Segment
X12 EDI Release 00405
To supply payment and control information to a provider for a particular service
Elements
  • SVC01C003Composite Medical Procedure IdentifierM必须(Mandatory)
    2352341339133913391339352
    • SVC0101235Product/Service ID Qualifier
      ID
      M必须(Mandatory)

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

      Codes (517)
    • SVC0102234Product/Service ID
      AN
      M必须(Mandatory)
      Min 0 / Max 48

      Identifying number for a product or service

    • SVC01031339Procedure 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

    • SVC01041339Procedure 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

    • SVC01051339Procedure 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

    • SVC01061339Procedure 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

    • SVC0107352Description
      AN
      O可选(Optional)
      Min 1 / Max 80

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

  • SVC02782Monetary Amount
    R
    M必须(Mandatory)
    Min 1 / Max 18

    Monetary amount

  • SVC03782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • SVC04234Product/Service ID
    AN
    O可选(Optional)
    Min 1 / Max 48

    Identifying number for a product or service

  • SVC05380Quantity
    R
    O可选(Optional)
    Min 1 / Max 15

    Numeric value of quantity

  • SVC06C003Composite Medical Procedure IdentifierO可选(Optional)
    2352341339133913391339352
    • SVC0601235Product/Service ID Qualifier
      ID
      M必须(Mandatory)

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

      Codes (517)
    • SVC0602234Product/Service ID
      AN
      M必须(Mandatory)
      Min 0 / Max 48

      Identifying number for a product or service

    • SVC06031339Procedure 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

    • SVC06041339Procedure 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

    • SVC06051339Procedure 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

    • SVC06061339Procedure 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

    • SVC0607352Description
      AN
      O可选(Optional)
      Min 1 / Max 80

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

  • SVC07380Quantity
    R
    O可选(Optional)
    Min 1 / Max 15

    Numeric value of quantity