AMT

Medicare Paid Amount - 80%

Pos: 300	Max: 1
Detail - Optional
Loop: 2320	Elements: 2

Ref

Id

Element Name

Req

Type

Min/Max

Usage

AMT01

522

Amount Qualifier Code
Description: Code to qualify amount
Use this qualifier until a more suitable one is developed. At this time, the qualifier represents what the amount is being used for (see monetary amount description).

M

ID

1/3

Required

Code

Name

PG

Payoff

AMT02

782

Monetary Amount
Description: Monetary amount
Industry: Medicare Paid at 80% Amount
Record Type 93 Field No. 5 (For COB use [temporary qualifier]. Use this amount for the claim level allowed charges Medicare paid at 80%.)

M

R

1/18

Required

Notes:

1. This segment is for COB use.
2. This segment is used to convey the COB Medicare Paid Amount - 80% applicable to this claim when known.

Example:

AMT*PG*639.4~