Da Vinci Prior Authorization Support (PAS) FHIR IG
2.2.0-ballot - STU 2.2 - Ballot

Da Vinci Prior Authorization Support (PAS) FHIR IG, 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-pas/ and changes regularly. See the Directory of published versions

## Extension:

Official URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail | Version: 2.2.0-ballot
Standards status: Trial-use Active as of 2026-01-30 | Maturity Level: 3 | Computable Name: ItemAuthorizedDetail
Other Identifiers: OID:2.16.840.1.113883.4.642.40.24.42.19

The details of what has been authorized for this item.

Context of Use

This extension may be used on the following element(s)

- Element ID: `ExplanationOfBenefit`
- Element ID: `ExplanationOfBenefit.item`
- Element ID: `ClaimResponse.item`

Usage info

Usages:

- Use this Extension: PAS Claim Response Base and PAS Claim Response Base
- Examples for this Extension: Bundle/PASSubscriptionNotification, Bundle/ReferralAuthorizationResponseBundleExample, ClaimResponse/PractitionerRequestorAdditionalContentResponseExample and ClaimResponse/PractitionerRequestorResponseExample

You can also check for usages in the FHIR IG Statistics

### Formal Views of Extension Content

Description Differentials, Snapshots, and other representations.

- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Extension
Slices for extension |  |  |  | Content/Rules for all slices
extension:productOrServiceCode |  | 0..1 | Extension | Extension
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "productOrServiceCode"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: X12278RequestedServiceType (2.2.0-ballot) (required)
extension:productOrServiceCodeEnd |  | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12278RequestedServiceType (2.2.0-ballot) (required)
extension:modifier |  | 0..* | Extension | Extension
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "modifier"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: X12278RequestedServiceModifierType (2.2.0-ballot) (required)
extension:unitPrice |  | 0..1 | Extension | Extension
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "unitPrice"
value[x] |  | 0..1 | Money | Value of extension
extension:quantity |  | 0..1 | Extension | Extension
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "quantity"
value[x] |  | 0..1 | PASQuantity(2.2.0-ballot) | Value of extension
extension:epsdtIndicator |  | 0..1 | boolean | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
extension:nursingHomeLevelOfCare |  | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare Binding: https://valueset.x12.org/x217/005010/request/2000F/SV1/1/20/00/1337 (required): Codes specifying the level of care provided by a nursing home facility. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:revenue |  | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode Binding: AHANUBCRevenueCodes (2.2.0-ballot) (required)
extension:revenueUnitRateLimit |  | 0..1 | decimal | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
extension:authorizedService |  | 0..1 | Reference(PAS Medication Request(2.2.0-ballot) | PAS Service Request(2.2.0-ballot) | PAS Device Request(2.2.0-ballot) | PAS Nutrition Order(2.2.0-ballot)) | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService
url |  | 1..1 | uri | "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
value[x] |  | 0..0 |  | Value of extension
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Extension.extension:productOrServiceCode.​value[x] | Base | required | X12 278 Requested Service Type | 📍2.2.0-ballot | This IG
Extension.extension:modifier.​value[x] | Base | required | X12 278 Requested Service Modifier Type | 📍2.2.0-ballot | This IG

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:productOrServiceCode |  | 0..1 | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "productOrServiceCode"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: X12278RequestedServiceType (2.2.0-ballot) (required)
extension:productOrServiceCodeEnd |  | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12278RequestedServiceType (2.2.0-ballot) (required)
extension:modifier |  | 0..* | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "modifier"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: X12278RequestedServiceModifierType (2.2.0-ballot) (required)
extension:unitPrice |  | 0..1 | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "unitPrice"
value[x] |  | 0..1 | Money | Value of extension
extension:quantity |  | 0..1 | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "quantity"
value[x] |  | 0..1 | PASQuantity(2.2.0-ballot) | Value of extension
extension:epsdtIndicator |  | 0..1 | boolean | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
extension:nursingHomeLevelOfCare |  | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare Binding: https://valueset.x12.org/x217/005010/request/2000F/SV1/1/20/00/1337 (required): Codes specifying the level of care provided by a nursing home facility. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:revenue |  | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode Binding: AHANUBCRevenueCodes (2.2.0-ballot) (required)
extension:revenueUnitRateLimit |  | 0..1 | decimal | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
extension:authorizedService |  | 0..1 | Reference(PAS Medication Request(2.2.0-ballot) | PAS Service Request(2.2.0-ballot) | PAS Device Request(2.2.0-ballot) | PAS Nutrition Order(2.2.0-ballot)) | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService
url |  | 1..1 | uri | "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Extension.extension:productOrServiceCode.​value[x] | Base | required | X12 278 Requested Service Type | 📍2.2.0-ballot | This IG
Extension.extension:modifier.​value[x] | Base | required | X12 278 Requested Service Modifier Type | 📍2.2.0-ballot | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Summary

Complex Extension: The details of what has been authorized for this item.

- productOrServiceCode: CodeableConcept: An Extension
- modifier: CodeableConcept: An Extension
- unitPrice: Money: An Extension
- quantity: Quantity: An Extension

Maturity: 3

Differential ViewDifferential View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Extension
Slices for extension |  |  |  | Content/Rules for all slices
extension:productOrServiceCode |  | 0..1 | Extension | Extension
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "productOrServiceCode"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: X12278RequestedServiceType (2.2.0-ballot) (required)
extension:productOrServiceCodeEnd |  | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12278RequestedServiceType (2.2.0-ballot) (required)
extension:modifier |  | 0..* | Extension | Extension
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "modifier"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: X12278RequestedServiceModifierType (2.2.0-ballot) (required)
extension:unitPrice |  | 0..1 | Extension | Extension
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "unitPrice"
value[x] |  | 0..1 | Money | Value of extension
extension:quantity |  | 0..1 | Extension | Extension
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "quantity"
value[x] |  | 0..1 | PASQuantity(2.2.0-ballot) | Value of extension
extension:epsdtIndicator |  | 0..1 | boolean | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
extension:nursingHomeLevelOfCare |  | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare Binding: https://valueset.x12.org/x217/005010/request/2000F/SV1/1/20/00/1337 (required): Codes specifying the level of care provided by a nursing home facility. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:revenue |  | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode Binding: AHANUBCRevenueCodes (2.2.0-ballot) (required)
extension:revenueUnitRateLimit |  | 0..1 | decimal | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
extension:authorizedService |  | 0..1 | Reference(PAS Medication Request(2.2.0-ballot) | PAS Service Request(2.2.0-ballot) | PAS Device Request(2.2.0-ballot) | PAS Nutrition Order(2.2.0-ballot)) | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService
url |  | 1..1 | uri | "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
value[x] |  | 0..0 |  | Value of extension
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Extension.extension:productOrServiceCode.​value[x] | Base | required | X12 278 Requested Service Type | 📍2.2.0-ballot | This IG
Extension.extension:modifier.​value[x] | Base | required | X12 278 Requested Service Modifier Type | 📍2.2.0-ballot | This IG

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:productOrServiceCode |  | 0..1 | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "productOrServiceCode"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: X12278RequestedServiceType (2.2.0-ballot) (required)
extension:productOrServiceCodeEnd |  | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12278RequestedServiceType (2.2.0-ballot) (required)
extension:modifier |  | 0..* | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "modifier"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: X12278RequestedServiceModifierType (2.2.0-ballot) (required)
extension:unitPrice |  | 0..1 | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "unitPrice"
value[x] |  | 0..1 | Money | Value of extension
extension:quantity |  | 0..1 | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "quantity"
value[x] |  | 0..1 | PASQuantity(2.2.0-ballot) | Value of extension
extension:epsdtIndicator |  | 0..1 | boolean | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
extension:nursingHomeLevelOfCare |  | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare Binding: https://valueset.x12.org/x217/005010/request/2000F/SV1/1/20/00/1337 (required): Codes specifying the level of care provided by a nursing home facility. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.
extension:revenue |  | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode Binding: AHANUBCRevenueCodes (2.2.0-ballot) (required)
extension:revenueUnitRateLimit |  | 0..1 | decimal | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
extension:authorizedService |  | 0..1 | Reference(PAS Medication Request(2.2.0-ballot) | PAS Service Request(2.2.0-ballot) | PAS Device Request(2.2.0-ballot) | PAS Nutrition Order(2.2.0-ballot)) | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService
url |  | 1..1 | uri | "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Extension.extension:productOrServiceCode.​value[x] | Base | required | X12 278 Requested Service Type | 📍2.2.0-ballot | This IG
Extension.extension:modifier.​value[x] | Base | required | X12 278 Requested Service Modifier Type | 📍2.2.0-ballot | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Summary

Complex Extension: The details of what has been authorized for this item.

- productOrServiceCode: CodeableConcept: An Extension
- modifier: CodeableConcept: An Extension
- unitPrice: Money: An Extension
- quantity: Quantity: An Extension

Maturity: 3

Other representations of profile: CSV, Excel, Schematron