HL7 Terminology (THO)
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This page is part of the HL7 Terminology (v5.5.0: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

ValueSet: Coverage Copay Type Codes

Official URL: http://terminology.hl7.org/ValueSet/coverage-copay-type Version: 1.0.0
Draft as of 2020-02-24 Maturity Level: 2 Responsible: Health Level Seven International Computable Name: CoverageCopayTypeCodes
Other Identifiers: urn:ietf:rfc:3986#Uniform Resource Identifier (URI)#urn:oid:2.16.840.1.113883.4.642.3.527

Copyright/Legal: 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

This value set includes sample Coverage Copayment Type codes.


This value set is not used here; it may be used elsewhere (e.g. specifications and/or implementations that use this content)

Logical Definition (CLD)



Expansion based on codesystem Coverage Copay Type Codes v1.0.0 (CodeSystem)

This value set contains 10 concepts.

  gpvisithttp://terminology.hl7.org/CodeSystem/coverage-copay-typeGP Office Visit

An office visit for a general practitioner of a discipline.

  spvisithttp://terminology.hl7.org/CodeSystem/coverage-copay-typeSpecialist Office Visit

An office visit for a specialist practitioner of a discipline


An episode in an emergency department.

  inpthosphttp://terminology.hl7.org/CodeSystem/coverage-copay-typeInpatient Hospital

An episode of an Inpatient hospital stay.


A visit held where the patient is remote relative to the practitioner, e.g. by phone, computer or video conference.

  urgentcarehttp://terminology.hl7.org/CodeSystem/coverage-copay-typeUrgent Care

A visit to an urgent care facility - typically a community care clinic.

  copaypcthttp://terminology.hl7.org/CodeSystem/coverage-copay-typeCopay Percentage

A standard percentage applied to all classes or service or product not otherwise specified.

  copayhttp://terminology.hl7.org/CodeSystem/coverage-copay-typeCopay Amount

A standard fixed currency amount applied to all classes or service or product not otherwise specified.


The accumulated amount of patient payment before the coverage begins to pay for services.

  maxoutofpockethttp://terminology.hl7.org/CodeSystem/coverage-copay-typeMaximum out of pocket

The maximum amout of payment for services which a patient, or family, is expected to incur - typically annually.

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


2023-11-14reviseTSMGMarc DuteauAdd standard copyright and contact to internal content; up-476
2020-10-14reviseVocabulary WGGrahame GrieveReset Version after migration to UTG
2020-05-06reviseVocabulary WGTed KleinMigrated to the UTG maintenance environment and publishing tooling.