Consumer Real-Time Pharmacy Benefit Check FHIR IG
2.0.0-ballot - STU 2 Ballot

Consumer Real-Time Pharmacy Benefit Check FHIR IG, published by HL7 International / Pharmacy. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/carin-rtpbc/ and changes regularly. See the Directory of published versions

## : RTPBC Patient Pay Type Code System (Temporary)

Page standards status: Trial-use | Maturity Level: 2

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    <CodeSystem xmlns="http://hl7.org/fhir">
      <id value="rtpbc-patient-pay-type-temporary"/>
      <language value="en"/>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: CodeSystem rtpbc-patient-pay-type-temporary</b></p><a name="rtpbc-patient-pay-type-temporary"> </a><a name="hcrtpbc-patient-pay-type-temporary"> </a><p>This case-insensitive code system <code>http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary</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">deductible<a name="rtpbc-patient-pay-type-temporary-deductible"> </a></td><td>Deductible</td><td>Amount to be collected from a patient to be applied to a periodic deductible</td></tr><tr><td style="white-space:nowrap">accumulated-deductible<a name="rtpbc-patient-pay-type-temporary-accumulated-deductible"> </a></td><td>Accumulated deductible</td><td>Total deductible paid after amount associated with this request</td></tr><tr><td style="white-space:nowrap">remaining-deductible<a name="rtpbc-patient-pay-type-temporary-remaining-deductible"> </a></td><td>Remaining deductible</td><td>Remaining deductible amount after payment associated with this request</td></tr><tr><td style="white-space:nowrap">coinsurance<a name="rtpbc-patient-pay-type-temporary-coinsurance"> </a></td><td>Per prescription coinsurance</td><td>Amount to be collected from a patient to satisfy a per prescription coinsurance</td></tr><tr><td style="white-space:nowrap">copay<a name="rtpbc-patient-pay-type-temporary-copay"> </a></td><td>Copay</td><td>Amount to be collected from the patient to satisfy a per prescription copay</td></tr><tr><td style="white-space:nowrap">tax<a name="rtpbc-patient-pay-type-temporary-tax"> </a></td><td>Tax</td><td>Amount to be collected from the patient for sales tax</td></tr><tr><td style="white-space:nowrap">cash-price<a name="rtpbc-patient-pay-type-temporary-cash-price"> </a></td><td>Full product cash price</td><td>Full product cash price before discounts or coupons</td></tr><tr><td style="white-space:nowrap">coupon-discount<a name="rtpbc-patient-pay-type-temporary-coupon-discount"> </a></td><td>Coupon discount amount</td><td>Coupon discount reducing the amount to be collected from the patient</td></tr><tr><td style="white-space:nowrap">member-discount<a name="rtpbc-patient-pay-type-temporary-member-discount"> </a></td><td>Member discount amount</td><td>Member discount reducing the amount to be collected from the patient</td></tr><tr><td style="white-space:nowrap">other-discount<a name="rtpbc-patient-pay-type-temporary-other-discount"> </a></td><td>Other discount amount</td><td>Other discount reducing the amount to be collected from the patient</td></tr><tr><td style="white-space:nowrap">other-cost<a name="rtpbc-patient-pay-type-temporary-other-cost"> </a></td><td>Other cost</td><td>Other amount to be collected from the patient</td></tr><tr><td style="white-space:nowrap">eligible<a name="rtpbc-patient-pay-type-temporary-eligible"> </a></td><td>Eligible amount</td><td>Amount that is considered for adjudication</td></tr><tr><td style="white-space:nowrap">total<a name="rtpbc-patient-pay-type-temporary-total"> </a></td><td>Total patient responsibility</td><td>Amount equalling the total patient responsibility for a prescription product's cost</td></tr></table></div>
      </text>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
        <valueInteger value="2"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
        <valueCode value="phx"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
        <valueCode value="trial-use">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
            <valueCanonical
                            value="http://hl7.org/fhir/us/carin-rtpbc/ImplementationGuide/hl7.fhir.us.carin-rtpbc"/>
          </extension>
        </valueCode>
      </extension>
      <url
           value="http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary"/>
      <version value="2.0.0-ballot"/>
      <name value="RtpbcPatientPayTypeCodeSystem"/>
      <title value="RTPBC Patient Pay Type Code System (Temporary)"/>
      <status value="active"/>
      <experimental value="false"/>
      <date value="2026-03-01T00:00:00-05:00"/>
      <publisher value="HL7 International / Pharmacy"/>
      <contact>
        <name value="HL7 International / Pharmacy"/>
        <telecom>
          <system value="url"/>
          <value value="http://www.hl7.org/Special/committees/medication"/>
        </telecom>
      </contact>
      <contact>
        <name value="Frank McKinney"/>
        <telecom>
          <system value="email"/>
          <value value="fm@frankmckinney.com"/>
        </telecom>
      </contact>
      <description
                   value="This code system defines components of a patient's responsibility for a prescription product's cost. (The contents of this code system are expected to be incorporated into the THO code system https://terminology.hl7.org/en/CodeSystem-adjudication.html)"/>
      <jurisdiction>
        <coding>
          <system value="urn:iso:std:iso:3166"/>
          <code value="US"/>
          <display value="United States of America"/>
        </coding>
      </jurisdiction>
      <caseSensitive value="false"/>
      <content value="complete"/>
      <count value="13"/>
      <concept>
        <code value="deductible"/>
        <display value="Deductible"/>
        <definition
                    value="Amount to be collected from a patient to be applied to a periodic deductible"/>
      </concept>
      <concept>
        <code value="accumulated-deductible"/>
        <display value="Accumulated deductible"/>
        <definition
                    value="Total deductible paid after amount associated with this request"/>
      </concept>
      <concept>
        <code value="remaining-deductible"/>
        <display value="Remaining deductible"/>
        <definition
                    value="Remaining deductible amount after payment associated with this request"/>
      </concept>
      <concept>
        <code value="coinsurance"/>
        <display value="Per prescription coinsurance"/>
        <definition
                    value="Amount to be collected from a patient to satisfy a per prescription coinsurance"/>
      </concept>
      <concept>
        <code value="copay"/>
        <display value="Copay"/>
        <definition
                    value="Amount to be collected from the patient to satisfy a per prescription copay"/>
      </concept>
      <concept>
        <code value="tax"/>
        <display value="Tax"/>
        <definition
                    value="Amount to be collected from the patient for sales tax"/>
      </concept>
      <concept>
        <code value="cash-price"/>
        <display value="Full product cash price"/>
        <definition value="Full product cash price before discounts or coupons"/>
      </concept>
      <concept>
        <code value="coupon-discount"/>
        <display value="Coupon discount amount"/>
        <definition
                    value="Coupon discount reducing the amount to be collected from the patient"/>
      </concept>
      <concept>
        <code value="member-discount"/>
        <display value="Member discount amount"/>
        <definition
                    value="Member discount reducing the amount to be collected from the patient"/>
      </concept>
      <concept>
        <code value="other-discount"/>
        <display value="Other discount amount"/>
        <definition
                    value="Other discount reducing the amount to be collected from the patient"/>
      </concept>
      <concept>
        <code value="other-cost"/>
        <display value="Other cost"/>
        <definition value="Other amount to be collected from the patient"/>
      </concept>
      <concept>
        <code value="eligible"/>
        <display value="Eligible amount"/>
        <definition value="Amount that is considered for adjudication"/>
      </concept>
      <concept>
        <code value="total"/>
        <display value="Total patient responsibility"/>
        <definition
                    value="Amount equalling the total patient responsibility for a prescription product's cost"/>
      </concept>
    </CodeSystem>