To identify the basis of service including the type, date and charge.
| Position | Element | Name | Type | Min/Max | Repeat | |
|---|---|---|---|---|---|---|
| E025-10 | 9641 | Service basis code qualifier | Mandatory | ID | 1/3 | 1 |
| E025-20 | 7135 | Product identifier | Mandatory | Alphanumeric | 1/35 | 1 |
| E025-30 | 1131 | Code list identification code | Opt | ID | 1/17 | 1 |
| E025-40 | 2380 | Date or time or period value | Opt | Alphanumeric | 1/35 | 1 |
| E025-50 | 2379 | Date or time or period format code | Opt | ID | 1/3 | 1 |
| E025-60 | 5004 | Monetary amount | Opt | Decimal | 1/20 | 1 |
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