ChargeItem — The billing entry

Every technical act, consultation, dispensed medication potentially creates a ChargeItem. The finest granularity of FHIR billing, upstream of Invoice and Claim.

Purpose

ChargeItem represents a unitary financial entry for an act, product or service: a consultation coded CPT, a dispensed medication priced, a device implanted, a billed lab test. Each ChargeItem carries a pricing code (CPT, HCPCS, NDC in the US; CCAM, NABM, NGAP in France) and a price.

ChargeItems are posted on an Account, then aggregated in an Invoice or a Claim to the payer.

Key fields

Field	Type	Cardinality	Role
`identifier`	Identifier[]	0..*	External identifiers (entry number).
`definitionUri`	uri[]	0..*	Canonical URL of the fee schedule or pricing definition.
`definitionCanonical`	canonical(ChargeItemDefinition)[]	0..*	Reference to a ChargeItemDefinition.
`status`	code	1..1	Mandatory. `planned` \| `billable` \| `not-billable` \| `aborted` \| `billed` \| `entered-in-error` \| `unknown`.
`partOf`	Reference(ChargeItem)[]	0..*	Parent entry (grouping).
`code`	CodeableConcept	1..1	Mandatory. Pricing code.
`subject`	Reference(Patient \| Group)	1..1	Mandatory. Patient concerned.
`encounter`	Reference(Encounter)	0..1	Source encounter.
`occurrence[x]`	dateTime \| Period \| Timing	0..1	When the act occurred.
`performer`	BackboneElement[]	0..*	Performer(s).
`performingOrganization`	Reference(Organization)	0..1	Performing organization.
`quantity`	Quantity	0..1	Quantity (# of acts, doses, volumes).
`bodysite`	CodeableConcept[]	0..*	Anatomical site.
`unitPriceComponent`	MonetaryComponent	0..1	Unit price (R5).
`totalPriceComponent`	MonetaryComponent	0..1	Total price (R5).
`overrideReason`	CodeableConcept	0..1	Reason for overriding the default price.
`enterer`	Reference(Practitioner \| PractitionerRole \| Organization \| Patient \| Device \| RelatedPerson)	0..1	Who entered.
`enteredDate`	dateTime	0..1	Entry date.
`reason`	CodeableConcept[]	0..*	Clinical reason (ICD-10, SNOMED).
`service`	CodeableReference(DiagnosticReport \| ImagingStudy \| Immunization \| MedicationAdministration \| MedicationDispense \| Observation \| Procedure \| SupplyDelivery)[]	0..*	Justifying clinical resource.
`product`	CodeableReference(Device \| Medication \| Substance)[]	0..*	Consumed product.
`account`	Reference(Account)[]	0..*	Posting account(s).

JSON example

Entry for a 12-lead ECG (CPT 93000) on Peter Chalmers, price $50, posted on Account/example:

json chargeitem-ecg.json

{
  "resourceType": "ChargeItem",
  "id": "example",
  "identifier": [{
    "system": "http://myHospital.com/ChargeItems",
    "value": "654321"
  }],
  "definitionUri": ["http://www.kbv.de/tools/ebm/html/01520_2904360860826220813632.html"],
  "status": "billable",
  "subject": { "reference": "Patient/example" },
  "encounter": { "reference": "Encounter/example" },
  "occurrencePeriod": {
    "start": "2026-05-14T10:00:00+02:00",
    "end": "2026-05-14T10:25:00+02:00"
  },
  "performer": [{
    "function": {
      "coding": [{
        "system": "http://snomed.info/sct",
        "code": "17561000",
        "display": "Cardiologist"
      }]
    },
    "actor": { "reference": "Practitioner/example" }
  }],
  "performingOrganization": { "reference": "Organization/hospital-1" },
  "quantity": { "value": 1 },
  "bodysite": [{
    "coding": [{
      "system": "http://snomed.info/sct",
      "code": "80891009",
      "display": "Heart structure"
    }]
  }],
  "code": {
    "coding": [{
      "system": "http://www.ama-assn.org/go/cpt",
      "code": "93000",
      "display": "Electrocardiogram, routine ECG with at least 12 leads"
    }]
  },
  "unitPriceComponent": {
    "type": "base",
    "amount": { "value": 50.00, "currency": "USD" }
  },
  "totalPriceComponent": {
    "type": "base",
    "amount": { "value": 50.00, "currency": "USD" }
  },
  "account": [{ "reference": "Account/example" }]
}

Common pitfalls

No pricing code — without a code (CPT, HCPCS, CCAM...), no downstream billing chain can process the entry.
No account — an orphan ChargeItem (no account) will never be billed.
Price diverging from schedule — always set overrideReason when the unit price differs from the ChargeItemDefinition schedule.
Confusion with MedicationDispense — medication consumption is a MedicationDispense; the ChargeItem is the billed entry that references it via product.
Quantity 0 or negative — use status=aborted or not-billable instead of absurd quantities.

Account — posting account.
Invoice — ChargeItem aggregation into a bill.
Claim — insurance claim.
ChargeItemDefinition — reference fee schedule.
Coverage — applicable coverage.

Foundations

Standards

Flagship messages

Tools

ChargeItem — The billing entry

Purpose

Key fields

JSON example

Common pitfalls

ChargeItem — The billing entry

Purpose

Key fields

JSON example

Common pitfalls

Related resources