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4.4.1.388 ValueSet http://hl7.org/fhir/ValueSet/ex-benefitcategory

Responsible Owner: Financial Management icon

Work Group

Informative

Use Context: Country: World

Official URL: `http://hl7.org/fhir/ValueSet/ex-benefitcategory`				Version: 6.0.0-ballot3
active as of 2025-11-20				Computable Name: BenefitCategoryCodes
Flags:				OID: 2.16.840.1.113883.4.642.3.1174

This value set is used in the following places:

Resource: CoverageEligibilityResponse.insurance.item.category (CodeableConcept / Example)
Resource: ExplanationOfBenefit.item.category (CodeableConcept / Example)
Resource: ExplanationOfBenefit.item.detail.category (CodeableConcept / Example)
Resource: ExplanationOfBenefit.item.detail.subDetail.category (CodeableConcept / Example)
Resource: ExplanationOfBenefit.addItem.category (CodeableConcept / Example)
Resource: ExplanationOfBenefit.benefitBalance.category (CodeableConcept / Example)
Resource: ClaimResponse.addItem.category (CodeableConcept / Example)
Resource: Coverage.costToBeneficiary.category (CodeableConcept / Example)
Resource: CoverageEligibilityRequest.item.category (CodeableConcept / Example)
Resource: Claim.item.category (CodeableConcept / Example)
Resource: Claim.item.detail.category (CodeableConcept / Example)
Resource: Claim.item.detail.subDetail.category (CodeableConcept / Example)

4.4.1.388.1 Definition

This value set includes examples of Benefit Category codes.

4.4.1.388.2 Content Logical Definition

Generated Narrative: ValueSet ex-benefitcategory

Last updated: 2025-11-20T23:56:49.898Z

Include all codes defined in http://terminology.hl7.org/CodeSystem/ex-benefitcategory version 📦1.0.1

4.4.1.388.3 Expansion

This expansion generated 20 Nov 2025

ValueSet

Expansion performed internally based on codesystem Benefit Category Codes v1.0.1 (CodeSystem) icon

This value set contains 28 concepts

System	Code	Display	Definition
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	1	Medical Care	Medical Care.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	2	Surgical	Surgical.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	3	Consultation	Consultation.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	4	Diagnostic XRay	Diagnostic XRay.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	5	Diagnostic Lab	Diagnostic Lab.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	14	Renal Supplies	Renal Supplies excluding Dialysis.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	23	Diagnostic Dental	Diagnostic Dental.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	24	Periodontics	Periodontics.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	25	Restorative	Restorative.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	26	Endodontics	Endodontics.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	27	Maxillofacial Prosthetics	Maxillofacial Prosthetics.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	28	Adjunctive Dental Services	Adjunctive Dental Services.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	30	Health Benefit Plan Coverage	Health Benefit Plan Coverage.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	35	Dental Care	Dental Care.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	36	Dental Crowns	Dental Crowns.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	37	Dental Accident	Dental Accident.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	49	Hospital Room and Board	Hospital Room and Board.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	55	Major Medical	Major Medical.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	56	Medically Related Transportation	Medically Related Transportation.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	61	In-vitro Fertilization	In-vitro Fertilization.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	62	MRI Scan	MRI Scan.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	63	Donor Procedures	Donor Procedures such as organ harvest.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	69	Maternity	Maternity.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	76	Renal Dialysis	Renal dialysis.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	F1	Medical Coverage	Medical Coverage.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	F3	Dental Coverage	Dental Coverage.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	F4	Hearing Coverage	Hearing Coverage.
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	F6	Vision Coverage	Vision Coverage.

See the full registry of value sets defined as part of FHIR.

Explanation of the columns that may appear on this page:

Lvl

A few code lists that FHIR defines are hierarchical - each code is assigned a level. For value sets, levels are mostly used to organize codes for user convenience, but may follow code system hierarchy - see Code System for further information

Source

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). If the code is in italics, this indicates that the code is not selectable ('Abstract')

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