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- Line Number
- Billable: Green checkmark = Yes; Red X = No
- DOS From & To
- Facility
- Rendering
- POS: Place of Service
- CPT® Code
- Description: Procedure Description
- Modifiers: M1, M2, M3, M4
- Dx Codes: Diagnoses that are linked to the specific line item
- Units
- RVUs (if applicable)
- Allowed Fee: From your Allowed Fee Schedule(s).
- Charge: Fee Amount

Partially Submitted Claims
Partially submitted and excluded lines are color-coded with hover-over information.
- Included: Green check mark

- Excluded from the Claim: Red X

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