Parent File | Name | Number | Package |
---|---|---|---|
PROSTHETICS 1358(#664) | BILLING ITEM | 664.02 | Prosthetics |
Field # | Name | Loc | Type | Details |
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.01 | BILLING ITEM | 0;1 | POINTER TO PROS ITEM MASTER FILE (#661) | ************************REQUIRED FIELD************************ PROS ITEM MASTER(#661)
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1 | BRIEF DESCRIPTION | 0;2 | FREE TEXT | ************************REQUIRED FIELD************************
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2 | UNIT COST | 0;3 | NUMBER | ************************REQUIRED FIELD************************
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3 | QTY | 0;4 | NUMBER | ************************REQUIRED FIELD************************
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4 | UNIT OF ISSUE | 0;5 | POINTER TO UNIT OF ISSUE FILE (#420.5) | ************************REQUIRED FIELD************************ UNIT OF ISSUE(#420.5)
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5 | AMIS FLAG | 0;6 | SET |
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6 | ACT UNIT COST | 0;7 | NUMBER |
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7 | REMARKS | 0;8 | FREE TEXT |
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8 | TYPE OF TRANSACTION | 0;9 | SET | ************************REQUIRED FIELD************************
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9 | PATIENT CATEGORY | 0;10 | SET | ************************REQUIRED FIELD************************
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10 | SPECIAL CATEGORY | 0;11 | SET |
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11 | SOURCE | 0;12 | SET | ************************REQUIRED FIELD************************
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12 | APPLIANCE/REPAIR | 0;13 | POINTER TO RECORD OF PROS APPLIANCE/REPAIR FILE (#660) | RECORD OF PROS APPLIANCE/REPAIR(#660)
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13 | CONTRACT # | 0;14 | FREE TEXT |
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14 | EXTENDED DESCRIPTION | 1;0 | WORD-PROCESSING #664.214 |
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15 | SERIAL NUMBER | 0;15 | FREE TEXT |
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15.2 | MANUFACTURER | 2;1 | FREE TEXT |
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15.4 | MODEL | 2;2 | FREE TEXT |
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15.6 | LOT # | 2;3 | FREE TEXT |
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16 | PSAS HCPCS | 0;16 | POINTER TO PROSTHETIC HCPCS FILE (#661.1) | ************************REQUIRED FIELD************************ PROSTHETIC HCPCS(#661.1)
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16.1 | CPT MODIFIER | 4;2 | FREE TEXT |
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17 | VENDOR TRACKING NUMBER | 4;1 | FREE TEXT |
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18 | EXCLUDE/WAIVER | 2;4 | SET |
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19 | NUMBER OF BIDS | 0;17 | NUMBER |
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