National Directory of Healthcare Providers & Services (NDH) Implementation Guide, published by HL7 International / Patient Administration. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-us-ndh/ and changes regularly. See the Directory of published versions
Official URL: http://hl7.org/fhir/us/ndh/ValueSet/BenefitTypeVS | Version: 1.0.0 | |||
Standards status: Trial-use | Computable Name: BenefitTypeVS |
Codes for Insurance Benefit Type.
References
Generated Narrative: ValueSet BenefitTypeVS
http://terminology.hl7.org/CodeSystem/insurance-benefit-type
Code | Display | Definition |
pcpov | Primary Care Visit to Treat an Injury or Illness | Benefit plan covers services rendered by a primary care physician during an office visit with the purpose to treat injury or illness, except for preventive care services. |
specialistov | Specialist Office Visit | Covered healthcare service rendered to a patient by a specialty provider. |
mlpov | Other Practitioner Office Visit (Nurse, Physician Assistant) - Mid Level Professional | Benefit plan covers covered health related services rendered by a practitioner other than MD or DO and referred to as other practitioner. |
outpatient | Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | Benefit plan covers health related services rendered to patient at an outpatient facility, outside of a facility that requires a patient admission. |
outpatstx | Outpatient Surgery Physician/Surgical Services | Benefit plan covers surgical services rendered to patient outside of a facility admission, referred to as outpatient. |
hospserv | Hospice Services | Benefit plan covers hospice services. |
routinedental | Routine Dental Services (Adult) | Benefit plan covers routine dental services. |
infertilitytx | Infertility Treatment | Benefit plan covers eligible infertility treatment services. |
ltnhc | Long-Term/Custodial Nursing Home Care | Long-Term/Custodial Nursing Home Care. |
privatenurse | Private-Duty Nursing | Private-Duty Nursing. |
routineeye | Routine Eye Exam (Adult) | Routine Eye Exam (Adult). |
ucservice | Urgent Care Centers or Facilities | Urgent Care Centers or Facilities. |
homehealth | Home Health | Home health services insurance coverage. |
erservice | Emergency Room Services | Emergency Room Services. |
ambulance | Emergency Room Services | Emergency Room Services. |
inpatienthospital | Inpatient Hospital Services (e.g., Hospital Stay) | A person who is hospitalized for at least one night to receive treatment or participate in a study. |
inpatientprovider | Inpatient Physician and Surgical Services | A healthcare provider who is delivering healthcare services in a hospital environment. |
bariatricsurg | Bariatric Surgery | Bariatric surgery service Skilled nursing service (qualifier value). |
cosmeticsurg | Cosmetic Surgery | Cosmetic surgery service Skilled nursing service (qualifier value). |
skillednursing | Skilled Nursing Facility | Skilled nursing service (qualifier value). |
ppnatalcare | Prenatal and Postnatal Care | Prenatal and Postnatal services. |
maternitycare | Delivery and All Inpatient Services for Maternity Care | All maternity care services. |
menthlthoutp | Mental/Behavioral Health Outpatient Services | Mental health service delivered in an outpatient setting. |
menthlthinp | Mental/Behavioral Health Inpatient Services | Mental health service delivered in an hospital or inpatient facility setting. |
sadoutp | Substance Abuse Disorder Outpatient Services | Substance abuse related services delivered in a outpatient setting. |
sadinp | Substance Abuse Disorder Inpatient Services | Substance abuse related services delivered in a inpatient setting. |
drggenric | Generic Drugs | Generic drugs eligible benefits. |
drgbrand | Preferred Brand Drugs | Preferred brand drugs eligible benefits. |
drgnonpreferred | Non-Preferred Brand Drugs | Non-Preferred drugs brands eligible benefits. |
drgspecialty | Specialty Drugs | Benefit plan covers specialty drugs. |
rehaboutp | Outpatient Rehabilitation Services | Benefit plan covers outpatient rehabilitation services. |
servicehablitation | Habilitation Services | Habilitation Services. |
chiro | Chiropractic Care | Benefit plan covers chiropractor eligible benefits. |
dme | Durable Medical Equipment | Benefit plan covers Durable medical equipment eligible benefits. |
hearingaids | Hearing Aids | Benefit plan covers hearing aids. |
imgctpetmri | Imaging (CT/PET Scans, MRIs) | Benefit plan covers advances imaging techniques services (CT/PET Scans, MRIs) eligible services. |
prev | Preventive Care/Screening/Immunization | Routine healthcare services to prevent health related problems eligible benefits. |
rtnpod | Routine Foot Care | Routine Foot Care. |
acupuncture | Acupuncture | Benefit plan covers acupuncture treatment. |
weightloss | Weight Loss Programs | Benefit plan covers weight loss services eligible benefits. |
rtneyechld | Routine Eye Exam for Children | Routine eye exam for children eligible benefits. |
glasseschld | Eye Glasses for Children | Eye glasses children eligible benefits. |
rtndntlchld | Dental Check-Up for Children | Dental Check-Up for Children. |
speachthpy | Rehabilitative Speech Therapy | Benefit plan covers rehabilitative speech therapy eligible benefits. |
rehaboccandpt | Rehabilitative Occupational and Rehabilitative Physical Therapy | Benefit plan covers rehabilitative occupational and rehabilitative physical eligible benefits. |
wellbaby | Well Baby Visits and Care | Regularly scheduled, preventive care services, including immunizations, provided to children up to an age as specified by a health insurance company or mandated by a government agency. |
laboutp | Laboratory Outpatient and Professional Services | Benefit plan covers laboratory testing and related professional services received as outpatient. |
imagingdx | X-rays and Diagnostic Imaging | Benefit plan covers diagnostic imaging procedures that produce images of internal structures of the human body and uses radiation to diagnose and treat diseases. |
dntlbaschld | Basic Dental Care - Child | Benefit plan covers diagnostic basic dental care. |
orthochld | Orthodontia - Child | Benefit plan covers orthodontia for children. |
dntlmajchld | Major Dental Care - Child | Benefit plan covers major dental care for children. |
dntlbasadlt | Basic Dental Care - Adult | Benefit plan covers basic dental care for adults. |
orthodadlt | Orthodontia - Adult | Benefits plan covers services provided that are required for orthodontic purposes for an adult. |
dntlmajadlt | Major Dental Care - Adult | Benefit plan covers major dental care for adult. |
abortion | Abortion for Which Public Funding is Prohibited | Benefit plan covers services for abortion for which public funding is prohibited. |
transplant | Transplant | Benefit plan covers transplant related services. |
accdntl | Accidental Dental | Benefit plan covers dental care services related to an accident. |
dialysis | Dialysis | The plan benefit covers services used to treat end stage renal disease. |
testallrgy | Allergy Testing | The plan benefits covers services for diagnostic procedures ordered or performed to evaluate whether a sensitivity to a substance is present. This test may be associated with specimen collection and/or substance administration challenge activities. |
chemotherapy | Chemotherapy | The plan benefits cover services the use of drugs and approved chemicals to treat disease. |
radiation | Radiation | The plan benefits cover services the use radiation to treat disease. |
edudiab | Diabetes Education | The plan benefits cover services related to instruction or training that encourages behaviors most likely to optimize health potentials through information about diabetes; facilitates the prevention of diabetes. |
prosthetic | Prosthetic Devices | Plan benefit covers services related to prosthesis devices. |
infusiontx | Infusion Therapy | Plan benefit covers services related to infusion therapy. |
tmjtx | Treatment for Temporomandibular Joint Disorders | Plan benefit covers services related to treatment of Temporomandibular Joint disorder. |
nutrition | Nutritional Counseling | Nutritional Counseling. |
reconsurg | Reconstructive Surgery | Plan benefit covers services related to reconstructive surgery. |
ValueSet
Expansion performed internally based on codesystem Insurance Benefit Type Code System v1.0.0 (CodeSystem)
This value set contains 67 concepts
Code | System | Display (en-US) | Definition |
pcpov | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Primary Care Visit to Treat an Injury or Illness | Benefit plan covers services rendered by a primary care physician during an office visit with the purpose to treat injury or illness, except for preventive care services. |
specialistov | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Specialist Office Visit | Covered healthcare service rendered to a patient by a specialty provider. |
mlpov | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Other Practitioner Office Visit (Nurse, Physician Assistant) - Mid Level Professional | Benefit plan covers covered health related services rendered by a practitioner other than MD or DO and referred to as other practitioner. |
outpatient | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | Benefit plan covers health related services rendered to patient at an outpatient facility, outside of a facility that requires a patient admission. |
outpatstx | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Outpatient Surgery Physician/Surgical Services | Benefit plan covers surgical services rendered to patient outside of a facility admission, referred to as outpatient. |
hospserv | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Hospice Services | Benefit plan covers hospice services. |
routinedental | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Routine Dental Services (Adult) | Benefit plan covers routine dental services. |
infertilitytx | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Infertility Treatment | Benefit plan covers eligible infertility treatment services. |
ltnhc | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Long-Term/Custodial Nursing Home Care | Long-Term/Custodial Nursing Home Care. |
privatenurse | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Private-Duty Nursing | Private-Duty Nursing. |
routineeye | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Routine Eye Exam (Adult) | Routine Eye Exam (Adult). |
ucservice | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Urgent Care Centers or Facilities | Urgent Care Centers or Facilities. |
homehealth | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Home Health | Home health services insurance coverage. |
erservice | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Emergency Room Services | Emergency Room Services. |
ambulance | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Emergency Room Services | Emergency Room Services. |
inpatienthospital | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Inpatient Hospital Services (e.g., Hospital Stay) | A person who is hospitalized for at least one night to receive treatment or participate in a study. |
inpatientprovider | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Inpatient Physician and Surgical Services | A healthcare provider who is delivering healthcare services in a hospital environment. |
bariatricsurg | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Bariatric Surgery | Bariatric surgery service Skilled nursing service (qualifier value). |
cosmeticsurg | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Cosmetic Surgery | Cosmetic surgery service Skilled nursing service (qualifier value). |
skillednursing | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Skilled Nursing Facility | Skilled nursing service (qualifier value). |
ppnatalcare | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Prenatal and Postnatal Care | Prenatal and Postnatal services. |
maternitycare | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Delivery and All Inpatient Services for Maternity Care | All maternity care services. |
menthlthoutp | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Mental/Behavioral Health Outpatient Services | Mental health service delivered in an outpatient setting. |
menthlthinp | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Mental/Behavioral Health Inpatient Services | Mental health service delivered in an hospital or inpatient facility setting. |
sadoutp | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Substance Abuse Disorder Outpatient Services | Substance abuse related services delivered in a outpatient setting. |
sadinp | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Substance Abuse Disorder Inpatient Services | Substance abuse related services delivered in a inpatient setting. |
drggenric | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Generic Drugs | Generic drugs eligible benefits. |
drgbrand | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Preferred Brand Drugs | Preferred brand drugs eligible benefits. |
drgnonpreferred | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Non-Preferred Brand Drugs | Non-Preferred drugs brands eligible benefits. |
drgspecialty | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Specialty Drugs | Benefit plan covers specialty drugs. |
rehaboutp | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Outpatient Rehabilitation Services | Benefit plan covers outpatient rehabilitation services. |
servicehablitation | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Habilitation Services | Habilitation Services. |
chiro | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Chiropractic Care | Benefit plan covers chiropractor eligible benefits. |
dme | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Durable Medical Equipment | Benefit plan covers Durable medical equipment eligible benefits. |
hearingaids | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Hearing Aids | Benefit plan covers hearing aids. |
imgctpetmri | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Imaging (CT/PET Scans, MRIs) | Benefit plan covers advances imaging techniques services (CT/PET Scans, MRIs) eligible services. |
prev | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Preventive Care/Screening/Immunization | Routine healthcare services to prevent health related problems eligible benefits. |
rtnpod | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Routine Foot Care | Routine Foot Care. |
acupuncture | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Acupuncture | Benefit plan covers acupuncture treatment. |
weightloss | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Weight Loss Programs | Benefit plan covers weight loss services eligible benefits. |
rtneyechld | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Routine Eye Exam for Children | Routine eye exam for children eligible benefits. |
glasseschld | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Eye Glasses for Children | Eye glasses children eligible benefits. |
rtndntlchld | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Dental Check-Up for Children | Dental Check-Up for Children. |
speachthpy | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Rehabilitative Speech Therapy | Benefit plan covers rehabilitative speech therapy eligible benefits. |
rehaboccandpt | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Rehabilitative Occupational and Rehabilitative Physical Therapy | Benefit plan covers rehabilitative occupational and rehabilitative physical eligible benefits. |
wellbaby | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Well Baby Visits and Care | Regularly scheduled, preventive care services, including immunizations, provided to children up to an age as specified by a health insurance company or mandated by a government agency. |
laboutp | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Laboratory Outpatient and Professional Services | Benefit plan covers laboratory testing and related professional services received as outpatient. |
imagingdx | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | X-rays and Diagnostic Imaging | Benefit plan covers diagnostic imaging procedures that produce images of internal structures of the human body and uses radiation to diagnose and treat diseases. |
dntlbaschld | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Basic Dental Care - Child | Benefit plan covers diagnostic basic dental care. |
orthochld | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Orthodontia - Child | Benefit plan covers orthodontia for children. |
dntlmajchld | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Major Dental Care - Child | Benefit plan covers major dental care for children. |
dntlbasadlt | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Basic Dental Care - Adult | Benefit plan covers basic dental care for adults. |
orthodadlt | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Orthodontia - Adult | Benefits plan covers services provided that are required for orthodontic purposes for an adult. |
dntlmajadlt | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Major Dental Care - Adult | Benefit plan covers major dental care for adult. |
abortion | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Abortion for Which Public Funding is Prohibited | Benefit plan covers services for abortion for which public funding is prohibited. |
transplant | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Transplant | Benefit plan covers transplant related services. |
accdntl | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Accidental Dental | Benefit plan covers dental care services related to an accident. |
dialysis | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Dialysis | The plan benefit covers services used to treat end stage renal disease. |
testallrgy | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Allergy Testing | The plan benefits covers services for diagnostic procedures ordered or performed to evaluate whether a sensitivity to a substance is present. This test may be associated with specimen collection and/or substance administration challenge activities. |
chemotherapy | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Chemotherapy | The plan benefits cover services the use of drugs and approved chemicals to treat disease. |
radiation | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Radiation | The plan benefits cover services the use radiation to treat disease. |
edudiab | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Diabetes Education | The plan benefits cover services related to instruction or training that encourages behaviors most likely to optimize health potentials through information about diabetes; facilitates the prevention of diabetes. |
prosthetic | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Prosthetic Devices | Plan benefit covers services related to prosthesis devices. |
infusiontx | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Infusion Therapy | Plan benefit covers services related to infusion therapy. |
tmjtx | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Treatment for Temporomandibular Joint Disorders | Plan benefit covers services related to treatment of Temporomandibular Joint disorder. |
nutrition | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Nutritional Counseling | Nutritional Counseling. |
reconsurg | http://terminology.hl7.org/CodeSystem/insurance-benefit-type | Reconstructive Surgery | Plan benefit covers services related to reconstructive surgery. |
Explanation of the columns that may appear on this page:
Level | A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies |
System | The source of the definition of the code (when the value set draws in codes defined elsewhere) |
Code | The code (used as the code in the resource instance) |
Display | The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application |
Definition | An explanation of the meaning of the concept |
Comments | Additional notes about how to use the code |