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Segment
in
X12 Release 003030

SV2 Institutional Service

To specify the claim service detail for a Health Care institution
Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
234
Product/Service ID
String (AN)
Conditional
1
30
-
Identifying number for a product or service.
R0103
SV201 is revenue code.
02
Product/Service ID Qualifier
Identifier (ID)
Conditional
2
2
-
Code identifying the type/source of the descriptive number used in Product/Service ID (234).
P0203
Codes (275)
03
Product/Service ID
String (AN)
Conditional
1
30
-
Identifying number for a product or service.
04
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
SV204 is submitted charge amount.
05
Unit or Basis for Measurement Code
Identifier (ID)
Conditional
2
2
-
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
P0506
Codes (682)
06
Quantity
Decimal number (R)
Conditional
1
15
-
Numeric value of quantity.
07
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
08
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
09
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
10
Unit Rate
Decimal number (R)
Optional
1
10
-
The rate per unit of associate revenue for hospital accommodation
11
Description
String (AN)
Optional
1
80
-
A free-form description to clarify the related data elements and their content.
SV211 is procedure description.
12
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
SV212 is non-covered charge amount.
13
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
-
Code indicating a Yes or No condition or response.
SV213 is detail service line indicator. A ``Y'' value indicates a detail service line. An ``N'' value indicates a summary service line.
Codes (3)
14
Nursing Home Residential Status Code
Identifier (ID)
Optional
1
1
-
Code specifying the status of a nursing home resident at the time of service
Codes (9)
15
Level of Care Code
Identifier (ID)
Optional
1
1
-
Code specifying the level of care provided by a nursing home facility
Codes (7)
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Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.