AMT

Service Supplemental Amount

Pos: 110	Max: 12
Detail - Optional
Loop: 2110	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

T

Tax

B6

Allowed - Actual

DY

Per Day Limit

NOT ADVISED Medicare uses this to report the provider per diem amount, where applicable.

KH

Deduction Amount

Late Filing Reduction

NE

Net Billed

NOT ADVISED

T2

Total Claim Before Taxes

Use this monetary amount for the service charge before taxes.

ZK

Federal Medicare or Medicaid Payment Mandate - Category 1

ZL

Federal Medicare or Medicaid Payment Mandate - Category 2

ZM

Federal Medicare or Medicaid Payment Mandate - Category 3

ZN

Federal Medicare or Medicaid Payment Mandate - Category 4

ZO

Federal Medicare or Medicaid Payment Mandate - Category 5

AMT02

782

Monetary Amount
Description: Monetary amount
Industry: Service Supplemental Amount

M

R

1/18

Required

Notes:

1. This segment is used to convey information only. It is not part of the financial balancing of the 835. Use this segment only when the value of specific amounts identified in the AMT01 qualifier are Non-zero.

Example:

AMT*B6*425~