AMT

Patient Amount Paid

Pos: 175	Max: 1
Detail - Optional
Loop: 2300	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

F5

Patient Amount Paid

AMT02

782

Monetary Amount
Description: Monetary amount
Industry: Patient Amount Paid
NSF Reference: XA0-19.0

M

R

1/18

Required

Notes:

1. Required if the patient has paid any amount toward the claim.
2. Patient Amount Paid refers to the sum of all amounts paid on the claim by the patient or his/her representative.
3. The Patient amount Paid indicated in this segment applies to the entire claim. It is recommended that the Patient Amount Paid AMT segment be used at either the line or claim level but not at both.

Example:

AMT*F5*8.5~