| Code | Display | Definition |
| coinsurance |
Co-insurance |
The amount the insured individual pays, as a set percentage of the cost of covered medical services, as an out-of-pocket payment to the provider. Example: Insured pays 20% and the insurer pays 80%. |
| noncovered |
Noncovered |
The portion of the cost of this service that was deemed not eligible by the insurer because the service or member was not covered by the subscriber contract. |
| priorpayerpaid |
Prior payer paid |
The reduction in the payment amount to reflect the carrier as a secondary payer. |
| paidbypatient |
Paid by patient |
The total amount paid by the patient without specifying the source. |
| paidbypatientcash |
Paid by patient - cash |
The amount paid by the patient using cash, check, or other personal account. |
| paidbypatientother |
Paid by patient - other |
The amount paid by the patient using a method different than cash (cash, check, or personal account) or health account. |
| paidbypatienthealthaccount |
Paid by patient - health account |
The amount paid by the patient using another method like HSA, HRA, FSA or other type of health account. |
| paidtoprovider |
Paid to provider |
The amount paid to the provider. |
| paidtopatient |
Paid to patient |
paid to patient |
| memberliability |
Member liability |
The amount of the member's liability. |
| discount |
Discount |
The amount of the discount |
| drugcost |
Drug cost |
Price paid for the drug excluding mfr or other discounts. It typically is the sum of the following components: ingredient cost, dispensing fee, sales tax, and vaccine administration |