NDH Payer Characteristics Code System - National Directory of Healthcare Providers & Services (NDH) Implementation Guide v1.0.0-ballot

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

CodeSystem: NDH Payer Characteristics Code System

Official URL: http://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCS				Version: 1.0.0-ballot
Active as of 2024-04-04				Computable Name: NdhPayerCharacteristicsCS

NDH Payer Characteristics

This Code system is referenced in the content logical definition of the following value sets:

This case-sensitive code system http://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCS defines the following codes:

Code	Display	Definition
medical	Medical	Medical insurance coverage.
dental	Dental	Dental insurance coverage.
menthlth	Mental Health	Mental health insurance coverage.
substanceabuse	Substance Abuse	Substance abuse services insurance coverage.
vision	Vision	Vision insurance coverage.
drug	Drug	Prescription drug coverage.
stc	Short Term Care	Short term care.
ltc	Long Term Care	Long term care.
hospice	Hospice	Hospice insurance coverage.
homehealth	Home Health	Home health services insurance coverage.
dmepos	DMEPOS	Durable Medical Equipment, Prosthetics/Orthotics and Supplies.
imagingadv	Advanced Imaging (CT/PET Scans, MRIs)	Advances imaging techniques services (CT/PET Scans, MRIs) coverage.
rehab	Rehabilitation	Rehabilitation.
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 practioner 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.
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.
days	Days	Measure of service covered by the plan benefit expressed in a definite number of days.
visit	Visits	Measure of service covered by the plan benefit expressed in a definite number of visits.
procedure	Procedures	Measure of service covered by the plan benefit expressed in a set of actions covered.
admission	Admissions	Measure of services covered by the benefit plan expressed in relation to patient's acceptance for medical and nursing care in a hospital or other health care institution.
visithrs	Hours per visit	Measure expresses how many hours per visit are covered by the insurance benefit plan.
weekhrs	Hours per week	Measure expresses how many hours per week are covered by the insurance benefit plan.
mthhrs	Hours per month	Measure expressed how many hours per month are covered by the insurance benefit plan.
yrhrs	Hours per year	Measure expreses how many hours per year are covered by the insurance benfit plan.
daysperwk	Days per week	Measure of service covered by the plan benefit expressed in a how many days are covered in a week.
dayspermth	Days per month	Measure of service covered by the plan benefit expressed in a how many days are covered in a month.
daysperyr	Days per year	Measure of service covered by the plan benefit expressed in a how many days are covered in a year.
mthsperyr	Months per year	Measure of service covered by the plan benefit expressed in a how many month are covered in a year.
visitsperday	Visits per day	Measure of service covered by the plan benefit expressed in a definite number of visits covered per day.
visitsperweek	Visits per week	Measure of service covered by the plan benefit expressed in a definite number of visits covered per week.
visitspermth	Visits per month	Measure of service covered by the plan benefit expressed in a definite number of visits covered per month.
visitsperyr	Visits per year	Measure of service covered by the plan benefit expressed in a definite number of visits covered per year.
lifetimevisits	Lifetime visits	Measure of service covered by the plan benefit expressed in a definite number of visits covered through lifetime.
txperweek	Treatments per week	Measure of service covered by the plan benefit expressed in a definite number of treatment actions covered in a week.
txpermnth	Treatments per month	Measure of service covered by the plan benefit expressed in a definite number of treatment actions covered in a month.
txlifetime	Lifetime treatments	Measure of service covered by the plan benefit expressed in a definite number of treatment actions covered in a lifetime.
admitslifetime	Lifetime admissions	Measure of service covered by the plan benefit expressed in a definite number admission actions covered through lifetime.
procperwk	Procedures per week	Measure of service covered by the plan benefit expressed in a definite number procedure covered per week.
procpermnth	Procedures per month	Measure of service covered by the plan benefit expressed in a definite number procedure covered per month.
procperyr	Procedures per year	Measure of service covered by the plan benefit expressed in a definite number procedure covered per year.
proclifetime	Lifetime procedures	Measure of service covered by the plan benefit expressed in a definite number procedure covered per lifetime.
daysperadmission	Days per admission	Measure of service covered by the plan benefit expressed in a definite number of days covered for each individual admission.
procperepi	Procedures per episode	Measure of service covered by the plan benefit expressed in a definite number of procedures covered for each individual treatment episode.
cat	Catastrophic	'Catastrophic' health insurance plans have low monthly premiums and very high deductibles. They may cover worst-case scenarios, like getting seriously sick or injured. Patient pays most routine medical expenses.
bronze	Bronze	'Bronze' type plan defines the estimated split costs of the plan, where patient is responsible for 40% of their healthcare cost while 60% is covered by the plan.
bronzeexp	Expanded Bronze	The 'extended bronze' plan is an addition to the bronze metal level which establishes the de minimis variation range for the actuarial value (AV) level of coverage to allow variation in the AV to -4/+2 percentage points.
silver	Silver	'Silver' type plan defines the estimated split costs of the plan, where patient is responsible for 30% of their healthcare cost while 70% is covered by the plan.
gold	Gold	'Gold' type plan defines the estimated split costs of the plan, where patient is responsible for 20% of their healthcare cost while 80% is covered by the plan.
platinum	Platinum	'Platinum' type plan defines the estimated split costs of the plan, where patient is responsible for 10% of their healthcare cost while 90% is covered by the plan.
lowded	Low deductible	A health insurance plan with higher premiums and lower out of pocket cost than a traditional health plan.
highded	High deductible	A health insurance plan with lower premiums and higher out of pocket cost than a traditional health plan.