Coverage Copay Type Codes - HL7 Terminology (THO) v7.5.0

HL7 Terminology (THO)
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CodeSystem: Coverage Copay Type Codes

Official URL: http://terminology.hl7.org/CodeSystem/coverage-copay-type		Version: 2.0.0	Highlight text changes?
Active as of 2026-10-27	Maturity Level: 2	Responsible: Health Level Seven International	Computable Name: CoverageCopayTypeCodes
Other Identifiers: OID:2.16.840.1.113883.4.642.1.1149
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 Code system is referenced in the definition of the following value sets:

Coverage Copay Type Codes

Last updated: 2026-06-12 00:00:00+0000

Profile: Shareable CodeSystem

This case-sensitive code system http://terminology.hl7.org/CodeSystem/coverage-copay-type defines the following codes in a Is-A hierarchy:

Lvl	Code	Display	Definition
1	gpvisit	GP Office Visit	An office visit for a general practitioner of a discipline.
1	spvisit	Specialist Office Visit	An office visit for a specialist practitioner of a discipline
1	emergency	Emergency	An episode in an emergency department.
1	inpthosp	Inpatient Hospital	An episode of an Inpatient hospital stay.
1	televisit	Tele-visit	A visit held where the patient is remote relative to the practitioner, e.g. by phone, computer or video conference.
1	urgentcare	Urgent Care	A visit to an urgent care facility - typically a community care clinic.
1	rx	Prescription	Prescription drug and pharmacy-related services.
1	copaypct	Copay Percentage	A standard percentage applied to all classes or service or product not otherwise specified.
1	copay	Copay Amount	A standard fixed currency amount applied to all classes or service or product not otherwise specified.
1	deductible	Deductible	The accumulated amount of patient payment before the coverage begins to pay for services.
2	FamOutDed	Family Out of Network Deductible	The accumulated amount applied toward the family's out-of-network deductible before the coverage begins to pay for covered out-of-network services.
2	FamInDed	Family In Network Deductible	The accumulated amount applied toward the family's in-network deductible before the coverage begins to pay for covered in-network services.
2	FamRxOutDed	Family Pharmacy Out of Network Deductible	The accumulated amount applied toward the family's out-of-network pharmacy deductible before the coverage begins to pay for covered out-of-network pharmacy services.
2	FamRxInDed	Family Pharmacy In Network Deductible	The accumulated amount applied toward the family's in-network pharmacy deductible before the coverage begins to pay for covered in-network pharmacy services.
2	IndOutDed	Invidual Out of Network Deductible	The accumulated amount applied toward the individual's out-of-network deductible before the coverage begins to pay for covered out-of-network services.
2	IndInDed	Individual In Network Deductible	The accumulated amount applied toward the individual's in-network deductible before the coverage begins to pay for covered in-network services.
2	IndRxOutDed	Individual Pharmacy Out of Network Deductible	The accumulated amount applied toward the individual's out-of-network pharmacy deductible before the coverage begins to pay for covered out-of-network pharmacy services.
2	IndRxInDed	Individual Pharmacy In Network Deductible	The accumulated amount applied toward the individual's in-network pharmacy deductible before the coverage begins to pay for covered in-network pharmacy services.
1	maxoutofpocket	Maximum out of pocket	The maximum amout of payment for services which a patient, or family, is expected to incur - typically annually.
2	FamOutMax	Family Out of Network Out of Pocket Maximum	The maximum amount of out-of-pocket payment that a family is expected to incur for covered out-of-network services.
2	FamInMax	Family In Network Out of Pocket Maximum	The maximum amount of out-of-pocket payment that a family is expected to incur for covered in-network services.
2	FamRxOutMax	Family Pharmacy Out of Network Out of Pocket Maximum	The maximum amount of out-of-pocket payment that a family is expected to incur for covered out-of-network pharmacy services.
2	FamRxInMax	Family Pharmacy In Network Out of Pocket Maximum	The maximum amount of out-of-pocket payment that a family is expected to incur for covered in-network pharmacy services.
2	IndOutMax	Individual Out of Network Out of Pocket Maximum	The maximum amount of out-of-pocket payment that an individual is expected to incur for covered out-of-network services.
2	IndInMax	Individual In Network Out of Pocket Maximum	The maximum amount of out-of-pocket payment that an individual is expected to incur for covered in-network services.
2	IndRxOutMax	Individual Pharmacy Out of Network Out of Pocket Maximum	The maximum amount of out-of-pocket payment that an individual is expected to incur for covered out-of-network pharmacy services.
2	IndRxInMax	Individual Pharmacy In Network Out of Pocket Maximum	The maximum amount of out-of-pocket payment that an individual is expected to incur for covered in-network pharmacy services.