SV1 Professional Service

Batch

To specify the service line item detail for a health care professional

Elements

Position	Element	Name		Type	Min/Max	Repeat

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	1/3	1
6	1271	Industry Code	Opt	Alphanumeric	1/30	1
7	1328	Diagnosis Code Pointer	Opt	Number	1/2	12
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	1/80	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

ID782

NameMonetary Amount

LengthMin 1 / Max 18

Position2

RequirementOpt