# Insurance Benefit Type Code System - National Directory of Healthcare Providers & Services (NDH) Implementation Guide v2.0.0-current

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **Insurance Benefit Type Code System**

## CodeSystem: Insurance Benefit Type Code System 

| | | |
| :--- | :--- | :--- |
| *Official URL*:http://terminology.hl7.org/CodeSystem/insurance-benefit-type | *Version*:2.0.0-current | |
| * Standards status: *[Trial-use](http://hl7.org/fhir/R4/versions.html#std-process) | [Maturity Level](http://hl7.org/fhir/versions.html#maturity): 4 | *Computable Name*:InsuranceBenefitType |

 
Categories of insurance benefits. 

 This Code system is referenced in the content logical definition of the following value sets: 

* [BenefitTypeVS](ValueSet-BenefitTypeVS.md)



## Resource Content

```json
{
  "resourceType" : "CodeSystem",
  "id" : "insurance-benefit-type",
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "pa"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 4,
    "_valueInteger" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/us/ndh/ImplementationGuide/hl7.fhir.us.ndh"
      }]
    }
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode" : "trial-use",
    "_valueCode" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/us/ndh/ImplementationGuide/hl7.fhir.us.ndh"
      }]
    }
  }],
  "url" : "http://terminology.hl7.org/CodeSystem/insurance-benefit-type",
  "version" : "2.0.0-current",
  "name" : "InsuranceBenefitType",
  "title" : "Insurance Benefit Type Code System",
  "status" : "active",
  "experimental" : false,
  "date" : "2026-03-30T14:03:58+00:00",
  "publisher" : "HL7 International / Patient Administration",
  "contact" : [{
    "name" : "HL7 International / Patient Administration",
    "telecom" : [{
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/pafm"
    },
    {
      "system" : "email",
      "value" : "pafm@lists.hl7.org"
    }]
  }],
  "description" : "Categories of insurance benefits.",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "US",
      "display" : "United States of America"
    }]
  }],
  "caseSensitive" : true,
  "content" : "complete",
  "count" : 114,
  "concept" : [{
    "code" : "medical",
    "display" : "Medical",
    "definition" : "Medical insurance coverage."
  },
  {
    "code" : "dental",
    "display" : "Dental",
    "definition" : "Dental insurance coverage."
  },
  {
    "code" : "menthlth",
    "display" : "Mental Health",
    "definition" : "Mental health insurance coverage."
  },
  {
    "code" : "substanceabuse",
    "display" : "Substance Abuse",
    "definition" : "Substance abuse services insurance coverage."
  },
  {
    "code" : "vision",
    "display" : "Vision",
    "definition" : "Vision insurance coverage."
  },
  {
    "code" : "drug",
    "display" : "Drug",
    "definition" : "Prescription drug coverage."
  },
  {
    "code" : "stc",
    "display" : "Short Term Care",
    "definition" : "Short term care."
  },
  {
    "code" : "ltc",
    "display" : "Long Term Care",
    "definition" : "Long term care."
  },
  {
    "code" : "hospice",
    "display" : "Hospice",
    "definition" : "Hospice insurance coverage."
  },
  {
    "code" : "homehealth",
    "display" : "Home Health",
    "definition" : "Home health services insurance coverage."
  },
  {
    "code" : "dmepos",
    "display" : "DMEPOS",
    "definition" : "Durable Medical Equipment, Prosthetics/Orthotics and Supplies."
  },
  {
    "code" : "imagingadv",
    "display" : "Advanced Imaging (CT/PET Scans, MRIs)",
    "definition" : "Advances imaging techniques services (CT/PET Scans, MRIs) coverage."
  },
  {
    "code" : "rehab",
    "display" : "Rehabilitation",
    "definition" : "Rehabilitation."
  },
  {
    "code" : "pcpov",
    "display" : "Primary Care Visit to Treat an Injury or Illness",
    "definition" : "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."
  },
  {
    "code" : "specialistov",
    "display" : "Specialist Office Visit",
    "definition" : "Covered healthcare service rendered to a patient by a specialty provider."
  },
  {
    "code" : "mlpov",
    "display" : "Other Practitioner Office Visit (Nurse, Physician Assistant) - Mid Level Professional",
    "definition" : "Benefit plan covers covered health related services rendered by a practitioner other than MD or DO and referred to as other practitioner."
  },
  {
    "code" : "outpatient",
    "display" : "Outpatient Facility Fee (e.g., Ambulatory Surgery Center)",
    "definition" : "Benefit plan covers health related services rendered to patient at an outpatient facility, outside of a facility that requires a patient admission."
  },
  {
    "code" : "outpatstx",
    "display" : "Outpatient Surgery Physician/Surgical Services",
    "definition" : "Benefit plan covers surgical services rendered to patient outside of a facility admission, referred to as outpatient."
  },
  {
    "code" : "hospserv",
    "display" : "Hospice Services",
    "definition" : "Benefit plan covers hospice services."
  },
  {
    "code" : "routinedental",
    "display" : "Routine Dental Services (Adult)",
    "definition" : "Benefit plan covers routine dental services."
  },
  {
    "code" : "infertilitytx",
    "display" : "Infertility Treatment",
    "definition" : "Benefit plan covers eligible infertility treatment services."
  },
  {
    "code" : "ltnhc",
    "display" : "Long-Term/Custodial Nursing Home Care",
    "definition" : "Long-Term/Custodial Nursing Home Care."
  },
  {
    "code" : "privatenurse",
    "display" : "Private-Duty Nursing",
    "definition" : "Private-Duty Nursing."
  },
  {
    "code" : "routineeye",
    "display" : "Routine Eye Exam (Adult)",
    "definition" : "Routine Eye Exam (Adult)."
  },
  {
    "code" : "ucservice",
    "display" : "Urgent Care Centers or Facilities",
    "definition" : "Urgent Care Centers or Facilities."
  },
  {
    "code" : "erservice",
    "display" : "Emergency Room Services",
    "definition" : "Emergency Room Services."
  },
  {
    "code" : "ambulance",
    "display" : "Emergency Room Services",
    "definition" : "Emergency Room Services."
  },
  {
    "code" : "inpatienthospital",
    "display" : "Inpatient Hospital Services (e.g., Hospital Stay)",
    "definition" : "A person who is hospitalized for at least one night to receive treatment or participate in a study."
  },
  {
    "code" : "inpatientprovider",
    "display" : "Inpatient Physician and Surgical Services",
    "definition" : "A healthcare provider who is delivering healthcare services in a hospital environment."
  },
  {
    "code" : "bariatricsurg",
    "display" : "Bariatric Surgery",
    "definition" : "Bariatric surgery service Skilled nursing service (qualifier value)."
  },
  {
    "code" : "cosmeticsurg",
    "display" : "Cosmetic Surgery",
    "definition" : "Cosmetic surgery service Skilled nursing service (qualifier value)."
  },
  {
    "code" : "skillednursing",
    "display" : "Skilled Nursing Facility",
    "definition" : "Skilled nursing service (qualifier value)."
  },
  {
    "code" : "ppnatalcare",
    "display" : "Prenatal and Postnatal Care",
    "definition" : "Prenatal and Postnatal services."
  },
  {
    "code" : "maternitycare",
    "display" : "Delivery and All Inpatient Services for Maternity Care",
    "definition" : "All maternity care services."
  },
  {
    "code" : "menthlthoutp",
    "display" : "Mental/Behavioral Health Outpatient Services",
    "definition" : "Mental health service delivered in an outpatient setting."
  },
  {
    "code" : "menthlthinp",
    "display" : "Mental/Behavioral Health Inpatient Services",
    "definition" : "Mental health service delivered in an hospital or inpatient facility setting."
  },
  {
    "code" : "sadoutp",
    "display" : "Substance Abuse Disorder Outpatient Services",
    "definition" : "Substance abuse related services delivered in a outpatient setting."
  },
  {
    "code" : "sadinp",
    "display" : "Substance Abuse Disorder Inpatient Services",
    "definition" : "Substance abuse related services delivered in a inpatient setting."
  },
  {
    "code" : "drggenric",
    "display" : "Generic Drugs",
    "definition" : "Generic drugs eligible benefits."
  },
  {
    "code" : "drgbrand",
    "display" : "Preferred Brand Drugs",
    "definition" : "Preferred brand drugs eligible benefits."
  },
  {
    "code" : "drgnonpreferred",
    "display" : "Non-Preferred Brand Drugs",
    "definition" : "Non-Preferred drugs brands eligible benefits."
  },
  {
    "code" : "drgspecialty",
    "display" : "Specialty Drugs",
    "definition" : "Benefit plan covers specialty drugs."
  },
  {
    "code" : "rehaboutp",
    "display" : "Outpatient Rehabilitation Services",
    "definition" : "Benefit plan covers outpatient rehabilitation services."
  },
  {
    "code" : "servicehablitation",
    "display" : "Habilitation Services",
    "definition" : "Habilitation Services."
  },
  {
    "code" : "chiro",
    "display" : "Chiropractic Care",
    "definition" : "Benefit plan covers chiropractor eligible benefits."
  },
  {
    "code" : "dme",
    "display" : "Durable Medical Equipment",
    "definition" : "Benefit plan covers Durable medical equipment eligible benefits."
  },
  {
    "code" : "hearingaids",
    "display" : "Hearing Aids",
    "definition" : "Benefit plan covers hearing aids."
  },
  {
    "code" : "imgctpetmri",
    "display" : "Imaging (CT/PET Scans, MRIs)",
    "definition" : "Benefit plan covers advances imaging techniques services (CT/PET Scans, MRIs) eligible services."
  },
  {
    "code" : "prev",
    "display" : "Preventive Care/Screening/Immunization",
    "definition" : "Routine healthcare services to prevent health related problems eligible benefits."
  },
  {
    "code" : "rtnpod",
    "display" : "Routine Foot Care",
    "definition" : "Routine Foot Care."
  },
  {
    "code" : "acupuncture",
    "display" : "Acupuncture",
    "definition" : "Benefit plan covers acupuncture treatment."
  },
  {
    "code" : "weightloss",
    "display" : "Weight Loss Programs",
    "definition" : "Benefit plan covers weight loss services eligible benefits."
  },
  {
    "code" : "rtneyechld",
    "display" : "Routine Eye Exam for Children",
    "definition" : "Routine eye exam for children eligible benefits."
  },
  {
    "code" : "glasseschld",
    "display" : "Eye Glasses for Children",
    "definition" : "Eye glasses children eligible benefits."
  },
  {
    "code" : "rtndntlchld",
    "display" : "Dental Check-Up for Children",
    "definition" : "Dental Check-Up for Children."
  },
  {
    "code" : "speachthpy",
    "display" : "Rehabilitative Speech Therapy",
    "definition" : "Benefit plan covers rehabilitative speech therapy eligible benefits."
  },
  {
    "code" : "rehaboccandpt",
    "display" : "Rehabilitative Occupational and Rehabilitative Physical Therapy",
    "definition" : "Benefit plan covers rehabilitative occupational and rehabilitative physical eligible benefits."
  },
  {
    "code" : "wellbaby",
    "display" : "Well Baby Visits and Care",
    "definition" : "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."
  },
  {
    "code" : "laboutp",
    "display" : "Laboratory Outpatient and Professional Services",
    "definition" : "Benefit plan covers laboratory testing and related professional services received as outpatient."
  },
  {
    "code" : "imagingdx",
    "display" : "X-rays and Diagnostic Imaging",
    "definition" : "Benefit plan covers diagnostic imaging procedures that produce images of internal structures of the human body and uses radiation to diagnose and treat diseases."
  },
  {
    "code" : "dntlbaschld",
    "display" : "Basic Dental Care - Child",
    "definition" : "Benefit plan covers diagnostic basic dental care."
  },
  {
    "code" : "orthochld",
    "display" : "Orthodontia - Child",
    "definition" : "Benefit plan covers orthodontia for children."
  },
  {
    "code" : "dntlmajchld",
    "display" : "Major Dental Care - Child",
    "definition" : "Benefit plan covers major dental care for children."
  },
  {
    "code" : "dntlbasadlt",
    "display" : "Basic Dental Care - Adult",
    "definition" : "Benefit plan covers basic dental care for adults."
  },
  {
    "code" : "orthodadlt",
    "display" : "Orthodontia - Adult",
    "definition" : "Benefits plan covers services provided that are required for orthodontic purposes for an adult."
  },
  {
    "code" : "dntlmajadlt",
    "display" : "Major Dental Care - Adult",
    "definition" : "Benefit plan covers major dental care for adult."
  },
  {
    "code" : "abortion",
    "display" : "Abortion for Which Public Funding is Prohibited",
    "definition" : "Benefit plan covers services for abortion for which public funding is prohibited."
  },
  {
    "code" : "transplant",
    "display" : "Transplant",
    "definition" : "Benefit plan covers transplant related services."
  },
  {
    "code" : "accdntl",
    "display" : "Accidental Dental",
    "definition" : "Benefit plan covers dental care services related to an accident."
  },
  {
    "code" : "dialysis",
    "display" : "Dialysis",
    "definition" : "The plan benefit covers services used to treat end stage renal disease."
  },
  {
    "code" : "testallrgy",
    "display" : "Allergy Testing",
    "definition" : "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."
  },
  {
    "code" : "chemotherapy",
    "display" : "Chemotherapy",
    "definition" : "The plan benefits cover services the use of drugs and approved chemicals to treat disease."
  },
  {
    "code" : "radiation",
    "display" : "Radiation",
    "definition" : "The plan benefits cover services the use radiation to treat disease."
  },
  {
    "code" : "edudiab",
    "display" : "Diabetes Education",
    "definition" : "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."
  },
  {
    "code" : "prosthetic",
    "display" : "Prosthetic Devices",
    "definition" : "Plan benefit covers services related to prosthesis devices."
  },
  {
    "code" : "infusiontx",
    "display" : "Infusion Therapy",
    "definition" : "Plan benefit covers services related to infusion therapy."
  },
  {
    "code" : "tmjtx",
    "display" : "Treatment for Temporomandibular Joint Disorders",
    "definition" : "Plan benefit covers services related to treatment of Temporomandibular Joint disorder."
  },
  {
    "code" : "nutrition",
    "display" : "Nutritional Counseling",
    "definition" : "Nutritional Counseling."
  },
  {
    "code" : "reconsurg",
    "display" : "Reconstructive Surgery",
    "definition" : "Plan benefit covers services related to reconstructive surgery."
  },
  {
    "code" : "days",
    "display" : "Days",
    "definition" : "Measure of service covered by the plan benefit expressed in a definite number of days."
  },
  {
    "code" : "visit",
    "display" : "Visits",
    "definition" : "Measure of service covered by the plan benefit expressed in a definite number of visits."
  },
  {
    "code" : "procedure",
    "display" : "Procedures",
    "definition" : "Measure of service covered by the plan benefit expressed in a set of actions covered."
  },
  {
    "code" : "admission",
    "display" : "Admissions",
    "definition" : "Measure of services covered by the benefit plan expressed in relation to patient's acceptance for medical and nursing care in a hospital or other health care institution."
  },
  {
    "code" : "visithrs",
    "display" : "Hours per visit",
    "definition" : "Measure expresses how many hours per visit are covered by the insurance benefit plan."
  },
  {
    "code" : "weekhrs",
    "display" : "Hours per week",
    "definition" : "Measure expresses how many hours per week are covered by the insurance benefit plan."
  },
  {
    "code" : "mthhrs",
    "display" : "Hours per month",
    "definition" : "Measure expressed how many hours per month are covered by the insurance benefit plan."
  },
  {
    "code" : "yrhrs",
    "display" : "Hours per year",
    "definition" : "Measure expreses how many hours per year are covered by the insurance benfit plan."
  },
  {
    "code" : "daysperwk",
    "display" : "Days per week",
    "definition" : "Measure of service covered by the plan benefit expressed in a how many days are covered in a week."
  },
  {
    "code" : "dayspermth",
    "display" : "Days per month",
    "definition" : "Measure of service covered by the plan benefit expressed in a how many days are covered in a month."
  },
  {
    "code" : "daysperyr",
    "display" : "Days per year",
    "definition" : "Measure of service covered by the plan benefit expressed in a how many days are covered in a year."
  },
  {
    "code" : "mthsperyr",
    "display" : "Months per year",
    "definition" : "Measure of service covered by the plan benefit expressed in a how many month are covered in a year."
  },
  {
    "code" : "visitsperday",
    "display" : "Visits per day",
    "definition" : "Measure of service covered by the plan benefit expressed in a definite number of visits covered per day."
  },
  {
    "code" : "visitsperweek",
    "display" : "Visits per week",
    "definition" : "Measure of service covered by the plan benefit expressed in a definite number of visits covered per week."
  },
  {
    "code" : "visitspermth",
    "display" : "Visits per month",
    "definition" : "Measure of service covered by the plan benefit expressed in a definite number of visits covered per month."
  },
  {
    "code" : "visitsperyr",
    "display" : "Visits per year",
    "definition" : "Measure of service covered by the plan benefit expressed in a definite number of visits covered per year."
  },
  {
    "code" : "lifetimevisits",
    "display" : "Lifetime visits",
    "definition" : "Measure of service covered by the plan benefit expressed in a definite number of visits covered through lifetime."
  },
  {
    "code" : "txperweek",
    "display" : "Treatments per week",
    "definition" : "Measure of service covered by the plan benefit expressed in a definite number of treatment actions covered in a week."
  },
  {
    "code" : "txpermnth",
    "display" : "Treatments per month",
    "definition" : "Measure of service covered by the plan benefit expressed in a definite number of treatment actions covered in a month."
  },
  {
    "code" : "txlifetime",
    "display" : "Lifetime treatments",
    "definition" : "Measure of service covered by the plan benefit expressed in a definite number of treatment actions covered in a lifetime."
  },
  {
    "code" : "admitslifetime",
    "display" : "Lifetime admissions",
    "definition" : "Measure of service covered by the plan benefit expressed in a definite number admission actions covered through lifetime."
  },
  {
    "code" : "procperwk",
    "display" : "Procedures per week",
    "definition" : "Measure of service covered by the plan benefit expressed in a definite number procedure covered per week."
  },
  {
    "code" : "procpermnth",
    "display" : "Procedures per month",
    "definition" : "Measure of service covered by the plan benefit expressed in a definite number procedure covered per month."
  },
  {
    "code" : "procperyr",
    "display" : "Procedures per year",
    "definition" : "Measure of service covered by the plan benefit expressed in a definite number procedure covered per year."
  },
  {
    "code" : "proclifetime",
    "display" : "Lifetime procedures",
    "definition" : "Measure of service covered by the plan benefit expressed in a definite number procedure covered per lifetime."
  },
  {
    "code" : "daysperadmission",
    "display" : "Days per admission",
    "definition" : "Measure of service covered by the plan benefit expressed in a definite number of days covered for each individual admission."
  },
  {
    "code" : "procperepi",
    "display" : "Procedures per episode",
    "definition" : "Measure of service covered by the plan benefit expressed in a definite number of procedures covered for each individual treatment episode."
  },
  {
    "code" : "cat",
    "display" : "Catastrophic",
    "definition" : "'Catastrophic' health insurance plans have low monthly premiums and very high deductibles. They may cover worst-case scenarios, like getting seriously sick or injured. Patient pays most routine medical expenses."
  },
  {
    "code" : "bronze",
    "display" : "Bronze",
    "definition" : "'Bronze' type plan defines the estimated split costs of the plan, where patient is responsible for 40% of their healthcare cost while 60% is covered by the plan."
  },
  {
    "code" : "bronzeexp",
    "display" : "Expanded Bronze",
    "definition" : "The 'extended bronze' plan is an addition to the bronze metal level which establishes the de minimis variation range for the actuarial value (AV) level of coverage to allow variation in the AV to -4/+2 percentage points."
  },
  {
    "code" : "silver",
    "display" : "Silver",
    "definition" : "'Silver' type plan defines the estimated split costs of the plan, where patient is responsible for 30% of their healthcare cost while 70% is covered by the plan."
  },
  {
    "code" : "gold",
    "display" : "Gold",
    "definition" : "'Gold' type plan defines the estimated split costs of the plan, where patient is responsible for 20% of their healthcare cost while 80% is covered by the plan."
  },
  {
    "code" : "platinum",
    "display" : "Platinum",
    "definition" : "'Platinum' type plan defines the estimated split costs of the plan, where patient is responsible for 10% of their healthcare cost while 90% is covered by the plan."
  },
  {
    "code" : "lowded",
    "display" : "Low deductible",
    "definition" : "A health insurance plan with higher premiums and lower out of pocket cost than a traditional health plan."
  },
  {
    "code" : "highded",
    "display" : "High deductible",
    "definition" : "A health insurance plan with lower premiums and higher out of pocket cost than a traditional health plan."
  }]
}

```
