Validated Healthcare Directory, published by HL7 International / Patient Administration. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/VhDir/ and changes regularly. See the Directory of published versions

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: VhDir Benefit Type - JSON Representation

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{
  "resourceType" : "ValueSet",
  "id" : "benefit-type",
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ValueSet benefit-type</b></p><a name=\"benefit-type\"> </a><a name=\"hcbenefit-type\"> </a><a name=\"benefit-type-en-US\"> </a><ul><li>Include these codes as defined in <a href=\"CodeSystem-payercharacteristics.html\"><code>http://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristics</code></a><table class=\"none\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-pcpov\">pcpov</a></td><td style=\"color: #cccccc\">Primary Care Visit to Treat an Injury or Illness</td><td>Benefit plan covers services rendered by a primary care physician during an office visit with the purpose to treat injury or illness, except for preventive care services.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-specialistov\">specialistov</a></td><td style=\"color: #cccccc\">Specialist Office Visit</td><td>Covered healthcare service rendered to a patient by a specialty provider.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-mlpov\">mlpov</a></td><td style=\"color: #cccccc\">Other Practitioner Office Visit (Nurse, Physician Assistant) - Mid Level Professional</td><td>Benefit plan covers covered health related services rendered by a practioner other than MD or DO and referred to as other practitioner.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-outpatient\">outpatient</a></td><td style=\"color: #cccccc\">Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)</td><td>Benefit plan covers health related services rendered to patient at an outpatient facility, outside of a facility that requires a patient admission.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-outpatstx\">outpatstx</a></td><td style=\"color: #cccccc\">Outpatient Surgery Physician/Surgical Services</td><td>Benefit plan covers surgical services rendered to patient outside of a facility admission, referred to as outpatient.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-hospserv\">hospserv</a></td><td style=\"color: #cccccc\">Hospice Services</td><td>Benefit plan covers hospice services.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-routinedental\">routinedental</a></td><td style=\"color: #cccccc\">Routine Dental Services (Adult)</td><td>Benefit plan covers routine dental services.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-infertilitytx\">infertilitytx</a></td><td style=\"color: #cccccc\">Infertility Treatment</td><td>Benefit plan covers eligible infertility treatment services.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-ltnhc\">ltnhc</a></td><td style=\"color: #cccccc\">Long-Term/Custodial Nursing Home Care</td><td>Long-Term/Custodial Nursing Home Care.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-privatenurse\">privatenurse</a></td><td style=\"color: #cccccc\">Private-Duty Nursing</td><td>Private-Duty Nursing.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-routineeye\">routineeye</a></td><td style=\"color: #cccccc\">Routine Eye Exam (Adult)</td><td>Routine Eye Exam (Adult).</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-ucservice\">ucservice</a></td><td style=\"color: #cccccc\">Urgent Care Centers or Facilities</td><td>Urgent Care Centers or Facilities.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-homehealth\">homehealth</a></td><td style=\"color: #cccccc\">Home Health</td><td>Home health services insurance coverage.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-erservice\">erservice</a></td><td style=\"color: #cccccc\">Emergency Room Services</td><td>Emergency Room Services.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-ambulance\">ambulance</a></td><td style=\"color: #cccccc\">Emergency Room Services</td><td>Emergency Room Services.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-inpatienthospital\">inpatienthospital</a></td><td style=\"color: #cccccc\">Inpatient Hospital Services (e.g., Hospital Stay)</td><td>A person who is hospitalized for at least one night to receive treatment or participate in a study.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-inpatientprovider\">inpatientprovider</a></td><td style=\"color: #cccccc\">Inpatient Physician and Surgical Services</td><td>A healthcare provider who is delivering healthcare services in a hospital environment.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-bariatricsurg\">bariatricsurg</a></td><td style=\"color: #cccccc\">Bariatric Surgery</td><td>Bariatric surgery service Skilled nursing service (qualifier value).</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-cosmeticsurg\">cosmeticsurg</a></td><td style=\"color: #cccccc\">Cosmetic Surgery</td><td>Cosmetic surgery service  Skilled nursing service (qualifier value).</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-skillednursing\">skillednursing</a></td><td style=\"color: #cccccc\">Skilled Nursing Facility</td><td>Skilled nursing service (qualifier value).</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-ppnatalcare\">ppnatalcare</a></td><td style=\"color: #cccccc\">Prenatal and Postnatal Care</td><td>Prenatal and Postnatal services.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-maternitycare\">maternitycare</a></td><td style=\"color: #cccccc\">Delivery and All Inpatient Services for Maternity Care</td><td>All maternity care services.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-menthlthoutp\">menthlthoutp</a></td><td style=\"color: #cccccc\">Mental/Behavioral Health Outpatient Services</td><td>Mental health service delivered in an outpatient setting.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-menthlthinp\">menthlthinp</a></td><td style=\"color: #cccccc\">Mental/Behavioral Health Inpatient Services</td><td>Mental health service delivered in an hospital or inpatient facility setting.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-sadoutp\">sadoutp</a></td><td style=\"color: #cccccc\">Substance Abuse Disorder Outpatient Services</td><td>Substance abuse related services delivered in a outpatient setting.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-sadinp\">sadinp</a></td><td style=\"color: #cccccc\">Substance Abuse Disorder Inpatient Services</td><td>Substance abuse related services delivered in a inpatient setting.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-drggenric\">drggenric</a></td><td style=\"color: #cccccc\">Generic Drugs</td><td>Generic drugs eligible benefits.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-drgbrand\">drgbrand</a></td><td style=\"color: #cccccc\">Preferred Brand Drugs</td><td>Preferred brand drugs eligible benefits.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-drgnonpreferred\">drgnonpreferred</a></td><td style=\"color: #cccccc\">Non-Preferred Brand Drugs</td><td>Non-Preferred drugs brands eligible benefits.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-drgspecialty\">drgspecialty</a></td><td style=\"color: #cccccc\">Specialty Drugs</td><td>Benefit plan covers specialty drugs.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-rehaboutp\">rehaboutp</a></td><td style=\"color: #cccccc\">Outpatient Rehabilitation Services</td><td>Benefit plan covers outpatient rehabilitation services.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-servicehablitation\">servicehablitation</a></td><td style=\"color: #cccccc\">Habilitation Services</td><td>Habilitation Services.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-chiro\">chiro</a></td><td style=\"color: #cccccc\">Chiropractic Care</td><td>Benefit plan covers chiropractor eligible benefits.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-dme\">dme</a></td><td style=\"color: #cccccc\">Durable Medical Equipment</td><td>Benefit plan covers Durable medical equipment eligible benefits.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-hearingaids\">hearingaids</a></td><td style=\"color: #cccccc\">Hearing Aids</td><td>Benefit plan covers hearing aids.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-imgctpetmri\">imgctpetmri</a></td><td style=\"color: #cccccc\">Imaging (CT/PET Scans, MRIs)</td><td>Benefit plan covers advances imaging techniques services (CT/PET Scans, MRIs) eligible services.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-prev\">prev</a></td><td style=\"color: #cccccc\">Preventive Care/Screening/Immunization</td><td>Routine healthcare services to prevent health related problems eligible benefits.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-rtnpod\">rtnpod</a></td><td style=\"color: #cccccc\">Routine Foot Care</td><td>Routine Foot Care.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-acupuncture\">acupuncture</a></td><td style=\"color: #cccccc\">Acupuncture</td><td>Benefit plan covers acupuncture treatment.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-weightloss\">weightloss</a></td><td style=\"color: #cccccc\">Weight Loss Programs</td><td>Benefit plan covers weight loss services eligible benefits.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-rtneyechld\">rtneyechld</a></td><td style=\"color: #cccccc\">Routine Eye Exam for Children</td><td>Routine eye exam for children eligible benefits.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-glasseschld\">glasseschld</a></td><td style=\"color: #cccccc\">Eye Glasses for Children</td><td>Eye glasses children eligible benefits.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-rtndntlchld\">rtndntlchld</a></td><td style=\"color: #cccccc\">Dental Check-Up for Children</td><td>Dental Check-Up for Children.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-speachthpy\">speachthpy</a></td><td style=\"color: #cccccc\">Rehabilitative Speech Therapy</td><td>Benefit plan covers rehabilitative speech therapy eligible benefits.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-rehaboccandpt\">rehaboccandpt</a></td><td style=\"color: #cccccc\">Rehabilitative Occupational and Rehabilitative Physical Therapy</td><td>Benefit plan covers rehabilitative occupational and rehabilitative physical  eligible benefits.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-wellbaby\">wellbaby</a></td><td style=\"color: #cccccc\">Well Baby Visits and Care</td><td>Regularly scheduled, preventive care services, including immunizations, provided to children up to an age as specified by a health insurance company or mandated by a government agency.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-laboutp\">laboutp</a></td><td style=\"color: #cccccc\">Laboratory Outpatient and Professional Services</td><td>Benefit plan covers laboratory testing and related professional services received as outpatient.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-imagingdx\">imagingdx</a></td><td style=\"color: #cccccc\">X-rays and Diagnostic Imaging</td><td>Benefit plan covers diagnostic imaging procedures that produce images of internal structures of the human body and uses radiation to diagnose and treat diseases.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-dntlbaschld\">dntlbaschld</a></td><td style=\"color: #cccccc\">Basic Dental Care – Child</td><td>Benefit plan covers diagnostic basic dental care.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-orthochld\">orthochld</a></td><td style=\"color: #cccccc\">Orthodontia – Child</td><td>Benefit plan covers orthodontia for children.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-dntlmajchld\">dntlmajchld</a></td><td style=\"color: #cccccc\">Major Dental Care – Child</td><td>Benefit plan covers major dental care for children.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-dntlbasadlt\">dntlbasadlt</a></td><td style=\"color: #cccccc\">Basic Dental Care – Adult</td><td>Benefit plan covers basic dental care for adults.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-orthodadlt\">orthodadlt</a></td><td style=\"color: #cccccc\">Orthodontia – Adult</td><td>Benefits plan covers services provided that are required for orthodontic purposes for an adult.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-dntlmajadlt\">dntlmajadlt</a></td><td style=\"color: #cccccc\">Major Dental Care – Adult</td><td>Benefit plan covers major dental care for adult.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-abortion\">abortion</a></td><td style=\"color: #cccccc\">Abortion for Which Public Funding is Prohibited</td><td>Benefit plan covers services for abortion for which public funding is prohibited.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-transplant\">transplant</a></td><td style=\"color: #cccccc\">Transplant</td><td>Benefit plan covers transplant related services.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-accdntl\">accdntl</a></td><td style=\"color: #cccccc\">Accidental Dental</td><td>Benefit plan covers dental care services related to an accident.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-dialysis\">dialysis</a></td><td style=\"color: #cccccc\">Dialysis</td><td>The plan benefit  covers services used to treat end stage renal disease.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-testallrgy\">testallrgy</a></td><td style=\"color: #cccccc\">Allergy Testing</td><td>The plan benefits covers services for diagnostic procedures ordered or performed to evaluate whether a sensitivity to a substance is present. This test may be associated with specimen collection and/or substance administration challenge activities.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-chemotherapy\">chemotherapy</a></td><td style=\"color: #cccccc\">Chemotherapy</td><td>The plan benefits cover services the use of drugs and approved chemicals to treat disease.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-radiation\">radiation</a></td><td style=\"color: #cccccc\">Radiation</td><td>The plan benefits cover services the use radiation to treat disease.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-edudiab\">edudiab</a></td><td style=\"color: #cccccc\">Diabetes Education</td><td>The plan benefits cover services related to instruction or training that encourages behaviors most likely to optimize health potentials through information about diabetes; facilitates the prevention of diabetes.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-prosthetic\">prosthetic</a></td><td style=\"color: #cccccc\">Prosthetic Devices</td><td>Plan benefit covers services related to  prosthesis devices.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-infusiontx\">infusiontx</a></td><td style=\"color: #cccccc\">Infusion Therapy</td><td>Plan benefit covers services related to infusion therapy.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-tmjtx\">tmjtx</a></td><td style=\"color: #cccccc\">Treatment for Temporomandibular Joint Disorders</td><td>Plan benefit covers services related to treatment of Temporomandibular Joint disorder.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-nutrition\">nutrition</a></td><td style=\"color: #cccccc\">Nutritional Counseling</td><td>Nutritional Counseling.</td></tr><tr><td><a href=\"CodeSystem-payercharacteristics.html#payercharacteristics-reconsurg\">reconsurg</a></td><td style=\"color: #cccccc\">Reconstructive Surgery</td><td>Plan benefit covers services related to reconstructive surgery.</td></tr></table></li></ul></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode" : "pa"
    }
  ],
  "url" : "http://hl7.org/fhir/uv/vhdir/ValueSet/benefit-type",
  "version" : "1.0.0",
  "name" : "VhDirBenefitType",
  "title" : "VhDir Benefit Type",
  "status" : "active",
  "experimental" : false,
  "date" : "2018-02-21",
  "publisher" : "HL7 International / Patient Administration",
  "contact" : [
    {
      "name" : "HL7 International / Patient Administration",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/pafm"
        },
        {
          "system" : "email",
          "value" : "pafm@lists.HL7.org"
        }
      ]
    }
  ],
  "description" : "This value set defines a set of codes that indicate the type of benefit in a product/plan.",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
          "code" : "001",
          "display" : "World"
        }
      ]
    }
  ],
  "copyright" : "Used by permission of HL7 International all rights reserved Creative Commons License",
  "compose" : {
    "include" : [
      {
        "system" : "http://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristics",
        "concept" : [
          {
            "code" : "pcpov"
          },
          {
            "code" : "specialistov"
          },
          {
            "code" : "mlpov"
          },
          {
            "code" : "outpatient"
          },
          {
            "code" : "outpatstx"
          },
          {
            "code" : "hospserv"
          },
          {
            "code" : "routinedental"
          },
          {
            "code" : "infertilitytx"
          },
          {
            "code" : "ltnhc"
          },
          {
            "code" : "privatenurse"
          },
          {
            "code" : "routineeye"
          },
          {
            "code" : "ucservice"
          },
          {
            "code" : "homehealth"
          },
          {
            "code" : "erservice"
          },
          {
            "code" : "ambulance"
          },
          {
            "code" : "inpatienthospital"
          },
          {
            "code" : "inpatientprovider"
          },
          {
            "code" : "bariatricsurg"
          },
          {
            "code" : "cosmeticsurg"
          },
          {
            "code" : "skillednursing"
          },
          {
            "code" : "ppnatalcare"
          },
          {
            "code" : "maternitycare"
          },
          {
            "code" : "menthlthoutp"
          },
          {
            "code" : "menthlthinp"
          },
          {
            "code" : "sadoutp"
          },
          {
            "code" : "sadinp"
          },
          {
            "code" : "drggenric"
          },
          {
            "code" : "drgbrand"
          },
          {
            "code" : "drgnonpreferred"
          },
          {
            "code" : "drgspecialty"
          },
          {
            "code" : "rehaboutp"
          },
          {
            "code" : "servicehablitation"
          },
          {
            "code" : "chiro"
          },
          {
            "code" : "dme"
          },
          {
            "code" : "hearingaids"
          },
          {
            "code" : "imgctpetmri"
          },
          {
            "code" : "prev"
          },
          {
            "code" : "rtnpod"
          },
          {
            "code" : "acupuncture"
          },
          {
            "code" : "weightloss"
          },
          {
            "code" : "rtneyechld"
          },
          {
            "code" : "glasseschld"
          },
          {
            "code" : "rtndntlchld"
          },
          {
            "code" : "speachthpy"
          },
          {
            "code" : "rehaboccandpt"
          },
          {
            "code" : "wellbaby"
          },
          {
            "code" : "laboutp"
          },
          {
            "code" : "imagingdx"
          },
          {
            "code" : "dntlbaschld"
          },
          {
            "code" : "orthochld"
          },
          {
            "code" : "dntlmajchld"
          },
          {
            "code" : "dntlbasadlt"
          },
          {
            "code" : "orthodadlt"
          },
          {
            "code" : "dntlmajadlt"
          },
          {
            "code" : "abortion"
          },
          {
            "code" : "transplant"
          },
          {
            "code" : "accdntl"
          },
          {
            "code" : "dialysis"
          },
          {
            "code" : "testallrgy"
          },
          {
            "code" : "chemotherapy"
          },
          {
            "code" : "radiation"
          },
          {
            "code" : "edudiab"
          },
          {
            "code" : "prosthetic"
          },
          {
            "code" : "infusiontx"
          },
          {
            "code" : "tmjtx"
          },
          {
            "code" : "nutrition"
          },
          {
            "code" : "reconsurg"
          }
        ]
      }
    ]
  }
}