National Directory of Healthcare Providers & Services (NDH) Implementation Guide
2.0.0-current - ci-build

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 2.0.0-current 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

## ValueSet: Benefit Type Value Set

Official URL: http://hl7.org/fhir/us/ndh/ValueSet/BenefitTypeVS | Version: 2.0.0-current
Standards status: Trial-use | Maturity Level: 4 | Computable Name: BenefitTypeVS

Codes for Insurance Benefit Type.

References

- NDH InsurancePlan Profile
- NDH InsurancePlan Profile

### Logical Definition (CLD)

- Include these codes as defined in `http://terminology.hl7.org/CodeSystem/insurance-benefit-type` version 📦2.0.0-current

  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.

### Expansion

Expansion performed internally based on codesystem Insurance Benefit Type Code System v2.0.0-current (CodeSystem)

This value set contains 67 concepts

System | Code | Display (en) | Definition | JSON | XML
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | 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. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | specialistov | Specialist Office Visit | Covered healthcare service rendered to a patient by a specialty provider. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | 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. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | 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. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | outpatstx | Outpatient Surgery Physician/Surgical Services | Benefit plan covers surgical services rendered to patient outside of a facility admission, referred to as outpatient. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | hospserv | Hospice Services | Benefit plan covers hospice services. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | routinedental | Routine Dental Services (Adult) | Benefit plan covers routine dental services. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | infertilitytx | Infertility Treatment | Benefit plan covers eligible infertility treatment services. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | ltnhc | Long-Term/Custodial Nursing Home Care | Long-Term/Custodial Nursing Home Care. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | privatenurse | Private-Duty Nursing | Private-Duty Nursing. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | routineeye | Routine Eye Exam (Adult) | Routine Eye Exam (Adult). |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | ucservice | Urgent Care Centers or Facilities | Urgent Care Centers or Facilities. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | homehealth | Home Health | Home health services insurance coverage. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | erservice | Emergency Room Services | Emergency Room Services. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | ambulance | Emergency Room Services | Emergency Room Services. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | 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. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | inpatientprovider | Inpatient Physician and Surgical Services | A healthcare provider who is delivering healthcare services in a hospital environment. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | bariatricsurg | Bariatric Surgery | Bariatric surgery service Skilled nursing service (qualifier value). |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | cosmeticsurg | Cosmetic Surgery | Cosmetic surgery service Skilled nursing service (qualifier value). |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | skillednursing | Skilled Nursing Facility | Skilled nursing service (qualifier value). |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | ppnatalcare | Prenatal and Postnatal Care | Prenatal and Postnatal services. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | maternitycare | Delivery and All Inpatient Services for Maternity Care | All maternity care services. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | menthlthoutp | Mental/Behavioral Health Outpatient Services | Mental health service delivered in an outpatient setting. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | menthlthinp | Mental/Behavioral Health Inpatient Services | Mental health service delivered in an hospital or inpatient facility setting. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | sadoutp | Substance Abuse Disorder Outpatient Services | Substance abuse related services delivered in a outpatient setting. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | sadinp | Substance Abuse Disorder Inpatient Services | Substance abuse related services delivered in a inpatient setting. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | drggenric | Generic Drugs | Generic drugs eligible benefits. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | drgbrand | Preferred Brand Drugs | Preferred brand drugs eligible benefits. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | drgnonpreferred | Non-Preferred Brand Drugs | Non-Preferred drugs brands eligible benefits. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | drgspecialty | Specialty Drugs | Benefit plan covers specialty drugs. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | rehaboutp | Outpatient Rehabilitation Services | Benefit plan covers outpatient rehabilitation services. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | servicehablitation | Habilitation Services | Habilitation Services. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | chiro | Chiropractic Care | Benefit plan covers chiropractor eligible benefits. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | dme | Durable Medical Equipment | Benefit plan covers Durable medical equipment eligible benefits. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | hearingaids | Hearing Aids | Benefit plan covers hearing aids. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | imgctpetmri | Imaging (CT/PET Scans, MRIs) | Benefit plan covers advances imaging techniques services (CT/PET Scans, MRIs) eligible services. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | prev | Preventive Care/Screening/Immunization | Routine healthcare services to prevent health related problems eligible benefits. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | rtnpod | Routine Foot Care | Routine Foot Care. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | acupuncture | Acupuncture | Benefit plan covers acupuncture treatment. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | weightloss | Weight Loss Programs | Benefit plan covers weight loss services eligible benefits. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | rtneyechld | Routine Eye Exam for Children | Routine eye exam for children eligible benefits. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | glasseschld | Eye Glasses for Children | Eye glasses children eligible benefits. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | rtndntlchld | Dental Check-Up for Children | Dental Check-Up for Children. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | speachthpy | Rehabilitative Speech Therapy | Benefit plan covers rehabilitative speech therapy eligible benefits. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | rehaboccandpt | Rehabilitative Occupational and Rehabilitative Physical Therapy | Benefit plan covers rehabilitative occupational and rehabilitative physical eligible benefits. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | 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. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | laboutp | Laboratory Outpatient and Professional Services | Benefit plan covers laboratory testing and related professional services received as outpatient. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | 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. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | dntlbaschld | Basic Dental Care - Child | Benefit plan covers diagnostic basic dental care. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | orthochld | Orthodontia - Child | Benefit plan covers orthodontia for children. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | dntlmajchld | Major Dental Care - Child | Benefit plan covers major dental care for children. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | dntlbasadlt | Basic Dental Care - Adult | Benefit plan covers basic dental care for adults. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | orthodadlt | Orthodontia - Adult | Benefits plan covers services provided that are required for orthodontic purposes for an adult. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | dntlmajadlt | Major Dental Care - Adult | Benefit plan covers major dental care for adult. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | abortion | Abortion for Which Public Funding is Prohibited | Benefit plan covers services for abortion for which public funding is prohibited. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | transplant | Transplant | Benefit plan covers transplant related services. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | accdntl | Accidental Dental | Benefit plan covers dental care services related to an accident. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | dialysis | Dialysis | The plan benefit covers services used to treat end stage renal disease. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | 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. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | chemotherapy | Chemotherapy | The plan benefits cover services the use of drugs and approved chemicals to treat disease. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | radiation | Radiation | The plan benefits cover services the use radiation to treat disease. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | 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. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | prosthetic | Prosthetic Devices | Plan benefit covers services related to prosthesis devices. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | infusiontx | Infusion Therapy | Plan benefit covers services related to infusion therapy. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | tmjtx | Treatment for Temporomandibular Joint Disorders | Plan benefit covers services related to treatment of Temporomandibular Joint disorder. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | nutrition | Nutritional Counseling | Nutritional Counseling. |  |
`http://terminology.hl7.org/CodeSystem/insurance-benefit-type` | reconsurg | 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