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
Composite Medical Procedure Identifier
Composite (composite)
Mandatory
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
48
-
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.
SVC-02
Monetary Amount
Decimal number (R)
Mandatory
1
15
-
Monetary amount
SVC02 is the submitted service charge.
SVC-03
Monetary Amount
Decimal number (R)
Mandatory
1
15
-
Monetary amount
SVC03 is the amount paid this service.
SVC-04
Product/Service ID
String (AN)
Optional
1
48
-
Identifying number for a product or service
SVC04 is the National Uniform Billing Committee Revenue Code.
SVC-05
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity
SVC05 is the paid units of service.
SVC-06
Composite Medical Procedure Identifier
Composite (composite)
Optional
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
48
-
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.
SVC-07
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity
SVC07 is the original submitted units of service.

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