AMT

Subscriber Spend Down Amount

Pos: 135

Max: 1

Detail - Optional

Loop: 2110C

Elements: 2

	Ref	Id	Element Name	Req	Type	Min/Max	Usage
	AMT01	522	Amount Qualifier Code Description: Code to qualify amount	M	ID	1/3	Required

	Code	Name
	R	Spend Down

AMT02

782

Monetary Amount
Description: Monetary amount
Industry: Spend Down Amount
Use this monetary amount to specify the dollar amount associated with this inquiry.

1/18

Required

Notes:

1. Use this segment only if it is necessary to report a Spend Down amount. Under certain Medicaid programs, individuals must indicate the dollar amount that they wish to apply towards their deductible. These programs require individuals to pay a certain amount towards their health care cost before Medicaid coverage starts.
2. If the EQ segment is used, either EQ01 - Service Type Code or EQ02 -Composite Medical Procedure Identifier must be used. EQ02 -Composite Medical Procedure Identifier is used only if an information source can support this high-level functionality. The EQ02 allows for a very specific inquiry, such as on based on a procedure code. Additional information such as diagnosis codes and place of service can be supplied in the III segment of loop 2110C. If this level of functionality is not supported, use EQ01.

Example:

AMT*R*37.5~