See Code Source 132: National Uniform Billing Committee (NUBC) Codes.
ExternalCodeList
Name: 132
Description: National Uniform Billing Committee (NUBC) Codes
SV202 C003 Composite Medical Procedure Identifier
X Comp Situational 1
Situational Rule: Required for outpatient claims when an appropriate procedure code exists for this service line item.
OR
Required for inpatient claims when an appropriate HCPCS (drugs and/or biologics only) or HIPPS code exists for this service line item. If not required by this implementation guide, do not send.
SV202-01 235 Product/Service ID Qualifier M ID 2/2 Required 1
Code Name
ER Jurisdiction Specific Procedure and Supply Codes
This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the Jurisdiction Specific Procedure and Supply Codes as an allowable code set under HIPAA,
OR
The Secretary grants an exception to use the code set as a pilot project as allowed under the law,
OR
For claims which are not covered under HIPAA.
CODE SOURCE:
576: Workers Compensation Specific Procedure and Supply Codes
HC Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes
Because the AMA’s CPT codes are also level 1 HCPCS codes, they are reported under HC.
CODE SOURCE:
130: Health Care Financing Administration Common Procedural Coding System HP Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate
Code
CODE SOURCE:
716: Health Insurance Prospective Payment
System (HIPPS) Rate Code for Skilled Nursing Facilities IV Home Infusion EDI Coalition (HIEC) Product/Service Code
This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used:
If a new rule names the Home Infusion EDI Coalition Codes as an allowable code set under HIPAA,
OR
The Secretary grants an exception to use the code set as a pilot project as allowed under the law,
OR
For claims which are not covered under HIPAA.
CODE SOURCE:
WK Advanced Billing Concepts (ABC) Codes
This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used:
If a new rule names the Complimentary, Alternative, or Holistic Procedure Codes as an allowable code set under HIPAA,
OR
The Secretary grants an exception to use the code set as a pilot project as allowed under the law,
OR
For claims which are not covered under HIPAA.
CODE SOURCE:
843: Advanced Billing Concepts (ABC) Codes
SV202-02 234 Product/Service ID M AN 1/48 Required 1
ExternalCodeList
Name: 130
Description: Health Care Financing Administration Common Procedural Coding System
ExternalCodeList
Name: 513
Description: Home Infusion EDI Coalition (HIEC) Product/Service Code List
ExternalCodeList
Name: 576
Description: Workers Compensation Specific Procedure and Supply Codes
ExternalCodeList
Name: 716
Description: HIPPS Rate Code for Skilled Nursing Facilities
ExternalCodeList
Name: 843
Description: Advanced Billing Concepts (ABC) Codes
SV202-03 1339 Procedure Modifier O AN 2/2 Situational 1 Situational Rule: Required when a modifier clarifies or improves the reporting accuracy of the associated
procedure code. This is the first procedure code modifier. If not required by this implementation guide, do not send.
ExternalCodeList
Name: 130
Description: Health Care Financing Administration Common Procedural Coding System
ExternalCodeList
Name: 513
Description: Home Infusion EDI Coalition (HIEC) Product/Service Code List
ExternalCodeList
Name: 576
Description: Workers Compensation Specific Procedure and Supply Codes
ExternalCodeList
Name: 843
Description: Advanced Billing Concepts (ABC) Codes
SV202-04 1339 Procedure Modifier O AN 2/2 Situational 1
Situational Rule: Required when a third modifier clarifies or improves the reporting accuracy of the associated procedure code. If not required by this implementation guide, do not send.
ExternalCodeList
Name: 130
Description: Health Care Financing Administration Common Procedural Coding System
ExternalCodeList
Name: 513
Description: Home Infusion EDI Coalition (HIEC) Product/Service Code List
5010X837IA2.ecs 167 For internal use only
ExternalCodeList
Name: 576
Description: Workers Compensation Specific Procedure and Supply Codes
ExternalCodeList
Name: 843
Description: Advanced Billing Concepts (ABC) Codes
SV202-05 1339 Procedure Modifier O AN 2/2 Situational 1
Situational Rule: Required when a third modifier clarifies or improves the reporting accuracy of the associated procedure code. If not required by this implementation guide, do not send.
ExternalCodeList
Name: 130
Description: Health Care Financing Administration Common Procedural Coding System
ExternalCodeList
Name: 513
Description: Home Infusion EDI Coalition (HIEC) Product/Service Code List
ExternalCodeList
Name: 576
Description: Workers Compensation Specific Procedure and Supply Codes
ExternalCodeList
Name: 843
Description: Advanced Billing Concepts (ABC) Codes
SV202-06 1339 Procedure Modifier O AN 2/2 Situational 1
Situational Rule: Required when a third modifier clarifies or improves the reporting accuracy of the associated procedure code. If not required by this implementation guide, do not send.
ExternalCodeList
Name: 130
Description: Health Care Financing Administration Common Procedural Coding System
ExternalCodeList
Name: 513
Description: Home Infusion EDI Coalition (HIEC) Product/Service Code List
ExternalCodeList
Name: 576
Description: Workers Compensation Specific Procedure and Supply Codes
ExternalCodeList
Name: 843
Description: Advanced Billing Concepts (ABC) Codes
SV202-07 352 Description O AN 1/80 Situational 1 Situational Rule: Required when, in the judgment of the submitter, the Procedure Code does not
definitively describe the service/product/supply and Loop ID-2410 is not used.
OR
Required when SV202-2 is a non-specific Procedure Code. Non-specific codes may include in their descriptors terms such as: Not Otherwise Classified (NOC); Unlisted; Unspecified; Unclassified; Other;
Miscellaneous; Prescription Drug, Generic; or Prescription Drug, Brand Name.
If not required by this implementation guide, do not send.
SV203 782 Monetary Amount O R 1/18 Required 1
This is the total charge amount for this service line. The amount is inclusive of the provider’s base charge and any applicable tax amounts reported within this line’s AMT segments.
Zero “0” is an acceptable value for this element.
The maximum length for this field is 8 digits excluding the decimal. When a decimal is used, the maximum number of digits allowed to the right of the decimal is three.
SV207 782 Monetary Amount O R 1/18 Situational 1
Situational Rule: Required if needed to report line specific noncovered charge amount. If not required this implementation guide, do not send.
TR3 Example:
SV2*0300*HC:80019*73.42*UN*1~
SV2*0120**1500*DA*5*300~
5010X837IA2.ecs 169 For internal use only