Summary of Benefits and Coverage (SBC) FHIR Implementation Guide
0.1.0 - ci-build United States of America

Summary of Benefits and Coverage (SBC) FHIR Implementation Guide, published by SBC FHIR Project. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/jdjkelly/fhir-sbc/ and changes regularly. See the Directory of published versions

ValueSet: SBC Benefit Category Value Set

Official URL: http://flexpa.com/fhir/sbc/ValueSet/sbc-benefit-category Version: 0.1.0
Draft as of 2026-02-16 Computable Name: SBCBenefitCategoryVS

Value set containing all 30 benefit service categories required in Summary of Benefits and Coverage (SBC) documents

References

Logical Definition (CLD)

 

Expansion

Expansion performed internally based on codesystem SBC Benefit Category Code System v0.1.0 (CodeSystem)

This value set contains 30 concepts

SystemCodeDisplay (en)DefinitionJSONXML
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  primary-care-visitPrimary Care Visit to Treat an Injury or IllnessVisits to primary care physicians to treat illness or injury
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  specialist-visitSpecialist VisitVisits to specialist physicians
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  preventive-carePreventive Care/Screening/ImmunizationPreventive care services, health screenings, and immunizations
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  diagnostic-testDiagnostic Test (X-ray, Blood Work)X-rays, blood work, and other diagnostic tests
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  imagingImaging (CT/PET Scans, MRIs)Advanced imaging services including CT scans, PET scans, and MRIs
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  generic-drugsGeneric DrugsGeneric prescription medications
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  preferred-brand-drugsPreferred Brand DrugsBrand-name prescription medications on the preferred drug list
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  non-preferred-brand-drugsNon-Preferred Brand DrugsBrand-name prescription medications not on the preferred drug list
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  specialty-drugsSpecialty DrugsHigh-cost or specialty prescription medications
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  outpatient-facility-feeFacility Fee (e.g., Ambulatory Surgery Center)Facility charges for outpatient surgery
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  outpatient-physician-feePhysician/Surgeon Fees (Outpatient Surgery)Professional fees for physicians and surgeons for outpatient surgery
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  emergency-room-careEmergency Room CareEmergency department services
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  emergency-medical-transportEmergency Medical TransportationAmbulance and emergency medical transport services
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  urgent-careUrgent CareUrgent care facility services
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  hospital-facility-feeFacility Fee (e.g., Hospital Room)Facility charges for hospital inpatient stays
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  hospital-physician-feePhysician/Surgeon Fees (Hospital Stay)Professional fees for physicians and surgeons during hospital stays
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  mental-health-outpatientMental/Behavioral Health Outpatient ServicesOutpatient mental health and substance abuse services
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  mental-health-inpatientMental/Behavioral Health Inpatient ServicesInpatient mental health and substance abuse services
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  pregnancy-office-visitsOffice Visits (Pregnancy)Prenatal and postnatal office visits
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  pregnancy-delivery-professionalChildbirth/Delivery Professional ServicesProfessional services for childbirth and delivery
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  pregnancy-delivery-facilityChildbirth/Delivery Facility ServicesFacility services for childbirth and delivery
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  home-health-careHome Health CareHome health care services
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  rehabilitationRehabilitation ServicesOutpatient physical, occupational, and speech therapy
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  habilitationHabilitation ServicesHealth care services that help develop or maintain daily living skills
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  skilled-nursingSkilled Nursing CareSkilled nursing facility services
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  durable-medical-equipmentDurable Medical EquipmentMedical equipment for home use such as wheelchairs, oxygen equipment
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  hospiceHospice ServicesEnd-of-life care services
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  children-eye-examChildren's Eye ExamEye examinations for children
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  children-glassesChildren's GlassesEyeglasses for children
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  children-dentalChildren's Dental Check-upRoutine dental care for children

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