Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
Code Category
Identifier (ID)
Mandatory
2
2
1
Code specifying the situation or category to which the code applies
02
Product/Service ID Qualifier
Identifier (ID)
Mandatory
2
2
1
Code identifying the type/source of the descriptive number used in
Product/Service ID (234)
03
Product/Service ID
String (AN)
Mandatory
1
80
1
Identifying number for a product or service
04
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
05
Quantity
Decimal number (R)
Optional
1
15
1
Numeric value of quantity
06
Percentage as Decimal
Decimal number (R)
Optional
1
10
1
Percentage expressed as a decimal (e.g., 0.0 through 1.0 represents 0% through
100%)