crd-coverage-detail
type: CodeSystem
node role: treeRoot
id:
  v: crd-coverage-detail
text:
  status:
    v: generated
  div: Generated Narrative: CodeSystem crd-coverage-detail Properties This code system defines the following properties for its concepts Name Code URI Type Not Selectable abstract http://hl7.org/fhir/concept-properties#notSelectable boolean Concepts This case-sensitive code system http://terminology.hl7.org/CodeSystem/crd-coverage-detail defines the following codes in a Is-A hierarchy: Lvl Code Display Definition Not Selectable 1 _limitation Limitation details Identifies detail codes that define limitations of coverage. (Category should be 'cat-limitation') true 2 allowed-quantity Maximum quantity Indicates limitations on the number of services/products allowed (possibly per time period). Value should be a Quantity 2 allowed-period Maximum allowed period Indicates the maximum period of time that can be covered in a single order. Value should be a Period 1 _decisional Decisional details Identifies detail codes that may impact patient and clinician decision making (Category should be 'cat-decisional') true 2 in-network-copay Copay for in-network Indicates a percentage co-pay to expect if delivered in-network. Value should be a Quantity. 2 out-network-copay Copay for out-of-network Indicates a percentage co-pay to expect if delivered out-of-network. Value should be a Quantity. 2 concurrent-review Concurrent review Additional payer-defined documentation will be required prior to claim payment. Value should be a boolean. 2 appropriate-use-needed Appropriate use Payer-defined appropriate use process must be invoked to determine coverage. Value should be a boolean. 1 _other Other details Identifies detail codes that are generally not relevant to clinicians/patients (Category should be 'cat-other') true 2 policy-link Policy Link A URL pointing to the specific portion of a payer policy, coverage agreement or similar authoritative document that provides a portion of the basis for the decision documented in the coverage-information. Value should be a url. 1 instructions Instructions …
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-wg
  value: code
    v: fm
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm
  value: integer
    v: 1
url:
  v: http://terminology.hl7.org/CodeSystem/crd-coverage-detail
identifier:
  system:
    v: urn:ietf:rfc:3986
  value:
    v: urn:oid:2.16.840.1.113883.5.177
version:
  v: 1.0.0
name:
  v: CRDCoverageDetail
title:
  v: CRD Coverage Detail Codes
status:
  v: active
experimental:
  v: false
date:
  v: 2025-10-16T00:00:00+00:00
publisher:
  v: Health Level Seven International
contact:
  telecom:
    system:
      v: url
    value:
      v: http://hl7.org
  telecom:
    system:
      v: email
description:
  v: Codes that describe additional details related to a coverage information assertion. These live in THO rather than the CRD specification to support adding additional concepts without putting out a new CRD release.
copyright:
  v: This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license
case sensitive:
  v: true
hierarchy meaning:
  v: is-a
content:
  v: complete
property:
  code:
    v: abstract
  uri:
    v: http://hl7.org/fhir/concept-properties#notSelectable
  type:
    v: boolean
concept:
  code:
    v: _limitation
  display:
    v: Limitation details
  definition:
    v: Identifies detail codes that define limitations of coverage. (Category should be 'cat-limitation')
  property:
    code:
      v: abstract
    value: boolean
      v: true
  concept:
    code:
      v: allowed-quantity
    display:
      v: Maximum quantity
    definition:
      v: Indicates limitations on the number of services/products allowed (possibly per time period). Value should be a Quantity
  concept:
    code:
      v: allowed-period
    display:
      v: Maximum allowed period
    definition:
      v: Indicates the maximum period of time that can be covered in a single order. Value should be a Period
concept:
  code:
    v: _decisional
  display:
    v: Decisional details
  definition:
    v: Identifies detail codes that may impact patient and clinician decision making (Category should be 'cat-decisional')
  property:
    code:
      v: abstract
    value: boolean
      v: true
  concept:
    code:
      v: in-network-copay
    display:
      v: Copay for in-network
    definition:
      v: Indicates a percentage co-pay to expect if delivered in-network. Value should be a Quantity.
  concept:
    code:
      v: out-network-copay
    display:
      v: Copay for out-of-network
    definition:
      v: Indicates a percentage co-pay to expect if delivered out-of-network. Value should be a Quantity.
  concept:
    code:
      v: concurrent-review
    display:
      v: Concurrent review
    definition:
      v: Additional payer-defined documentation will be required prior to claim payment. Value should be a boolean.
  concept:
    code:
      v: appropriate-use-needed
    display:
      v: Appropriate use
    definition:
      v: Payer-defined appropriate use process must be invoked to determine coverage. Value should be a boolean.
concept:
  code:
    v: _other
  display:
    v: Other details
  definition:
    v: Identifies detail codes that are generally not relevant to clinicians/patients (Category should be 'cat-other')
  property:
    code:
      v: abstract
    value: boolean
      v: true
  concept:
    code:
      v: policy-link
    display:
      v: Policy Link
    definition:
      v: A URL pointing to the specific portion of a payer policy, coverage agreement or similar authoritative document that provides a portion of the basis for the decision documented in the coverage-information. Value should be a url.
concept:
  code:
    v: instructions
  display:
    v: Instructions
  definition:
    v: Information to display to the user that gives guidance about what steps to take in achieving the recommended actions identified by this coverage-information (e.g. special instructions about requesting authorization, details about information needed, details about data retention, etc.). Value should be a string. (Category may vary.)