Validated Healthcare Directory
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Validated Healthcare Directory, published by HL7 International - Patient Administration Work Group. This is not an authorized publication; it is the continuous build for version 0.2.0). This version is based on the current content of https://github.com/HL7/VhDir/ and changes regularly. See the Directory of published versions

ValueSet: VhDir Benefit Type

Official URL: http://hl7.org/fhir/uv/vhdir/ValueSet/benefit-type Version: 0.2.0
Active as of 2018-02-21 Computable Name: VhDirBenefitType

Copyright/Legal: Used by permission of HL7 International all rights reserved Creative Commons License

This value set defines a set of codes that indicate the type of benefit in a product/plan.

References

Logical Definition (CLD)

  • Include these codes as defined in http://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristics
    CodeDisplayDefinition
    pcpovPrimary Care Visit to Treat an Injury or IllnessBenefit 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.
    specialistovSpecialist Office VisitCovered healthcare service rendered to a patient by a specialty provider.
    mlpovOther Practitioner Office Visit (Nurse, Physician Assistant) - Mid Level ProfessionalBenefit plan covers covered health related services rendered by a practioner other than MD or DO and referred to as other practitioner.
    outpatientOutpatient 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.
    outpatstxOutpatient Surgery Physician/Surgical ServicesBenefit plan covers surgical services rendered to patient outside of a facility admission, referred to as outpatient.
    hospservHospice ServicesBenefit plan covers hospice services.
    routinedentalRoutine Dental Services (Adult)Benefit plan covers routine dental services.
    infertilitytxInfertility TreatmentBenefit plan covers eligible infertility treatment services.
    ltnhcLong-Term/Custodial Nursing Home CareLong-Term/Custodial Nursing Home Care.
    privatenursePrivate-Duty NursingPrivate-Duty Nursing.
    routineeyeRoutine Eye Exam (Adult)Routine Eye Exam (Adult).
    ucserviceUrgent Care Centers or FacilitiesUrgent Care Centers or Facilities.
    homehealthHome HealthHome health services insurance coverage.
    erserviceEmergency Room ServicesEmergency Room Services.
    ambulanceEmergency Room ServicesEmergency Room Services.
    inpatienthospitalInpatient Hospital Services (e.g., Hospital Stay)A person who is hospitalized for at least one night to receive treatment or participate in a study.
    inpatientproviderInpatient Physician and Surgical ServicesA healthcare provider who is delivering healthcare services in a hospital environment.
    bariatricsurgBariatric SurgeryBariatric surgery service Skilled nursing service (qualifier value).
    cosmeticsurgCosmetic SurgeryCosmetic surgery service Skilled nursing service (qualifier value).
    skillednursingSkilled Nursing FacilitySkilled nursing service (qualifier value).
    ppnatalcarePrenatal and Postnatal CarePrenatal and Postnatal services.
    maternitycareDelivery and All Inpatient Services for Maternity CareAll maternity care services.
    menthlthoutpMental/Behavioral Health Outpatient ServicesMental health service delivered in an outpatient setting.
    menthlthinpMental/Behavioral Health Inpatient ServicesMental health service delivered in an hospital or inpatient facility setting.
    sadoutpSubstance Abuse Disorder Outpatient ServicesSubstance abuse related services delivered in a outpatient setting.
    sadinpSubstance Abuse Disorder Inpatient ServicesSubstance abuse related services delivered in a inpatient setting.
    drggenricGeneric DrugsGeneric drugs eligible benefits.
    drgbrandPreferred Brand DrugsPreferred brand drugs eligible benefits.
    drgnonpreferredNon-Preferred Brand DrugsNon-Preferred drugs brands eligible benefits.
    drgspecialtySpecialty DrugsBenefit plan covers specialty drugs.
    rehaboutpOutpatient Rehabilitation ServicesBenefit plan covers outpatient rehabilitation services.
    servicehablitationHabilitation ServicesHabilitation Services.
    chiroChiropractic CareBenefit plan covers chiropractor eligible benefits.
    dmeDurable Medical EquipmentBenefit plan covers Durable medical equipment eligible benefits.
    hearingaidsHearing AidsBenefit plan covers hearing aids.
    imgctpetmriImaging (CT/PET Scans, MRIs)Benefit plan covers advances imaging techniques services (CT/PET Scans, MRIs) eligible services.
    prevPreventive Care/Screening/ImmunizationRoutine healthcare services to prevent health related problems eligible benefits.
    rtnpodRoutine Foot CareRoutine Foot Care.
    acupunctureAcupunctureBenefit plan covers acupuncture treatment.
    weightlossWeight Loss ProgramsBenefit plan covers weight loss services eligible benefits.
    rtneyechldRoutine Eye Exam for ChildrenRoutine eye exam for children eligible benefits.
    glasseschldEye Glasses for ChildrenEye glasses children eligible benefits.
    rtndntlchldDental Check-Up for ChildrenDental Check-Up for Children.
    speachthpyRehabilitative Speech TherapyBenefit plan covers rehabilitative speech therapy eligible benefits.
    rehaboccandptRehabilitative Occupational and Rehabilitative Physical TherapyBenefit plan covers rehabilitative occupational and rehabilitative physical eligible benefits.
    wellbabyWell Baby Visits and CareRegularly 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.
    laboutpLaboratory Outpatient and Professional ServicesBenefit plan covers laboratory testing and related professional services received as outpatient.
    imagingdxX-rays and Diagnostic ImagingBenefit plan covers diagnostic imaging procedures that produce images of internal structures of the human body and uses radiation to diagnose and treat diseases.
    dntlbaschldBasic Dental Care – ChildBenefit plan covers diagnostic basic dental care.
    orthochldOrthodontia – ChildBenefit plan covers orthodontia for children.
    dntlmajchldMajor Dental Care – ChildBenefit plan covers major dental care for children.
    dntlbasadltBasic Dental Care – AdultBenefit plan covers basic dental care for adults.
    orthodadltOrthodontia – AdultBenefits plan covers services provided that are required for orthodontic purposes for an adult.
    dntlmajadltMajor Dental Care – AdultBenefit plan covers major dental care for adult.
    abortionAbortion for Which Public Funding is ProhibitedBenefit plan covers services for abortion for which public funding is prohibited.
    transplantTransplantBenefit plan covers transplant related services.
    accdntlAccidental DentalBenefit plan covers dental care services related to an accident.
    dialysisDialysisThe plan benefit covers services used to treat end stage renal disease.
    testallrgyAllergy TestingThe 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.
    chemotherapyChemotherapyThe plan benefits cover services the use of drugs and approved chemicals to treat disease.
    radiationRadiationThe plan benefits cover services the use radiation to treat disease.
    edudiabDiabetes EducationThe 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.
    prostheticProsthetic DevicesPlan benefit covers services related to prosthesis devices.
    infusiontxInfusion TherapyPlan benefit covers services related to infusion therapy.
    tmjtxTreatment for Temporomandibular Joint DisordersPlan benefit covers services related to treatment of Temporomandibular Joint disorder.
    nutritionNutritional CounselingNutritional Counseling.
    reconsurgReconstructive SurgeryPlan benefit covers services related to reconstructive surgery.

 

Expansion

This value set contains 67 concepts

Expansion based on codesystem VhDir Payer Characteristics Code System v0.2.0 (CodeSystem)

CodeSystemDisplayDefinition
  pcpovhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsPrimary 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.

  specialistovhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsSpecialist Office Visit

Covered healthcare service rendered to a patient by a specialty provider.

  mlpovhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsOther Practitioner Office Visit (Nurse, Physician Assistant) - Mid Level Professional

Benefit plan covers covered health related services rendered by a practioner other than MD or DO and referred to as other practitioner.

  outpatienthttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsOutpatient 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.

  outpatstxhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsOutpatient Surgery Physician/Surgical Services

Benefit plan covers surgical services rendered to patient outside of a facility admission, referred to as outpatient.

  hospservhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsHospice Services

Benefit plan covers hospice services.

  routinedentalhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsRoutine Dental Services (Adult)

Benefit plan covers routine dental services.

  infertilitytxhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsInfertility Treatment

Benefit plan covers eligible infertility treatment services.

  ltnhchttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsLong-Term/Custodial Nursing Home Care

Long-Term/Custodial Nursing Home Care.

  privatenursehttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsPrivate-Duty Nursing

Private-Duty Nursing.

  routineeyehttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsRoutine Eye Exam (Adult)

Routine Eye Exam (Adult).

  ucservicehttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsUrgent Care Centers or Facilities

Urgent Care Centers or Facilities.

  homehealthhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsHome Health

Home health services insurance coverage.

  erservicehttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsEmergency Room Services

Emergency Room Services.

  ambulancehttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsEmergency Room Services

Emergency Room Services.

  inpatienthospitalhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsInpatient Hospital Services (e.g., Hospital Stay)

A person who is hospitalized for at least one night to receive treatment or participate in a study.

  inpatientproviderhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsInpatient Physician and Surgical Services

A healthcare provider who is delivering healthcare services in a hospital environment.

  bariatricsurghttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsBariatric Surgery

Bariatric surgery service Skilled nursing service (qualifier value).

  cosmeticsurghttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsCosmetic Surgery

Cosmetic surgery service Skilled nursing service (qualifier value).

  skillednursinghttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsSkilled Nursing Facility

Skilled nursing service (qualifier value).

  ppnatalcarehttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsPrenatal and Postnatal Care

Prenatal and Postnatal services.

  maternitycarehttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsDelivery and All Inpatient Services for Maternity Care

All maternity care services.

  menthlthoutphttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsMental/Behavioral Health Outpatient Services

Mental health service delivered in an outpatient setting.

  menthlthinphttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsMental/Behavioral Health Inpatient Services

Mental health service delivered in an hospital or inpatient facility setting.

  sadoutphttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsSubstance Abuse Disorder Outpatient Services

Substance abuse related services delivered in a outpatient setting.

  sadinphttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsSubstance Abuse Disorder Inpatient Services

Substance abuse related services delivered in a inpatient setting.

  drggenrichttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsGeneric Drugs

Generic drugs eligible benefits.

  drgbrandhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsPreferred Brand Drugs

Preferred brand drugs eligible benefits.

  drgnonpreferredhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsNon-Preferred Brand Drugs

Non-Preferred drugs brands eligible benefits.

  drgspecialtyhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsSpecialty Drugs

Benefit plan covers specialty drugs.

  rehaboutphttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsOutpatient Rehabilitation Services

Benefit plan covers outpatient rehabilitation services.

  servicehablitationhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsHabilitation Services

Habilitation Services.

  chirohttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsChiropractic Care

Benefit plan covers chiropractor eligible benefits.

  dmehttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsDurable Medical Equipment

Benefit plan covers Durable medical equipment eligible benefits.

  hearingaidshttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsHearing Aids

Benefit plan covers hearing aids.

  imgctpetmrihttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsImaging (CT/PET Scans, MRIs)

Benefit plan covers advances imaging techniques services (CT/PET Scans, MRIs) eligible services.

  prevhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsPreventive Care/Screening/Immunization

Routine healthcare services to prevent health related problems eligible benefits.

  rtnpodhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsRoutine Foot Care

Routine Foot Care.

  acupuncturehttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsAcupuncture

Benefit plan covers acupuncture treatment.

  weightlosshttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsWeight Loss Programs

Benefit plan covers weight loss services eligible benefits.

  rtneyechldhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsRoutine Eye Exam for Children

Routine eye exam for children eligible benefits.

  glasseschldhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsEye Glasses for Children

Eye glasses children eligible benefits.

  rtndntlchldhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsDental Check-Up for Children

Dental Check-Up for Children.

  speachthpyhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsRehabilitative Speech Therapy

Benefit plan covers rehabilitative speech therapy eligible benefits.

  rehaboccandpthttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsRehabilitative Occupational and Rehabilitative Physical Therapy

Benefit plan covers rehabilitative occupational and rehabilitative physical eligible benefits.

  wellbabyhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsWell 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.

  laboutphttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsLaboratory Outpatient and Professional Services

Benefit plan covers laboratory testing and related professional services received as outpatient.

  imagingdxhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsX-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.

  dntlbaschldhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsBasic Dental Care – Child

Benefit plan covers diagnostic basic dental care.

  orthochldhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsOrthodontia – Child

Benefit plan covers orthodontia for children.

  dntlmajchldhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsMajor Dental Care – Child

Benefit plan covers major dental care for children.

  dntlbasadlthttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsBasic Dental Care – Adult

Benefit plan covers basic dental care for adults.

  orthodadlthttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsOrthodontia – Adult

Benefits plan covers services provided that are required for orthodontic purposes for an adult.

  dntlmajadlthttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsMajor Dental Care – Adult

Benefit plan covers major dental care for adult.

  abortionhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsAbortion for Which Public Funding is Prohibited

Benefit plan covers services for abortion for which public funding is prohibited.

  transplanthttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsTransplant

Benefit plan covers transplant related services.

  accdntlhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsAccidental Dental

Benefit plan covers dental care services related to an accident.

  dialysishttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsDialysis

The plan benefit covers services used to treat end stage renal disease.

  testallrgyhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsAllergy 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.

  chemotherapyhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsChemotherapy

The plan benefits cover services the use of drugs and approved chemicals to treat disease.

  radiationhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsRadiation

The plan benefits cover services the use radiation to treat disease.

  edudiabhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsDiabetes 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.

  prosthetichttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsProsthetic Devices

Plan benefit covers services related to prosthesis devices.

  infusiontxhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsInfusion Therapy

Plan benefit covers services related to infusion therapy.

  tmjtxhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsTreatment for Temporomandibular Joint Disorders

Plan benefit covers services related to treatment of Temporomandibular Joint disorder.

  nutritionhttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsNutritional Counseling

Nutritional Counseling.

  reconsurghttp://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristicsReconstructive Surgery

Plan benefit covers services related to reconstructive surgery.


Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
System The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance)
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code