HL7 GP1 Grouping/Reimbursement - Visit
HL7 field reference GP1 fields from HL7 v2.5.1 Show fields
These are the generated fields for the version selected at the top of the page. The document stays the same, but the reference panel follows that version.
Fields
GP1 carries visit-level grouping and reimbursement details used by billing and case-mix workflows.
The standard describes GP1 this way: These fields are used in grouping and reimbursement for CMS APCs. Please refer to the "Outpatient Prospective Payment System Final Rule" ("OPPS Final Rule") issued by CMS.
Billing segments are where clinical activity starts turning into charge, reimbursement, and account data. They can look administrative, but a bad code or account reference can cause real downstream cleanup.
Treat charge codes, revenue codes, grouping values, effective dates, and account identifiers as controlled data. Free-text labels are useful for humans, but receivers usually post, price, or group from the coded values.
The v2.5.1 structures show GP1 in BAR_P10 - Transmit Ambulatory Payment Classification(APC). That tells you where it can appear, but the implementation guide still decides which optional fields are meaningful.
For practical interface work, read the generated field panel for datatype, required, repeatable, and table details, then use the notes below to decide what the field should mean in the receiving workflow.
GP1-1 identifies the Type of Bill Code for this billing workflow. Send the identifier that the receiving system actually keys on, and keep the assigning authority or coding system visible when the datatype supports it.
The generated panel links this to HL7 table 0455; many real interfaces narrow that list further, so follow the receiver's implementation guide.
GP1-2 identifies the Revenue Code for this billing workflow. Send the identifier that the receiving system actually keys on, and keep the assigning authority or coding system visible when the datatype supports it.
If there are several identifiers, use repetitions deliberately and make each repeat self-explanatory rather than relying on position alone.
GP1-3 identifies the Overall Claim Disposition Code for this billing workflow. Send the identifier that the receiving system actually keys on, and keep the assigning authority or coding system visible when the datatype supports it.
The generated panel links this to HL7 table 0457; many real interfaces narrow that list further, so follow the receiver's implementation guide.
GP1-4 identifies the OCE Edits per Visit Code for this billing workflow. Send the identifier that the receiving system actually keys on, and keep the assigning authority or coding system visible when the datatype supports it.
If there are several identifiers, use repetitions deliberately and make each repeat self-explanatory rather than relying on position alone.
GP1-5 carries a measured, counted, priced, or dosed value. A number without the expected unit, currency, or companion qualifier is much easier to misread than an empty field.