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
| 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
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category version 📦0.1.0
Expansion performed internally based on codesystem SBC Benefit Category Code System v0.1.0 (CodeSystem)
This value set contains 30 concepts
| System | Code | Display (en) | Definition | JSON | XML |
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | primary-care-visit | Primary Care Visit to Treat an Injury or Illness | Visits to primary care physicians to treat illness or injury | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | specialist-visit | Specialist Visit | Visits to specialist physicians | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | preventive-care | Preventive Care/Screening/Immunization | Preventive care services, health screenings, and immunizations | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | diagnostic-test | Diagnostic Test (X-ray, Blood Work) | X-rays, blood work, and other diagnostic tests | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | imaging | Imaging (CT/PET Scans, MRIs) | Advanced imaging services including CT scans, PET scans, and MRIs | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | generic-drugs | Generic Drugs | Generic prescription medications | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | preferred-brand-drugs | Preferred Brand Drugs | Brand-name prescription medications on the preferred drug list | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | non-preferred-brand-drugs | Non-Preferred Brand Drugs | Brand-name prescription medications not on the preferred drug list | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | specialty-drugs | Specialty Drugs | High-cost or specialty prescription medications | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | outpatient-facility-fee | Facility Fee (e.g., Ambulatory Surgery Center) | Facility charges for outpatient surgery | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | outpatient-physician-fee | Physician/Surgeon Fees (Outpatient Surgery) | Professional fees for physicians and surgeons for outpatient surgery | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | emergency-room-care | Emergency Room Care | Emergency department services | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | emergency-medical-transport | Emergency Medical Transportation | Ambulance and emergency medical transport services | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | urgent-care | Urgent Care | Urgent care facility services | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | hospital-facility-fee | Facility Fee (e.g., Hospital Room) | Facility charges for hospital inpatient stays | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | hospital-physician-fee | Physician/Surgeon Fees (Hospital Stay) | Professional fees for physicians and surgeons during hospital stays | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | mental-health-outpatient | Mental/Behavioral Health Outpatient Services | Outpatient mental health and substance abuse services | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | mental-health-inpatient | Mental/Behavioral Health Inpatient Services | Inpatient mental health and substance abuse services | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | pregnancy-office-visits | Office Visits (Pregnancy) | Prenatal and postnatal office visits | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | pregnancy-delivery-professional | Childbirth/Delivery Professional Services | Professional services for childbirth and delivery | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | pregnancy-delivery-facility | Childbirth/Delivery Facility Services | Facility services for childbirth and delivery | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | home-health-care | Home Health Care | Home health care services | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | rehabilitation | Rehabilitation Services | Outpatient physical, occupational, and speech therapy | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | habilitation | Habilitation Services | Health care services that help develop or maintain daily living skills | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | skilled-nursing | Skilled Nursing Care | Skilled nursing facility services | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | durable-medical-equipment | Durable Medical Equipment | Medical equipment for home use such as wheelchairs, oxygen equipment | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | hospice | Hospice Services | End-of-life care services | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | children-eye-exam | Children's Eye Exam | Eye examinations for children | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | children-glasses | Children's Glasses | Eyeglasses for children | ||
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category | children-dental | Children's Dental Check-up | Routine 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 |