EDI
API DocsTerminal

SV1 Professional Service

To specify the claim service detail for a Health Care professional

Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
235
Product/Service ID Qualifier
Identifier (ID)
Mandatory
2
2
-
Code identifying the type/source of the descriptive number used in Product/Service ID (234).
Codes (275)
02
Product/Service ID
String (AN)
Mandatory
1
30
-
Identifying number for a product or service.
03
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
SV103 is submitted charge amount.
04
Unit or Basis for Measurement Code
Identifier (ID)
Conditional
2
2
-
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
P0405: If either SV1-04 or SV1-05 is present, then the other is required
Codes (682)
05
Quantity
Decimal number (R)
Conditional
1
15
-
Numeric value of quantity.
06
Facility Code
Identifier (ID)
Optional
1
2
-
Code identifying the type of facility where services were performed; the first position of the uniform bill type or place of service from health care financing administration claim form or place of treatment from the dental claim form
SV106 is place of service.
07
Service Type Code
Identifier (ID)
Optional
1
2
-
Code identifying the classification of service
Codes (21)
08
Diagnosis Code Pointer
Numeric (N0)
Optional
1
2
-
A pointer to the claim diagnosis code in the order of importance to this service
09
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
10
Diagnosis Code Pointer
Numeric (N0)
Optional
1
2
-
A pointer to the claim diagnosis code in the order of importance to this service
11
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
12
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
13
Description
String (AN)
Optional
1
80
-
A free-form description to clarify the related data elements and their content.
SV113 is procedure code description.
14
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
SV114 is independent lab charges.
15
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
-
Code indicating a Yes or No condition or response.
SV115 is emergency related indicator. A ``Y'' value indicates service provided was emergency related. An ``N'' value indicates service provided was not emergency related.
Codes (3)
16
Multiple Procedure Code
Identifier (ID)
Optional
1
2
-
Code indicating proper adjudication and payment determination in cases involving multiple surgical procedures during the same surgical session
Codes (3)
17
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
-
Code indicating a Yes or No condition or response.
SV117 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.
Codes (3)
18
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
-
Code indicating a Yes or No condition or response.
SV118 is family planning involvement. A ``Y'' value indicates family planning services involvement. An ``N'' value indicates no family planning services involvement.
Codes (3)
19
Review Code
Identifier (ID)
Optional
1
2
-
Code identifying extenuating circumstances or justifications which might assist any review of the medical necessity for this service
If SV119 is equal to ``L'' or ``N'', then SV120 is required.
Codes (5)
20
National or Local Assigned Review Value
String (AN)
Optional
1
2
-
Value assigned by national or local organizations for various healthcare data elements
21
Copay Status Code
Identifier (ID)
Optional
1
1
-
Code indicating whether or not co-payment requirements were met on a line by line basis
Codes (4)
22
Healthcare Manpower Shortage Area Code
Identifier (ID)
Optional
1
1
-
Code identifying a Healthcare Manpower Shortage Area (HMSA)
23
Reference Number
String (AN)
Optional
1
30
-
Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.
SV123 is Healthcare Manpower Shortage Area (HMSA) facility identification.
24
Postal Code
Identifier (ID)
Optional
3
9
-
Code defining international postal zone code excluding punctuation and blanks (zip code for United States).
SV124 is Healthcare Manpower Shortage Area (HMSA) zip code.
25
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
SV125 is non-covered charge amount.
26
Level of Care Code
Identifier (ID)
Optional
1
1
-
Code specifying the level of care provided by a nursing home facility
Codes (7)
27
Provider Agreement Code
Identifier (ID)
Optional
1
1
-
Code indicating the type of agreement under which the provider is submitting this claim
Codes (7)

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Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.