National Directory of Healthcare Providers & Services (NDH) Implementation Guide
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National Directory of Healthcare Providers & Services (NDH) Implementation Guide, published by HL7 International / Patient Administration. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-us-ndh/ and changes regularly. See the Directory of published versions

ValueSet: NDH Benefit Type Value Set

Official URL: http://hl7.org/fhir/us/ndh/ValueSet/NdhBenefitTypeVS Version: 1.0.0-ballot
Active as of 2024-06-07 Computable Name: NdhBenefitTypeVS

Codes for NDH Insurance Benefit Type.

References

Logical Definition (CLD)

  • Include these codes as defined in http://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCS
    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

Expansion based on codesystem NDH Payer Characteristics Code System v1.0.0-ballot (CodeSystem)

This value set contains 67 concepts

CodeSystemDisplayDefinition
  pcpovhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSPrimary 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/us/ndh/CodeSystem/NdhPayerCharacteristicsCSSpecialist Office Visit

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

  mlpovhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSOther 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/us/ndh/CodeSystem/NdhPayerCharacteristicsCSOutpatient 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/us/ndh/CodeSystem/NdhPayerCharacteristicsCSOutpatient 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/us/ndh/CodeSystem/NdhPayerCharacteristicsCSHospice Services

Benefit plan covers hospice services.

  routinedentalhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSRoutine Dental Services (Adult)

Benefit plan covers routine dental services.

  infertilitytxhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSInfertility Treatment

Benefit plan covers eligible infertility treatment services.

  ltnhchttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSLong-Term/Custodial Nursing Home Care

Long-Term/Custodial Nursing Home Care.

  privatenursehttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSPrivate-Duty Nursing

Private-Duty Nursing.

  routineeyehttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSRoutine Eye Exam (Adult)

Routine Eye Exam (Adult).

  ucservicehttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSUrgent Care Centers or Facilities

Urgent Care Centers or Facilities.

  homehealthhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSHome Health

Home health services insurance coverage.

  erservicehttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSEmergency Room Services

Emergency Room Services.

  ambulancehttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSEmergency Room Services

Emergency Room Services.

  inpatienthospitalhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSInpatient 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/us/ndh/CodeSystem/NdhPayerCharacteristicsCSInpatient Physician and Surgical Services

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

  bariatricsurghttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSBariatric Surgery

Bariatric surgery service Skilled nursing service (qualifier value).

  cosmeticsurghttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSCosmetic Surgery

Cosmetic surgery service Skilled nursing service (qualifier value).

  skillednursinghttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSSkilled Nursing Facility

Skilled nursing service (qualifier value).

  ppnatalcarehttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSPrenatal and Postnatal Care

Prenatal and Postnatal services.

  maternitycarehttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSDelivery and All Inpatient Services for Maternity Care

All maternity care services.

  menthlthoutphttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSMental/Behavioral Health Outpatient Services

Mental health service delivered in an outpatient setting.

  menthlthinphttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSMental/Behavioral Health Inpatient Services

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

  sadoutphttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSSubstance Abuse Disorder Outpatient Services

Substance abuse related services delivered in a outpatient setting.

  sadinphttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSSubstance Abuse Disorder Inpatient Services

Substance abuse related services delivered in a inpatient setting.

  drggenrichttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSGeneric Drugs

Generic drugs eligible benefits.

  drgbrandhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSPreferred Brand Drugs

Preferred brand drugs eligible benefits.

  drgnonpreferredhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSNon-Preferred Brand Drugs

Non-Preferred drugs brands eligible benefits.

  drgspecialtyhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSSpecialty Drugs

Benefit plan covers specialty drugs.

  rehaboutphttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSOutpatient Rehabilitation Services

Benefit plan covers outpatient rehabilitation services.

  servicehablitationhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSHabilitation Services

Habilitation Services.

  chirohttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSChiropractic Care

Benefit plan covers chiropractor eligible benefits.

  dmehttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSDurable Medical Equipment

Benefit plan covers Durable medical equipment eligible benefits.

  hearingaidshttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSHearing Aids

Benefit plan covers hearing aids.

  imgctpetmrihttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSImaging (CT/PET Scans, MRIs)

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

  prevhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSPreventive Care/Screening/Immunization

Routine healthcare services to prevent health related problems eligible benefits.

  rtnpodhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSRoutine Foot Care

Routine Foot Care.

  acupuncturehttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSAcupuncture

Benefit plan covers acupuncture treatment.

  weightlosshttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSWeight Loss Programs

Benefit plan covers weight loss services eligible benefits.

  rtneyechldhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSRoutine Eye Exam for Children

Routine eye exam for children eligible benefits.

  glasseschldhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSEye Glasses for Children

Eye glasses children eligible benefits.

  rtndntlchldhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSDental Check-Up for Children

Dental Check-Up for Children.

  speachthpyhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSRehabilitative Speech Therapy

Benefit plan covers rehabilitative speech therapy eligible benefits.

  rehaboccandpthttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSRehabilitative Occupational and Rehabilitative Physical Therapy

Benefit plan covers rehabilitative occupational and rehabilitative physical eligible benefits.

  wellbabyhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSWell 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/us/ndh/CodeSystem/NdhPayerCharacteristicsCSLaboratory Outpatient and Professional Services

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

  imagingdxhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSX-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/us/ndh/CodeSystem/NdhPayerCharacteristicsCSBasic Dental Care - Child

Benefit plan covers diagnostic basic dental care.

  orthochldhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSOrthodontia - Child

Benefit plan covers orthodontia for children.

  dntlmajchldhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSMajor Dental Care - Child

Benefit plan covers major dental care for children.

  dntlbasadlthttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSBasic Dental Care - Adult

Benefit plan covers basic dental care for adults.

  orthodadlthttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSOrthodontia - Adult

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

  dntlmajadlthttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSMajor Dental Care - Adult

Benefit plan covers major dental care for adult.

  abortionhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSAbortion for Which Public Funding is Prohibited

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

  transplanthttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSTransplant

Benefit plan covers transplant related services.

  accdntlhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSAccidental Dental

Benefit plan covers dental care services related to an accident.

  dialysishttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSDialysis

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

  testallrgyhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSAllergy 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/us/ndh/CodeSystem/NdhPayerCharacteristicsCSChemotherapy

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

  radiationhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSRadiation

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

  edudiabhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSDiabetes 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/us/ndh/CodeSystem/NdhPayerCharacteristicsCSProsthetic Devices

Plan benefit covers services related to prosthesis devices.

  infusiontxhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSInfusion Therapy

Plan benefit covers services related to infusion therapy.

  tmjtxhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSTreatment for Temporomandibular Joint Disorders

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

  nutritionhttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSNutritional Counseling

Nutritional Counseling.

  reconsurghttp://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCSReconstructive 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