Condition Information - Institutional

The Condition Information section displays information related to the delivery of health care. This is required when condition information applies to the claim.

The Condition Information fields are defined below:

Was an EPSDT referral given?Was an EPSDT referral given?

Indicates whether an EPSDT referral was given to the patient. Options are Yes or No.

EPSDT Referral 1-3EPSDT Referral 1-3

An indicator of whether or not Early and Periodic Screening for Diagnosis and Treatment of children services are involved with this detail line. Select the code related to the condition from the drop-down menu. Options are:

AV	Available - Not Used. Patient Refused Referral.
NU	Not Used. This condition indicator must be used when the submitter answers N in Certification Condition Indicator field.
S2	Under Treatment. Patient is currently under treatment for referred diagnostic or corrective health problem.
ST	New Services. Patient is referred to another provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service (not including dental referrals). OR Patient is 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).

Service Authorization Exception CodeService Authorization Exception Code

Code identifying a service authorization exception. Used only in claims where providers are required by state law (e.g. New York State Medicaid) to obtain authorization for specific services, but for the reasons listed, performed the service without obtaining the service authorization. Check with your state Medicaid to see if this applies in your state. Allowable values for this field include:

1	Immediate/Urgent Care
2	Services Rendered in a Retroactive Period
3	Emergency Care
4	Client has Temporary Medicaid
5	Request from County for Second Opinion to Determine if Recipient Can Work
6	Request for Override Pending
7	Special Handling

Investigation Device Exempt NumberInvestigation Device Exempt Number

Exemption number permitting a facility to use a medical device for test purposes when that medical device has not yet been approved for general use.

Demonstration Project IDDemonstration Project ID
Peer Review Authorization NumberPeer Review Authorization Number

Identification number for a Medicare demonstration project.

An authorization number provided by a review organization after the review has been completed. Required when an external peer review organization assigns an approval number to services deemed medically necessary by that organization.