<?xml version="1.0" encoding="UTF-8"?>
<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="crd-coverage-detail"/>
  <language value="en"/>
  <text>
    <status value="generated"/>
    <div value="&lt;div xmlns=&quot;http://www.w3.org/1999/xhtml&quot; xml:lang=&quot;en&quot; lang=&quot;en&quot;&gt;&lt;p class=&quot;res-header-id&quot;&gt;&lt;b&gt;Generated Narrative: CodeSystem crd-coverage-detail&lt;/b&gt;&lt;/p&gt;&lt;a name=&quot;crd-coverage-detail&quot;&gt; &lt;/a&gt;&lt;a name=&quot;hccrd-coverage-detail&quot;&gt; &lt;/a&gt;&lt;div style=&quot;display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%&quot;&gt;&lt;p style=&quot;margin-bottom: 0px&quot;&gt;Language: en&lt;/p&gt;&lt;/div&gt;&lt;p&gt;&lt;b&gt;Properties&lt;/b&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;This code system defines the following properties for its concepts&lt;/b&gt;&lt;/p&gt;&lt;table class=&quot;grid&quot;&gt;&lt;tr&gt;&lt;td&gt;&lt;b&gt;Name&lt;/b&gt;&lt;/td&gt;&lt;td&gt;&lt;b&gt;Code&lt;/b&gt;&lt;/td&gt;&lt;td&gt;&lt;b&gt;URI&lt;/b&gt;&lt;/td&gt;&lt;td&gt;&lt;b&gt;Type&lt;/b&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Not Selectable&lt;/td&gt;&lt;td&gt;abstract&lt;/td&gt;&lt;td&gt;http://hl7.org/fhir/concept-properties#notSelectable&lt;/td&gt;&lt;td&gt;boolean&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;&lt;p&gt;&lt;b&gt;Concepts&lt;/b&gt;&lt;/p&gt;&lt;p&gt;This case-sensitive code system &lt;code&gt;http://terminology.hl7.org/CodeSystem/crd-coverage-detail&lt;/code&gt; defines the following codes in a Is-A hierarchy:&lt;/p&gt;&lt;table class=&quot;codes&quot;&gt;&lt;tr&gt;&lt;td&gt;&lt;b&gt;Lvl&lt;/b&gt;&lt;/td&gt;&lt;td style=&quot;white-space:nowrap&quot;&gt;&lt;b&gt;Code&lt;/b&gt;&lt;/td&gt;&lt;td&gt;&lt;b&gt;Display&lt;/b&gt;&lt;/td&gt;&lt;td&gt;&lt;b&gt;Definition&lt;/b&gt;&lt;/td&gt;&lt;td&gt;&lt;b&gt;Not Selectable&lt;/b&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;1&lt;/td&gt;&lt;td style=&quot;white-space:nowrap&quot;&gt;_limitation&lt;a name=&quot;crd-coverage-detail-_limitation&quot;&gt; &lt;/a&gt;&lt;/td&gt;&lt;td&gt;Limitation details&lt;/td&gt;&lt;td&gt;Identifies detail codes that define limitations of coverage.  (Category should be &apos;cat-limitation&apos;)&lt;/td&gt;&lt;td&gt;true&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;2&lt;/td&gt;&lt;td style=&quot;white-space:nowrap&quot;&gt;  allowed-quantity&lt;a name=&quot;crd-coverage-detail-allowed-quantity&quot;&gt; &lt;/a&gt;&lt;/td&gt;&lt;td&gt;Maximum quantity&lt;/td&gt;&lt;td&gt;Indicates limitations on the number of services/products allowed (possibly per time period).  Value should be a Quantity&lt;/td&gt;&lt;td/&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;2&lt;/td&gt;&lt;td style=&quot;white-space:nowrap&quot;&gt;  allowed-period&lt;a name=&quot;crd-coverage-detail-allowed-period&quot;&gt; &lt;/a&gt;&lt;/td&gt;&lt;td&gt;Maximum allowed period&lt;/td&gt;&lt;td&gt;Indicates the maximum period of time that can be covered in a single order.  Value should be a Period&lt;/td&gt;&lt;td/&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;1&lt;/td&gt;&lt;td style=&quot;white-space:nowrap&quot;&gt;_decisional&lt;a name=&quot;crd-coverage-detail-_decisional&quot;&gt; &lt;/a&gt;&lt;/td&gt;&lt;td&gt;Decisional details&lt;/td&gt;&lt;td&gt;Identifies detail codes that may impact patient and clinician decision making  (Category should be &apos;cat-decisional&apos;)&lt;/td&gt;&lt;td&gt;true&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;2&lt;/td&gt;&lt;td style=&quot;white-space:nowrap&quot;&gt;  in-network-copay&lt;a name=&quot;crd-coverage-detail-in-network-copay&quot;&gt; &lt;/a&gt;&lt;/td&gt;&lt;td&gt;Copay for in-network&lt;/td&gt;&lt;td&gt;Indicates a percentage co-pay to expect if delivered in-network.  Value should be a Quantity.&lt;/td&gt;&lt;td/&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;2&lt;/td&gt;&lt;td style=&quot;white-space:nowrap&quot;&gt;  out-network-copay&lt;a name=&quot;crd-coverage-detail-out-network-copay&quot;&gt; &lt;/a&gt;&lt;/td&gt;&lt;td&gt;Copay for out-of-network&lt;/td&gt;&lt;td&gt;Indicates a percentage co-pay to expect if delivered out-of-network.  Value should be a Quantity.&lt;/td&gt;&lt;td/&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;2&lt;/td&gt;&lt;td style=&quot;white-space:nowrap&quot;&gt;  concurrent-review&lt;a name=&quot;crd-coverage-detail-concurrent-review&quot;&gt; &lt;/a&gt;&lt;/td&gt;&lt;td&gt;Concurrent review&lt;/td&gt;&lt;td&gt;Additional payer-defined documentation will be required prior to claim payment.  Value should be a boolean.&lt;/td&gt;&lt;td/&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;2&lt;/td&gt;&lt;td style=&quot;white-space:nowrap&quot;&gt;  appropriate-use-needed&lt;a name=&quot;crd-coverage-detail-appropriate-use-needed&quot;&gt; &lt;/a&gt;&lt;/td&gt;&lt;td&gt;Appropriate use&lt;/td&gt;&lt;td&gt;Payer-defined appropriate use process must be invoked to determine coverage.  Value should be a boolean.&lt;/td&gt;&lt;td/&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;1&lt;/td&gt;&lt;td style=&quot;white-space:nowrap&quot;&gt;_other&lt;a name=&quot;crd-coverage-detail-_other&quot;&gt; &lt;/a&gt;&lt;/td&gt;&lt;td&gt;Other details&lt;/td&gt;&lt;td&gt;Identifies detail codes that are generally not relevant to clinicians/patients  (Category should be &apos;cat-other&apos;)&lt;/td&gt;&lt;td&gt;true&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;2&lt;/td&gt;&lt;td style=&quot;white-space:nowrap&quot;&gt;  policy-link&lt;a name=&quot;crd-coverage-detail-policy-link&quot;&gt; &lt;/a&gt;&lt;/td&gt;&lt;td&gt;Policy Link&lt;/td&gt;&lt;td&gt;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.&lt;/td&gt;&lt;td/&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;1&lt;/td&gt;&lt;td style=&quot;white-space:nowrap&quot;&gt;instructions&lt;a name=&quot;crd-coverage-detail-instructions&quot;&gt; &lt;/a&gt;&lt;/td&gt;&lt;td&gt;Instructions&lt;/td&gt;&lt;td&gt;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.)&lt;/td&gt;&lt;td/&gt;&lt;/tr&gt;&lt;/table&gt;&lt;/div&gt;"/>
  </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="1"/>
  </extension>
  <url value="http://terminology.hl7.org/CodeSystem/crd-coverage-detail"/>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.16.840.1.113883.5.177"/>
  </identifier>
  <version value="1.0.0"/>
  <name value="CRDCoverageDetail"/>
  <title value="CRD Coverage Detail Codes"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2025-10-16T00:00:00+00:00"/>
  <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="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."/>
  <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"/>
  <hierarchyMeaning value="is-a"/>
  <content value="complete"/>
  <property>
    <code value="abstract"/>
    <uri value="http://hl7.org/fhir/concept-properties#notSelectable"/>
    <type value="boolean"/>
  </property>
  <concept>
    <code value="_limitation"/>
    <display value="Limitation details"/>
    <definition value="Identifies detail codes that define limitations of coverage.  (Category should be &apos;cat-limitation&apos;)"/>
    <property>
      <code value="abstract"/>
      <valueBoolean value="true"/>
    </property>
    <concept>
      <code value="allowed-quantity"/>
      <display value="Maximum quantity"/>
      <definition value="Indicates limitations on the number of services/products allowed (possibly per time period).  Value should be a Quantity"/>
    </concept>
    <concept>
      <code value="allowed-period"/>
      <display value="Maximum allowed period"/>
      <definition value="Indicates the maximum period of time that can be covered in a single order.  Value should be a Period"/>
    </concept>
  </concept>
  <concept>
    <code value="_decisional"/>
    <display value="Decisional details"/>
    <definition value="Identifies detail codes that may impact patient and clinician decision making  (Category should be &apos;cat-decisional&apos;)"/>
    <property>
      <code value="abstract"/>
      <valueBoolean value="true"/>
    </property>
    <concept>
      <code value="in-network-copay"/>
      <display value="Copay for in-network"/>
      <definition value="Indicates a percentage co-pay to expect if delivered in-network.  Value should be a Quantity."/>
    </concept>
    <concept>
      <code value="out-network-copay"/>
      <display value="Copay for out-of-network"/>
      <definition value="Indicates a percentage co-pay to expect if delivered out-of-network.  Value should be a Quantity."/>
    </concept>
    <concept>
      <code value="concurrent-review"/>
      <display value="Concurrent review"/>
      <definition value="Additional payer-defined documentation will be required prior to claim payment.  Value should be a boolean."/>
    </concept>
    <concept>
      <code value="appropriate-use-needed"/>
      <display value="Appropriate use"/>
      <definition value="Payer-defined appropriate use process must be invoked to determine coverage.  Value should be a boolean."/>
    </concept>
  </concept>
  <concept>
    <code value="_other"/>
    <display value="Other details"/>
    <definition value="Identifies detail codes that are generally not relevant to clinicians/patients  (Category should be &apos;cat-other&apos;)"/>
    <property>
      <code value="abstract"/>
      <valueBoolean value="true"/>
    </property>
    <concept>
      <code value="policy-link"/>
      <display value="Policy Link"/>
      <definition value="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."/>
    </concept>
  </concept>
  <concept>
    <code value="instructions"/>
    <display value="Instructions"/>
    <definition value="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.)"/>
  </concept>
</CodeSystem>