{
  "description": "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.",
  "_filename": "CodeSystem-crd-coverage-detail.json",
  "package_name": "hl7.terminology.r4",
  "date": "2025-10-16T00:00:00+00:00",
  "publisher": "Health Level Seven International",
  "content": "complete",
  "property": [ {
    "uri": "http://hl7.org/fhir/concept-properties#notSelectable",
    "code": "abstract",
    "type": "boolean"
  } ],
  "name": "CRDCoverageDetail",
  "copyright": "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",
  "type": null,
  "experimental": "false",
  "resourceType": "CodeSystem",
  "title": "CRD Coverage Detail Codes",
  "package_version": "7.0.0",
  "extension": [ {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode": "fm"
  }, {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger": 1
  } ],
  "status": "active",
  "hierarchyMeaning": "is-a",
  "id": "23ca8555-4e61-4983-827e-9d9b370f630b",
  "kind": null,
  "url": "http://terminology.hl7.org/CodeSystem/crd-coverage-detail",
  "identifier": [ {
    "value": "urn:oid:2.16.840.1.113883.5.177",
    "system": "urn:ietf:rfc:3986"
  } ],
  "concept": [ {
    "code": "_limitation",
    "concept": [ {
      "code": "allowed-quantity",
      "display": "Maximum quantity",
      "definition": "Indicates limitations on the number of services/products allowed (possibly per time period).  Value should be a Quantity"
    }, {
      "code": "allowed-period",
      "display": "Maximum allowed period",
      "definition": "Indicates the maximum period of time that can be covered in a single order.  Value should be a Period"
    } ],
    "display": "Limitation details",
    "property": [ {
      "code": "abstract",
      "valueBoolean": true
    } ],
    "definition": "Identifies detail codes that define limitations of coverage.  (Category should be 'cat-limitation')"
  }, {
    "code": "_decisional",
    "concept": [ {
      "code": "in-network-copay",
      "display": "Copay for in-network",
      "definition": "Indicates a percentage co-pay to expect if delivered in-network.  Value should be a Quantity."
    }, {
      "code": "out-network-copay",
      "display": "Copay for out-of-network",
      "definition": "Indicates a percentage co-pay to expect if delivered out-of-network.  Value should be a Quantity."
    }, {
      "code": "concurrent-review",
      "display": "Concurrent review",
      "definition": "Additional payer-defined documentation will be required prior to claim payment.  Value should be a boolean."
    }, {
      "code": "appropriate-use-needed",
      "display": "Appropriate use",
      "definition": "Payer-defined appropriate use process must be invoked to determine coverage.  Value should be a boolean."
    } ],
    "display": "Decisional details",
    "property": [ {
      "code": "abstract",
      "valueBoolean": true
    } ],
    "definition": "Identifies detail codes that may impact patient and clinician decision making  (Category should be 'cat-decisional')"
  }, {
    "code": "_other",
    "concept": [ {
      "code": "policy-link",
      "display": "Policy Link",
      "definition": "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."
    } ],
    "display": "Other details",
    "property": [ {
      "code": "abstract",
      "valueBoolean": true
    } ],
    "definition": "Identifies detail codes that are generally not relevant to clinicians/patients  (Category should be 'cat-other')"
  }, {
    "code": "instructions",
    "display": "Instructions",
    "definition": "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.)"
  } ],
  "caseSensitive": true,
  "version": "1.0.0",
  "contact": [ {
    "telecom": [ {
      "value": "http://hl7.org",
      "system": "url"
    }, {
      "value": "hq@HL7.org",
      "system": "email"
    } ]
  } ]
}