Field | Format | Required? | Min | Max | Comments |
---|---|---|---|---|---|
Procedure | AN | Y | |||
Modifier1 | AN | N | 2 | 2 | |
Modifier2 | AN | N | 2 | 2 | |
Modifier3 | AN | N | 2 | 2 | |
ServiceLineBeginDate | DT | Y | 1 | 35 | (MM/DD/YYYY) |
ServiceLineEndDate | DT | Y | 1 | 35 | (MM/DD/YYYY) |
Charges | NUM | Y | 1 | 18 | |
Payments | NUM | Y | 1 | 18 | |
Units | NUM | N | 1 | 15 | |
StatusDetail1 | See Status Details | ||||
StatusDetail2 | See Status Details | ||||
StatusDetail3 | See Status Details |