Da Vinci - Coverage Requirements Discovery
2.2.0-snapshot - STU 2.2 Peer Review

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-snapshot 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

## ValueSet: Official CRD Coverage Detail Codes Value Set

Official URL: http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageDetailNew | Version: 2.2.0-snapshot | Highlight text changes?
Standards status: Trial-use Active as of 2026-02-19 | Maturity Level: 4 | Computable Name: CRDCoverageDetailCodesNew
Other Identifiers: OID:2.16.840.1.113883.4.642.40.18.48.26

Codes for name-value-pair details on a coverage assertion - now using official FHIR codes

References

- Coverage Information

### Logical Definition (CLD)

- Include these codes as defined in `http://terminology.hl7.org/CodeSystem/crd-coverage-detail` version 📦1.0.0

  Code | Display | Definition
  allowed-quantity | Maximum quantity | Indicates limitations on the number of services/products allowed (possibly per time period). Value should be a Quantity
  allowed-period | Maximum allowed period | Indicates the maximum period of time that can be covered in a single order. Value should be a Period
  in-network-copay | Copay for in-network | Indicates a percentage co-pay to expect if delivered in-network. Value should be a Quantity.
  out-network-copay | Copay for out-of-network | Indicates a percentage co-pay to expect if delivered out-of-network. Value should be a Quantity.
  concurrent-review | Concurrent review | Additional payer-defined documentation will be required prior to claim payment. Value should be a boolean.
  appropriate-use-needed | Appropriate use | Payer-defined appropriate use process must be invoked to determine coverage. Value should be a boolean.
  policy-link | Policy Link | 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.
  instructions | Instructions | 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.)

### Expansion

Expansion performed internally based on codesystem CRD Coverage Detail Codes v1.0.0 (CodeSystem)

This value set contains 8 concepts

System | Code | Display (en) | Definition | JSON | XML
`http://terminology.hl7.org/CodeSystem/crd-coverage-detail` | allowed-quantity | Maximum quantity | Indicates limitations on the number of services/products allowed (possibly per time period). Value should be a Quantity |  |
`http://terminology.hl7.org/CodeSystem/crd-coverage-detail` | allowed-period | Maximum allowed period | Indicates the maximum period of time that can be covered in a single order. Value should be a Period |  |
`http://terminology.hl7.org/CodeSystem/crd-coverage-detail` | in-network-copay | Copay for in-network | Indicates a percentage co-pay to expect if delivered in-network. Value should be a Quantity. |  |
`http://terminology.hl7.org/CodeSystem/crd-coverage-detail` | out-network-copay | Copay for out-of-network | Indicates a percentage co-pay to expect if delivered out-of-network. Value should be a Quantity. |  |
`http://terminology.hl7.org/CodeSystem/crd-coverage-detail` | concurrent-review | Concurrent review | Additional payer-defined documentation will be required prior to claim payment. Value should be a boolean. |  |
`http://terminology.hl7.org/CodeSystem/crd-coverage-detail` | appropriate-use-needed | Appropriate use | Payer-defined appropriate use process must be invoked to determine coverage. Value should be a boolean. |  |
`http://terminology.hl7.org/CodeSystem/crd-coverage-detail` | policy-link | Policy Link | 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. |  |
`http://terminology.hl7.org/CodeSystem/crd-coverage-detail` | instructions | Instructions | 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.) |  |

Description of the above table(s).