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4.4.1.420 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 2025-10-13				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)

4.4.1.420.1 Definition

This value set includes examples of Benefit Category codes.

4.4.1.420.2 Content Logical Definition

Generated Narrative: ValueSet ex-benefitcategory

Last updated: 2025-10-13T15:54:10.839Z

Profile: Shareable ValueSet

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

4.4.1.420.3 Expansion

This expansion generated 13 Oct 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
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	1	Medical Care
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	2	Surgical
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	3	Consultation
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	4	Diagnostic XRay
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	5	Diagnostic Lab
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	14	Renal Supplies
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	23	Diagnostic Dental
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	24	Periodontics
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	25	Restorative
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	26	Endodontics
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	27	Maxillofacial Prosthetics
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	28	Adjunctive Dental Services
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	30	Health Benefit Plan Coverage
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	35	Dental Care
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	36	Dental Crowns
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	37	Dental Accident
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	49	Hospital Room and Board
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	55	Major Medical
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	56	Medically Related Transportation
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	61	In-vitro Fertilization
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	62	MRI Scan
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	63	Donor Procedures
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	69	Maternity
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	76	Renal Dialysis
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	F1	Medical Coverage
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	F3	Dental Coverage
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	F4	Hearing Coverage
`http://terminology.hl7.org/CodeSystem/ex-benefitcategory`	F6	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