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

Financial Management icon

Work Group

Maturity Level: 1

Draft

Use Context: Country: World

Official URL: `http://hl7.org/fhir/ValueSet/ex-benefitcategory`				Version: 6.0.0-ballot3
draft as of 2025-08-28				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.benefitBalance.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)

4.4.1.208.1 Definition

This value set includes examples of Benefit Category codes.

4.4.1.208.2 Content Logical Definition

Generated Narrative: ValueSet ex-benefitcategory

Last updated: 2025-08-28T16:54:01.036Z

Profile: Shareable ValueSet

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

4.4.1.208.3 Expansion

This expansion generated 28 Aug 2025

ValueSet

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

This value set contains 28 concepts

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