|
C003Composite Medical Procedure IdentifierMandatory 1 |
| 2 | 782 | Monetary Amount | Opt | Decimal | 1/18 | 1 |
| 3 | 355 | Unit or Basis for Measurement Code | Rel | ID | 2/2 | 1 |
| 4 | 380 | Quantity | Rel | Decimal | 1/15 | 1 |
| 5 | 1331 | Facility Code Value | Opt | Alphanumeric | 1/2 | 1 |
| 6 | 1365 | Service Type Code | Opt | ID | 1/2 | 1 |
C004Composite Diagnosis Code PointerOpt 1 |
| 8 | 782 | Monetary Amount | Opt | Decimal | 1/18 | 1 |
| 9 | 1073 | Yes/No Condition or Response Code | Opt | ID | 1/1 | 1 |
| 10 | 1340 | Multiple Procedure Code | Opt | ID | 1/2 | 1 |
| 11 | 1073 | Yes/No Condition or Response Code | Opt | ID | 1/1 | 1 |
| 12 | 1073 | Yes/No Condition or Response Code | Opt | ID | 1/1 | 1 |
| 13 | 1364 | Review Code | Opt | ID | 1/2 | 1 |
| 14 | 1341 | National or Local Assigned Review Value | Opt | Alphanumeric | 1/2 | 1 |
| 15 | 1327 | Copay Status Code | Opt | ID | 1/1 | 1 |
| 16 | 1334 | Health Care Professional Shortage Area Code | Opt | ID | 1/1 | 1 |
| 17 | 127 | Reference Identification | Opt | Alphanumeric | 1/30 | 1 |
| 18 | 116 | Postal Code | Opt | ID | 3/15 | 1 |
| 19 | 782 | Monetary Amount | Opt | Decimal | 1/18 | 1 |
| 20 | 1337 | Level of Care Code | Opt | ID | 1/1 | 1 |
| 21 | 1360 | Provider Agreement Code | Opt | ID | 1/1 | 1 |
