German Practice Management FHIR Profiles (R4)
Version 0.99.1 - release

CodeSystem: Billing Rule Effect

Official URL: https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect Version: 1
Active as of 2026-08-22 Computable Name: BillingRuleEffectCS
Other Identifiers: OID:2.16.840.1.113883.3.7985.16.21

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Observable effects produced when a declarative billing rule matches or is violated.

This Code system is referenced in the content logical definition of the following value sets:

This case-sensitive code system https://fhir.cognovis.de/praxis/CodeSystem/billing-rule-effect defines the following codes:

CodeDisplayDefinition
reject Reject The billed item is non-conformant and must be rejected or corrected.
requires-justification Requires justification The billed item requires a documented justification.
requires-approval Requires approval The billed item requires an applicable approval or authorization.
requires-agreement Requires agreement The billed item requires an applicable patient or contractual agreement.
replace-code Replace code The billed item must be replaced by a declared alternative code.
price-adjust Price adjustment The rule changes the applicable price, points, factor, or valuation.
advisory Advisory The rule produces a non-blocking advisory finding.
reporting-only Reporting only The rule produces a reporting obligation without changing billability.