Segment
X12 EDI Release 00303
To specify the claim service detail for prescription drugs
Elements
Code identifying the type/source of the descriptive number used in Product/Service ID (234).
Codes (275)- A1Plant Equipment Number
- A2Department of Defense Identification Code (DoDIC)
- A3Locally Assigned Control Number
- A4Subsistence Identification Number
- A6Document Identification Code
- A7Subline Item Number
- A8Exhibit Line Item Number
- A9Activity
- AAAssembly Level Code, Vehicle Maintenance Reporting Standards (VMRS) 2000 Code Key 32
- ABAssembly
- ACAggregation Code (Used to Consolidate Part Families)
- ADAmerican Dental Association Codes
- AIAlternate ISBN
- AMAllocation Methodology Identification Code
- ANAsset Number
- APComponent Level Code, Vehicle Maintenance Reporting Standards (VMRS) 2000 Code Key 33
- ARARINC Part Number
- ASRear Axle Serial Number
- ATAssortability Code
- AXAssembly Lot Number
- AYSystem Level Code, Vehicle Maintenance Reporting Standards (VMRS) 2000 Code Key 31
- AZAxle Ratio
- B1Volume Set
- B2Library of Congress Code
- B3Edition Code
- B4Binding Code
- B5Title Code
- B6Author Code
- B7Publisher Code
- BABale Number
- BCSupplier Brand Code
- BEBuyer's Engineering Change Level Number
- BLBrand/Label
- BMBeam Number
- BNBar-Coded Serial Number
- BOBuyers Color
- BPBuyer's Part Number
- BSBill Subgroup Code
- BTVolume Type Identification Code
- BUBus Body Serial Number
- BXBill Credit Code
- CACase
- CBBuyer's Catalog Number
- CCCompatible Cut Number
- CDMotor Vehicle-Line Designator
- CEClass of Contract Code
- CFChassis Serial Number
- CGCommodity Grouping
- CHCountry of Origin Code
- CICommon Language Equipment Identifier (CLEI)
- CJCurrent Procedural Terminology (CPT) Codes
- CLColor
- CMNational Retail Federation Color Code
- CNCommodity Name
- COChemical Abstract Service (CAS) Registry Number
- CPCarry-over Part Number
- CQEquipment Code per COPAS standard
- CRContract Number
- CSService code per COPAS standard
- CTContinuation (ID Number Spans Multiple Product ID Data Elements)
- CUCut Number
- CVCustomer Provided Equipment
- CYCustomer Company Registry Number
- DEDesign Number
- DGDiscount Grouping
- DIDeposit Item Number
- DLDye Lot Number
- DNDie Number
- DPDiscontinued Part Number
- DRDrawing Revision Number
- DXInternational Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) - Diagnosis
- DZDiagnosis Code Pointer
- ECEngineering Change Level
- EDEngine Displacement Identification
- EIExpense Identifier
- ELBuyer's Subline Item Number
- EMEquipment Identification Number
- ENGTIN-13
- EPBuyer's End Product Number
- EQEquipment Type
- ESEngine Serial Number
- EXExchanged Part, Assembly or Product
- F1Catalog Number
- F2Technical Order Number
- F3Technical Manual Number
- F4Series Identifier
- F5Obligation Authority Number
- F7End-Item Description
- F8Next Higher Used Assembly
- FAFailed Subassembly Serial Number
- FFFifth Wheel Serial Number
- FIFinish Number
- FLFinish Lot Number
- FMFailed Subassembly Model Number
- FNFinal Test Lot Number
- FPFabric Pieces Per Roll
- FSNational Stock Number
- FTFederal Supply Classification
- FWNew Microcode
- GCGrade Code
- GDGrain Direction
- GKGlider Kit
- GNGrade Name
- GRGear Ratio
- GSGeneral Specification Number
- GUVolume Usage Identification Code
- HCHealthcare Common Procedure Coding System (HCPCS) Codes
- HDInternational Harmonized Commodity Code
- HIHIBC (Health Care Industry Bar Code) Supplier Labeling Standard Primary Data Message
- HNHeat Number
- IAInformation Media Type
- IBInternational Standard Book Number (ISBN)
- ICInterior Color Number
- IDInternational Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) - Procedure
- IMImprint (Trademark Code of Subsidiary)
- INBuyer's Item Number
- ISInternational Standard Serial Number (ISSN)
- ITBuyer's Style Number
- IWInterchangeability Code
- IZBuyer's Size Code
- JNJob Number
- JPPackage Type Code
- JSJob Sequence Number
- KPKanban Plan Number
- LGLift Gate Serial Number
- LTLot Number
- LULot Pricing Unit Number
- MAMachine Number
- MBMeasurement Type Code
- MCMortgage Credit Data Order Type
- MDMethod of Delivery Code
- MFManufacturer
- MGManufacturer's Part Number
- MIMortgage Insurance Product Code or Number
- MMMotor Equipment Manufacturing Association (MEMA) Product Type Code
- MNModel Number
- MOMovement Type Code
- MSMilitary Specification (MILSPEC) Number
- MTMajor Product/Material/Machine Type
- N1National Drug Code in 4-4-2 Format
- N2National Drug Code in 5-3-2 Format
- N3National Drug Code in 5-4-1 Format
- N4National Drug Code in 5-4-2 Format
- NC
- NDNational Drug Code (NDC)
- NHNational Health Related Item Code
- NRNon-resaleable item (excluding deposit) number
- NWNew Replacement Part or Assembly Defective
- NZCombined NCCMA/Bank Service Code
- OA
- OB
- OC
- OD
- OEOriginal Equipment Number
- OFOld Common Language Equipment Identifier (CLEI) Code
- OGOld Microcode
- OHOpposite-Hand Part Number
- OIOptical Industry Product Code
- OLOptical Cable Code
- ONCustomer Order Number
- OOOutside Production Operation Sheet Number
- OPObsolete Part Number
- P1Petroleum Accountants Society of Canada Operating and Maintenance Code - Goods and Services Tax Not Applicable
- P2Petroleum Accountants Society of Canada Capital Expenditure Code - Goods and Services Tax Not Applicable
- P3Petroleum Accountants Society of Canada Tubular Code
- P4Petroleum Accountants Society of Canada Non-Tubular Code
- PAPattern Number
- PCPrime Contractor Part Number
- PDPart Number Description
- PEPieces in Roll
- PGPackaging Specification Number
- PHProperty and Casualty Service Code
- PIPurchaser's Item Code
- PJProduct Date Code (A code indicating the period during which a product was manufactured.)
- PKPackaging Drawing
- PLPurchaser's Order Line Number
- PMNumber of Positions on Machine
- PNCompany Part Number
- POPurchase Order Number
- PPAir Transportation Association Proprietary Rights Code
- PQProduct ID Attribute Code
- PRProcess Number
- PSPosition
- PTPrint or Drawing
- PUPart Reference Number
- PWPart Drawing
- PZProduct Change Notice Number
- R1Replacement Subassembly Model Number
- R2Replacement Subassembly Serial Number
- RAReturn Code
- RBNational Uniform Billing Committee (NUBC) UB82 Codes
- RCReturnable Container Number
- RDReel Number
- REReefer Serial Number
- RFRepair From Product Code
- RKRack Number
- RNRelease Number
- RORoll Number
- RPReplaced Part Number
- RRReplacement Product Number
- RSSet Number
- RTReel Type
- RURun Number
- RVRepair Tag Number
- RWRelative Value Units
- RYRecord Keeping or Model Year
- SASchematic Diagram Reference Number
- SBSubmission Number
- SCSeller's Date Code
- SDSupplier Company Registry Number
- SESection Print Number
- SFSurface Finish
- SHService Requested
- SIStandard Industrial Classification Code
- SKStock Keeping Unit (SKU)
- SLSeller's Lot Number
- SMNational Retail Federation Size Code
- SNSerial Number
- SPSuperseded Purchase Order Number
- SQRoll Sequence Number
- SRSubstitute Product Number
- SSSuperseded Part Number
- STStyle Number
- SUSide Up/Side Down
- SVService Rendered
- SWStock Number
- SZVendor Alphanumeric Size Code
- TAPipeline Transaction Code
- TCTelecommunications Circuit ID
- TITrade In Identifier
- TMTelephone Industry Manufacturer Code
- TNRailroad-Owned Unit Train Number
- TPProduct Type Code
- TRTruck Body Serial Number
- TSTransmission Serial Number
- TTType Selvage
- TUTested Material Identification Number
- TXFederal Aviation Administration (FAA) Service Bulletin Number
- TYTelecommunications Industry Service Code
- U2
- UA
- UB
- UCProduct Variant
- UD
- UE
- UFUser-Defined Shipping Container Identifier
- UG
- UH
- UI
- UKGTIN-14
- UMUniversal Vendor Marking, Short Code (UVM; U Line)
- UN
- UOEAN.UCC Serial Shipping Container Code (SSCC)
- UPGTIN-12
- UQUnited Nations (UN) Number (Dangerous Goods)
- USUniform Stock Symbol System Code Number
- UTCompany-Owned Unit Train Number
- UVUniversal Vendor Marking, Long Code (UVM; R,P,M Lines)
- VAVendor's Style Number
- VBVendor's Engineering Change Level Number
- VCVendor's (Seller's) Catalog Number
- VEVendor Color
- VIVary Item Product Number
- VMVehicle Maintenance Reporting Standards
- VNVendor's (Seller's) Item Number
- VOVendor's Order Number
- VPVendor's (Seller's) Part Number
- VSVendor's Supplemental Item Number
- VUVendor's Basic Unit Number
- VVMotor Vehicle ID Number
- VXVendor's Specification Number
- WLWafer Lot Identifier
- WSWheel Chair Lift Serial Number
- XCExpendable Container Identification
- ZZMutually Defined
Code indicating whether or not the prescriber's instructions regarding generic substitution were followed
Codes (8)- 0Not Dispense As Written (DAW)
- 1Physician Dispense As Written (DAW)
- 2Patient Dispense As Written (DAW)
- 3Pharmacy Dispense As Written (DAW)
- 4No generic available
- 5Brand Dispensed as Generic
- 6Override
- 9Other
Code specifying the level of service rendered
Codes (10)- LLimited Treatment
- 00Not specified
- 01Patient Consultation
- 02Home delivery
- 03Emergency
- 0424 Hour
- 05Patient Consultation Regarding Generic Product Selection
- 09Other
- F1Full Treatment - Phase One
- F2Full Treatment - Phase Two
Code indicating the method by which the ingredient cost was calculated
Codes (10)- 0Not specified
- 1Average Wholesale Price (AWP)
- 2Local Wholesaler
- 3Direct
- 4Estimated Acquisition Cost
- 5Acquisition Cost
- 6Maximum Allowable Cost (MAC)
- 7Usual, Customary, and Reasonable (UCR)
- 8Unit Dose
- 9Brand Medically Necessary
Code indicating the form in which the drug is dispensed
Codes (60)- 10Tablet
- 11Enteric Coated Tablet
- 12Sustained Release Tablet
- 13Buccal or Sublingual Tablet
- 14Chewable Tablet
- 15Soluble Tablet
- 16Tablet Unspecified
- 20Capsule
- 21Sustained Release Capsule
- 22Capsule Unspecified
- 23Tablet 21 Day Supply
- 24Tablet 28 Day Supply
- 30Lozenge or Troche
- 31Internal Powder
- 32Chewing Gum
- 33Granules
- 40Injection
- 41Sustained Release Injection
- 42Injectable Unspecified
- 50Ophthalmic
- 51Ophthalmic Liquid
- 52Ophthalmic or Otic
- 60Elixir
- 61Suspension
- 62Syrup
- 63Solution
- 64Emulsion
- 65Drops
- 66Pediatric Liquid
- 67Liquid
- 68Oral, Liquid and Sustained Release
- 70Rectal Suppository
- 71Vaginal Suppository
- 72Vaginal Tablet
- 73Vaginal Cream
- 74Vaginal Foam
- 75Urethral Suppository
- 76Enema
- 77Douche
- 80External Ointment
- 81External Cream
- 82Dental Product
- 83Aerosol Powder
- 84Aerosol Spray
- 85External Liquid
- 86External Powder
- 90Irrigant
- 91Gargle
- 92Throat Spray and Swabs
- 93Nasal
- 94Inhalant
- 95Otic
- 96Soap
- 97Stick
- 98Dressing or Bandage
- 99Miscellaneous Unspecified
- 01Combination Forms
- 02Test Kits
- 03Contraceptive Devices
- 04Devices
Code specifying the level of care provided by a nursing home facility
Codes (7)- 1Skilled Nursing Facility (SNF)
- 2Intermediate Care Facility (ICF)
- 3Intermediate Care Facility - Mentally Retarded (ICF-MR)
- 4Chronic Disease Hospital (CD)
- 5Intermediate Care Facility (ICF) Level II
- 6Special Skilled Nursing Facility (SNF)
- 7Nursing Facility (NF)
Code indicating the type of prior authorization or medical certification that has occurred
Codes (8)- 0Not Specified
- 1Prior Authorization
- 2Medical Certification
- 3Early & Periodic Screening, Diagnosis, and Treatment (EPSDT)
- 4Exempt from Copay
- 5Exempt From Prescription Limits
- 6Family Planning
- 7Aid to Families with Dependent Children (AFDC)
