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Packagehl7.terminology.r5
Resource TypeCodeSystem
IdCodeSystem-coverage-copay-type.json
FHIR VersionR5

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Narrative

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Generated Narrative: CodeSystem coverage-copay-type

Last updated: 2026-06-12 00:00:00+0000

Profile: Shareable CodeSystem

This case-sensitive code system http://terminology.hl7.org/CodeSystem/coverage-copay-type defines the following codes in a Is-A hierarchy:

LvlCodeDisplayDefinition
1gpvisit GP Office VisitAn office visit for a general practitioner of a discipline.
1spvisit Specialist Office VisitAn office visit for a specialist practitioner of a discipline
1emergency EmergencyAn episode in an emergency department.
1inpthosp Inpatient HospitalAn episode of an Inpatient hospital stay.
1televisit Tele-visitA visit held where the patient is remote relative to the practitioner, e.g. by phone, computer or video conference.
1urgentcare Urgent CareA visit to an urgent care facility - typically a community care clinic.
1rx PrescriptionPrescription drug and pharmacy-related services.
1copaypct Copay PercentageA standard percentage applied to all classes or service or product not otherwise specified.
1copay Copay AmountA standard fixed currency amount applied to all classes or service or product not otherwise specified.
1deductible DeductibleThe accumulated amount of patient payment before the coverage begins to pay for services.
2  FamOutDed Family Out of Network DeductibleThe accumulated amount applied toward the family's out-of-network deductible before the coverage begins to pay for covered out-of-network services.
2  FamInDed Family In Network DeductibleThe accumulated amount applied toward the family's in-network deductible before the coverage begins to pay for covered in-network services.
2  FamRxOutDed Family Pharmacy Out of Network DeductibleThe accumulated amount applied toward the family's out-of-network pharmacy deductible before the coverage begins to pay for covered out-of-network pharmacy services.
2  FamRxInDed Family Pharmacy In Network DeductibleThe accumulated amount applied toward the family's in-network pharmacy deductible before the coverage begins to pay for covered in-network pharmacy services.
2  IndOutDed Invidual Out of Network DeductibleThe accumulated amount applied toward the individual's out-of-network deductible before the coverage begins to pay for covered out-of-network services.
2  IndInDed Individual In Network DeductibleThe accumulated amount applied toward the individual's in-network deductible before the coverage begins to pay for covered in-network services.
2  IndRxOutDed Individual Pharmacy Out of Network DeductibleThe accumulated amount applied toward the individual's out-of-network pharmacy deductible before the coverage begins to pay for covered out-of-network pharmacy services.
2  IndRxInDed Individual Pharmacy In Network DeductibleThe accumulated amount applied toward the individual's in-network pharmacy deductible before the coverage begins to pay for covered in-network pharmacy services.
1maxoutofpocket Maximum out of pocketThe maximum amout of payment for services which a patient, or family, is expected to incur - typically annually.
2  FamOutMax Family Out of Network Out of Pocket MaximumThe maximum amount of out-of-pocket payment that a family is expected to incur for covered out-of-network services.
2  FamInMax Family In Network Out of Pocket MaximumThe maximum amount of out-of-pocket payment that a family is expected to incur for covered in-network services.
2  FamRxOutMax Family Pharmacy Out of Network Out of Pocket MaximumThe maximum amount of out-of-pocket payment that a family is expected to incur for covered out-of-network pharmacy services.
2  FamRxInMax Family Pharmacy In Network Out of Pocket MaximumThe maximum amount of out-of-pocket payment that a family is expected to incur for covered in-network pharmacy services.
2  IndOutMax Individual Out of Network Out of Pocket MaximumThe maximum amount of out-of-pocket payment that an individual is expected to incur for covered out-of-network services.
2  IndInMax Individual In Network Out of Pocket MaximumThe maximum amount of out-of-pocket payment that an individual is expected to incur for covered in-network services.
2  IndRxOutMax Individual Pharmacy Out of Network Out of Pocket MaximumThe maximum amount of out-of-pocket payment that an individual is expected to incur for covered out-of-network pharmacy services.
2  IndRxInMax Individual Pharmacy In Network Out of Pocket MaximumThe maximum amount of out-of-pocket payment that an individual is expected to incur for covered in-network pharmacy services.

Source1

{
  "resourceType": "CodeSystem",
  "id": "coverage-copay-type",
  "meta": {
    "lastUpdated": "2026-06-12T00:00:00+00:00",
    "profile": [
      "http://hl7.org/fhir/StructureDefinition/shareablecodesystem"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "fm"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger": 2
    }
  ],
  "url": "http://terminology.hl7.org/CodeSystem/coverage-copay-type",
  "identifier": [
    {
      "system": "urn:ietf:rfc:3986",
      "value": "urn:oid:2.16.840.1.113883.4.642.1.1149"
    }
  ],
  "version": "2.0.0",
  "name": "CoverageCopayTypeCodes",
  "title": "Coverage Copay Type Codes",
  "status": "active",
  "experimental": false,
  "date": "2026-10-27T07:25:42+11:00",
  "publisher": "Health Level Seven International",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "http://hl7.org"
        },
        {
          "system": "email",
          "value": "hq@HL7.org"
        }
      ]
    }
  ],
  "description": "This value set includes sample Coverage Copayment Type codes.",
  "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",
  "caseSensitive": true,
  "valueSet": "http://terminology.hl7.org/ValueSet/coverage-copay-type",
  "hierarchyMeaning": "is-a",
  "content": "complete",
  "concept": [
    {
      "code": "gpvisit",
      "display": "GP Office Visit",
      "definition": "An office visit for a general practitioner of a discipline."
    },
    {
      "code": "spvisit",
      "display": "Specialist Office Visit",
      "definition": "An office visit for a specialist practitioner of a discipline"
    },
    {
      "code": "emergency",
      "display": "Emergency",
      "definition": "An episode in an emergency department."
    },
    {
      "code": "inpthosp",
      "display": "Inpatient Hospital",
      "definition": "An episode of an Inpatient hospital stay."
    },
    {
      "code": "televisit",
      "display": "Tele-visit",
      "definition": "A visit held where the patient is remote relative to the practitioner, e.g. by phone, computer or video conference."
    },
    {
      "code": "urgentcare",
      "display": "Urgent Care",
      "definition": "A visit to an urgent care facility - typically a community care clinic."
    },
    {
      "code": "rx",
      "display": "Prescription",
      "definition": "Prescription drug and pharmacy-related services."
    },
    {
      "code": "copaypct",
      "display": "Copay Percentage",
      "definition": "A standard percentage applied to all classes or service or product not otherwise specified."
    },
    {
      "code": "copay",
      "display": "Copay Amount",
      "definition": "A standard fixed currency amount applied to all classes or service or product not otherwise specified."
    },
    {
      "code": "deductible",
      "display": "Deductible",
      "definition": "The accumulated amount of patient payment before the coverage begins to pay for services.",
      "concept": [
        {
          "code": "FamOutDed",
          "display": "Family Out of Network Deductible",
          "definition": "The accumulated amount applied toward the family's out-of-network deductible before the coverage begins to pay for covered out-of-network services."
        },
        {
          "code": "FamInDed",
          "display": "Family In Network Deductible",
          "definition": "The accumulated amount applied toward the family's in-network deductible before the coverage begins to pay for covered in-network services."
        },
        {
          "code": "FamRxOutDed",
          "display": "Family Pharmacy Out of Network Deductible",
          "definition": "The accumulated amount applied toward the family's out-of-network pharmacy deductible before the coverage begins to pay for covered out-of-network pharmacy services."
        },
        {
          "code": "FamRxInDed",
          "display": "Family Pharmacy In Network Deductible",
          "definition": "The accumulated amount applied toward the family's in-network pharmacy deductible before the coverage begins to pay for covered in-network pharmacy services."
        },
        {
          "code": "IndOutDed",
          "display": "Invidual Out of Network Deductible",
          "definition": "The accumulated amount applied toward the individual's out-of-network deductible before the coverage begins to pay for covered out-of-network services."
        },
        {
          "code": "IndInDed",
          "display": "Individual In Network Deductible",
          "definition": "The accumulated amount applied toward the individual's in-network deductible before the coverage begins to pay for covered in-network services."
        },
        {
          "code": "IndRxOutDed",
          "display": "Individual Pharmacy Out of Network Deductible",
          "definition": "The accumulated amount applied toward the individual's out-of-network pharmacy deductible before the coverage begins to pay for covered out-of-network pharmacy services."
        },
        {
          "code": "IndRxInDed",
          "display": "Individual Pharmacy In Network Deductible",
          "definition": "The accumulated amount applied toward the individual's in-network pharmacy deductible before the coverage begins to pay for covered in-network pharmacy services."
        }
      ]
    },
    {
      "code": "maxoutofpocket",
      "display": "Maximum out of pocket",
      "definition": "The maximum amout of payment for services which a patient, or family, is expected to incur - typically annually.",
      "concept": [
        {
          "code": "FamOutMax",
          "display": "Family Out of Network Out of Pocket Maximum",
          "definition": "The maximum amount of out-of-pocket payment that a family is expected to incur for covered out-of-network services."
        },
        {
          "code": "FamInMax",
          "display": "Family In Network Out of Pocket Maximum",
          "definition": "The maximum amount of out-of-pocket payment that a family is expected to incur for covered in-network services."
        },
        {
          "code": "FamRxOutMax",
          "display": "Family Pharmacy Out of Network Out of Pocket Maximum",
          "definition": "The maximum amount of out-of-pocket payment that a family is expected to incur for covered out-of-network pharmacy services."
        },
        {
          "code": "FamRxInMax",
          "display": "Family Pharmacy In Network Out of Pocket Maximum",
          "definition": "The maximum amount of out-of-pocket payment that a family is expected to incur for covered in-network pharmacy services."
        },
        {
          "code": "IndOutMax",
          "display": "Individual Out of Network Out of Pocket Maximum",
          "definition": "The maximum amount of out-of-pocket payment that an individual is expected to incur for covered out-of-network services."
        },
        {
          "code": "IndInMax",
          "display": "Individual In Network Out of Pocket Maximum",
          "definition": "The maximum amount of out-of-pocket payment that an individual is expected to incur for covered in-network services."
        },
        {
          "code": "IndRxOutMax",
          "display": "Individual Pharmacy Out of Network Out of Pocket Maximum",
          "definition": "The maximum amount of out-of-pocket payment that an individual is expected to incur for covered out-of-network pharmacy services."
        },
        {
          "code": "IndRxInMax",
          "display": "Individual Pharmacy In Network Out of Pocket Maximum",
          "definition": "The maximum amount of out-of-pocket payment that an individual is expected to incur for covered in-network pharmacy services."
        }
      ]
    }
  ]
}