Consumer Real-Time Pharmacy Benefit Check FHIR IG
2.0.0-ballot - STU 2 Ballot United States of America flag

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
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:

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

CodeDisplayDefinition
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).