SV1 Professional Service

To specify the claim service detail for a Health Care professional

Position: SV1-01 · Element: 235 · Name: Product/Service ID Qualifier · Type: Identifier (ID) · Requirement: Mandatory · Min: 2 · Max: 2 · Repeat: -

Code identifying the type/source of the descriptive number used in Product/Service ID (234).

Position: SV1-02 · Element: 234 · Name: Product/Service ID · Type: String (AN) · Requirement: Mandatory · Min: 1 · Max: 30 · Repeat: -

Identifying number for a product or service.

Position: SV1-03 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 15 · Repeat: -

Monetary amount.

SV103 is submitted charge amount.

Position: SV1-04 · Element: 355 · Name: Unit or Basis for Measurement Code · Type: Identifier (ID) · Requirement: Conditional · Min: 2 · Max: 2 · Repeat: -

Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken

P0405: If either SV1-04 or SV1-05 is present, then the other is required

Position: SV1-05 · Element: 380 · Name: Quantity · Type: Decimal number (R) · Requirement: Conditional · Min: 1 · Max: 15 · Repeat: -

Numeric value of quantity.

Position: SV1-06 · Element: 1331 · Name: Facility Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: -

Code identifying the type of facility where services were performed; the first position of the uniform bill type or place of service from health care financing administration claim form or place of treatment from the dental claim form

SV106 is place of service.

Position: SV1-07 · Element: 1365 · Name: Service Type Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: -

Code identifying the classification of service

Position: SV1-08 · Element: 1328 · Name: Diagnosis Code Pointer · Type: Numeric (N0) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: -

A pointer to the claim diagnosis code in the order of importance to this service

Position: SV1-09 · Element: 1339 · Name: Procedure Modifier · Type: String (AN) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

This identifies special circumstances related to the performance of the service, as defined by trading partners

Position: SV1-10 · Element: 1328 · Name: Diagnosis Code Pointer · Type: Numeric (N0) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: -

A pointer to the claim diagnosis code in the order of importance to this service

Position: SV1-11 · Element: 1339 · Name: Procedure Modifier · Type: String (AN) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

This identifies special circumstances related to the performance of the service, as defined by trading partners

Position: SV1-12 · Element: 1339 · Name: Procedure Modifier · Type: String (AN) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

This identifies special circumstances related to the performance of the service, as defined by trading partners

Position: SV1-13 · Element: 352 · Name: Description · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 80 · Repeat: -

A free-form description to clarify the related data elements and their content.

SV113 is procedure code description.

Position: SV1-14 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 15 · Repeat: -

Monetary amount.

SV114 is independent lab charges.

Position: SV1-15 · Element: 1073 · Name: Yes/No Condition or Response Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

Code indicating a Yes or No condition or response.

SV115 is emergency related indicator. A ``Y'' value indicates service provided was emergency related. An ``N'' value indicates service provided was not emergency related.

Position: SV1-16 · Element: 1340 · Name: Multiple Procedure Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: -

Code indicating proper adjudication and payment determination in cases involving multiple surgical procedures during the same surgical session

Position: SV1-17 · Element: 1073 · Name: Yes/No Condition or Response Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

Code indicating a Yes or No condition or response.

SV117 is Early and Periodic Screen for Diagnosis and Treatment of children (EPSDT) involvement. A ``Y'' value indicates EPSDT involvement. An ``N'' value indicates no EPSDT involvement.

Position: SV1-18 · Element: 1073 · Name: Yes/No Condition or Response Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

Code indicating a Yes or No condition or response.

SV118 is family planning involvement. A ``Y'' value indicates family planning services involvement. An ``N'' value indicates no family planning services involvement.

Position: SV1-19 · Element: 1364 · Name: Review Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: -

Code identifying extenuating circumstances or justifications which might assist any review of the medical necessity for this service

If SV119 is equal to ``L'' or ``N'', then SV120 is required.

Position: SV1-20 · Element: 1341 · Name: National or Local Assigned Review Value · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: -

Value assigned by national or local organizations for various healthcare data elements

Position: SV1-21 · Element: 1327 · Name: Copay Status Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

Code indicating whether or not co-payment requirements were met on a line by line basis

Position: SV1-22 · Element: 1334 · Name: Healthcare Manpower Shortage Area Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

Code identifying a Healthcare Manpower Shortage Area (HMSA)

Position: SV1-23 · Element: 127 · Name: Reference Number · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 30 · Repeat: -

Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.

SV123 is Healthcare Manpower Shortage Area (HMSA) facility identification.

Position: SV1-24 · Element: 116 · Name: Postal Code · Type: Identifier (ID) · Requirement: Optional · Min: 3 · Max: 9 · Repeat: -

Code defining international postal zone code excluding punctuation and blanks (zip code for United States).

SV124 is Healthcare Manpower Shortage Area (HMSA) zip code.

Position: SV1-25 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 15 · Repeat: -

Monetary amount.

SV125 is non-covered charge amount.

Position: SV1-26 · Element: 1337 · Name: Level of Care Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

Code specifying the level of care provided by a nursing home facility

Position: SV1-27 · Element: 1360 · Name: Provider Agreement Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

Code indicating the type of agreement under which the provider is submitting this claim