Representing Health Insurance Coverage

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Federally required	Cost	Test Tool Availability
Standard	LOINC®	Final	Production	No	Free	N/A
Standard	SNOMED CT® U.S. Edition	Final	Production	No	Free	No
Standard	ICD-10-CM	Final	Production	No	Free	No
Standard	CPT®	Final	Production	No	$	N/A

Limitations, Dependencies, and Preconditions for Consideration	Applicable Value Set(s) and Starter Set(s)
Health insurance coverage is defined by the HL7 Gravity Project as documentation of presence and type of insurance. LOINC is used for Social Determinants of Health (SDOH) observations (assessment instrument panels, questions, and answers.) SNOMED CT U.S. Edition is used for SDOH observations, conditions, goals, and interventions. ICD-10-CM is used for SDOH diagnoses. CPT is used for SDOH procedures and interventions. Implementation information for Health Insurance Coverage exchange can be found in Structure and Exchange of Social Determinants of Health Information. For more information about observations and observation values, see Appendix III for an informational resource developed by the Health IT Standards Committee.	Health Insurance Coverage Status Screening Assessments (LOINC) Health Insurance Coverage Status Screening Assessments Questions (LOINC) Health Insurance Coverage Status Screening Assessments Answers (LOINC) Health Insurance Coverage Status Diagnoses (ICD-10-CM, SNOMED CT) Health Insurance Coverage Status Goals (SNOMED CT) Health Insurance Coverage Status Procedures (CPT, SNOMED CT) Health Insurance Coverage Status Service Requests (CPT, SNOMED CT)

Limitations, Dependencies, and Preconditions for Consideration

Applicable Value Set(s) and Starter Set(s)

Health insurance coverage is defined by the HL7 Gravity Project as documentation of presence and type of insurance.

LOINC is used for Social Determinants of Health (SDOH) observations (assessment instrument panels, questions, and answers.)

SNOMED CT U.S. Edition is used for SDOH observations, conditions, goals, and interventions.

ICD-10-CM is used for SDOH diagnoses.

CPT is used for SDOH procedures and interventions.

Implementation information for Health Insurance Coverage exchange can be found in Structure and Exchange of Social Determinants of Health Information.

For more information about observations and observation values, see Appendix III for an informational resource developed by the Health IT Standards Committee.

Health Insurance Coverage Status Screening Assessments (LOINC)
Health Insurance Coverage Status Screening Assessments Questions (LOINC)
Health Insurance Coverage Status Screening Assessments Answers (LOINC)
Health Insurance Coverage Status Diagnoses (ICD-10-CM, SNOMED CT)
Health Insurance Coverage Status Goals (SNOMED CT)
Health Insurance Coverage Status Procedures (CPT, SNOMED CT)
Health Insurance Coverage Status Service Requests (CPT, SNOMED CT)

Representing Health Insurance Coverage

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