HL7 Terminology (THO)
7.1.0 - Publication International flag

This page is part of the HL7 Terminology (v7.1.0: 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

CodeSystem: CRD Coverage Detail Codes

Official URL: http://terminology.hl7.org/CodeSystem/crd-coverage-detail Version: 1.0.0
Maturity Level: 1 Responsible: Health Level Seven International Computable Name: CRDCoverageDetail
Other Identifiers: OID:2.16.840.1.113883.5.177

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

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.

This Code system is referenced in the definition of the following value sets:

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

Language: en

Properties

This code system defines the following properties for its concepts

NameCodeURIType
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:

LvlCodeDisplayDefinitionNot 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 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.)

Description of the above table(s).

History

DateActionCustodianAuthorComment
2025-11-13createFMLloyd McKenzieAdd a new Coverage Detail code system to THO; up-670