| Name | Value |
|---|---|
| FORM FIELD REFERENCE | CMS-1500 |
| SECURITY LEVEL | NATIONAL,NO EDIT |
| DATA ELEMENT | N-CMS-1500 PURCH SVC TOTAL |
| PAD CHARACTER | NO PAD REQUIRED |
| FORMAT CODE | S IBXDATA=$S('IBXDATA:"",1:$$DOL^IBCEF77(IBXDATA,9)) I '$P($G(^DGCR(399,IBXIEN,"U2")),U,10) K IBXDATA |
| FORMAT CODE DESCRIPTION | Format the amount in 9 characters with 2 decimals. If there is not an Outside facility on the claim, then NO gets the "X" and the charges field will be blank. |