| Name | Description | Type | Additional information |
|---|---|---|---|
| MedicalProcedureID | CompositeMedicalProcedureIdentifier |
None. |
|
| ServiceLineAmount | decimal number |
None. |
|
| UnitOrBasisForMeasurementCode | UnitOrBasisForMeasurementCode |
None. |
|
| ServiceUnitCount | decimal number |
None. |
|
| DiagnosisCodePointer | CompositeDiagnosisCodePointer |
None. |
|
| EPSDTIndicator | YesNoConditionOrResponseCode |
None. |
|
| NursingHomeLevelOfCare | LevelOfCareCode |
None. |