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| | _Ref_ | Id | _________Element Name__________ | Req | Type | Min/Max | | |
| | QTY01 | 673 | Quantity Qualifier | M | ID | 2/2 | | |
| | | | Description: Code specifying the type of quantity |
| | | | | Code | Name_______________________________ |
| | | | | CA | Covered - Actual |
| | | | | | Description: Days covered on this service |
| | | | | CD | Co-insured - Actual |
| | | | | LA | Life-time Reserve - Actual |
| | | | | | Description: Medicare hospital insurance includes extra hospital days to be used if the patient has a long illness and is required to stay in the hospital over a specified number of days; this is the actual number of days in reserve |
| | | | | LE | Life-time Reserve - Estimated |
| | | | | | Description: Medicare hospital insurance includes extra hospital days to be used if the patient has a long illness and is required to stay in the hospital over a specified number of days; this is an estimate of the number of days in reserve |
| | | | | NA | Number of Non-covered Days |
| | | | | NE | Non-Covered - Estimated |
| | | | | NR | Not Replaced Blood Units |
| | | | | OU | Outlier Days |
| | | | | PS | Prescription |
| | | | | VS | Visits |
| | | | | ZK | Federal Medicare or Medicaid Payment Mandate - Category 1 |
| | | | | ZL | Federal Medicare or Medicaid Payment Mandate - Category 2 |
| | | | | ZM | Federal Medicare or Medicaid Payment Mandate - Category 3 |
| | | | | ZN | Federal Medicare or Medicaid Payment Mandate - Category 4 |
| | | | | ZO | Federal Medicare or Medicaid Payment Mandate - Category 5 |
| | QTY02 | 380 | Quantity | C | R | 1/15 | | |
| | | | Description: Numeric value of quantity |
