SV1 Professional Service
To specify the service line item 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)
C003-01 qualifies C003-02 and C003-08.
Identifying number for a product or service
If C003-08 is used, then C003-02 represents the beginning value in the range in which the code occurs.
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-03 modifies the value in C003-02 and C003-08.
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-04 modifies the value in C003-02 and C003-08.
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-05 modifies the value in C003-02 and C003-08.
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-06 modifies the value in C003-02 and C003-08.
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.
Identifying number for a product or service
C003-08 represents the ending value in the range in which the code occurs.
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-09 modifies the value in C003-02 and C003-08.
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-10 modifies the value in C003-02 and C003-08.
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-11 modifies the value in C003-02 and C003-08.
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-12 modifies the value in C003-02 and C003-08.
Monetary amount
SV102 is the submitted service line item 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 where services were, or may be, performed; the National Uniform Billing Committee (NUBC) Facility Type Code for Institutional Services or the Place of Service Codes for Professional or Dental Services.
SV105 is the place of service.
Code indicating a code from a specific industry code list
SV106 is the Service Type (Code Source 958).
A pointer to the diagnosis code in the order of importance to this service
The first pointer designates the primary diagnosis and remaining diagnosis pointers indicate declining level of importance.
Monetary amount
SV108 is the independent lab charges.
Code indicating a Yes or No condition or response
SV109 is the 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 the family planning involvement indicator. A "Y" value indicates family planning services involvement; an "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 the Health Care Professional Shortage Area Code (HPSA)
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification 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 service 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