Da Vinci - Coverage Requirements Discovery, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.2.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-crd/ and changes regularly. See the Directory of published versions

• Narrative Content
• XML
• JSON
• TTL

: CRD Coverage Detail Categories Value Set - JSON Representation

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{
  "resourceType" : "ValueSet",
  "id" : "coverageDetailCategories",
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ValueSet coverageDetailCategories</b></p><a name=\"coverageDetailCategories\"> </a><a name=\"hccoverageDetailCategories\"> </a><ul><li>Include these codes as defined in <a href=\"CodeSystem-coverage-information-codes.html\"><code>http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes</code></a><table class=\"none\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td><a href=\"CodeSystem-coverage-information-codes.html#coverage-information-codes-cat-limitation\">cat-limitation</a></td><td style=\"color: #cccccc\">Coverage Limitation</td><td>The statement being made about coverage or authorization that are being constrained in scope in some way.  I.e. It is not safe to interpret the statements of 'this is covered' or 'this does not require prior auth' without looking at this detail.</td></tr><tr><td><a href=\"CodeSystem-coverage-information-codes.html#coverage-information-codes-cat-decisional\">cat-decisional</a></td><td style=\"color: #cccccc\">Decision Considerations</td><td>The statement does not qualify the coverage statement, however it does provide information that may be relevant to the patient &amp; caregiver decision of whether a therapy is appropriate/reasonable.</td></tr><tr><td><a href=\"CodeSystem-coverage-information-codes.html#coverage-information-codes-cat-other\">cat-other</a></td><td style=\"color: #cccccc\">Other Details</td><td>The statement does not limit the coverage statement being made and is unlikely to influence a decision to proceed with care.  For example, instructions on how to submit a claim, reference to to policy, etc.</td></tr></table></li></ul></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger" : 1
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode" : "fm"
    },
    {
      "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/davinci-crd/ImplementationGuide/davinci-crd"
          }
        ]
      }
    }
  ],
  "url" : "http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageDetailCategories",
  "identifier" : [
    {
      "system" : "urn:ietf:rfc:3986",
      "value" : "urn:oid:2.16.840.1.113883.4.642.40.18.48.23"
    }
  ],
  "version" : "2.2.0-ballot",
  "name" : "CRDCoverageDetailCategories",
  "title" : "CRD Coverage Detail Categories Value Set",
  "status" : "active",
  "experimental" : false,
  "date" : "2025-08-05T21:20:40+00:00",
  "publisher" : "HL7 International / Financial Management",
  "contact" : [
    {
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/fm"
        }
      ]
    }
  ],
  "description" : "Codes that define the type of coverage information detail being provided",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US"
        }
      ]
    }
  ],
  "compose" : {
    "include" : [
      {
        "system" : "http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes",
        "concept" : [
          {
            "code" : "cat-limitation"
          },
          {
            "code" : "cat-decisional"
          },
          {
            "code" : "cat-other"
          }
        ]
      }
    ]
  }
}