FHIR IG Statistics: ValueSet/BenefitTypeVS
Resources that use this resource
Resources that this resource uses
Narrative
Note: links and images are rebased to the (stated) source
- Include these codes as defined in
http://terminology.hl7.org/CodeSystem/insurance-benefit-type| Code | Display | Definition |
| pcpov | Primary Care Visit to Treat an Injury or Illness | 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. |
| specialistov | Specialist Office Visit | Covered healthcare service rendered to a patient by a specialty provider. |
| mlpov | Other Practitioner Office Visit (Nurse, Physician Assistant) - Mid Level Professional | Benefit plan covers covered health related services rendered by a practitioner other than MD or DO and referred to as other practitioner. |
| outpatient | Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | Benefit plan covers health related services rendered to patient at an outpatient facility, outside of a facility that requires a patient admission. |
| outpatstx | Outpatient Surgery Physician/Surgical Services | Benefit plan covers surgical services rendered to patient outside of a facility admission, referred to as outpatient. |
| hospserv | Hospice Services | Benefit plan covers hospice services. |
| routinedental | Routine Dental Services (Adult) | Benefit plan covers routine dental services. |
| infertilitytx | Infertility Treatment | Benefit plan covers eligible infertility treatment services. |
| ltnhc | Long-Term/Custodial Nursing Home Care | Long-Term/Custodial Nursing Home Care. |
| privatenurse | Private-Duty Nursing | Private-Duty Nursing. |
| routineeye | Routine Eye Exam (Adult) | Routine Eye Exam (Adult). |
| ucservice | Urgent Care Centers or Facilities | Urgent Care Centers or Facilities. |
| homehealth | Home Health | Home health services insurance coverage. |
| erservice | Emergency Room Services | Emergency Room Services. |
| ambulance | Emergency Room Services | Emergency Room Services. |
| inpatienthospital | Inpatient Hospital Services (e.g., Hospital Stay) | A person who is hospitalized for at least one night to receive treatment or participate in a study. |
| inpatientprovider | Inpatient Physician and Surgical Services | A healthcare provider who is delivering healthcare services in a hospital environment. |
| bariatricsurg | Bariatric Surgery | Bariatric surgery service Skilled nursing service (qualifier value). |
| cosmeticsurg | Cosmetic Surgery | Cosmetic surgery service Skilled nursing service (qualifier value). |
| skillednursing | Skilled Nursing Facility | Skilled nursing service (qualifier value). |
| ppnatalcare | Prenatal and Postnatal Care | Prenatal and Postnatal services. |
| maternitycare | Delivery and All Inpatient Services for Maternity Care | All maternity care services. |
| menthlthoutp | Mental/Behavioral Health Outpatient Services | Mental health service delivered in an outpatient setting. |
| menthlthinp | Mental/Behavioral Health Inpatient Services | Mental health service delivered in an hospital or inpatient facility setting. |
| sadoutp | Substance Abuse Disorder Outpatient Services | Substance abuse related services delivered in a outpatient setting. |
| sadinp | Substance Abuse Disorder Inpatient Services | Substance abuse related services delivered in a inpatient setting. |
| drggenric | Generic Drugs | Generic drugs eligible benefits. |
| drgbrand | Preferred Brand Drugs | Preferred brand drugs eligible benefits. |
| drgnonpreferred | Non-Preferred Brand Drugs | Non-Preferred drugs brands eligible benefits. |
| drgspecialty | Specialty Drugs | Benefit plan covers specialty drugs. |
| rehaboutp | Outpatient Rehabilitation Services | Benefit plan covers outpatient rehabilitation services. |
| servicehablitation | Habilitation Services | Habilitation Services. |
| chiro | Chiropractic Care | Benefit plan covers chiropractor eligible benefits. |
| dme | Durable Medical Equipment | Benefit plan covers Durable medical equipment eligible benefits. |
| hearingaids | Hearing Aids | Benefit plan covers hearing aids. |
| imgctpetmri | Imaging (CT/PET Scans, MRIs) | Benefit plan covers advances imaging techniques services (CT/PET Scans, MRIs) eligible services. |
| prev | Preventive Care/Screening/Immunization | Routine healthcare services to prevent health related problems eligible benefits. |
| rtnpod | Routine Foot Care | Routine Foot Care. |
| acupuncture | Acupuncture | Benefit plan covers acupuncture treatment. |
| weightloss | Weight Loss Programs | Benefit plan covers weight loss services eligible benefits. |
| rtneyechld | Routine Eye Exam for Children | Routine eye exam for children eligible benefits. |
| glasseschld | Eye Glasses for Children | Eye glasses children eligible benefits. |
| rtndntlchld | Dental Check-Up for Children | Dental Check-Up for Children. |
| speachthpy | Rehabilitative Speech Therapy | Benefit plan covers rehabilitative speech therapy eligible benefits. |
| rehaboccandpt | Rehabilitative Occupational and Rehabilitative Physical Therapy | Benefit plan covers rehabilitative occupational and rehabilitative physical eligible benefits. |
| wellbaby | Well Baby Visits and Care | 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. |
| laboutp | Laboratory Outpatient and Professional Services | Benefit plan covers laboratory testing and related professional services received as outpatient. |
| imagingdx | X-rays and Diagnostic Imaging | Benefit plan covers diagnostic imaging procedures that produce images of internal structures of the human body and uses radiation to diagnose and treat diseases. |
| dntlbaschld | Basic Dental Care - Child | Benefit plan covers diagnostic basic dental care. |
| orthochld | Orthodontia - Child | Benefit plan covers orthodontia for children. |
| dntlmajchld | Major Dental Care - Child | Benefit plan covers major dental care for children. |
| dntlbasadlt | Basic Dental Care - Adult | Benefit plan covers basic dental care for adults. |
| orthodadlt | Orthodontia - Adult | Benefits plan covers services provided that are required for orthodontic purposes for an adult. |
| dntlmajadlt | Major Dental Care - Adult | Benefit plan covers major dental care for adult. |
| abortion | Abortion for Which Public Funding is Prohibited | Benefit plan covers services for abortion for which public funding is prohibited. |
| transplant | Transplant | Benefit plan covers transplant related services. |
| accdntl | Accidental Dental | Benefit plan covers dental care services related to an accident. |
| dialysis | Dialysis | The plan benefit covers services used to treat end stage renal disease. |
| testallrgy | Allergy Testing | 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. |
| chemotherapy | Chemotherapy | The plan benefits cover services the use of drugs and approved chemicals to treat disease. |
| radiation | Radiation | The plan benefits cover services the use radiation to treat disease. |
| edudiab | Diabetes Education | 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. |
| prosthetic | Prosthetic Devices | Plan benefit covers services related to prosthesis devices. |
| infusiontx | Infusion Therapy | Plan benefit covers services related to infusion therapy. |
| tmjtx | Treatment for Temporomandibular Joint Disorders | Plan benefit covers services related to treatment of Temporomandibular Joint disorder. |
| nutrition | Nutritional Counseling | Nutritional Counseling. |
| reconsurg | Reconstructive Surgery | Plan benefit covers services related to reconstructive surgery. |
Source
{
"resourceType": "ValueSet",
"id": "BenefitTypeVS",
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode": "pa"
},
{
"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/us/ndh/ImplementationGuide/hl7.fhir.us.ndh"
}
]
}
}
],
"url": "http://hl7.org/fhir/us/ndh/ValueSet/BenefitTypeVS",
"version": "2.0.0",
"name": "BenefitTypeVS",
"title": "Benefit Type Value Set",
"status": "active",
"experimental": false,
"date": "2025-07-20T00:19:51+00:00",
"publisher": "HL7 International / Patient Administration",
"contact": [
{
"name": "HL7 International / Patient Administration",
"telecom": [
{
"system": "url",
"value": "http://www.hl7.org/Special/committees/pafm"
},
{
"system": "email",
"value": "pafm@lists.hl7.org"
}
]
}
],
"description": "Codes for Insurance Benefit Type.",
"jurisdiction": [
{
"coding": [
{
"system": "urn:iso:std:iso:3166",
"code": "US",
"display": "United States of America"
}
]
}
],
"compose": {
"include": [
{
"system": "http://terminology.hl7.org/CodeSystem/insurance-benefit-type",
"concept": [
{
"code": "pcpov",
"display": "Primary Care Visit to Treat an Injury or Illness"
},
{
"code": "specialistov",
"display": "Specialist Office Visit"
},
{
"code": "mlpov",
"display": "Other Practitioner Office Visit (Nurse, Physician Assistant) - Mid Level Professional"
},
{
"code": "outpatient",
"display": "Outpatient Facility Fee (e.g., Ambulatory Surgery Center)"
},
{
"code": "outpatstx",
"display": "Outpatient Surgery Physician/Surgical Services"
},
{
"code": "hospserv",
"display": "Hospice Services"
},
{
"code": "routinedental",
"display": "Routine Dental Services (Adult)"
},
{
"code": "infertilitytx",
"display": "Infertility Treatment"
},
{
"code": "ltnhc",
"display": "Long-Term/Custodial Nursing Home Care"
},
{
"code": "privatenurse",
"display": "Private-Duty Nursing"
},
{
"code": "routineeye",
"display": "Routine Eye Exam (Adult)"
},
{
"code": "ucservice",
"display": "Urgent Care Centers or Facilities"
},
{
"code": "homehealth",
"display": "Home Health"
},
{
"code": "erservice",
"display": "Emergency Room Services"
},
{
"code": "ambulance",
"display": "Emergency Room Services"
},
{
"code": "inpatienthospital",
"display": "Inpatient Hospital Services (e.g., Hospital Stay)"
},
{
"code": "inpatientprovider",
"display": "Inpatient Physician and Surgical Services"
},
{
"code": "bariatricsurg",
"display": "Bariatric Surgery"
},
{
"code": "cosmeticsurg",
"display": "Cosmetic Surgery"
},
{
"code": "skillednursing",
"display": "Skilled Nursing Facility"
},
{
"code": "ppnatalcare",
"display": "Prenatal and Postnatal Care"
},
{
"code": "maternitycare",
"display": "Delivery and All Inpatient Services for Maternity Care"
},
{
"code": "menthlthoutp",
"display": "Mental/Behavioral Health Outpatient Services"
},
{
"code": "menthlthinp",
"display": "Mental/Behavioral Health Inpatient Services"
},
{
"code": "sadoutp",
"display": "Substance Abuse Disorder Outpatient Services"
},
{
"code": "sadinp",
"display": "Substance Abuse Disorder Inpatient Services"
},
{
"code": "drggenric",
"display": "Generic Drugs"
},
{
"code": "drgbrand",
"display": "Preferred Brand Drugs"
},
{
"code": "drgnonpreferred",
"display": "Non-Preferred Brand Drugs"
},
{
"code": "drgspecialty",
"display": "Specialty Drugs"
},
{
"code": "rehaboutp",
"display": "Outpatient Rehabilitation Services"
},
{
"code": "servicehablitation",
"display": "Habilitation Services"
},
{
"code": "chiro",
"display": "Chiropractic Care"
},
{
"code": "dme",
"display": "Durable Medical Equipment"
},
{
"code": "hearingaids",
"display": "Hearing Aids"
},
{
"code": "imgctpetmri",
"display": "Imaging (CT/PET Scans, MRIs)"
},
{
"code": "prev",
"display": "Preventive Care/Screening/Immunization"
},
{
"code": "rtnpod",
"display": "Routine Foot Care"
},
{
"code": "acupuncture",
"display": "Acupuncture"
},
{
"code": "weightloss",
"display": "Weight Loss Programs"
},
{
"code": "rtneyechld",
"display": "Routine Eye Exam for Children"
},
{
"code": "glasseschld",
"display": "Eye Glasses for Children"
},
{
"code": "rtndntlchld",
"display": "Dental Check-Up for Children"
},
{
"code": "speachthpy",
"display": "Rehabilitative Speech Therapy"
},
{
"code": "rehaboccandpt",
"display": "Rehabilitative Occupational and Rehabilitative Physical Therapy"
},
{
"code": "wellbaby",
"display": "Well Baby Visits and Care"
},
{
"code": "laboutp",
"display": "Laboratory Outpatient and Professional Services"
},
{
"code": "imagingdx",
"display": "X-rays and Diagnostic Imaging"
},
{
"code": "dntlbaschld",
"display": "Basic Dental Care - Child"
},
{
"code": "orthochld",
"display": "Orthodontia - Child"
},
{
"code": "dntlmajchld",
"display": "Major Dental Care - Child"
},
{
"code": "dntlbasadlt",
"display": "Basic Dental Care - Adult"
},
{
"code": "orthodadlt",
"display": "Orthodontia - Adult"
},
{
"code": "dntlmajadlt",
"display": "Major Dental Care - Adult"
},
{
"code": "abortion",
"display": "Abortion for Which Public Funding is Prohibited"
},
{
"code": "transplant",
"display": "Transplant"
},
{
"code": "accdntl",
"display": "Accidental Dental"
},
{
"code": "dialysis",
"display": "Dialysis"
},
{
"code": "testallrgy",
"display": "Allergy Testing"
},
{
"code": "chemotherapy",
"display": "Chemotherapy"
},
{
"code": "radiation",
"display": "Radiation"
},
{
"code": "edudiab",
"display": "Diabetes Education"
},
{
"code": "prosthetic",
"display": "Prosthetic Devices"
},
{
"code": "infusiontx",
"display": "Infusion Therapy"
},
{
"code": "tmjtx",
"display": "Treatment for Temporomandibular Joint Disorders"
},
{
"code": "nutrition",
"display": "Nutritional Counseling"
},
{
"code": "reconsurg",
"display": "Reconstructive Surgery"
}
]
}
]
}
}
FHIR