00558
Value Amount & Code (39-41)
2015-07-13
Definition: This field contains a monetary amount and an associated billing code. The pair in this field can repeat up to twelve times to represent/contain UB92 form locators 39a, 39b, 39c, 39d, 40a, 40b, 40c, 40d, 41a, 41b, 41c, and 41d. This field is defined by CMS or other regulatory agencies.
LengthNot specified
4 components
| 1 | R | Value Code | ||
| 2 | O | - | Value Amount | |
| 3 | O | - | Non-Monetary Value Amount / Quantity | |
| 4 | O | - | Non-Monetary Value Amount / Units |