Segment
X12 EDI Release 00403
To specify the claim service detail for durable medical equipment
Elements
  • SV501C003Composite Medical Procedure IdentifierM必须(Mandatory)
    2352341339133913391339352
    • SV50101235Product/Service ID Qualifier
      ID
      M必须(Mandatory)

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

      Codes (505)
    • SV50102234Product/Service ID
      AN
      M必须(Mandatory)
      Min 0 / Max 48

      Identifying number for a product or service

    • SV501031339Procedure 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

    • SV501041339Procedure 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

    • SV501051339Procedure 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

    • SV501061339Procedure 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

    • SV50107352Description
      AN
      O可选(Optional)
      Min 1 / Max 80

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

  • SV502355Unit or Basis for Measurement Code
    ID
    M必须(Mandatory)

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

    Codes (803)
  • SV503380Quantity
    R
    M必须(Mandatory)
    Min 1 / Max 15

    Numeric value of quantity

  • SV504782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • SV505782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • SV506594Frequency Code
    ID
    O可选(Optional)

    Code indicating frequency or type of activities or actions being reported

    Codes (22)
  • SV507923Prognosis Code
    ID
    O可选(Optional)

    Code indicating physician's prognosis for the patient

    Codes (8)