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

## : Official CRD Coverage Detail Codes Value Set

Page standards status: Trial-use | Maturity Level: 4

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      "resourceType" : "ValueSet",
      "id" : "coverageDetailNew",
      "language" : "en",
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        "status" : "extensions",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ValueSet coverageDetailNew</b></p><a name=\"coverageDetailNew\"> </a><a name=\"hccoverageDetailNew\"> </a><ul><li>Include these codes as defined in <a href=\"http://terminology.hl7.org/7.0.1/CodeSystem-crd-coverage-detail.html\"><code>http://terminology.hl7.org/CodeSystem/crd-coverage-detail</code></a><span title=\"Version is not explicitly stated, which means it is fixed to 1.0.0, the version found through the package references\"> version &#x1F4E6;1.0.0</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=\"http://terminology.hl7.org/7.0.1/CodeSystem-crd-coverage-detail.html#crd-coverage-detail-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=\"http://terminology.hl7.org/7.0.1/CodeSystem-crd-coverage-detail.html#crd-coverage-detail-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=\"http://terminology.hl7.org/7.0.1/CodeSystem-crd-coverage-detail.html#crd-coverage-detail-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=\"http://terminology.hl7.org/7.0.1/CodeSystem-crd-coverage-detail.html#crd-coverage-detail-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=\"http://terminology.hl7.org/7.0.1/CodeSystem-crd-coverage-detail.html#crd-coverage-detail-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=\"http://terminology.hl7.org/7.0.1/CodeSystem-crd-coverage-detail.html#crd-coverage-detail-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=\"http://terminology.hl7.org/7.0.1/CodeSystem-crd-coverage-detail.html#crd-coverage-detail-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=\"http://terminology.hl7.org/7.0.1/CodeSystem-crd-coverage-detail.html#crd-coverage-detail-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>"
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          "valueInteger" : 4,
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          "_valueCode" : {
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              }
            ]
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        }
      ],
      "url" : "http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageDetailNew",
      "identifier" : [
        {
          "system" : "urn:ietf:rfc:3986",
          "value" : "urn:oid:2.16.840.1.113883.4.642.40.18.48.26"
        }
      ],
      "version" : "2.2.0-snapshot",
      "name" : "CRDCoverageDetailCodesNew",
      "title" : "Official CRD Coverage Detail Codes Value Set",
      "status" : "active",
      "experimental" : false,
      "date" : "2026-02-19T15:54:35+00:00",
      "publisher" : "HL7 International / Financial Management",
      "contact" : [
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              "value" : "http://www.hl7.org/Special/committees/fm"
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      ],
      "description" : "Codes for name-value-pair details on a coverage assertion - now using official FHIR codes",
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              "system" : "urn:iso:std:iso:3166",
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              {
                "code" : "allowed-quantity"
              },
              {
                "code" : "allowed-period"
              },
              {
                "code" : "in-network-copay"
              },
              {
                "code" : "out-network-copay"
              },
              {
                "code" : "concurrent-review"
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                "code" : "appropriate-use-needed"
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                "code" : "policy-link"
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                "code" : "instructions"
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