diff --git a/lib/davinci_crd_test_kit/cross_suite/tags.rb b/lib/davinci_crd_test_kit/cross_suite/tags.rb
index 0cadf40f..c3038018 100644
--- a/lib/davinci_crd_test_kit/cross_suite/tags.rb
+++ b/lib/davinci_crd_test_kit/cross_suite/tags.rb
@@ -16,6 +16,15 @@ module DaVinciCRDTestKit
   DUPLICATED_HOOK_INSTANCE_TAG = 'duplicate_hook_instance'.freeze
   COVERAGE_INFO_DISABLED_TAG = 'coverage-info-disabled'.freeze
 
+  ALL_HOOK_TAGS = [
+    APPOINTMENT_BOOK_TAG,
+    ENCOUNTER_START_TAG,
+    ENCOUNTER_DISCHARGE_TAG,
+    ORDER_DISPATCH_TAG,
+    ORDER_SELECT_TAG,
+    ORDER_SIGN_TAG
+  ].freeze
+
   module TagMethods
     def hook_instance_tag(hook_instance)
       "#{HOOK_INSTANCE_TAG_PREFIX}#{hook_instance}"
diff --git a/lib/davinci_crd_test_kit/requirements/generated/crd_server_v221_requirements_coverage.csv b/lib/davinci_crd_test_kit/requirements/generated/crd_server_v221_requirements_coverage.csv
index 0ff60314..edfae99a 100644
--- a/lib/davinci_crd_test_kit/requirements/generated/crd_server_v221_requirements_coverage.csv
+++ b/lib/davinci_crd_test_kit/requirements/generated/crd_server_v221_requirements_coverage.csv
@@ -1,5 +1,5 @@
 Req Set,ID,URL,Requirement,Conformance,Actors,Conditionality,Not Tested Reason,Not Tested Details,Da Vinci CRD Server v2.2.1 Test Suite Short ID(s),Da Vinci CRD Server v2.2.1 Test Suite Full ID(s)
-hl7.fhir.us.davinci-crd_2.2.1,billopt-2,https://hl7.org/fhir/us/davinci-crd/2.2.1/en/StructureDefinition-ext-billing-options.html#ci-c-billopt-2,CRD servers **SHALL NOT** depend on the billing-options extension being present in order to provide a response.,SHALL NOT,CRD Server,true,,,"",""
+hl7.fhir.us.davinci-crd_2.2.1,billopt-2,https://hl7.org/fhir/us/davinci-crd/2.2.1/en/StructureDefinition-ext-billing-options.html#ci-c-billopt-2,CRD servers **SHALL NOT** depend on the billing-options extension being present in order to provide a response.,SHALL NOT,CRD Server,true,,,3.7.03,crd_server_v221-crd_v221_server_hooks-crd_v221_server_required_card_response_validation-verify_response_without_billing_options
 hl7.fhir.us.davinci-crd_2.2.1,billopt-3-A,https://hl7.org/fhir/us/davinci-crd/2.2.1/en/StructureDefinition-ext-billing-options.html#ci-c-billopt-3,"If codes are provided with the billing-options extension, CRD servers **SHALL** consider any codes provided",SHALL,CRD Server,false,,,"",""
 hl7.fhir.us.davinci-crd_2.2.1,billopt-3-B,https://hl7.org/fhir/us/davinci-crd/2.2.1/en/StructureDefinition-ext-billing-options.html#ci-c-billopt-3,"If codes are provided with the billing-options extension, CRD servers ... **MAY** consider additional codes determined by their own mapping when returning coverage information responses.",MAY,CRD Server,false,,,"",""
 hl7.fhir.us.davinci-crd_2.2.1,conf-2,https://hl7.org/fhir/us/davinci-crd/2.2.1/en/conformance.html#ci-c-conf-2,CRD servers **SHALL** be able to handle all three US Core versions.,SHALL,CRD Server,false,,,"",""
diff --git a/lib/davinci_crd_test_kit/server/server_test_helper.rb b/lib/davinci_crd_test_kit/server/server_test_helper.rb
index 64de97f9..bc4474dc 100644
--- a/lib/davinci_crd_test_kit/server/server_test_helper.rb
+++ b/lib/davinci_crd_test_kit/server/server_test_helper.rb
@@ -1,3 +1,5 @@
+require_relative '../cross_suite/tags'
+
 module DaVinciCRDTestKit
   module ServerTestHelper
     def parse_json(input)
@@ -5,9 +7,9 @@ def parse_json(input)
       JSON.parse(input)
     end
 
-    def verify_at_least_one_test_passes(test_groups, id_pattern, error_message, id_exclude_pattern = nil)
+    def verify_at_least_one_test_passes(test_groups, id_pattern, error_message, id_exclude_pattern = nil) # rubocop:disable Metrics/CyclomaticComplexity
       runnables = test_groups.map do |group|
-        next unless group.title.include?('-') # all hook group names have hyphens
+        next if ALL_HOOK_TAGS.none? { |hook_name| group.title.include?(hook_name) }
 
         group.groups[2].tests.find do |test| # response verification subgroup
           test.id.include?(id_pattern) && (!id_exclude_pattern || !test.id.include?(id_exclude_pattern))
diff --git a/lib/davinci_crd_test_kit/server/v2.2.1/server_required_card_response_validation_group.rb b/lib/davinci_crd_test_kit/server/v2.2.1/server_required_card_response_validation_group.rb
index 521c38ff..1c8a4987 100644
--- a/lib/davinci_crd_test_kit/server/v2.2.1/server_required_card_response_validation_group.rb
+++ b/lib/davinci_crd_test_kit/server/v2.2.1/server_required_card_response_validation_group.rb
@@ -1,16 +1,14 @@
 require_relative 'must_support/coverage_information_system_action_across_hooks_validation_test'
 require_relative 'must_support/coverage_information_must_support_test'
+require_relative 'verify_response/verify_response_without_billing_options_test'
 
 module DaVinciCRDTestKit
   module V221
     class ServerRequiredCardResponseValidationGroup < Inferno::TestGroup
-      title 'Required Card Response Validation'
+      title 'Cross-Hook Response Validation'
       description %(
-        This group contains tests to verify the presence and validity of required response types
-        across all hooks invoked. As per the [Da Vinci CRD Implementation Guide](https://hl7.org/fhir/us/davinci-crd/2.2.1/en/hooks.html#ci-c-hook-26),
-        CRD clients and servers SHALL, at minimum, support returning and
-        processing the Coverage Information system action for all invocations of
-        the appointment-book hook.
+        This group contains tests to verify the behavior of the server responses
+        across all hooks.
       )
       # verifies_requirements 'hl7.fhir.us.davinci-crd_2.0.1@247', 'hl7.fhir.us.davinci-crd_2.0.1@248',
       #                       'hl7.fhir.us.davinci-crd_2.0.1@249'
@@ -20,6 +18,7 @@ class ServerRequiredCardResponseValidationGroup < Inferno::TestGroup
 
       test from: :crd_v221_coverage_info_system_action_across_hooks_validation
       test from: :crd_v221_coverage_information_must_support
+      test from: :verify_response_without_billing_options
     end
   end
 end
diff --git a/lib/davinci_crd_test_kit/server/v2.2.1/verify_response/verify_response_without_billing_options_test.rb b/lib/davinci_crd_test_kit/server/v2.2.1/verify_response/verify_response_without_billing_options_test.rb
new file mode 100644
index 00000000..fa715c5a
--- /dev/null
+++ b/lib/davinci_crd_test_kit/server/v2.2.1/verify_response/verify_response_without_billing_options_test.rb
@@ -0,0 +1,43 @@
+require_relative '../../server_hook_helper'
+require_relative '../../../cross_suite/tags'
+
+module DaVinciCRDTestKit
+  module V221
+    class VerifyResponseWithoutBillingOptionsTest < Inferno::Test
+      include DaVinciCRDTestKit::ServerHookHelper
+
+      title 'Server does not require Billing Options Extension'
+      id :verify_response_without_billing_options
+      description <<~DESCRIPTION
+        The IG states that, "CRD servers **SHALL NOT** depend on the
+        billing-options extension being present in order to provide a response."
+
+        This test verifies that a successful response was received for a request
+        without any billing-options extensions.
+      DESCRIPTION
+
+      verifies_requirements 'hl7.fhir.us.davinci-crd_2.2.1@billopt-2'
+
+      BILLING_OPTIONS_URL = 'http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-billing-options'.freeze
+
+      run do
+        ALL_HOOK_TAGS.each do |tag|
+          load_tagged_requests(tag)
+        end
+
+        skip_if requests.blank?, 'No requests were made in a previous test as expected.'
+
+        successful_requests = requests.select { |request| request.status == 200 }
+        skip_if successful_requests.empty?, 'All service requests were unsuccessful.'
+
+        requests_without_billing_options =
+          successful_requests.reject { |request| request.request_body.include? BILLING_OPTIONS_URL }
+
+        skip_if requests_without_billing_options.blank?,
+                'All successful requests included the billing options extension. ' \
+                'Provide service call inputs which do not include the billing options extension ' \
+                'to verify that the server does not require the extension.'
+      end
+    end
+  end
+end
diff --git a/spec/davinci_crd_test_kit/v2.2.1/verify_response_without_billing_options_test_spec.rb b/spec/davinci_crd_test_kit/v2.2.1/verify_response_without_billing_options_test_spec.rb
new file mode 100644
index 00000000..b71255a5
--- /dev/null
+++ b/spec/davinci_crd_test_kit/v2.2.1/verify_response_without_billing_options_test_spec.rb
@@ -0,0 +1,126 @@
+RSpec.describe DaVinciCRDTestKit::V221::VerifyResponseWithoutBillingOptionsTest do
+  let(:suite_id) { 'crd_server_v221' }
+  let(:result) { repo_create(:result, test_session_id: test_session.id) }
+  let(:runnable) { described_class }
+  let(:appointment) { { resourceType: 'Appointment' } }
+  let(:appointment_with_coverage_info) do
+    appointment.merge(
+      extension: [
+        { url: 'http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information' }
+      ]
+    )
+  end
+
+  it 'passes if a successful request without a billing options extension has been made' do
+    bundle = FHIR::Bundle.new(
+      entry: [
+        {
+          resource: FHIR::Appointment.new(appointment)
+        }
+      ]
+    )
+
+    request_body = { context: { appointments: bundle.to_hash } }.to_json
+
+    repo_create(
+      :request,
+      direction: 'outgoing',
+      test_session_id: test_session.id,
+      result:,
+      request_body:,
+      response_body: '',
+      tags: [DaVinciCRDTestKit::APPOINTMENT_BOOK_TAG],
+      status: 200
+    )
+
+    result = run(runnable)
+
+    expect(result.result).to eq('pass'), result.result_message
+  end
+
+  it 'skips if no requests could be found' do
+    result = run(runnable)
+
+    expect(result.result).to eq('skip'), result.result_message
+    expect(result.result_message).to match(/No requests were made/)
+  end
+
+  it 'skips if no successful requests were made' do
+    bundle = FHIR::Bundle.new(
+      entry: [
+        {
+          resource: FHIR::Appointment.new(appointment)
+        }
+      ]
+    )
+
+    request_body = { context: { appointments: bundle.to_hash } }.to_json
+
+    repo_create(
+      :request,
+      direction: 'outgoing',
+      test_session_id: test_session.id,
+      result:,
+      request_body:,
+      response_body: '',
+      tags: [DaVinciCRDTestKit::APPOINTMENT_BOOK_TAG],
+      status: 500
+    )
+
+    result = run(runnable)
+
+    expect(result.result).to eq('skip'), result.result_message
+    expect(result.result_message).to match(/were unsuccessful/)
+  end
+
+  it 'skips if all successful requests contain the billing options extension' do
+    appointment.merge!(
+      serviceType: [
+        {
+          coding: [
+            {
+              code: 'ABC'
+            }
+          ],
+          extension: [
+            {
+              url: 'http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-billing-options',
+              valueCodeableConcept: {
+                coding: [
+                  {
+                    code: 'DEF'
+                  }
+                ]
+              }
+            }
+          ]
+        }
+      ]
+    )
+    bundle = FHIR::Bundle.new(
+      entry: [
+        {
+          resource: FHIR::Appointment.new(appointment)
+        }
+      ]
+    )
+
+    request_body = { context: { appointments: bundle.to_hash } }.to_json
+
+    repo_create(
+      :request,
+      direction: 'outgoing',
+      test_session_id: test_session.id,
+      result:,
+      request_body:,
+      response_body: '',
+      tags: [DaVinciCRDTestKit::APPOINTMENT_BOOK_TAG],
+      status: 200
+    )
+
+    result = run(runnable)
+
+    expect(result.result).to eq('skip'), result.result_message
+    expect(result.result_message).to match(/All successful requests included the billing options extension/)
+  end
+end