a></td><td>Acupuncture</td><td>Benefit plan covers acupuncture treatment.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-weightloss\">weightloss</a></td><td>Weight Loss Programs</td><td>Benefit plan covers weight loss services eligible benefits.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-rtneyechld\">rtneyechld</a></td><td>Routine Eye Exam for Children</td><td>Routine eye exam for children eligible benefits.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-glasseschld\">glasseschld</a></td><td>Eye Glasses for Children</td><td>Eye glasses children eligible benefits.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-rtndntlchld\">rtndntlchld</a></td><td>Dental Check-Up for Children</td><td>Dental Check-Up for Children.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-speachthpy\">speachthpy</a></td><td>Rehabilitative Speech Therapy</td><td>Benefit plan covers rehabilitative speech therapy eligible benefits.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-rehaboccandpt\">rehaboccandpt</a></td><td>Rehabilitative Occupational and Rehabilitative Physical Therapy</td><td>Benefit plan covers rehabilitative occupational and rehabilitative physical eligible benefits.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-wellbaby\">wellbaby</a></td><td>Well Baby Visits and Care</td><td>Regularly scheduled, preventive care services, including immunizations, provided to children up to an age as specified by a health insurance company or mandated by a government agency.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-laboutp\">laboutp</a></td><td>Laboratory Outpatient and Professional Services</td><td>Benefit plan covers laboratory testing and related professional services received as outpatient.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-imagingdx\">imagingdx</a></td><td>X-rays and Diagnostic Imaging</td><td>Benefit plan covers diagnostic imaging procedures that produce images of internal structures of the human body and uses radiation to diagnose and treat diseases.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-dntlbaschld\">dntlbaschld</a></td><td>Basic Dental Care - Child</td><td>Benefit plan covers diagnostic basic dental care.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-orthochld\">orthochld</a></td><td>Orthodontia - Child</td><td>Benefit plan covers orthodontia for children.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-dntlmajchld\">dntlmajchld</a></td><td>Major Dental Care - Child</td><td>Benefit plan covers major dental care for children.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-dntlbasadlt\">dntlbasadlt</a></td><td>Basic Dental Care - Adult</td><td>Benefit plan covers basic dental care for adults.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-orthodadlt\">orthodadlt</a></td><td>Orthodontia - Adult</td><td>Benefits plan covers services provided that are required for orthodontic purposes for an adult.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-dntlmajadlt\">dntlmajadlt</a></td><td>Major Dental Care - Adult</td><td>Benefit plan covers major dental care for adult.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-abortion\">abortion</a></td><td>Abortion for Which Public Funding is Prohibited</td><td>Benefit plan covers services for abortion for which public funding is prohibited.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-transplant\">transplant</a></td><td>Transplant</td><td>Benefit plan covers transplant related services.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-accdntl\">accdntl</a></td><td>Accidental Dental</td><td>Benefit plan covers dental care services related to an accident.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-dialysis\">dialysis</a></td><td>Dialysis</td><td>The plan benefit covers services used to treat end stage renal disease.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-testallrgy\">testallrgy</a></td><td>Allergy Testing</td><td>The plan benefits covers services for diagnostic procedures ordered or performed to evaluate whether a sensitivity to a substance is present. This test may be associated with specimen collection and/or substance administration challenge activities.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-chemotherapy\">chemotherapy</a></td><td>Chemotherapy</td><td>The plan benefits cover services the use of drugs and approved chemicals to treat disease.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-radiation\">radiation</a></td><td>Radiation</td><td>The plan benefits cover services the use radiation to treat disease.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-edudiab\">edudiab</a></td><td>Diabetes Education</td><td>The plan benefits cover services related to instruction or training that encourages behaviors most likely to optimize health potentials through information about diabetes; facilitates the prevention of diabetes.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-prosthetic\">prosthetic</a></td><td>Prosthetic Devices</td><td>Plan benefit covers services related to prosthesis devices.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-infusiontx\">infusiontx</a></td><td>Infusion Therapy</td><td>Plan benefit covers services related to infusion therapy.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-tmjtx\">tmjtx</a></td><td>Treatment for Temporomandibular Joint Disorders</td><td>Plan benefit covers services related to treatment of Temporomandibular Joint disorder.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-nutrition\">nutrition</a></td><td>Nutritional Counseling</td><td>Nutritional Counseling.</td></tr><tr><td><a href=\"CodeSystem-insurance-benefit-type.html#insurance-benefit-type-reconsurg\">reconsurg</a></td><td>Reconstructive Surgery</td><td>Plan benefit covers services related to reconstructive surgery.</td></tr></table></li></ul></div>",
    "status" : "extensions"
  }
}