SV2 Institutional Service

To specify the claim service detail for a Health Care institution

Position
Element
Name
Type
Requirement
Min
Max
Repeat
SV2-01
Product/Service ID
String (AN)
Conditional
1
40
-
Identifying number for a product or service.
R0102: At least one of SV2-01 or SV2-02 is required
SV201 is revenue code.
SV2-02
Composite Medical Procedure Identifier
Composite (composite)
Conditional
01
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
Product/Service ID
String (AN)
Mandatory
1
40
-
Identifying number for a product or service.
03
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
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
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
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
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.
SV2-03
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
SV203 is submitted charge amount.
SV2-04
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
P0405: If either SV2-04 or SV2-05 is present, then the other is required
SV2-05
Quantity
Decimal number (R)
Conditional
1
15
-
Numeric value of quantity.
SV2-06
Unit Rate
Decimal number (R)
Optional
1
10
-
The rate per unit of associate revenue for hospital accommodation
SV2-07
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
SV207 is non-covered charge amount.
SV2-08
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
-
Code indicating a Yes or No condition or response.
SV208 is detail service line indicator. A ``Y'' value indicates a detail service line. An ``N'' value indicates a summary service line.
SV2-09
Nursing Home Residential Status Code
Identifier (ID)
Optional
1
1
-
Code specifying the status of a nursing home resident at the time of service
SV2-10
Level of Care Code
Identifier (ID)
Optional
1
1
-
Code specifying the level of care provided by a nursing home facility

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