HL7 Terminology (THO)
7.5.0 - Publication
HL7 Terminology (THO)
7.5.0 - Publication
This page is part of the HL7 Terminology (v7.5.0: Release) based on FHIR (HL7® FHIR® Standard) v5.0.0. This is the current published version. For a full list of available versions, see the Directory of published versions
| Active as of 2026-10-27 | Maturity Level: 2 |
<CodeSystem xmlns="http://hl7.org/fhir">
<id value="coverage-copay-type"/>
<meta>
<lastUpdated value="2026-06-12T00:00:00+00:00"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/shareablecodesystem"/>
</meta>
<language value="en"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: CodeSystem coverage-copay-type</b></p><a name="coverage-copay-type"> </a><a name="hccoverage-copay-type"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Last updated: 2026-06-12 00:00:00+0000</p><p style="margin-bottom: 0px">Profile: <a href="http://hl7.org/fhir/R5/shareablecodesystem.html">Shareable CodeSystem</a></p></div><p>This case-sensitive code system <code>http://terminology.hl7.org/CodeSystem/coverage-copay-type</code> defines the following codes in a Is-A hierarchy:</p><table class="codes"><tr><td><b>Lvl</b></td><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td>1</td><td style="white-space:nowrap">gpvisit<a name="coverage-copay-type-gpvisit"> </a></td><td>GP Office Visit</td><td>An office visit for a general practitioner of a discipline.</td></tr><tr><td>1</td><td style="white-space:nowrap">spvisit<a name="coverage-copay-type-spvisit"> </a></td><td>Specialist Office Visit</td><td>An office visit for a specialist practitioner of a discipline</td></tr><tr><td>1</td><td style="white-space:nowrap">emergency<a name="coverage-copay-type-emergency"> </a></td><td>Emergency</td><td>An episode in an emergency department.</td></tr><tr><td>1</td><td style="white-space:nowrap">inpthosp<a name="coverage-copay-type-inpthosp"> </a></td><td>Inpatient Hospital</td><td>An episode of an Inpatient hospital stay.</td></tr><tr><td>1</td><td style="white-space:nowrap">televisit<a name="coverage-copay-type-televisit"> </a></td><td>Tele-visit</td><td>A visit held where the patient is remote relative to the practitioner, e.g. by phone, computer or video conference.</td></tr><tr><td>1</td><td style="white-space:nowrap">urgentcare<a name="coverage-copay-type-urgentcare"> </a></td><td>Urgent Care</td><td>A visit to an urgent care facility - typically a community care clinic.</td></tr><tr><td>1</td><td style="white-space:nowrap">rx<a name="coverage-copay-type-rx"> </a></td><td>Prescription</td><td>Prescription drug and pharmacy-related services.</td></tr><tr><td>1</td><td style="white-space:nowrap">copaypct<a name="coverage-copay-type-copaypct"> </a></td><td>Copay Percentage</td><td>A standard percentage applied to all classes or service or product not otherwise specified.</td></tr><tr><td>1</td><td style="white-space:nowrap">copay<a name="coverage-copay-type-copay"> </a></td><td>Copay Amount</td><td>A standard fixed currency amount applied to all classes or service or product not otherwise specified.</td></tr><tr><td>1</td><td style="white-space:nowrap">deductible<a name="coverage-copay-type-deductible"> </a></td><td>Deductible</td><td>The accumulated amount of patient payment before the coverage begins to pay for services.</td></tr><tr><td>2</td><td style="white-space:nowrap"> FamOutDed<a name="coverage-copay-type-FamOutDed"> </a></td><td>Family Out of Network Deductible</td><td>The accumulated amount applied toward the family's out-of-network deductible before the coverage begins to pay for covered out-of-network services.</td></tr><tr><td>2</td><td style="white-space:nowrap"> FamInDed<a name="coverage-copay-type-FamInDed"> </a></td><td>Family In Network Deductible</td><td>The accumulated amount applied toward the family's in-network deductible before the coverage begins to pay for covered in-network services.</td></tr><tr><td>2</td><td style="white-space:nowrap"> FamRxOutDed<a name="coverage-copay-type-FamRxOutDed"> </a></td><td>Family Pharmacy Out of Network Deductible</td><td>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.</td></tr><tr><td>2</td><td style="white-space:nowrap"> FamRxInDed<a name="coverage-copay-type-FamRxInDed"> </a></td><td>Family Pharmacy In Network Deductible</td><td>The accumulated amount applied toward the family's in-network pharmacy deductible before the coverage begins to pay for covered in-network pharmacy services.</td></tr><tr><td>2</td><td style="white-space:nowrap"> IndOutDed<a name="coverage-copay-type-IndOutDed"> </a></td><td>Invidual Out of Network Deductible</td><td>The accumulated amount applied toward the individual's out-of-network deductible before the coverage begins to pay for covered out-of-network services.</td></tr><tr><td>2</td><td style="white-space:nowrap"> IndInDed<a name="coverage-copay-type-IndInDed"> </a></td><td>Individual In Network Deductible</td><td>The accumulated amount applied toward the individual's in-network deductible before the coverage begins to pay for covered in-network services.</td></tr><tr><td>2</td><td style="white-space:nowrap"> IndRxOutDed<a name="coverage-copay-type-IndRxOutDed"> </a></td><td>Individual Pharmacy Out of Network Deductible</td><td>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.</td></tr><tr><td>2</td><td style="white-space:nowrap"> IndRxInDed<a name="coverage-copay-type-IndRxInDed"> </a></td><td>Individual Pharmacy In Network Deductible</td><td>The accumulated amount applied toward the individual's in-network pharmacy deductible before the coverage begins to pay for covered in-network pharmacy services.</td></tr><tr><td>1</td><td style="white-space:nowrap">maxoutofpocket<a name="coverage-copay-type-maxoutofpocket"> </a></td><td>Maximum out of pocket</td><td>The maximum amout of payment for services which a patient, or family, is expected to incur - typically annually.</td></tr><tr><td>2</td><td style="white-space:nowrap"> FamOutMax<a name="coverage-copay-type-FamOutMax"> </a></td><td>Family Out of Network Out of Pocket Maximum</td><td>The maximum amount of out-of-pocket payment that a family is expected to incur for covered out-of-network services.</td></tr><tr><td>2</td><td style="white-space:nowrap"> FamInMax<a name="coverage-copay-type-FamInMax"> </a></td><td>Family In Network Out of Pocket Maximum</td><td>The maximum amount of out-of-pocket payment that a family is expected to incur for covered in-network services.</td></tr><tr><td>2</td><td style="white-space:nowrap"> FamRxOutMax<a name="coverage-copay-type-FamRxOutMax"> </a></td><td>Family Pharmacy Out of Network Out of Pocket Maximum</td><td>The maximum amount of out-of-pocket payment that a family is expected to incur for covered out-of-network pharmacy services.</td></tr><tr><td>2</td><td style="white-space:nowrap"> FamRxInMax<a name="coverage-copay-type-FamRxInMax"> </a></td><td>Family Pharmacy In Network Out of Pocket Maximum</td><td>The maximum amount of out-of-pocket payment that a family is expected to incur for covered in-network pharmacy services.</td></tr><tr><td>2</td><td style="white-space:nowrap"> IndOutMax<a name="coverage-copay-type-IndOutMax"> </a></td><td>Individual Out of Network Out of Pocket Maximum</td><td>The maximum amount of out-of-pocket payment that an individual is expected to incur for covered out-of-network services.</td></tr><tr><td>2</td><td style="white-space:nowrap"> IndInMax<a name="coverage-copay-type-IndInMax"> </a></td><td>Individual In Network Out of Pocket Maximum</td><td>The maximum amount of out-of-pocket payment that an individual is expected to incur for covered in-network services.</td></tr><tr><td>2</td><td style="white-space:nowrap"> IndRxOutMax<a name="coverage-copay-type-IndRxOutMax"> </a></td><td>Individual Pharmacy Out of Network Out of Pocket Maximum</td><td>The maximum amount of out-of-pocket payment that an individual is expected to incur for covered out-of-network pharmacy services.</td></tr><tr><td>2</td><td style="white-space:nowrap"> IndRxInMax<a name="coverage-copay-type-IndRxInMax"> </a></td><td>Individual Pharmacy In Network Out of Pocket Maximum</td><td>The maximum amount of out-of-pocket payment that an individual is expected to incur for covered in-network pharmacy services.</td></tr></table></div>
</text>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
<valueCode value="fm"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
<valueInteger value="2"/>
</extension>
<url value="http://terminology.hl7.org/CodeSystem/coverage-copay-type"/>
<identifier>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:oid:2.16.840.1.113883.4.642.1.1149"/>
</identifier>
<version value="2.0.0"/>
<name value="CoverageCopayTypeCodes"/>
<title value="Coverage Copay Type Codes"/>
<status value="active"/>
<experimental value="false"/>
<date value="2026-10-27T07:45:07+11:00"/>
<publisher value="Health Level Seven International"/>
<contact>
<telecom>
<system value="url"/>
<value value="http://hl7.org"/>
</telecom>
<telecom>
<system value="email"/>
<value value="hq@HL7.org"/>
</telecom>
</contact>
<description
value="This value set includes sample Coverage Copayment Type codes."/>
<copyright
value="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"/>
<caseSensitive value="true"/>
<valueSet value="http://terminology.hl7.org/ValueSet/coverage-copay-type"/>
<hierarchyMeaning value="is-a"/>
<content value="complete"/>
<concept>
<code value="gpvisit"/>
<display value="GP Office Visit"/>
<definition
value="An office visit for a general practitioner of a discipline."/>
</concept>
<concept>
<code value="spvisit"/>
<display value="Specialist Office Visit"/>
<definition
value="An office visit for a specialist practitioner of a discipline"/>
</concept>
<concept>
<code value="emergency"/>
<display value="Emergency"/>
<definition value="An episode in an emergency department."/>
</concept>
<concept>
<code value="inpthosp"/>
<display value="Inpatient Hospital"/>
<definition value="An episode of an Inpatient hospital stay."/>
</concept>
<concept>
<code value="televisit"/>
<display value="Tele-visit"/>
<definition
value="A visit held where the patient is remote relative to the practitioner, e.g. by phone, computer or video conference."/>
</concept>
<concept>
<code value="urgentcare"/>
<display value="Urgent Care"/>
<definition
value="A visit to an urgent care facility - typically a community care clinic."/>
</concept>
<concept>
<code value="rx"/>
<display value="Prescription"/>
<definition value="Prescription drug and pharmacy-related services."/>
</concept>
<concept>
<code value="copaypct"/>
<display value="Copay Percentage"/>
<definition
value="A standard percentage applied to all classes or service or product not otherwise specified."/>
</concept>
<concept>
<code value="copay"/>
<display value="Copay Amount"/>
<definition
value="A standard fixed currency amount applied to all classes or service or product not otherwise specified."/>
</concept>
<concept>
<code value="deductible"/>
<display value="Deductible"/>
<definition
value="The accumulated amount of patient payment before the coverage begins to pay for services."/>
<concept>
<code value="FamOutDed"/>
<display value="Family Out of Network Deductible"/>
<definition
value="The accumulated amount applied toward the family's out-of-network deductible before the coverage begins to pay for covered out-of-network services."/>
</concept>
<concept>
<code value="FamInDed"/>
<display value="Family In Network Deductible"/>
<definition
value="The accumulated amount applied toward the family's in-network deductible before the coverage begins to pay for covered in-network services."/>
</concept>
<concept>
<code value="FamRxOutDed"/>
<display value="Family Pharmacy Out of Network Deductible"/>
<definition
value="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."/>
</concept>
<concept>
<code value="FamRxInDed"/>
<display value="Family Pharmacy In Network Deductible"/>
<definition
value="The accumulated amount applied toward the family's in-network pharmacy deductible before the coverage begins to pay for covered in-network pharmacy services."/>
</concept>
<concept>
<code value="IndOutDed"/>
<display value="Invidual Out of Network Deductible"/>
<definition
value="The accumulated amount applied toward the individual's out-of-network deductible before the coverage begins to pay for covered out-of-network services."/>
</concept>
<concept>
<code value="IndInDed"/>
<display value="Individual In Network Deductible"/>
<definition
value="The accumulated amount applied toward the individual's in-network deductible before the coverage begins to pay for covered in-network services."/>
</concept>
<concept>
<code value="IndRxOutDed"/>
<display value="Individual Pharmacy Out of Network Deductible"/>
<definition
value="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."/>
</concept>
<concept>
<code value="IndRxInDed"/>
<display value="Individual Pharmacy In Network Deductible"/>
<definition
value="The accumulated amount applied toward the individual's in-network pharmacy deductible before the coverage begins to pay for covered in-network pharmacy services."/>
</concept>
</concept>
<concept>
<code value="maxoutofpocket"/>
<display value="Maximum out of pocket"/>
<definition
value="The maximum amout of payment for services which a patient, or family, is expected to incur - typically annually."/>
<concept>
<code value="FamOutMax"/>
<display value="Family Out of Network Out of Pocket Maximum"/>
<definition
value="The maximum amount of out-of-pocket payment that a family is expected to incur for covered out-of-network services."/>
</concept>
<concept>
<code value="FamInMax"/>
<display value="Family In Network Out of Pocket Maximum"/>
<definition
value="The maximum amount of out-of-pocket payment that a family is expected to incur for covered in-network services."/>
</concept>
<concept>
<code value="FamRxOutMax"/>
<display value="Family Pharmacy Out of Network Out of Pocket Maximum"/>
<definition
value="The maximum amount of out-of-pocket payment that a family is expected to incur for covered out-of-network pharmacy services."/>
</concept>
<concept>
<code value="FamRxInMax"/>
<display value="Family Pharmacy In Network Out of Pocket Maximum"/>
<definition
value="The maximum amount of out-of-pocket payment that a family is expected to incur for covered in-network pharmacy services."/>
</concept>
<concept>
<code value="IndOutMax"/>
<display value="Individual Out of Network Out of Pocket Maximum"/>
<definition
value="The maximum amount of out-of-pocket payment that an individual is expected to incur for covered out-of-network services."/>
</concept>
<concept>
<code value="IndInMax"/>
<display value="Individual In Network Out of Pocket Maximum"/>
<definition
value="The maximum amount of out-of-pocket payment that an individual is expected to incur for covered in-network services."/>
</concept>
<concept>
<code value="IndRxOutMax"/>
<display
value="Individual Pharmacy Out of Network Out of Pocket Maximum"/>
<definition
value="The maximum amount of out-of-pocket payment that an individual is expected to incur for covered out-of-network pharmacy services."/>
</concept>
<concept>
<code value="IndRxInMax"/>
<display value="Individual Pharmacy In Network Out of Pocket Maximum"/>
<definition
value="The maximum amount of out-of-pocket payment that an individual is expected to incur for covered in-network pharmacy services."/>
</concept>
</concept>
</CodeSystem>
IG © 2020+ HL7 International - Vocabulary Work Group.
Package hl7.terminology#7.5.0 based on FHIR 5.0.0.
Generated
2026-10-27
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