NUMBER FIELD NAME POSITION LENGTH FIELD TYPE
1 RECORD_ID 1 12 Alphanumeric
2 REVENUE_CODE 13 4 Alphanumeric
3 HCPCS_QUALIFIER 17 2 Alphanumeric
4 HCPCS_PROCEDURE_CODE 19 5 Alphanumeric
5 MODIFIER_1 24 2 Alphanumeric
6 MODIFIER_2 26 2 Alphanumeric
7 MODIFIER_3 28 2 Alphanumeric
8 MODIFIER_4 30 2 Alphanumeric
9 UNIT_MEASUREMENT_CODE 32 2 Alphanumeric
10 UNITS_OF_SERVICE 34 7 Numeric
11 UNIT_RATE 41 12 Numeric
12 CHRGS_LINE_ITEM 53 14 Numeric
13 CHRGS_NON_COV 67 14 Numeric