Segment
X12 EDI Release 00401
To specify the claim service detail for a Health Care professional
Elements
  • SV101C003Composite Medical Procedure IdentifierM必须(Mandatory)
    2352341339133913391339352
    • SV10101235Product/Service ID Qualifier
      ID
      M必须(Mandatory)

      Code identifying the type/source of the descriptive number used in Product/Service ID (234)

      Codes (477)
    • SV10102234Product/Service ID
      AN
      M必须(Mandatory)
      Min 0 / Max 48

      Identifying number for a product or service

    • SV101031339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • SV101041339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • SV101051339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • SV101061339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • SV10107352Description
      AN
      O可选(Optional)
      Min 1 / Max 80

      A free-form description to clarify the related data elements and their content

  • SV102782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • SV103355Unit or Basis for Measurement Code
    ID
    O可选(Optional)

    Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken

    Codes (794)
  • SV104380Quantity
    R
    O可选(Optional)
    Min 1 / Max 15

    Numeric value of quantity

  • SV1051331Facility Code Value
    AN
    O可选(Optional)
    Min 1 / Max 2

    Code identifying the type of facility where services were performed; the first and second positions of the Uniform Bill Type code or the Place of Service code from the Electronic Media Claims National Standard Format

  • SV1061365Service Type Code
    ID
    O可选(Optional)

    Code identifying the classification of service

    Codes (143)
  • SV107C004Composite Diagnosis Code PointerO可选(Optional)
    1328132813281328
    • SV107011328Diagnosis Code Pointer
      N
      M必须(Mandatory)
      Min 0 / Max 2

      A pointer to the claim diagnosis code in the order of importance to this service

    • SV107021328Diagnosis Code Pointer
      N
      O可选(Optional)
      Min 1 / Max 2

      A pointer to the claim diagnosis code in the order of importance to this service

    • SV107031328Diagnosis Code Pointer
      N
      O可选(Optional)
      Min 1 / Max 2

      A pointer to the claim diagnosis code in the order of importance to this service

    • SV107041328Diagnosis Code Pointer
      N
      O可选(Optional)
      Min 1 / Max 2

      A pointer to the claim diagnosis code in the order of importance to this service

  • SV108782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • SV1091073Yes/No Condition or Response Code
    ID
    O可选(Optional)

    Code indicating a Yes or No condition or response

    Codes (4)
  • SV1101340Multiple Procedure Code
    ID
    O可选(Optional)

    Code indicating proper adjudication and payment determination in cases involving multiple surgical procedures during the same surgical session

    Codes (3)
  • SV1111073Yes/No Condition or Response Code
    ID
    O可选(Optional)

    Code indicating a Yes or No condition or response

    Codes (4)
  • SV1121073Yes/No Condition or Response Code
    ID
    O可选(Optional)

    Code indicating a Yes or No condition or response

    Codes (4)
  • SV1131364Review Code
    ID
    O可选(Optional)

    Code identifying extenuating circumstances or justifications which might assist any review of the medical necessity for this service

    Codes (8)
  • SV1141341National or Local Assigned Review Value
    AN
    O可选(Optional)
    Min 1 / Max 2

    Value assigned by national or local organizations for various healthcare data elements

  • SV1151327Copay Status Code
    ID
    O可选(Optional)

    Code indicating whether or not co-payment requirements were met on a line by line basis

    Codes (4)
  • SV1161334Health Care Professional Shortage Area Code
    ID
    O可选(Optional)
    Min 1 / Max 1

    Code identifying the Health Care Professional Shortage Area Code (HPSA)

  • SV117127Reference Identification
    AN
    O可选(Optional)
    Min 1 / Max 30

    Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

  • SV118116Postal Code
    ID
    O可选(Optional)
    Min 3 / Max 15

    Code defining international postal zone code excluding punctuation and blanks (zip code for United States)

  • SV119782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • SV1201337Level of Care Code
    ID
    O可选(Optional)

    Code specifying the level of care provided by a nursing home facility

    Codes (8)
  • SV1211360Provider Agreement Code
    ID
    O可选(Optional)

    Code indicating the type of agreement under which the provider is submitting this claim

    Codes (7)