To specify allowances, charges, or services
| Position | Element | Name | Type | Min/Max | Repeat | |
|---|---|---|---|---|---|---|
| 1 | 248  | Allowance or Charge Indicator Code | Mandatory | ID | 1/1 | AtMax 1 | 
| 2 | 559  | Agency Qualifier Code | Rel | ID | 2/2 | AtMax 1 | 
| 3 | 560  | Special Services Code | Rel | ID | 2/10 | AtMax 1 | 
| 4 | 331  | Allowance or Charge Method of Handling Code | Mandatory | ID | 2/2 | AtMax 1 | 
| 5 | 341  | Allowance or Charge Number | Opt | Alphanumeric | 1/16 | AtMax 1 | 
| 6 | 359  | Allowance or Charge Rate | Opt | Decimal | 1/15 | AtMax 1 | 
| 7 | 360  | Allowance or Charge Total Amount | Opt | Number | 1/15 | AtMax 1 | 
| 8 | 378  | Allowance/Charge Percent Qualifier | Opt | ID | 1/1 | AtMax 1 | 
| 9 | 332  | Percent, Decimal Format | Rel | Decimal | 1/6 | AtMax 1 | 
| 10 | 380  | Quantity | Rel | Decimal | 1/15 | AtMax 1 | 
| 11 | 355  | Unit or Basis for Measurement Code | Rel | ID | 2/2 | AtMax 1 | 
| 12 | 380  | Quantity | Rel | Decimal | 1/15 | AtMax 1 | 
| 13 | 352  | Description | Rel | Alphanumeric | 1/80 | AtMax 1 | 
| 14 | 150  | Special Charge or Allowance Code | Rel | ID | 3/3 | AtMax 1 | 
| 15 | 822  | Source Subqualifier | Opt | Alphanumeric | 1/15 | AtMax 1 | 
| 16 | 662  | Relationship Code | Opt | ID | 1/1 | AtMax 1 | 
| 17 | 355  | Unit or Basis for Measurement Code | Opt | ID | 2/2 | AtMax 1 |