AMT

Total Purchased Service Amount

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

NE

Net Billed

Use this code to indicate Total Purchased Service Charges.

AMT02

782

Monetary Amount
Description: Monetary amount
Industry: Total Purchased Service Amount
NSF Reference: EA0-31.0

M

R

1/18

Required

Notes:

1. Required if there are purchased service components to this claim.
2. Use this segment on vision claims when the acquisition cost of lenses is known to impact adjudication or reimbursement.
3. Required on service lines when the purchased service charge amount is necessary for processing.

Example:

AMT*NE*57.35~