FIELD 24F - $Charges [lines 1–6]


“$Charges” is the total billed amount for each service line.
NUCC INSTRUCTIONS: Enter the charge amount for each listed service.
Enter the number right justified in the left-hand area of the field. Do not use commas when reporting dollar amounts. Negative dollar amounts are not allowed. Dollar signs should not be entered. Enter 00 in the right-hand area of the field if the amount is a whole number.
MEDICARE INSTRUCTIONS: Enter the charge for each listed service.
If a situation arises where two or more diagnoses are required for a procedure code (e.g., pap smears), the provider shall reference only one of the diagnoses in item 21.
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Field 20 - Outside Lab? $Charges
“Outside lab? $Charges” indicates that services have been rendered by an independent provider as indicated in Item Number 32 and the related costs. NUCC INSTRUCTIONS: Complete this field when billing for purchased services by entering an X in “YES.” ...
Field 24a - Date(s) of Service [lines 1–6]
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FIELD 28- Total Charge
The “Total Charge” is the total billed amount for all services entered in 24F (lines 1–6). NUCC INSTRUCTIONS: Enter total charges for the services (i.e., total of all charges in 24F). Enter the amount right justified in the dollar area of the field. ...
FIELD 24C - EMG [lines 1–6]
“EMG” identifies if the service was an emergency. NUCC INSTRUCTIONS: Check with payer to determine if this information (emergency indicator) is necessary. If required, enter Y for “YES” or leave blank if “NO” in the bottom, unshaded area of the ...
FIELD 24E - Diagnosis Pointer [lines 1–6]
The “Diagnosis Pointer” is the line letter from Item Number 21 that relates to the reason the service(s) was performed. NUCC INSTRUCTIONS: In 24E, enter the diagnosis code reference letter (pointer) as shown in Item Number 21 to relate the date of ...