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Using Codes Code Systems Value Sets Concept Maps Identifier Systems

4.4.1.635 4.4.1.693 Value Set ValueSet http://hl7.org/fhir/ValueSet/adjudication

  Maturity Level : 1

Responsible Owner: Financial Management Work Group

Draft Normative

Use Context : Any Country: World

This is a value set defined by the FHIR project. Summary

• Defining URL: Narrative http://hl7.org/fhir/ValueSet/adjudication
• XML Version:
• 4.0.1 JSON
• Name: TTL AdjudicationValueCodes

Committee:

Official URL : Title: http://hl7.org/fhir/ValueSet/adjudication Adjudication Value Codes Definition:				This value set includes a smattering of Adjudication Value codes which includes codes to indicate the amounts eligible under the plan, the amount of benefit, copays etc. Version : 6.0.0-ballot3
active as of 2025-11-27				Financial Management Computable Name : AdjudicationValueCodes Work Group
OID: Flags :				2.16.840.1.113883.4.642.3.596 (for OID based terminology systems) Copyright: This is an example set. Source Resource XML / JSON : 2.16.840.1.113883.4.642.3.596

This value set is used in the following places:

• CodeSystem: This value set is the designated 'entire code system' value set for AdjudicationValueCodes Resource: ExplanationOfBenefit.item.adjudication.category (CodeableConcept / Example Preferred )
• Resource: ExplanationOfBenefit.total.category (CodeableConcept / Example )
• Resource: ClaimResponse.item.adjudication.category (CodeableConcept / Example Preferred )
• Resource: ClaimResponse.total.category (CodeableConcept / Example )

4.4.1.635.1 4.4.1.693.1 Content Logical Definition

This value set includes a smattering of Adjudication Value codes from which includes codes to indicate the following code systems: amounts eligible under the plan, the amount of benefit, copays etc.

4.4.1.693.2 Content Logical Definition

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4.4.1.635.2 4.4.1.693.3 Expansion

This expansion generated 01 27 Nov 2019 2025

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See the full registry of value sets defined as part of FHIR.

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Explanation of the columns that may appear on this page:

Lvl	A few code lists that FHIR defines are hierarchical - each code is assigned a level. For value sets, levels are mostly used to organize codes for user convenience, but may follow code system hierarchy - see Code System for further information
Source	The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code	The code (used as the code in the resource instance). If the code is in italics, this indicates that the code is not selectable ('Abstract')
Display	The display (used in the display element of a Coding ). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition	An explanation of the meaning of the concept
Comments	Additional notes about how to use the code