CR5 Oxygen Therapy Certification

Opt

AtMax 1

To supply information regarding certification of medical necessity for home oxygen therapy

Elements

Position	Element	Name		Type	Min/Max	Repeat

1	1322	Certification Type Code	Opt	ID	1/1	AtMax 1
2	380	Quantity	Opt	Decimal	1/15	AtMax 1
3	1348	Oxygen Equipment Type Code	Opt	ID	1/1	AtMax 1
4	1348	Oxygen Equipment Type Code	Opt	ID	1/1	AtMax 1
5	352	Description	Opt	Alphanumeric	1/80	AtMax 1
6	380	Quantity	Opt	Decimal	1/15	AtMax 1
7	380	Quantity	Opt	Decimal	1/15	AtMax 1
8	380	Quantity	Opt	Decimal	1/15	AtMax 1
9	352	Description	Opt	Alphanumeric	1/80	AtMax 1
10	380	Quantity	Opt	Decimal	1/15	AtMax 1
11	380	Quantity	Opt	Decimal	1/15	AtMax 1
12	1349	Oxygen Test Condition Code	Opt	ID	1/1	AtMax 1
13	1350	Oxygen Test Findings Code	Opt	ID	1/1	AtMax 1
14	1350	Oxygen Test Findings Code	Opt	ID	1/1	AtMax 1
15	1350	Oxygen Test Findings Code	Opt	ID	1/1	AtMax 1
16	380	Quantity	Opt	Decimal	1/15	AtMax 1
17	1382	Oxygen Delivery System Code	Opt	ID	1/1	AtMax 1
18	1348	Oxygen Equipment Type Code	Opt	ID	1/1	AtMax 1

Element Details

ID1322

NameCertification Type Code

LengthMin 1 / Max 1

Position1

RequirementOpt

Codes

<>A
Certification of Current Cost and Pricing Data
<>1
Appeal - Immediate
<>D
Final
<>4
Extension
<>B
Certification of Overhead
<>2
Appeal - Standard
<>R
Renewal
<>E
Recertification
<>5
Notification
<>C
Certification Not Required
<>3
Cancel
<>S
Revised
<>6
Verification
<>I
Initial