SV1 Professional Service
To specify the claim service detail for a Health Care professional
Position
Element
Name
Type
Requirement
Min
Max
Repeat
Code identifying the type/source of the descriptive number used in Product/Service ID (234).
Identifying number for a product or service.
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-03 modifies the value in C003-02.
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-04 modifies the value in C003-02.
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-05 modifies the value in C003-02.
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-06 modifies the value in C003-02.
A free-form description to clarify the related data elements and their content.
C003-07 is the description of the procedure identified in C003-02.
Monetary amount.
SV102 is submitted charge amount.
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
P0304: If either SV1-03 or SV1-04 is present, then the other is required
Numeric value of quantity.
Code identifying the type of facility where services were performed; the first and second 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
SV105 is place of service.
Code identifying the classification of service
A pointer to the claim diagnosis code in the order of importance to this service
C004-01 identifies the primary diagnosis code for this service line.
A pointer to the claim diagnosis code in the order of importance to this service
C004-02 identifies the second diagnosis code for this service line.
A pointer to the claim diagnosis code in the order of importance to this service
C004-03 identifies the third diagnosis code for this service line.
A pointer to the claim diagnosis code in the order of importance to this service
C004-04 identifies the fourth diagnosis code for this service line.
Monetary amount.
SV108 is independent lab charges.
Code indicating a Yes or No condition or response.
SV109 is emergency-related indicator; a "Y" value indicates service provided was emergency related; an "N" value indicates service provided was not emergency related.
Code indicating proper adjudication and payment determination in cases involving multiple surgical procedures during the same surgical session
Code indicating a Yes or No condition or response.
SV111 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.
Code indicating a Yes or No condition or response.
SV112 is family planning involvement; a "Y" value indicates family planning services involvement; a "N" value indicates no family planning services involvement.
Code identifying extenuating circumstances or justifications which might assist any review of the medical necessity for this service
If SV113 is equal to "L" or "N", then SV114 is required.
Value assigned by national or local organizations for various healthcare data elements
Code indicating whether or not co-payment requirements were met on a line by line basis
Code identifying a Healthcare Manpower Shortage Area (HMSA)
Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.
SV117 is the health care manpower shortage area (HMSA) facility identification.
Code defining international postal zone code excluding punctuation and blanks (zip code for United States).
SV118 is the health care manpower shortage area (HMSA) zip code.
Monetary amount.
SV119 is a non-covered charge amount.
Code specifying the level of care provided by a nursing home facility
Code indicating the type of agreement under which the provider is submitting this claim