CARIN Digital Insurance Card, published by HL7 International / Payer/Provider Information Exchange Work Group. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/carin-digital-insurance-card/ and changes regularly. See the Directory of published versions

• Narrative Content
• XML
• JSON
• TTL

: Cost Tier Code System - JSON Representation

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{
  "resourceType" : "CodeSystem",
  "id" : "cost-tier",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem cost-tier</b></p><a name=\"cost-tier\"> </a><a name=\"hccost-tier\"> </a><p>This case-sensitive code system <code>http://hl7.org/fhir/us/insurance-card/CodeSystem/cost-tier</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\">value-choice<a name=\"cost-tier-value-choice\"> </a></td><td>Value Choice Provider</td><td>Cost sharing that applies when the service is delivered by a provider the plan has designated in its value or preferred-value tier</td></tr><tr><td style=\"white-space:nowrap\">standard<a name=\"cost-tier-standard\"> </a></td><td>Standard Provider</td><td>Cost sharing that applies when the service is delivered by an in-network provider without a special designation</td></tr><tr><td style=\"white-space:nowrap\">virtual<a name=\"cost-tier-virtual\"> </a></td><td>Virtual Visit</td><td>Cost sharing that applies when the service is delivered virtually (telehealth modality) rather than in person</td></tr></table></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode" : "claims"
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode" : "informative",
      "_valueCode" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical" : "http://hl7.org/fhir/us/insurance-card/ImplementationGuide/hl7.fhir.us.insurance-card"
          }
        ]
      }
    }
  ],
  "url" : "http://hl7.org/fhir/us/insurance-card/CodeSystem/cost-tier",
  "version" : "2.0.0",
  "name" : "CostTierCS",
  "title" : "Cost Tier Code System",
  "status" : "draft",
  "experimental" : true,
  "date" : "2026-06-25T21:16:04+00:00",
  "publisher" : "HL7 International / Payer/Provider Information Exchange Work Group",
  "contact" : [
    {
      "name" : "HL7 International / Payer/Provider Information Exchange Work Group",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/claims"
        },
        {
          "system" : "email",
          "value" : "pie@lists.HL7.org"
        }
      ]
    }
  ],
  "description" : "Code system for cost-sharing tiers that distinguish multiple cost amounts for the same benefit and network status, based on provider designation or modality of care",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US"
        }
      ]
    }
  ],
  "caseSensitive" : true,
  "content" : "complete",
  "count" : 3,
  "concept" : [
    {
      "code" : "value-choice",
      "display" : "Value Choice Provider",
      "definition" : "Cost sharing that applies when the service is delivered by a provider the plan has designated in its value or preferred-value tier"
    },
    {
      "code" : "standard",
      "display" : "Standard Provider",
      "definition" : "Cost sharing that applies when the service is delivered by an in-network provider without a special designation"
    },
    {
      "code" : "virtual",
      "display" : "Virtual Visit",
      "definition" : "Cost sharing that applies when the service is delivered virtually (telehealth modality) rather than in person"
    }
  ]
}