| Element/Gruppe | No/Code | Beschreibung | Opt/Mand. |
|---|
| Gruppe | E206 | The identification of an object. | Mandatory |
| Gruppe | E021 | To identify a service and any modifications. | Optional |
| Element | 1229 | Code specifying the action to be taken or already taken. | Optional |
| Gruppe | E017 | Amount of goods or services stated as a monetary amount in a specified currency. | Optional |
| Element | 6060 | Alphanumeric representation of a quantity. | Optional |
| Gruppe | E030 | To identify the adjustment category, reason and related monetary amount. | Optional |
| Element | 9620 | Code specifying a policy limitation. | Optional |
| Element | 5389 | Code specifying the name of a product group. | Optional |
| Gruppe | E507 | Date and/or time, or period relevant to the specified date/time/period type. | Optional |
| Element | 9639 | Code specifying a diagnosis category. | Optional |
| Element | 5482 | To specify a percentage. | Optional |
