DPS.1_Diagnosis_Code_-_MCPSequential Number: 1
Description: Diagnosis Code - MCP
Data Type: CWE
Item ID: 3472
Table: 0051
DPS.2_Procedure_CodeSequential Number: 2
Description: Procedure Code
Data Type: CWE
Item ID: 3484
Table: 0941
Sequential Number: 3
Description: Effective Date/Time
Data Type: DTM
Item ID: 662
Sequential Number: 4
Description: Expiration Date/Time
Data Type: DTM
Item ID: 3473
Sequential Number: 5
Description: Type of Limitation
Data Type: CNE
Item ID: 3474
Table: 0940
any