Patient Cost Transparency Implementation Guide
2.0.2 - STU 2 United States of America flag

Patient Cost Transparency Implementation Guide, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.0.2 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pct/ and changes regularly. See the Directory of published versions

: Claim Medical Product or Service Value Set

Page standards status: Trial-use Maturity Level: 2

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<ValueSet xmlns="http://hl7.org/fhir">
  <id value="USClaimMedicalProductOrServiceCodes"/>
  <language value="en"/>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: ValueSet USClaimMedicalProductOrServiceCodes</b></p><a name="USClaimMedicalProductOrServiceCodes"> </a><a name="hcUSClaimMedicalProductOrServiceCodes"> </a><p>This value set includes codes based on the following rules:</p><ul><li>Include all codes defined in <a href="http://terminology.hl7.org/6.1.0/CodeSystem-CPT.html"><code>http://www.ama-assn.org/go/cpt</code></a><span title="Version is not explicitly stated. No matching Code System found"> version Not Stated (use latest from terminology server)</span></li><li>Include all codes defined in <a href="http://terminology.hl7.org/6.1.0/CodeSystem-CDT.html"><code>http://www.ada.org/cdt</code></a><span title="Version is not explicitly stated. No matching Code System found"> version Not Stated (use latest from terminology server)</span></li><li>Include all codes defined in <a href="http://terminology.hl7.org/6.1.0/CodeSystem-hcpcs-Level-II.html"><code>http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets</code></a><span title="Version is not explicitly stated. No matching Code System found"> version Not Stated (use latest from terminology server)</span></li><li>Include all codes defined in <a href="http://terminology.hl7.org/6.1.0/CodeSystem-HIPPS.html"><code>https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/HIPPSCodes</code></a><span title="Version is not explicitly stated. No matching Code System found"> version Not Stated (use latest from terminology server)</span></li><li>Include these codes as defined in <a href="http://terminology.hl7.org/7.1.0/CodeSystem-data-absent-reason.html"><code>http://terminology.hl7.org/CodeSystem/data-absent-reason</code></a><span title="Version is explicitly stated to be 1.0.0"> version &#x1F4CD;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/7.1.0/CodeSystem-data-absent-reason.html#data-absent-reason-not-applicable">not-applicable</a></td><td>Not Applicable</td><td>There is no proper value for this element (e.g. last menstrual period for a male).</td></tr></table></li></ul></div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="fm"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="2">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
        <valueCanonical
                        value="http://hl7.org/fhir/us/davinci-pct/ImplementationGuide/hl7.fhir.us.davinci-pct"/>
      </extension>
    </valueInteger>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="trial-use">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
        <valueCanonical
                        value="http://hl7.org/fhir/us/davinci-pct/ImplementationGuide/hl7.fhir.us.davinci-pct"/>
      </extension>
    </valueCode>
  </extension>
  <url
       value="http://hl7.org/fhir/us/davinci-pct/ValueSet/USClaimMedicalProductOrServiceCodes"/>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.16.840.1.113883.4.642.40.4.48.36"/>
  </identifier>
  <version value="2.0.2"/>
  <name value="USClaimMedicalProductOrServiceCodes"/>
  <title value="Claim Medical Product or Service Value Set"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2026-11-09T22:17:29+00:00"/>
  <publisher value="HL7 International / Financial Management"/>
  <contact>
    <name value="HL7 International / Financial Management"/>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/fm"/>
    </telecom>
    <telecom>
      <system value="email"/>
      <value value="fmlists@lists.hl7.org"/>
    </telecom>
  </contact>
  <description
               value="CPT - HCPCS - HIPPS - CDT codes to report medical procedures and services under public and private health insurance programs"/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <copyright
             value="Current Procedural Terminology (CPT) is copyright 2020 American Medical Association. All rights reserved

This artifact incorporates content from ANSI/ADA Standard No. 218, Dentistry—Designation Systems for Teeth and Areas of the Oral Cavity, the ADA Dental Claim Form (Version 2024), and the Code on Dental Procedures and Nomenclature (CDT Code), all of which are copyrighted works of, and owned exclusively by, the American Dental Association (ADA). Implementers and users of this artifact assume full responsibility for obtaining and maintaining all necessary rights and licenses from the ADA for any use of ADA-proprietary content. For licensing information, refer to: https://www.ada.org/en/publications/ada-catalog/cdt-products/licensing-for-commercial-users"/>
  <compose>
    <include>
      <system value="http://www.ama-assn.org/go/cpt"/>
    </include>
    <include>
      <system value="http://www.ada.org/cdt"/>
    </include>
    <include>
      <system
              value="http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets"/>
    </include>
    <include>
      <system
              value="https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/HIPPSCodes"/>
    </include>
    <include>
      <system
              value="http://terminology.hl7.org/CodeSystem/data-absent-reason"/>
      <version value="1.0.0"/>
      <concept>
        <code value="not-applicable"/>
        <display value="Not Applicable"/>
      </concept>
    </include>
  </compose>
</ValueSet>