| Name | Description | Type | Additional information |
|---|---|---|---|
| Version | string |
Required String length: inclusive between 1 and 6 |
|
| ProviderId | string |
Required String length: inclusive between 36 and 36 |
|
| PatientId | string |
Required String length: inclusive between 36 and 36 |
|
| ServiceType | Collection of string |
Required |
|
| HCPCSCode | Collection of string |
Required |