CRC

EPSDT Referral

Pos: 220	Max: 1
Detail - Optional
Loop: 2300	Elements: 5

Ref

Id

Element Name

Req

Type

Min/Max

Usage

CRC01

1136

Code Category
Description: Specifies the situation or category to which the code applies

M

ID

2/2

Required

Code

Name

ZZ

Mutually Defined

EPSDT Screening referral information.

CRC02

1073

Yes/No Condition or Response Code
Description: Code indicating a Yes or No condition or response
Industry: Certification Condition Indicator
Alias: Certification Condition Code Applies Indicator
Was an EPSDT referral given to the patient?

M

ID

1/1

Required

Code

Name

N

No

If no, then choose “NU” in CRC03 indicating no referral given.

Y

Yes

CRC03

1321

Condition Indicator
Description: Code indicating a condition
Industry: Condition Code
Alias: Condition Indicator
The codes for CRC03 also can be used for CRC04 through CRC07.

M

ID

2/2

Required

Code

Name

AV

Available - Not Used

Patient refused referral.

NU

Not Used

This conditioner indicator must be used when the submitter answers “N” in CRC02.

S2

Under Treatment

Patient is currently under treatment for referred diagnostic or corrective health problem.

ST

New Services Requested

Referral to another provider for diagnostic or corrective treatment/scheduled for another appointment with screening provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service (not including dental referrals).

CRC04

1321

Condition Indicator
Description: Code indicating a condition
Industry: Condition Code
Use codes listed in CRC03.
Required if additional condition codes are needed.

O

ID

2/2

Situational

Code

Name

AV

Available - Not Used

Patient refused referral.

NU

Not Used

This conditioner indicator must be used when the submitter answers “N” in CRC02.

S2

Under Treatment

Patient is currently under treatment for referred diagnostic or corrective health problem.

ST

New Services Requested

Referral to another provider for diagnostic or corrective treatment/scheduled for another appointment with screening provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service (not including dental referrals).

CRC05

1321

Condition Indicator
Description: Code indicating a condition
Industry: Condition Code
Use codes listed in CRC03.
Required if additional condition codes are needed.

O

ID

2/2

Situational

Code

Name

AV

Available - Not Used

Patient refused referral.

NU

Not Used

This conditioner indicator must be used when the submitter answers “N” in CRC02.

S2

Under Treatment

Patient is currently under treatment for referred diagnostic or corrective health problem.

ST

New Services Requested

Referral to another provider for diagnostic or corrective treatment/scheduled for another appointment with screening provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service (not including dental referrals).

1.

CRC01 qualifies CRC03 through CRC07.

2.

CRC02 is a Certification Condition Code applies indicator. A "Y" value indicates the condition codes in CRC03 through CRC07 apply; an "N" value indicates the condition codes in CRC03 through CRC07 do not apply.

Notes:

1. Required on Early & Periodic Screening, Diagnosis, and Treatment (EPSDT) claims/encounters.

Example:

CRC*ZZ*Y*ST~