Sequence

Element

Name

Type

Requirement

Min

Max

Repeat

01

Yes/No Condition or Response Code

Identifier (ID)

Mandatory

1

1

1

Code indicating a Yes or No condition or response

CR401 is enteral or parenteral indicator. A "Y" value indicates enteral; an "N"
value indicates parenteral.

02

Certification Type Code

Identifier (ID)

Optional

1

1

1

Code indicating the type of certification

03

Unit or Basis for Measurement Code

Identifier (ID)

Conditional

2

2

1

Code specifying the units in which a value is being expressed, or manner in
which a measurement has been taken

P0304: If either CR4-03 or CR4-04 is present, then the other is required

04

Quantity

Decimal number (R)

Conditional

1

15

1

Numeric value of quantity

CR404 is the estimated duration of therapy.

05

Unit or Basis for Measurement Code

Identifier (ID)

Conditional

2

2

1

Code specifying the units in which a value is being expressed, or manner in
which a measurement has been taken

P0506: If either CR4-05 or CR4-06 is present, then the other is required

06

Quantity

Decimal number (R)

Conditional

1

15

1

Numeric value of quantity

CR406 is the time period covered by this certification.

07

Non-Visit Code

Identifier (ID)

Optional

1

1

1

Code indicating on what a medical evaluation is based, when not based on a
physician's visit

08

Unit or Basis for Measurement Code

Identifier (ID)

Conditional

2

2

1

Code specifying the units in which a value is being expressed, or manner in
which a measurement has been taken

P0809: If either CR4-08 or CR4-09 is present, then the other is required

09

Quantity

Decimal number (R)

Conditional

1

15

1

Numeric value of quantity

CR409 is the age of the patient.

10

Unit or Basis for Measurement Code

Identifier (ID)

Conditional

2

2

1

Code specifying the units in which a value is being expressed, or manner in
which a measurement has been taken

P1011: If either CR4-10 or CR4-11 is present, then the other is required

11

Height

Decimal number (R)

Conditional

1

8

1

Vertical dimension of an object measured when the object is in the upright
position

CR411 is the height of the patient.

12

Unit or Basis for Measurement Code

Identifier (ID)

Conditional

2

2

1

Code specifying the units in which a value is being expressed, or manner in
which a measurement has been taken

P1213: If either CR4-12 or CR4-13 is present, then the other is required

13

Weight

Decimal number (R)

Conditional

1

10

1

Numeric value of weight

CR413 is the weight of the patient.

14

Quantity

Decimal number (R)

Optional

1

15

1

Numeric value of quantity

CR414 is the number of times the patient is fed per week for parenteral claims
or the number of times the patient is fed per day for enteral claims.

15

Description

String (AN)

Optional

1

80

1

A free-form description to clarify the related data elements and their content

CR415 is the product name.

16

Nutrient Administration Method Code

Identifier (ID)

Optional

1

1

1

Code indicating the method used to administer nutrient to a patient

17

Nutrient Administration Technique Code

Identifier (ID)

Optional

1

1

1

Code indicating the technique used to administer nutrient to a patient

18

Quantity

Decimal number (R)

Optional

1

15

1

Numeric value of quantity

CR418 is the total number of calories per day of all nutrients prescribed.

19

Quantity

Decimal number (R)

Optional

1

15

1

Numeric value of quantity

CR419 is the total number of calories per day prescribed for this product.

20

Description

String (AN)

Optional

1

80

1

A free-form description to clarify the related data elements and their content

CR420 is the amino acid name.

21

Quantity

Decimal number (R)

Optional

1

15

1

Numeric value of quantity

CR421 is the number of milliliters of amino acid solution used in the
prescription per day.

22

Percentage as Decimal

Decimal number (R)

Optional

1

10

1

Percentage expressed as a decimal (e.g., 0.0 through 1.0 represents 0% through
100%)

CR422 is the percentage of concentration of amino acid used in the
prescription.

23

Quantity

Decimal number (R)

Optional

1

15

1

Numeric value of quantity

CR423 is the number of grams of amino acid used per day.

24

Quantity

Decimal number (R)

Optional

1

15

1

Numeric value of quantity

CR424 is the number of milliliters of dextrose solution used in the
prescription per day.

25

Percentage as Decimal

Decimal number (R)

Optional

1

10

1

Percentage expressed as a decimal (e.g., 0.0 through 1.0 represents 0% through
100%)

CR425 is the percentage of concentration of dextrose used in the prescription.

26

Quantity

Decimal number (R)

Optional

1

15

1

Numeric value of quantity

CR426 is the number of milliliters of lipids used in the prescription.

27

Percentage as Decimal

Decimal number (R)

Optional

1

10

1

Percentage expressed as a decimal (e.g., 0.0 through 1.0 represents 0% through
100%)

CR427 is the percentage of concentration of lipids used in the prescription.

28

Quantity

Decimal number (R)

Optional

1

15

1

Numeric value of quantity

CR428 is the number of times per week lipids are used in the prescription.

29

Description

String (AN)

Optional

1

80

1

A free-form description to clarify the related data elements and their content

CR429 is the special circumstances or medical justification.