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4.4.1.538 ValueSet http://hl7.org/fhir/ValueSet/coverage-copay-type

Responsible Owner: Financial Management Work Group

Normative

Use Context: Country: World

• Narrative
• XML
• JSON
• TTL

This value set is used in the following places:

• Resource: Coverage.costToBeneficiary.type (CodeableConcept / Extensible)

4.4.1.538.1 Definition

This value set includes sample Coverage Copayment Type codes.

4.4.1.538.2 Content Logical Definition

4.4.1.538.3 Expansion

This expansion generated 07 Nov 2026

ValueSet

Expansion performed internally based on codesystem Coverage Copay Type Codes v2.0.0 (CodeSystem)

This value set contains 27 concepts

Level	System	Code	Display	Definition
1	http://terminology.hl7.org/CodeSystem/coverage-copay-type	gpvisit	GP Office Visit	An office visit for a general practitioner of a discipline.
1	http://terminology.hl7.org/CodeSystem/coverage-copay-type	spvisit	Specialist Office Visit	An office visit for a specialist practitioner of a discipline
1	http://terminology.hl7.org/CodeSystem/coverage-copay-type	emergency	Emergency	An episode in an emergency department.
1	http://terminology.hl7.org/CodeSystem/coverage-copay-type	inpthosp	Inpatient Hospital	An episode of an Inpatient hospital stay.
1	http://terminology.hl7.org/CodeSystem/coverage-copay-type	televisit	Tele-visit	A visit held where the patient is remote relative to the practitioner, e.g. by phone, computer or video conference.
1	http://terminology.hl7.org/CodeSystem/coverage-copay-type	urgentcare	Urgent Care	A visit to an urgent care facility - typically a community care clinic.
1	http://terminology.hl7.org/CodeSystem/coverage-copay-type	rx	Prescription	Prescription drug and pharmacy-related services.
1	http://terminology.hl7.org/CodeSystem/coverage-copay-type	copaypct	Copay Percentage	A standard percentage applied to all classes or service or product not otherwise specified.
1	http://terminology.hl7.org/CodeSystem/coverage-copay-type	copay	Copay Amount	A standard fixed currency amount applied to all classes or service or product not otherwise specified.
1	http://terminology.hl7.org/CodeSystem/coverage-copay-type	deductible	Deductible	The accumulated amount of patient payment before the coverage begins to pay for services.
2	http://terminology.hl7.org/CodeSystem/coverage-copay-type	FamOutDed	Family Out of Network Deductible	The accumulated amount applied toward the family's out-of-network deductible before the coverage begins to pay for covered out-of-network services.
2	http://terminology.hl7.org/CodeSystem/coverage-copay-type	FamInDed	Family In Network Deductible	The accumulated amount applied toward the family's in-network deductible before the coverage begins to pay for covered in-network services.
2	http://terminology.hl7.org/CodeSystem/coverage-copay-type	FamRxOutDed	Family Pharmacy Out of Network Deductible	The accumulated amount applied toward the family's out-of-network pharmacy deductible before the coverage begins to pay for covered out-of-network pharmacy services.
2	http://terminology.hl7.org/CodeSystem/coverage-copay-type	FamRxInDed	Family Pharmacy In Network Deductible	The accumulated amount applied toward the family's in-network pharmacy deductible before the coverage begins to pay for covered in-network pharmacy services.
2	http://terminology.hl7.org/CodeSystem/coverage-copay-type	IndOutDed	Invidual Out of Network Deductible	The accumulated amount applied toward the individual's out-of-network deductible before the coverage begins to pay for covered out-of-network services.
2	http://terminology.hl7.org/CodeSystem/coverage-copay-type	IndInDed	Individual In Network Deductible	The accumulated amount applied toward the individual's in-network deductible before the coverage begins to pay for covered in-network services.
2	http://terminology.hl7.org/CodeSystem/coverage-copay-type	IndRxOutDed	Individual Pharmacy Out of Network Deductible	The accumulated amount applied toward the individual's out-of-network pharmacy deductible before the coverage begins to pay for covered out-of-network pharmacy services.
2	http://terminology.hl7.org/CodeSystem/coverage-copay-type	IndRxInDed	Individual Pharmacy In Network Deductible	The accumulated amount applied toward the individual's in-network pharmacy deductible before the coverage begins to pay for covered in-network pharmacy services.
1	http://terminology.hl7.org/CodeSystem/coverage-copay-type	maxoutofpocket	Maximum out of pocket	The maximum amout of payment for services which a patient, or family, is expected to incur - typically annually.
2	http://terminology.hl7.org/CodeSystem/coverage-copay-type	FamOutMax	Family Out of Network Out of Pocket Maximum	The maximum amount of out-of-pocket payment that a family is expected to incur for covered out-of-network services.
2	http://terminology.hl7.org/CodeSystem/coverage-copay-type	FamInMax	Family In Network Out of Pocket Maximum	The maximum amount of out-of-pocket payment that a family is expected to incur for covered in-network services.
2	http://terminology.hl7.org/CodeSystem/coverage-copay-type	FamRxOutMax	Family Pharmacy Out of Network Out of Pocket Maximum	The maximum amount of out-of-pocket payment that a family is expected to incur for covered out-of-network pharmacy services.
2	http://terminology.hl7.org/CodeSystem/coverage-copay-type	FamRxInMax	Family Pharmacy In Network Out of Pocket Maximum	The maximum amount of out-of-pocket payment that a family is expected to incur for covered in-network pharmacy services.
2	http://terminology.hl7.org/CodeSystem/coverage-copay-type	IndOutMax	Individual Out of Network Out of Pocket Maximum	The maximum amount of out-of-pocket payment that an individual is expected to incur for covered out-of-network services.
2	http://terminology.hl7.org/CodeSystem/coverage-copay-type	IndInMax	Individual In Network Out of Pocket Maximum	The maximum amount of out-of-pocket payment that an individual is expected to incur for covered in-network services.
2	http://terminology.hl7.org/CodeSystem/coverage-copay-type	IndRxOutMax	Individual Pharmacy Out of Network Out of Pocket Maximum	The maximum amount of out-of-pocket payment that an individual is expected to incur for covered out-of-network pharmacy services.
2	http://terminology.hl7.org/CodeSystem/coverage-copay-type	IndRxInMax	Individual Pharmacy In Network Out of Pocket Maximum	The maximum amount of out-of-pocket payment that an individual is expected to incur for covered in-network pharmacy services.

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

Explanation of the columns that may appear on this page: