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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    {
      "resourceType" : "CodeSystem",
      "id" : "rtpbc-patient-pay-type-temporary",
      "language" : "en",
      "text" : {
        "status" : "generated",
        "div" : "<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>"
      },
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
          "valueInteger" : 2
        },
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
          "valueCode" : "phx"
        },
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
          "valueCode" : "trial-use",
          "_valueCode" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
                "valueCanonical" : "http://hl7.org/fhir/us/carin-rtpbc/ImplementationGuide/hl7.fhir.us.carin-rtpbc"
              }
            ]
          }
        }
      ],
      "url" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary",
      "version" : "2.0.0-ballot",
      "name" : "RtpbcPatientPayTypeCodeSystem",
      "title" : "RTPBC Patient Pay Type Code System (Temporary)",
      "status" : "active",
      "experimental" : false,
      "date" : "2026-03-01T00:00:00-05:00",
      "publisher" : "HL7 International / Pharmacy",
      "contact" : [
        {
          "name" : "HL7 International / Pharmacy",
          "telecom" : [
            {
              "system" : "url",
              "value" : "http://www.hl7.org/Special/committees/medication"
            }
          ]
        },
        {
          "name" : "Frank McKinney",
          "telecom" : [
            {
              "system" : "email",
              "value" : "fm@frankmckinney.com"
            }
          ]
        }
      ],
      "description" : "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" : "urn:iso:std:iso:3166",
              "code" : "US",
              "display" : "United States of America"
            }
          ]
        }
      ],
      "caseSensitive" : false,
      "content" : "complete",
      "count" : 13,
      "concept" : [
        {
          "code" : "deductible",
          "display" : "Deductible",
          "definition" : "Amount to be collected from a patient to be applied to a periodic deductible"
        },
        {
          "code" : "accumulated-deductible",
          "display" : "Accumulated deductible",
          "definition" : "Total deductible paid after amount associated with this request"
        },
        {
          "code" : "remaining-deductible",
          "display" : "Remaining deductible",
          "definition" : "Remaining deductible amount after payment associated with this request"
        },
        {
          "code" : "coinsurance",
          "display" : "Per prescription coinsurance",
          "definition" : "Amount to be collected from a patient to satisfy a per prescription coinsurance"
        },
        {
          "code" : "copay",
          "display" : "Copay",
          "definition" : "Amount to be collected from the patient to satisfy a per prescription copay"
        },
        {
          "code" : "tax",
          "display" : "Tax",
          "definition" : "Amount to be collected from the patient for sales tax"
        },
        {
          "code" : "cash-price",
          "display" : "Full product cash price",
          "definition" : "Full product cash price before discounts or coupons"
        },
        {
          "code" : "coupon-discount",
          "display" : "Coupon discount amount",
          "definition" : "Coupon discount reducing the amount to be collected from the patient"
        },
        {
          "code" : "member-discount",
          "display" : "Member discount amount",
          "definition" : "Member discount reducing the amount to be collected from the patient"
        },
        {
          "code" : "other-discount",
          "display" : "Other discount amount",
          "definition" : "Other discount reducing the amount to be collected from the patient"
        },
        {
          "code" : "other-cost",
          "display" : "Other cost",
          "definition" : "Other amount to be collected from the patient"
        },
        {
          "code" : "eligible",
          "display" : "Eligible amount",
          "definition" : "Amount that is considered for adjudication"
        },
        {
          "code" : "total",
          "display" : "Total patient responsibility",
          "definition" : "Amount equalling the total patient responsibility for a prescription product's cost"
        }
      ]
    }