billing-rule-class
type: CodeSystem
node role: treeRoot
resource.id:
  value: billing-rule-class
domain resource.text:
  narrative.status:
    value: generated
  narrative.div: Generated Narrative: CodeSystem billing-rule-class Properties This code system defines the following properties for its concepts Name Code URI Type Description defaultEffect defaultEffect https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class#defaultEffect Coding Default effect when a rule instance does not declare a more specific supported effect requiredFactTypes requiredFactTypes https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class#requiredFactTypes Coding Declared floor of fact categories for this class. A conforming evaluator derives the authoritative required-fact set from the rule class together with its instance parameters; that derived set is never smaller than this floor and may be larger. since since https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class#since string Semantic major in which this immutable class concept was introduced replacedBy replacedBy https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class#replacedBy Coding Successor class concept when this concept is retired Concepts This case-sensitive code system https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class defines the following codes: Code Display Definition defaultEffect requiredFactTypes since quantity-limit Quantity limit Limits the number of matching services within a counting scope. Reject Service occurrence 1 value-limit Value limit Limits the sum of a measure, such as currency, points, or minutes, within a counting scope. Reject Service value 1 mutual-exclusion Mutual exclusion Forbids selected services from occurring together within a counting scope. Reject Service occurrence 1 inclusive-component Inclusive component Declares that a component service is included in a containing service and is not separately billable in the stated direction. Reject Service occurrence 1 companion-required Companion required Requires one or more companion services, optionally with ordering constraints, within a counting scope. Reject Service occurrence 1 repeat-in…
code system.url:
  value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class
code system.identifier:
  index: 0
  identifier.system:
    value: urn:ietf:rfc:3986
  identifier.value:
    value: urn:oid:2.16.840.1.113883.3.7985.16.20
code system.version:
  value: 1
code system.name:
  value: BillingRuleClassCS
code system.title:
  value: Billing Rule Class
code system.status:
  value: active
code system.experimental:
  value: false
code system.date:
  value: 2026-08-22T18:18:46+02:00
code system.publisher:
  value: cognovis GmbH
code system.contact:
  index: 0
  contact detail.name:
    value: cognovis GmbH
  contact detail.telecom:
    index: 0
    contact point.system:
      value: url
    contact point.value:
      value: https://www.cognovis.de
  contact detail.telecom:
    index: 1
    contact point.system:
      value: email
code system.description:
  value: Regime-neutral classes of declarative billing rules. A rule class names an observable evaluation algorithm; fee schedules and contracts provide instance parameters.
code system.jurisdiction:
  index: 0
  codeable concept.coding:
    index: 0
    coding.system:
      value: urn:iso:std:iso:3166
    coding.code:
      value: DE
code system.copyright:
  value: Copyright 2026+ cognovis GmbH. Cognovis-authored material is licensed under Apache-2.0; third-party material retains its own terms as documented in THIRD_PARTY_NOTICES.md.
code system.case sensitive:
  value: true
code system.content:
  value: complete
code system.count:
  value: 20
code system.property:
  index: 0
  code system.property.code:
    value: defaultEffect
  code system.property.uri:
    value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class#defaultEffect
  code system.property.description:
    value: Default effect when a rule instance does not declare a more specific supported effect
  code system.property.type:
    value: Coding
code system.property:
  index: 1
  code system.property.code:
    value: requiredFactTypes
  code system.property.uri:
    value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class#requiredFactTypes
  code system.property.description:
    value: Declared floor of fact categories for this class. A conforming evaluator derives the authoritative required-fact set from the rule class together with its instance parameters; that derived set is never smaller than this floor and may be larger.
  code system.property.type:
    value: Coding
code system.property:
  index: 2
  code system.property.code:
    value: since
  code system.property.uri:
    value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class#since
  code system.property.description:
    value: Semantic major in which this immutable class concept was introduced
  code system.property.type:
    value: string
code system.property:
  index: 3
  code system.property.code:
    value: replacedBy
  code system.property.uri:
    value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-class#replacedBy
  code system.property.description:
    value: Successor class concept when this concept is retired
  code system.property.type:
    value: Coding
code system.concept:
  index: 0
  code system.concept.code:
    value: quantity-limit
  code system.concept.display:
    value: Quantity limit
  code system.concept.definition:
    value: Limits the number of matching services within a counting scope.
  code system.concept.property:
    index: 0
    code system.concept.property.code:
      value: defaultEffect
    code system.concept.property.value coding:
      coding.system:
        value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect
      coding.code:
        value: reject
  code system.concept.property:
    index: 1
    code system.concept.property.code:
      value: requiredFactTypes
    code system.concept.property.value coding:
      coding.system:
        value: https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact
      coding.code:
        value: service-occurrence
  code system.concept.property:
    index: 2
    code system.concept.property.code:
      value: since
    code system.concept.property.value string:
      value: 1
code system.concept:
  index: 1
  code system.concept.code:
    value: value-limit
  code system.concept.display:
    value: Value limit
  code system.concept.definition:
    value: Limits the sum of a measure, such as currency, points, or minutes, within a counting scope.
  code system.concept.property:
    index: 0
    code system.concept.property.code:
      value: defaultEffect
    code system.concept.property.value coding:
      coding.system:
        value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect
      coding.code:
        value: reject
  code system.concept.property:
    index: 1
    code system.concept.property.code:
      value: requiredFactTypes
    code system.concept.property.value coding:
      coding.system:
        value: https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact
      coding.code:
        value: service-value
  code system.concept.property:
    index: 2
    code system.concept.property.code:
      value: since
    code system.concept.property.value string:
      value: 1
code system.concept:
  index: 2
  code system.concept.code:
    value: mutual-exclusion
  code system.concept.display:
    value: Mutual exclusion
  code system.concept.definition:
    value: Forbids selected services from occurring together within a counting scope.
  code system.concept.property:
    index: 0
    code system.concept.property.code:
      value: defaultEffect
    code system.concept.property.value coding:
      coding.system:
        value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect
      coding.code:
        value: reject
  code system.concept.property:
    index: 1
    code system.concept.property.code:
      value: requiredFactTypes
    code system.concept.property.value coding:
      coding.system:
        value: https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact
      coding.code:
        value: service-occurrence
  code system.concept.property:
    index: 2
    code system.concept.property.code:
      value: since
    code system.concept.property.value string:
      value: 1
code system.concept:
  index: 3
  code system.concept.code:
    value: inclusive-component

value: Inclusive component

value: Declares that a component service is included in a containing service and is not separately billable in the stated direction.

index: 0
code system.concept.property.code:
  value: defaultEffect
code system.concept.property.value coding:
  coding.system:
    value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect
  coding.code:
    value: reject

index: 1
code system.concept.property.code:
  value: requiredFactTypes
code system.concept.property.value coding:
  coding.system:
    value: https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact
  coding.code:
    value: service-occurrence

index: 2
code system.concept.property.code:
  value: since
code system.concept.property.value string:
  value: 1

index: 4
code system.concept.code:
  value: companion-required
code system.concept.display:
  value: Companion required
code system.concept.definition:
  value: Requires one or more companion services, optionally with ordering constraints, within a counting scope.
code system.concept.property:
  index: 0
  code system.concept.property.code:
    value: defaultEffect
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect
    coding.code:
      value: reject
code system.concept.property:
  index: 1
  code system.concept.property.code:
    value: requiredFactTypes
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact
    coding.code:
      value: service-occurrence
code system.concept.property:
  index: 2
  code system.concept.property.code:
    value: since
  code system.concept.property.value string:
    value: 1

index: 5
code system.concept.code:
  value: repeat-interval
code system.concept.display:
  value: Repeat interval
code system.concept.definition:
  value: Requires a minimum interval before a matching service may be repeated for the same counting subject.
code system.concept.property:
  index: 0
  code system.concept.property.code:
    value: defaultEffect
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect
    coding.code:
      value: reject
code system.concept.property:
  index: 1
  code system.concept.property.code:
    value: requiredFactTypes
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact
    coding.code:
      value: service-occurrence
code system.concept.property:
  index: 2
  code system.concept.property.code:
    value: since
  code system.concept.property.value string:
    value: 1

index: 6
code system.concept.code:
  value: diagnosis-requirement
code system.concept.display:
  value: Diagnosis requirement
code system.concept.definition:
  value: Requires or forbids a diagnosis matching a declared selector, certainty, and time window.
code system.concept.property:
  index: 0
  code system.concept.property.code:
    value: defaultEffect
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect
    coding.code:
      value: reject
code system.concept.property:
  index: 1
  code system.concept.property.code:
    value: requiredFactTypes
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact
    coding.code:
      value: diagnosis
code system.concept.property:
  index: 2
  code system.concept.property.code:
    value: since
  code system.concept.property.value string:
    value: 1

index: 7
code system.concept.code:
  value: procedure-finding-requirement
code system.concept.display:
  value: Procedure or finding requirement
code system.concept.definition:
  value: Requires a documented procedure, finding, or measurement matching the declared selector.
code system.concept.property:
  index: 0
  code system.concept.property.code:
    value: defaultEffect
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect
    coding.code:
      value: reject
code system.concept.property:
  index: 1
  code system.concept.property.code:
    value: requiredFactTypes
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact
    coding.code:
      value: procedure
code system.concept.property:
  index: 2
  code system.concept.property.code:
    value: requiredFactTypes
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact
    coding.code:
      value: finding
code system.concept.property:
  index: 3
  code system.concept.property.code:
    value: since
  code system.concept.property.value string:
    value: 1

index: 8
code system.concept.code:
  value: patient-attribute-constraint
code system.concept.display:
  value: Patient attribute constraint
code system.concept.definition:
  value: Constrains applicability using declared patient demographic or status predicates.
code system.concept.property:
  index: 0
  code system.concept.property.code:
    value: defaultEffect
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect
    coding.code:
      value: reject
code system.concept.property:
  index: 1
  code system.concept.property.code:
    value: requiredFactTypes
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact
    coding.code:
      value: patient-attribute
code system.concept.property:
  index: 2
  code system.concept.property.code:
    value: since
  code system.concept.property.value string:
    value: 1

index: 9
code system.concept.code:
  value: provider-eligibility
code system.concept.display:
  value: Provider eligibility
code system.concept.definition:
  value: Constrains applicability using declared provider specialty, authorization, or relationship predicates.
code system.concept.property:
  index: 0
  code system.concept.property.code:
    value: defaultEffect
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect
    coding.code:
      value: reject
code system.concept.property:
  index: 1
  code system.concept.property.code:
    value: requiredFactTypes
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact
    coding.code:
      value: provider-eligibility
code system.concept.property:
  index: 2
  code system.concept.property.code:
    value: since
  code system.concept.property.value string:
    value: 1

index: 10
code system.concept.code:
  value: setting-constraint
code system.concept.display:
  value: Setting constraint
code system.concept.definition:
  value: Constrains applicability using declared care setting, billing case, place, time, or treatment-kind predicates.
code system.concept.property:
  index: 0
  code system.concept.property.code:
    value: defaultEffect
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect
    coding.code:
      value: reject
code system.concept.property:
  index: 1
  code system.concept.property.code:
    value: requiredFactTypes
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact
    coding.code:
      value: care-setting
code system.concept.property:
  index: 2
  code system.concept.property.code:
    value: since
  code system.concept.property.value string:
    value: 1

index: 11
code system.concept.code:
  value: contract-participation
code system.concept.display:
  value: Contract participation
code system.concept.definition:
  value: Requires participation in a declared contract or module by the patient, provider, or practice.
code system.concept.property:
  index: 0
  code system.concept.property.code:
    value: defaultEffect
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect
    coding.code:
      value: reject
code system.concept.property:
  index: 1
  code system.concept.property.code:
    value: requiredFactTypes
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact
    coding.code:
      value: contract-participation
code system.concept.property:
  index: 2
  code system.concept.property.code:
    value: since
  code system.concept.property.value string:
    value: 1

index: 12
code system.concept.code:
  value: accompanying-information-required
code system.concept.display:
  value: Accompanying information required
code system.concept.definition:
  value: Requires declared structured information, justification, report, or itemized cost evidence.
code system.concept.property:
  index: 0
  code system.concept.property.code:
    value: defaultEffect
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect
    coding.code:
      value: requires-justification
code system.concept.property:
  index: 1
  code system.concept.property.code:
    value: requiredFactTypes
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact
    coding.code:
      value: accompanying-information
code system.concept.property:
  index: 2
  code system.concept.property.code:
    value: since
  code system.concept.property.value string:
    value: 1

index: 13
code system.concept.code:
  value: prior-authorization-required
code system.concept.display:
  value: Prior authorization required
code system.concept.definition:
  value: Requires an approved plan or authorization before the service is rendered or billed.
code system.concept.property:
  index: 0
  code system.concept.property.code:
    value: defaultEffect
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect
    coding.code:
      value: requires-approval
code system.concept.property:
  index: 1
  code system.concept.property.code:
    value: requiredFactTypes
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact
    coding.code:
      value: prior-authorization
code system.concept.property:
  index: 2
  code system.concept.property.code:
    value: since
  code system.concept.property.value string:
    value: 1

index: 14
code system.concept.code:
  value: patient-agreement-required
code system.concept.display:
  value: Patient agreement required
code system.concept.definition:
  value: Requires a declared patient agreement before billing under the stated conditions.
code system.concept.property:
  index: 0
  code system.concept.property.code:
    value: defaultEffect
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect
    coding.code:
      value: requires-agreement
code system.concept.property:
  index: 1
  code system.concept.property.code:
    value: requiredFactTypes
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact
    coding.code:
      value: patient-agreement
code system.concept.property:
  index: 2
  code system.concept.property.code:
    value: since
  code system.concept.property.value string:
    value: 1

index: 15
code system.concept.code:
  value: factor-bound
code system.concept.display:
  value: Factor bound
code system.concept.definition:
  value: Applies declared multiplier bounds and maps threshold crossings to a declared effect.
code system.concept.property:
  index: 0
  code system.concept.property.code:
    value: defaultEffect
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect
    coding.code:
      value: requires-justification
code system.concept.property:
  index: 1
  code system.concept.property.code:
    value: requiredFactTypes
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact
    coding.code:
      value: billing-factor
code system.concept.property:
  index: 2
  code system.concept.property.code:
    value: since
  code system.concept.property.value string:
    value: 1

index: 16
code system.concept.code:
  value: analogue-service
code system.concept.display:
  value: Analogue service
code system.concept.definition:
  value: Constrains billing of an unlisted service by reference to a declared equivalent listed service.
code system.concept.property:
  index: 0
  code system.concept.property.code:
    value: defaultEffect
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect
    coding.code:
      value: requires-justification
code system.concept.property:
  index: 1
  code system.concept.property.code:
    value: requiredFactTypes
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact
    coding.code:
      value: analogue-reference
code system.concept.property:
  index: 2
  code system.concept.property.code:
    value: since
  code system.concept.property.value string:
    value: 1

index: 17
code system.concept.code:
  value: cost-reimbursement-constraint
code system.concept.display:
  value: Cost reimbursement constraint
code system.concept.definition:
  value: Constrains material or laboratory cost reimbursement using declared evidence requirements or limits.
code system.concept.property:
  index: 0
  code system.concept.property.code:
    value: defaultEffect
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect
    coding.code:
      value: requires-justification
code system.concept.property:
  index: 1
  code system.concept.property.code:
    value: requiredFactTypes
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact
    coding.code:
      value: cost-evidence
code system.concept.property:
  index: 2
  code system.concept.property.code:
    value: since
  code system.concept.property.value string:
    value: 1

index: 18
code system.concept.code:
  value: quota-degression
code system.concept.display:
  value: Quota degression
code system.concept.definition:
  value: Applies a declared reduced valuation after a volume threshold is exceeded.
code system.concept.property:
  index: 0
  code system.concept.property.code:
    value: defaultEffect
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect
    coding.code:
      value: price-adjust
code system.concept.property:
  index: 1
  code system.concept.property.code:
    value: requiredFactTypes
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact
    coding.code:
      value: volume
code system.concept.property:
  index: 2
  code system.concept.property.code:
    value: requiredFactTypes
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact
    coding.code:
      value: service-value
code system.concept.property:
  index: 3
  code system.concept.property.code:
    value: since
  code system.concept.property.value string:
    value: 1

index: 19
code system.concept.code:
  value: plan-finding-entitlement
code system.concept.display:
  value: Plan and finding entitlement
code system.concept.definition:
  value: Derives a permitted treatment path or subsidy from declared findings and an approved plan.
code system.concept.property:
  index: 0
  code system.concept.property.code:
    value: defaultEffect
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect
    coding.code:
      value: price-adjust
code system.concept.property:
  index: 1
  code system.concept.property.code:
    value: requiredFactTypes
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact
    coding.code:
      value: approved-plan
code system.concept.property:
  index: 2
  code system.concept.property.code:
    value: requiredFactTypes
  code system.concept.property.value coding:
    coding.system:
      value: https://fhir.cognovis.de/praxis/CodeSystem/billing-required-fact
    coding.code:
      value: finding
code system.concept.property:
  index: 3
  code system.concept.property.code:
    value: since
  code system.concept.property.value string:
    value: 1