To specify the service line item detail for a health care institution
| Position | Element | Name | Type | Min/Max | Repeat | ||
|---|---|---|---|---|---|---|---|
| 1 | 234 | Product/Service ID | Rel | Alphanumeric | 1/80 | AtMax 1 | |
AtMax 1 | |||||||
| 3 | 782 | Monetary Amount | Opt | Decimal | 1/18 | AtMax 1 | |
| 4 | 355 | Unit or Basis for Measurement Code | Rel | ID | 2/2 | AtMax 1 | |
| 5 | 380 | Quantity | Rel | Decimal | 1/15 | AtMax 1 | |
| 6 | 1371 | Unit Rate | Opt | Decimal | 1/10 | AtMax 1 | |
| 7 | 782 | Monetary Amount | Opt | Decimal | 1/18 | AtMax 1 | |
| 8 | 1073 | Yes/No Condition or Response Code | Opt | ID | 1/1 | AtMax 1 | |
| 9 | 1345 | Nursing Home Residential Status Code | Opt | ID | 1/1 | AtMax 1 | |
| 10 | 1337 | Level of Care Code | Opt | ID | 1/1 | AtMax 1 | |