D12A

ALLOWANCE OR CHARGE

To identify allowance or charge details.

Segment structure

5463       ALLOWANCE OR CHARGE CODE QUALIFIER                 M   an1..3
C552       ALLOWANCE/CHARGE INFORMATION                       C
   1230    Allowance or charge identifier                     C   an1..35
   5189    Allowance or charge identification code            C   an1..3
4471       SETTLEMENT MEANS CODE                              C   an1..3
1227       CALCULATION SEQUENCE CODE                          C   an1..3
C214       SPECIAL SERVICES IDENTIFICATION                    C
   7161    Special service description code                   C   an1..3
   1131    Code list identification code                      C   an1..17
   3055    Code list responsible agency code                  C   an1..3
   7160    Special service description                        C   an1..35
   7160    Special service description                        C   an1..35