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ChargeItemDefinition $apply

The $apply operation applies a ChargeItemDefinition resource to a specific ChargeItem, calculating the appropriate pricing based on the definition's property groups and applicability rules.

Use Cases​

  • Automated Pricing Calculations: Automatically calculate prices for lab tests, procedures, or services based on predefined rules
  • Insurance-Specific Rates: Apply different pricing based on payer contracts or insurance types
  • Dynamic Discount Management: Calculate surcharges or discounts based on patient eligibility or service context
  • Revenue Cycle Automation: Streamline billing workflows by programmatically determining charge amounts

Invocation​

POST [base]/ChargeItemDefinition/[id]/$apply

Input Parameters​

ParameterCardinalityTypeDescription
chargeItem1..1Reference<ChargeItem>Reference to the ChargeItem to which pricing should be applied

Output​

The operation returns the updated ChargeItem resource with the priceOverride field set based on the ChargeItemDefinition's pricing rules.

Behavior​

The operation processes the ChargeItemDefinition's propertyGroup elements to determine pricing:

  1. Base Price: Finds the first applicable property group with a priceComponent of type base and uses its amount
  2. Applicability: Evaluates FHIRPath expressions in applicability conditions against the ChargeItem to determine if a property group applies
  3. Price Modifiers: Applies surcharge and discount price components:
    • Surcharge: Adds the amount or calculates basePrice * factor
    • Discount: Subtracts the amount or calculates basePrice * factor

Example​

Request​

POST /fhir/R4/ChargeItemDefinition/lab-panel-pricing/$apply
Content-Type: application/fhir+json

{
  "resourceType": "Parameters",
  "parameter": [
    {
      "name": "chargeItem",
      "valueReference": {
        "reference": "ChargeItem/abc123"
      }
    }
  ]
}

Response​

{
  "resourceType": "ChargeItem",
  "id": "abc123",
  "status": "billable",
  "code": {
    "coding": [
      {
        "system": "http://example.org/lab-codes",
        "code": "PANEL001"
      }
    ]
  },
  "subject": {
    "reference": "Patient/patient123"
  },
  "priceOverride": {
    "value": 150.00,
    "currency": "USD"
  }
}

Error Responses​

Status CodeDescription
400 Bad RequestMissing required chargeItem parameter
404 Not FoundChargeItemDefinition or ChargeItem not found
403 ForbiddenInsufficient permissions