SVC Service Information

To supply payment and control information to a provider for a particular service

Position

Element

Name

Type

Requirement

Min

Max

Repeat

SVC-01 C003 Composite Medical Procedure Identifier Composite (composite) Mandatory

01 · 235 · Product/Service ID Qualifier · Identifier (ID) · Mandatory · 2 · 2 · -

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

02 · 234 · Product/Service ID · String (AN) · Mandatory · 1 · 30 · -

Identifying number for a product or service.

03 · 1339 · Procedure Modifier · String (AN) · Optional · 2 · 2 · -

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

C003-03 modifies the value in C003-02.

04 · 1339 · Procedure Modifier · String (AN) · Optional · 2 · 2 · -

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

C003-04 modifies the value in C003-02.

05 · 1339 · Procedure Modifier · String (AN) · Optional · 2 · 2 · -

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

C003-05 modifies the value in C003-02.

06 · 1339 · Procedure Modifier · String (AN) · Optional · 2 · 2 · -

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

C003-06 modifies the value in C003-02.

07 · 352 · Description · String (AN) · Optional · 1 · 80 · -

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.

SVC-02 · 782 · Monetary Amount · Decimal number (R) · Mandatory · 1 · 15 · -

Monetary amount.

SVC02 is the submitted service charge.

SVC-03 · 782 · Monetary Amount · Decimal number (R) · Mandatory · 1 · 15 · -

Monetary amount.

SVC03 is the amount paid this service.

SVC-04 · 234 · Product/Service ID · String (AN) · Optional · 1 · 30 · -

Identifying number for a product or service.

SVC04 is the National Uniform Billing Committee Revenue Code.

SVC-05 · 380 · Quantity · Decimal number (R) · Optional · 1 · 15 · -

Numeric value of quantity.

SVC05 is the paid Units of Service.

SVC-06 C003 Composite Medical Procedure Identifier Composite (composite) Optional

01 · 235 · Product/Service ID Qualifier · Identifier (ID) · Mandatory · 2 · 2 · -

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

02 · 234 · Product/Service ID · String (AN) · Mandatory · 1 · 30 · -

Identifying number for a product or service.

03 · 1339 · Procedure Modifier · String (AN) · Optional · 2 · 2 · -

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

C003-03 modifies the value in C003-02.

04 · 1339 · Procedure Modifier · String (AN) · Optional · 2 · 2 · -

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

C003-04 modifies the value in C003-02.

05 · 1339 · Procedure Modifier · String (AN) · Optional · 2 · 2 · -

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

C003-05 modifies the value in C003-02.

06 · 1339 · Procedure Modifier · String (AN) · Optional · 2 · 2 · -

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

C003-06 modifies the value in C003-02.

07 · 352 · Description · String (AN) · Optional · 1 · 80 · -

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.

SVC-07 · 380 · Quantity · Decimal number (R) · Optional · 1 · 15 · -

Numeric value of quantity.

SVC07 is the original submitted Units of Service.