C058 Adjustment Reason

To provide a reason and related explanation for a Health Care Claim or Service change in payment versus the original submitted charges

Position: C058-01 · Element: 1034 · Name: Claim Adjustment Reason Code · Type: Identifier (ID) · Requirement: Mandatory · Min: 1 · Max: 5 · Repeat: -

Code identifying the detailed reason the adjustment was made

Position: C058-02 · Element: 1270 · Name: Code List Qualifier Code · Type: Identifier (ID) · Requirement: Conditional · Min: 1 · Max: 3 · Repeat: -

Code identifying a specific industry code list

P0203: If either C058-02 or C058-03 is present, then the other is required

C05802 qualifies C05803, C05804, C05805, C05806 and C05807.

Position: C058-03 · Element: 1271 · Name: Industry Code · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 30 · Repeat: -

Code indicating a code from a specific industry code list

Position: C058-04 · Element: 1271 · Name: Industry Code · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 30 · Repeat: -

Code indicating a code from a specific industry code list

C0403: If C058-04 is present, then C058-03 is required

Position: C058-05 · Element: 1271 · Name: Industry Code · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 30 · Repeat: -

Code indicating a code from a specific industry code list

C0504: If C058-05 is present, then C058-04 is required

Position: C058-06 · Element: 1271 · Name: Industry Code · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 30 · Repeat: -

Code indicating a code from a specific industry code list

C0605: If C058-06 is present, then C058-05 is required

Position: C058-07 · Element: 1271 · Name: Industry Code · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 30 · Repeat: -

Code indicating a code from a specific industry code list

C0706: If C058-07 is present, then C058-06 is required