SVC

Service Line Information

Pos: 130

Max: 1

Detail - Optional

Loop: 2210D

Elements: 4

User Option (Usage): Situational

To supply payment and control information to a provider for a particular service

Element Summary:

Ref	Id	Element Name	Req	Type	Min/Max	Usage
SVC01	C003	Composite Medical Procedure Identifier Description: To identify a medical procedure by its standardized codes and applicable modifiers Industry: Product or Service ID Qualifier SVC01 will contain the procedure code of the adjudicated claim. If the adjudicated code is not known then SVC01 will contain the original submitted procedure code.	M	Comp		Required
	235	Product/Service ID Qualifier Description: Code identifying the type/source of the descriptive number used in Product/Service ID (234)	M	ID	2/2	Required

Code

Name

American Dental Association Codes

CODE SOURCE:

135: American Dental Association Codes

Common Language Equipment Identifier (CLEI)

Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes

Because the CPT codes of the American Medical Association are also level 1 HCPCS codes, the CPT codes are reported under the code HC.

CODE SOURCE:

130: Health Care Financing Administration Common Procedural Coding System

International Classification of Diseases Clinical Modification (ICD-9-CM) - Procedure

CODE SOURCE:

131: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

Home Infusion EDI Coalition (HIEC) Product/Service Code

CODE SOURCE:

513: Home Infusion EDI Coalition (HIEC) Product/Service Code List

National Drug Code in 4-4-2 Format

CODE SOURCE:

240: National Drug Code by Format

National Drug Code in 5-3-2 Format

CODE SOURCE:

240: National Drug Code by Format

National Drug Code in 5-4-1 Format

CODE SOURCE:

240: National Drug Code by Format

National Drug Code in 5-4-2 Format

CODE SOURCE:

240: National Drug Code by Format

National Drug Code (NDC)

CODE SOURCE:

134: National Drug Code

National Health Related Item Code

National Uniform Billing Committee (NUBC) UB92 Codes

This code is the NUBC Revenue Code.

CODE SOURCE:

132: National Uniform Billing Committee (NUBC) Codes

National Uniform Billing Committee (NUBC) UB82 Codes

CODE SOURCE:

132: National Uniform Billing Committee (NUBC) Codes

234

Product/Service ID
Description: Identifying number for a product or service
Industry: Service Identification Code
If the value in SVC01-1 is �NU�, then this element is an NUBC Revenue Code. If a value is present here, then SVC04 is not used.

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Required

	ExternalCodeList
	Name: 130
	Description: Health Care Financing Administration Common Procedural Coding System

	ExternalCodeList
	Name: 131
	Description: International Classification of Diseases Clinical Mod (ICD-9-CM) Procedure

	ExternalCodeList
	Name: 132
	Description: National Uniform Billing Committee (NUBC) Codes

	ExternalCodeList
	Name: 134
	Description: National Drug Code

	ExternalCodeList
	Name: 135
	Description: American Dental Association Codes

	ExternalCodeList
	Name: 240
	Description: National Drug Code by Format

	ExternalCodeList
	Name: 513
	Description: Home Infusion EDI Coalition (HIEC) Product/Service Code List

	1339	Procedure Modifier Description: This identifies special circumstances related to the performance of the service, as defined by trading partners Required if submitted on the original claim service line.	O	AN	2/2	Situational
	1339	Procedure Modifier Description: This identifies special circumstances related to the performance of the service, as defined by trading partners Required if submitted on the original claim service line.	O	AN	2/2	Situational
	1339	Procedure Modifier Description: This identifies special circumstances related to the performance of the service, as defined by trading partners Required if submitted on the original claim service line.	O	AN	2/2	Situational
	1339	Procedure Modifier Description: This identifies special circumstances related to the performance of the service, as defined by trading partners Required if submitted on the original claim service line.	O	AN	2/2	Situational
SVC02	782	Monetary Amount Description: Monetary amount Industry: Line Item Charge Amount This amount is the original submitted charge.	M	R	1/18	Required
SVC04	234	Product/Service ID Description: Identifying number for a product or service Industry: Revenue Code This is the NUBC Revenue Code. When SVC-101 equals �NU�, then the NUBC Revenue Code belongs in SVC01-2.	O	AN	1/48	Situational

	ExternalCodeList
	Name: 132
	Description: National Uniform Billing Committee (NUBC) Codes

SVC07

380

Quantity
Description: Numeric value of quantity
Industry: Original Units of Service Count
These are the submitted units of service. The default is 1 unit. This element is required when the submitted units are greater than 1.

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Situational

1.	SVC01 is the medical procedure upon which adjudication is based.
2.	SVC02 is the submitted service charge.
3.	SVC03 is the amount paid this service.
4.	SVC04 is the National Uniform Billing Committee Revenue Code.
5.	SVC05 is the paid units of service.
6.	SVC06 is the original submitted medical procedure.
7.	SVC07 is the original submitted units of service.

1.	For Medicare Part A claims, SVC01 would be the Health Care Financing Administration (HCFA) Common Procedural Coding System (HCPCS) Code (see code source 130) and SVC04 would be the Revenue Code (see code source 132).

Notes:

1. Use this segment to request status information about a service line.
2. This segment is required if loop is used by ASC X12 syntax because it is the first segment in Loop ID -2210 (Service Line Information).
3. For Medicare Institutional claims, SVC01 would be the Health Care Financing Administration (HCFA), Common Procedural Coding System (HCPCS) Code (See Code Source 130) and SVC04 would be the Revenue Code (see Code Source 132).

Example:

SVC*HC:99214*75*****1~
or
SVC*NU:71X*50*****1~