REF

Investigational Device Exemption Number

Pos: 180	Max: 1
Detail - Optional
Loop: 2300	Elements: 2

Ref

Id

Element Name

Req

Type

Min/Max

Usage

REF01

128

Reference Identification Qualifier
Description: Code qualifying the Reference Identification

M

ID

2/3

Required

Code

Name

LX

Qualified Products List

REF02

127

Reference Identification
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Industry: Investigational Device Exemption Identifier
EMC v.6.0 Reference: Record Type 34 Field No. 5

C

AN

1/30

Required

1.

R0203 - At least one of REF02,REF03 is required

1.

REF04 contains data relating to the value cited in REF02.

Notes:

1. Required only on claims involving an FDA assigned investigational device exemption (IDE) number. Only one IDE per claim is to be reported.

Example:

REF*LX*432907~