SVC

Service Payment Information

Pos: 070

Max: 1

Detail - Optional

Loop: 2110

Elements: 7


User Option (Usage): Recommended
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
Use the adjudicated Medical Procedure Code.
This code is a composite data structure.

M

Comp

 

Required

 

 

235

Product/Service ID Qualifier
Description: Code identifying the type/source of the descriptive number used in Product/Service ID (234)
Industry: Product or Service ID Qualifier
The value in SVC01-01 qualifies the values in SVC01-02, SVC01-03, SVC01-04, SVC01-05, and SVC01-06.

M

ID

2/2

Required

 

Code

Name

 

AD

American Dental Association Codes

CODE SOURCE:

135: American Dental Association Codes

 

ER

Jurisdiction Specific Procedure and Supply Codes

This is specific to Workman’s Compensation Claims.

 

HC

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, they are reported under the code HC.

CODE SOURCE:

130: Health Care Financing Administration Common Procedural Coding System

 

ID

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

CODE SOURCE:

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

 

IV

Home Infusion EDI Coalition (HIEC) Product/Service Code

This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used 1) If a new rule names HIEC as an allowable code set under HIPAA. 2) For Property & Casualty claims/encounters that are not covered under HIPAA.

CODE SOURCE:

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

 

N4

National Drug Code in 5-4-2 Format

CODE SOURCE:

240: National Drug Code by Format

 

NU

National Uniform Billing Committee (NUBC) UB92 Codes

CODE SOURCE:

132: National Uniform Billing Committee (NUBC) Codes

 

RB

National Uniform Billing Committee (NUBC) UB82 Codes

CODE SOURCE:

132: National Uniform Billing Committee (NUBC) Codes

 

ZZ

Mutually Defined

This is used to convey the Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code. This code list is
available from: Division of Institutional Care
Health Care Financing Administration S1-03-06
7500 Security Boulevard Baltimore, MD 21244-1850

 

 

234

Product/Service ID
Description: Identifying number for a product or service
Industry: Procedure Code

M

AN

1/48

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: 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

 

ExternalCodeList

 

Name: SNFR

 

Description: Skilled Nursing Facility Rate Code

 

 

1339

Procedure Modifier
Description: This identifies special circumstances related to the performance of the service, as defined by trading partners
Required when procedure code modifiers apply to this service.

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 when procedure code modifiers apply to this service.

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 when procedure code modifiers apply to this service.

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 when procedure code modifiers apply to this service.

O

AN

2/2

Situational

 

 

352

Description
Description: A free-form description to clarify the related data elements and their content
Industry: Procedure Code Description
Avoid using the description to make it easier for the computer to process the information provided.
Used only when a description was received for the service on the original claim, and the adjudicated code is the submitted code.

O

AN

1/80

Not recommended

 

SVC02

782

Monetary Amount
Description: Monetary amount
Industry: Line Item Charge Amount
Use this monetary amount for the submitted service charge amount.

M

R

1/18

Required

 

SVC03

782

Monetary Amount
Description: Monetary amount
Industry: Line Item Provider Payment Amount
Use this number for the service amount paid. The value in SVC03 should equal the value in SVC02 minus all monetary amounts in the subsequent CAS segments of this loop. See 2.2.1, Balancing, for additional information.

O

R

1/18

Required

 

SVC04

234

Product/Service ID
Description: Identifying number for a product or service
Industry: National Uniform Billing Committee Revenue Code
Use the National Uniform Billing Committee Revenue Code.
Required when an NUBC revenue code was considered during adjudication in addition to a procedure code already identified in SVC01. If the original claim and adjudication only referenced an NUBC revenue code, that is supplied in SVC01 and this element is not used.

O

AN

1/48

Situational

 

ExternalCodeList

 

Name: 132

 

Description: National Uniform Billing Committee (NUBC) Codes

 

SVC05

380

Quantity
Description: Numeric value of quantity
Industry: Units of Service Paid Count
Use this number for the paid units of service. If not present, the value is assumed to be one.

O

R

1/15

Situational

 

SVC06

C003

Composite Medical Procedure Identifier
Description: To identify a medical procedure by its standardized codes and applicable modifiers
This is REQUIRED when the adjudicated procedure code provided in SVC01 is different from the submitted procedure code from the original claim. This is NOT USED when the submitted code is the same as the code on SVC01.
This code is a composite data structure.

O

Comp

 

Situational

 

 

235

Product/Service ID Qualifier
Description: Code identifying the type/source of the descriptive number used in Product/Service ID (234)
Industry: Product or Service ID Qualifier
The value in SVC06-01 qualifies the values in SVC06-02, SVC06-03, SVC06-04, SVC06-05, and SVC06-06.

M

ID

2/2

Required

 

Code

Name

 

AD

American Dental Association Codes

CODE SOURCE:

135: American Dental Association Codes

 

ER

Jurisdiction Specific Procedure and Supply Codes

This is specific to Workman’s Compensation Claims.

 

HC

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, they are reported under the code HC.

CODE SOURCE:

130: Health Care Financing Administration Common Procedural Coding System

 

ID

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

CODE SOURCE:

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

 

IV

Home Infusion EDI Coalition (HIEC) Product/Service Code

This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used 1) If a new rule names HIEC as an allowable code set under HIPAA. 2) For Property & Casualty claims/encounters that are not covered under HIPAA.

CODE SOURCE:

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

 

N4

National Drug Code in 5-4-2 Format

CODE SOURCE:

240: National Drug Code by Format

 

NU

National Uniform Billing Committee (NUBC) UB92 Codes

CODE SOURCE:

132: National Uniform Billing Committee (NUBC) Codes

 

RB

National Uniform Billing Committee (NUBC) UB82 Codes

CODE SOURCE:

132: National Uniform Billing Committee (NUBC) Codes

 

ZZ

Mutually Defined

This is used to convey the Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code. This code list is
available from: Division of Institutional Care Health Care Financing Administration S1-03-06
7500 Security Boulevard Baltimore, MD 21244-1850

 

 

234

Product/Service ID
Description: Identifying number for a product or service
Industry: Procedure Code

M

AN

1/48

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: 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

 

ExternalCodeList

 

Name: SNFR

 

Description: Skilled Nursing Facility Rate Code

 

 

1339

Procedure Modifier
Description: This identifies special circumstances related to the performance of the service, as defined by trading partners
Required when procedure code modifiers apply to this service.

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 when procedure code modifiers apply to this service.

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 when procedure code modifiers apply to this service.

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 when procedure code modifiers apply to this service.

O

AN

2/2

Situational

 

 

352

Description
Description: A free-form description to clarify the related data elements and their content
Industry: Procedure Code Description
Avoid using the description to make it easier for the computer to process the information provided.
Required when a description was received for the service on the original claim.

O

AN

1/80

Not recommended

 

SVC07

380

Quantity
Description: Numeric value of quantity
Industry: Original Units of Service Count
This is REQUIRED when the paid units of service provided in SVC05 is different from the submitted units of service from the original claim. This is NOT USED when the submitted units is the same as the value in SVC05.

O

R

1/15

Situational


Semantics:

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.

Comments:

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. Although the SVC loop is optional, there are times when it should be considered mandatory. Whenever the actual payment has been reduced due to service line specific adjustments, the SVC loop is necessary in order to understand the remittance information. This situation is particularly applicable to professional and fee-based services.
2. An exception to note 1 occurs with institutional claims when the room per diem is the only service line adjustment. In this instance, a claim level CAS adjustment to the per diem is appropriate (i.e., CAS*CO*78*25~).
3. See 2.2.6, Procedure Code Bundling and Unbundling, for important SVC segment usage information.

Example:

SVC*HC:99214*100*80~


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