QTY

Service Supplemental Quantity

Pos: 120	Max: 6
Detail - Optional
Loop: 2110	Elements: 2

Ref

Id

Element Name

Req

Type

Min/Max

Usage

QTY01

673

Quantity Qualifier
Description: Code specifying the type of quantity

M

ID

2/2

Required

Code

Name

NE

Non-Covered - Estimated

Use this code for actual line item non-covered visits.

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

QTY02

380

Quantity
Description: Numeric value of quantity
Industry: Service Supplemental Quantity Count

C

R

1/15

Required

1.

R0204 - At least one of QTY02,QTY04 is required

2.

E0204 - Only one of QTY02,QTY04 may be presented

1.

QTY04 is used when the quantity is non-numeric.

Notes:

1. Use this segment to convey information only. It is not part of the financial balancing of the 835.
2. Use this segment only when the value of specific quantities identified in the QTY01 qualifier are Non-zero.

Example:

QTY*ZL*3.75~