Monetary amount

SV102 is the submitted charge amount.

Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken

Numeric value of quantity

Code identifying the type of facility where services were performed; the first and second positions of the Uniform Bill Type code or the Place of Service code from the Electronic Media Claims National Standard Format

SV105 is the place of service.

Code identifying the classification of service

Monetary amount

SV108 is the independent lab charges.

Code indicating a Yes or No condition or response

SV109 is the emergency-related indicator; a "Y" value indicates service provided was emergency related; an "N" value indicates service provided was not emergency related.

Code indicating proper adjudication and payment determination in cases involving multiple surgical procedures during the same surgical session

Code indicating a Yes or No condition or response

SV111 is early and periodic screen for diagnosis and treatment of children (EPSDT) involvement; a "Y" value indicates EPSDT involvement; an "N" value indicates no EPSDT involvement.

Code indicating a Yes or No condition or response

SV112 is the family planning involvement indicator. A "Y" value indicates family planning services involvement; an "N" value indicates no family planning services involvement.

Code identifying extenuating circumstances or justifications which might assist any review of the medical necessity for this service

If SV113 is equal to "L" or "N", then SV114 is required.

Value assigned by national or local organizations for various healthcare data elements

Code indicating whether or not co-payment requirements were met on a line by line basis

Code identifying the Health Care Professional Shortage Area Code (HPSA)

Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

SV117 is the health care manpower shortage area (HMSA) facility identification.

Code defining international postal zone code excluding punctuation and blanks (zip code for United States)

SV118 is the health care manpower shortage area (HMSA) zip code.

Monetary amount

SV119 is a noncovered charge amount.

Code specifying the level of care provided by a nursing home facility

Code indicating the type of agreement under which the provider is submitting this claim