Da Vinci - Coverage Requirements Discovery
2.2.1 - STU 2.2

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 2.2.1 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

## : Deprecated CRD Coverage Detail Codes Value Set

Page standards status: Deprecated | Maturity Level: 4

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    {
      "resourceType" : "ValueSet",
      "id" : "coverageDetail",
      "language" : "en",
      "text" : {
        "status" : "extensions",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ValueSet coverageDetail</b></p><a name=\"coverageDetail\"> </a><a name=\"hccoverageDetail\"> </a><ul><li>Include these codes as defined in <a href=\"CodeSystem-temp.html\"><code>http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp</code></a><span title=\"Version is not explicitly stated, which means it is fixed to the version provided in this specification\"> version &#x1F4E6;2.2.1</span><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-temp.html#temp-allowed-quantity\">allowed-quantity</a></td><td style=\"color: #cccccc\">Maximum quantity</td><td>Indicates limitations on the number of services/products allowed (possibly per time period).  Value should be a Quantity</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-allowed-period\">allowed-period</a></td><td style=\"color: #cccccc\">Maximum allowed period</td><td>Indicates the maximum period of time that can be covered in a single order.  Value should be a Period</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-in-network-copay\">in-network-copay</a></td><td style=\"color: #cccccc\">Copay for in-network</td><td>Indicates a percentage co-pay to expect if delivered in-network.  Value should be a Quantity.</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-out-network-copay\">out-network-copay</a></td><td style=\"color: #cccccc\">Copay for out-of-network</td><td>Indicates a percentage co-pay to expect if delivered out-of-network.  Value should be a Quantity.</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-concurrent-review\">concurrent-review</a></td><td style=\"color: #cccccc\">Concurrent review</td><td>Additional payer-defined documentation will be required prior to claim payment.  Value should be a boolean.</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-appropriate-use-needed\">appropriate-use-needed</a></td><td style=\"color: #cccccc\">Appropriate use</td><td>Payer-defined appropriate use process must be invoked to determine coverage.  Value should be a boolean.</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-policy-link\">policy-link</a></td><td style=\"color: #cccccc\">Policy Link</td><td>A URL pointing to the specific portion of a payer policy, coverage agreement or similar authoritative document that provides a portion of the basis for the decision documented in the coverage-information.  Value should be a url.</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-instructions\">instructions</a></td><td style=\"color: #cccccc\">Instructions</td><td>Information to display to the user that gives guidance about what steps to take in achieving the recommended actions identified by this coverage-information (e.g. special instructions about requesting authorization, details about information needed, details about data retention, etc.).  Value should be a string.  (Category may vary.)</td></tr></table></li></ul></div>"
      },
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
          "valueCode" : "deprecated"
        },
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
          "valueCode" : "fm"
        },
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
          "valueInteger" : 4,
          "_valueInteger" : {
            "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/coverageDetail",
      "identifier" : [
        {
          "system" : "urn:ietf:rfc:3986",
          "value" : "urn:oid:2.16.840.1.113883.4.642.40.18.48.12"
        }
      ],
      "version" : "2.2.1",
      "name" : "CRDCoverageDetailCodes",
      "title" : "Deprecated CRD Coverage Detail Codes Value Set",
      "status" : "retired",
      "experimental" : false,
      "date" : "2026-03-26T15:54:25+00:00",
      "publisher" : "HL7 International / Financial Management",
      "contact" : [
        {
          "telecom" : [
            {
              "system" : "url",
              "value" : "http://www.hl7.org/Special/committees/fm"
            }
          ]
        }
      ],
      "description" : "Codes for name-value-pair details on a coverage assertion - replaced by the coverageDetailNew value set.  Support for this ValueSet will be dropped in a future version.",
      "jurisdiction" : [
        {
          "coding" : [
            {
              "system" : "urn:iso:std:iso:3166",
              "code" : "US"
            }
          ]
        }
      ],
      "compose" : {
        "include" : [
          {
            "system" : "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
            "concept" : [
              {
                "code" : "allowed-quantity"
              },
              {
                "code" : "allowed-period"
              },
              {
                "code" : "in-network-copay"
              },
              {
                "code" : "out-network-copay"
              },
              {
                "code" : "concurrent-review"
              },
              {
                "code" : "appropriate-use-needed"
              },
              {
                "code" : "policy-link"
              },
              {
                "code" : "instructions"
              }
            ]
          }
        ]
      }
    }