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

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

Official URL: http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary | Version: 2.0.0-ballot | Highlight text changes?
Standards status: Trial-use Active as of 2026-03-01 | Maturity Level: 2 | Computable Name: RtpbcPatientPayTypeCodeSystem

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)

This Code system is referenced in the definition of the following value sets:

- RtbpcPatientPayTypeValueSet

This case-insensitive code system `http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary` defines the following codes:

Code | Display | Definition
deductible | Deductible | Amount to be collected from a patient to be applied to a periodic deductible
accumulated-deductible | Accumulated deductible | Total deductible paid after amount associated with this request
remaining-deductible | Remaining deductible | Remaining deductible amount after payment associated with this request
coinsurance | Per prescription coinsurance | Amount to be collected from a patient to satisfy a per prescription coinsurance
copay | Copay | Amount to be collected from the patient to satisfy a per prescription copay
tax | Tax | Amount to be collected from the patient for sales tax
cash-price | Full product cash price | Full product cash price before discounts or coupons
coupon-discount | Coupon discount amount | Coupon discount reducing the amount to be collected from the patient
member-discount | Member discount amount | Member discount reducing the amount to be collected from the patient
other-discount | Other discount amount | Other discount reducing the amount to be collected from the patient
other-cost | Other cost | Other amount to be collected from the patient
eligible | Eligible amount | Amount that is considered for adjudication
total | Total patient responsibility | Amount equalling the total patient responsibility for a prescription product's cost

Description of the above table(s).