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Variable Definitions

Note

These definitions are scraped from ResDAC. Click on the header of a variable description to see the ResDAC page.

Carrier Claim Beneficiary Paid Amount

  • Short SAS Name: CLM_BENE_PD_AMT
  • Long SAS Name: CLM_BENE_PD_AMT

Contained in

The amount paid by the beneficiary for the non-institutional Part B (carrier, or DMERC) claim.

Values

Code
XXX.XX

Carrier Claim Cash Deductible Applied Amount*

  • Short SAS Name: DEDAPPLY
  • Long SAS Name: CARR_CLM_CASH_DDCTBL_APLD_AMT

Contained in

Effective with Version H, the amount of the cash deductible as submitted on the claim.

NOTE: Beginning with NCH weekly process date 10/3/97 this field was populated with data. Claims processed prior to 10/3/97 will contain zeroes in this field.

Carrier Claim Entry Code

  • Short SAS Name: ENTRY_CD
  • Long SAS Name: CARR_CLM_ENTRY_CD

Contained in

Carrier-generated code describing whether the Part B claim is an original debit, full credit, or replacement debit.

Carrier Claim HCPCS Year Code

  • Short SAS Name: HCPCS_YR
  • Long SAS Name: CARR_CLM_HCPCS_YR_CD

Variable Names

Dataset 2012 2011 2010 2009 2008
Carrier hcpcs_yr hcpcs_yr hcpcs_yr hcpcs_yr hcpcs_yr
Dataset 2007 2006 2005 2004 2003
Carrier hcpcs_yr hcpcs_yr hcpcs_yr hcpcs_yr hcpcs_yr
Dataset 2002 2001 2000 1999
Carrier hcpcs_yr hcpcs_yr hcpcs_yr hcpcs_yr

Contained in

Effective with Version H, the terminal digit of HCPCS version used to code the claim.

NOTE: Beginning with NCH weekly process date 10/3/97 this field was populated with data. Claims processed prior to 10/3/97 will contain zeroes in this field.

Carrier Claim Payment Denial Code

  • Short SAS Name: PMTDNLCD
  • Long SAS Name: CARR_CLM_PMT_DNL_CD

Variable Names

Dataset 2012 2011 2010 2009 2008
Carrier pmtdnlcd pmtdnlcd pmtdnlcd pmtdnlcd pmtdnlcd
Dataset 2007 2006 2005 2004 2003
Carrier pmtdnlcd pmtdnlcd pmtdnlcd pmtdnlcd pmtdnlcd
Dataset 2002 2001 2000
Carrier pmtdnlcd pmtdnlcd pmtdnlcd

Contained in

The code on a noninstitutional claim indicating to whom payment was made or if the claim was denied.

NOTE1: Effective with Version 'J', the field has been expanded on the NCH record to 2 bytes, With this expansion, the NCH will no longer use the character values to represent the official two byte values sent in by CWF since 4/2002. During the Version J conversion, all character values were converted to the two byte values.

NOTE2: Effective 4/1/02, this field was expanded to two bytes to accommodate new values. The NCH Nearline file did not expand the current 1-byte field but instituted a crosswalk of the 2-byte field to the 1-byte character value. See table of code for the crosswalk.

Values

Carrier Claim Payment Denial Table.txt

Carrier Claim Primary Payer Paid Amount*

  • Short SAS Name: PRPAYAMT
  • Long SAS Name: CARR_CLM_PRMRY_PYR_PD_AMT

Variable Names

Dataset 2013 2012 2011 2010 2009
Inpatient prpayamt prpayamt prpayamt prpayamt prpayamt
MedPAR prpayamt prpayamt prpayamt prpayamt prpayamt
Outpatient prpayamt prpayamt prpayamt prpayamt prpayamt
Dataset 2008 2007 2006 2005 2004
Inpatient prpayamt prpayamt prpayamt prpayamt prpayamt
MedPAR prpayamt prpayamt prpayamt prpayamt prpayamt
Outpatient prpayamt prpayamt prpayamt prpayamt prpayamt
Dataset 2003 2002 2001 2000 1999
Inpatient prpayamt prpayamt prpayamt prpayamt prpayamt
MedPAR prpayamt prpayamt mppamt mppamt mppamt
Outpatient prpayamt prpayamt prpayamt prpayamt prpayamt

Contained in

Effective with Version H, the amount of a payment made on behalf of a Medicare bene- ficiary by a primary payer other than Medicare, that the provider is applying to covered Medicare charges on a non-institutional claim.

NOTE: During the Version H conversion, this field was populated with data throughout history (back to service year 1991) by summing up the line item primary payer amounts.

Carrier Claim Provider Assignment Indicator Switch

  • Short SAS Name: ASGMNTCD
  • Long SAS Name: CARR_CLM_PRVDR_ASGNMT_IND_SW

Contained in

A switch indicating whether or not the provider accepts assignment for the noninstitutional claim.

Values

Code Code Value
A Assigned claim
N Non-assigned claim

Carrier Number

  • Short SAS Name: CARR_NUM
  • Long SAS Name: CARR_NUM

Contained in

The identification number assigned by CMS to a carrier authorized to process claims from a physician or supplier. Effective July 2006, the Medicare Administrative Contractors (MACs) began replacing the existing carriers and started processing physician or supplier claim records for states assigned to its jurisdiction.

NOTE: The 5-position MAC number will be housed in the existing CARR_NUM field. During the transi- tion from a carrier to a MAC the CARR_NUM field could contain either a Carrier number or a MAC number. See the CARR_NUM table of codes to identify the new MAC numbers and their effective dates.

Values

Carrier Number-MAC Table.txt

Claim Diagnosis Code I

  • Short SAS Name: ICD_DGNS_CD1
  • Long SAS Name: ICD_DGNS_CD1

Variable Names

Dataset 2013 2012 2011 2010 2009
Carrier icd_dgns_cd1 icd_dgns_cd1 icd_dgns_cd1 dgns_cd1
Inpatient icd_dgns_cd1 icd_dgns_cd1 icd_dgns_cd1 icd_dgns_cd1 dgnscd1
Outpatient icd_dgns_cd1 icd_dgns_cd1 icd_dgns_cd1 icd_dgns_cd1 dgnscd1
Dataset 2008 2007 2006 2005 2004
Carrier dgns_cd1 dgns_cd1 dgns_cd1 dgns_cd1 dgns_cd1
Inpatient dgnscd1 dgnscd1 dgnscd1 dgns_cd1 dgns_cd1
Outpatient dgnscd1 dgnscd1 dgnscd1 dgns_cd1 dgns_cd1
Dataset 2003 2002 2001 2000 1999
Carrier dgns_cd1 dgns_cd1 dgns_cd1 dgns_cd1 bdx1
Inpatient dgns_cd1 dgns_cd1 dgnscd1 dgnscd1 dgnscd1
Outpatient dgns_cd1 dgns_cd1 dgns_cd1 dgnscd1 dgnscd1

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code). NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10.

NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code I Diagnosis Version Code (ICD-9 or ICD-10)

  • Short SAS Name: ICD_DGNS_VRSN_CD1
  • Long SAS Name: ICD_DGNS_VRSN_CD1

Variable Names

Dataset 2013 2012 2011 2010
Carrier icd_dgns_vrsn_cd1 icd_dgns_vrsn_cd1
Inpatient icd_dgns_vrsn_cd1 icd_dgns_vrsn_cd1 icd_dgns_vrsn_cd1 icd_dgns_vrsn_cd1
Outpatient icd_dgns_vrsn_cd1 icd_dgns_vrsn_cd1 icd_dgns_vrsn_cd1 icd_dgns_vrsn_cd1

Contained in

Effective with Version 'J', the code used to indicate if the diagnosis code is ICD-9 or ICD-10.

NOTE: With 5010, the diagnosis and procedure codes have bee expanded to accommodate ICD-10, even though ICD-10 is not scheduled for implementation until 10/2013.

Values

Code Code Value
9 ICD-9
0 ICD-10

Claim Diagnosis Code II

  • Short SAS Name: ICD_DGNS_CD2
  • Long SAS Name: ICD_DGNS_CD2

Variable Names

Dataset 2013 2012 2011 2010 2009
Carrier icd_dgns_cd2 icd_dgns_cd2 icd_dgns_cd2 dgns_cd2
Inpatient icd_dgns_cd2 icd_dgns_cd2 icd_dgns_cd2 icd_dgns_cd2 dgnscd2
Outpatient icd_dgns_cd2 icd_dgns_cd2 icd_dgns_cd2 icd_dgns_cd2 dgnscd2
Dataset 2008 2007 2006 2005 2004
Carrier dgns_cd2 dgns_cd2 dgns_cd2 dgns_cd2 dgns_cd2
Inpatient dgnscd2 dgnscd2 dgnscd2 dgns_cd2 dgns_cd2
Outpatient dgnscd2 dgnscd2 dgnscd2 dgns_cd2 dgns_cd2
Dataset 2003 2002 2001 2000 1999
Carrier dgns_cd2 dgns_cd2 dgns_cd2 dgns_cd2 bdx2
Inpatient dgns_cd2 dgns_cd2 dgnscd2 dgnscd2 dgnscd2
Outpatient dgns_cd2 dgns_cd2 dgns_cd2 dgnscd2 dgnscd2

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code). NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10.

NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code II Diagnosis Version Code (ICD-9 or ICD-10)

  • Short SAS Name: ICD_DGNS_VRSN_CD2
  • Long SAS Name: ICD_DGNS_VRSN_CD2

Variable Names

Dataset 2013 2012 2011 2010
Carrier icd_dgns_vrsn_cd2 icd_dgns_vrsn_cd2
Inpatient icd_dgns_vrsn_cd2 icd_dgns_vrsn_cd2 icd_dgns_vrsn_cd2 icd_dgns_vrsn_cd2
Outpatient icd_dgns_vrsn_cd2 icd_dgns_vrsn_cd2 icd_dgns_vrsn_cd2 icd_dgns_vrsn_cd2

Contained in

Effective with Version 'J', the code used to indicate if the diagnosis code is ICD-9 or ICD-10.

NOTE: With 5010, the diagnosis and procedure codes have bee expanded to accommodate ICD-10, even though ICD-10 is not scheduled for implementation until 10/2013.

Values

Code Code Value
9 ICD-9
0 ICD-10

Claim Diagnosis Code III

  • Short SAS Name: ICD_DGNS_CD3
  • Long SAS Name: ICD_DGNS_CD3

Variable Names

Dataset 2013 2012 2011 2010 2009
Carrier icd_dgns_cd3 icd_dgns_cd3 icd_dgns_cd3 dgns_cd3
Inpatient icd_dgns_cd3 icd_dgns_cd3 icd_dgns_cd3 icd_dgns_cd3 dgnscd3
Outpatient icd_dgns_cd3 icd_dgns_cd3 icd_dgns_cd3 icd_dgns_cd3 dgnscd3
Dataset 2008 2007 2006 2005 2004
Carrier dgns_cd3 dgns_cd3 dgns_cd3 dgns_cd3 dgns_cd3
Inpatient dgnscd3 dgnscd3 dgnscd3 dgns_cd3 dgns_cd3
Outpatient dgnscd3 dgnscd3 dgnscd3 dgns_cd3 dgns_cd3
Dataset 2003 2002 2001 2000 1999
Carrier dgns_cd3 dgns_cd3 dgns_cd3 dgns_cd3 bdx3
Inpatient dgns_cd3 dgns_cd3 dgnscd3 dgnscd3 dgnscd3
Outpatient dgns_cd3 dgns_cd3 dgns_cd3 dgnscd3 dgnscd3

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code). NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10.

NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code III Diagnosis Version Code (ICD-9 or ICD-10)

  • Short SAS Name: ICD_DGNS_VRSN_CD3

Variable Names

Dataset 2013 2012 2011 2010
Carrier icd_dgns_vrsn_cd3 icd_dgns_vrsn_cd3
Inpatient icd_dgns_vrsn_cd3 icd_dgns_vrsn_cd3 icd_dgns_vrsn_cd3 icd_dgns_vrsn_cd3
Outpatient icd_dgns_vrsn_cd3 icd_dgns_vrsn_cd3 icd_dgns_vrsn_cd3 icd_dgns_vrsn_cd3

Contained in

Effective with Version 'J', the code used to indicate if the diagnosis code is ICD-9 or ICD-10.

NOTE: With 5010, the diagnosis and procedure codes have bee expanded to accommodate ICD-10, even though ICD-10 is not scheduled for implementation until 10/2013.

Values

Code Code Value
9 ICD-9
0 ICD-10

Claim Diagnosis Code IV

  • Short SAS Name: ICD_DGNS_CD4
  • Long SAS Name: ICD_DGNS_CD4

Variable Names

Dataset 2013 2012 2011 2010 2009
Carrier icd_dgns_cd4 icd_dgns_cd4 icd_dgns_cd4 dgns_cd4
Inpatient icd_dgns_cd4 icd_dgns_cd4 icd_dgns_cd4 icd_dgns_cd4 dgnscd4
Outpatient icd_dgns_cd4 icd_dgns_cd4 icd_dgns_cd4 icd_dgns_cd4 dgnscd4
Dataset 2008 2007 2006 2005 2004
Carrier dgns_cd4 dgns_cd4 dgns_cd4 dgns_cd4 dgns_cd4
Inpatient dgnscd4 dgnscd4 dgnscd4 dgns_cd4 dgns_cd4
Outpatient dgnscd4 dgnscd4 dgnscd4 dgns_cd4 dgns_cd4
Dataset 2003 2002 2001 2000 1999
Carrier dgns_cd4 dgns_cd4 dgns_cd4 dgns_cd4 bdx4
Inpatient dgns_cd4 dgns_cd4 dgnscd4 dgnscd4 dgnscd4
Outpatient dgns_cd4 dgns_cd4 dgns_cd4 dgnscd4 dgnscd4

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code). NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10.

NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code IV Diagnosis Version Code (ICD-9 or ICD-10)

  • Short SAS Name: ICD_DGNS_VRSN_CD4

Variable Names

Dataset 2013 2012 2011 2010
Carrier icd_dgns_vrsn_cd4 icd_dgns_vrsn_cd4
Inpatient icd_dgns_vrsn_cd4 icd_dgns_vrsn_cd4 icd_dgns_vrsn_cd4 icd_dgns_vrsn_cd4
Outpatient icd_dgns_vrsn_cd4 icd_dgns_vrsn_cd4 icd_dgns_vrsn_cd4 icd_dgns_vrsn_cd4

Contained in

Effective with Version 'J', the code used to indicate if the diagnosis code is ICD-9 or ICD-10.

NOTE: With 5010, the diagnosis and procedure codes have bee expanded to accommodate ICD-10, even though ICD-10 is not scheduled for implementation until 10/2013.

Values

Code Code Value
9 ICD-9
0 ICD-10

Claim Diagnosis Code IX

  • Short SAS Name: ICD_DGNS_CD9
  • Long SAS Name: ICD_DGNS_CD9

Variable Names

Dataset 2013 2012 2011 2010 2009
Carrier icd_dgns_cd9 icd_dgns_cd9 icd_dgns_cd9
Inpatient icd_dgns_cd9 icd_dgns_cd9 icd_dgns_cd9 icd_dgns_cd9 dgnscd9
Outpatient icd_dgns_cd9 icd_dgns_cd9 icd_dgns_cd9 icd_dgns_cd9 dgnscd9
Dataset 2008 2007 2006 2005 2004
Carrier
Inpatient dgnscd9 dgnscd9 dgnscd9 dgns_cd9 dgns_cd9
Outpatient dgnscd9 dgnscd9 dgnscd9 dgns_cd9 dgns_cd9
Dataset 2003 2002 2001 2000 1999
Carrier
Inpatient dgns_cd9 dgns_cd9 dgnscd9 dgnscd9 dgnscd9
Outpatient dgns_cd9 dgns_cd9 dgns_cd9 dgnscd9 dgnscd9

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10. NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code IX Diagnosis Version Code (ICD-9 or ICD-10)

  • Short SAS Name: ICD_DGNS_VRSN_CD9

Variable Names

Dataset 2013 2012 2011 2010
Carrier icd_dgns_vrsn_cd9 icd_dgns_vrsn_cd9
Inpatient icd_dgns_vrsn_cd9 icd_dgns_vrsn_cd9 icd_dgns_vrsn_cd9 icd_dgns_vrsn_cd9
Outpatient icd_dgns_vrsn_cd9 icd_dgns_vrsn_cd9 icd_dgns_vrsn_cd9 icd_dgns_vrsn_cd9

Contained in

Effective with Version 'J', the code used to indicate if the diagnosis code is ICD-9 or ICD-10.

NOTE: With 5010, the diagnosis and procedure codes have bee expanded to accommodate ICD-10, even though ICD-10 is not scheduled for implementation until 10/2013.

Values

Code Code Value
9 ICD-9
0 ICD-10

Claim Diagnosis Code V

  • Short SAS Name: ICD_DGNS_CD5
  • Long SAS Name: ICD_DGNS_CD5

Variable Names

Dataset 2013 2012 2011 2010 2009
Carrier icd_dgns_cd5 icd_dgns_cd5 icd_dgns_cd5 dgns_cd5
Inpatient icd_dgns_cd5 icd_dgns_cd5 icd_dgns_cd5 icd_dgns_cd5 dgnscd5
Outpatient icd_dgns_cd5 icd_dgns_cd5 icd_dgns_cd5 icd_dgns_cd5 dgnscd5
Dataset 2008 2007 2006 2005 2004
Carrier dgns_cd5 dgns_cd5 dgns_cd5
Inpatient dgnscd5 dgnscd5 dgnscd5 dgns_cd5 dgns_cd5
Outpatient dgnscd5 dgnscd5 dgnscd5 dgns_cd5 dgns_cd5
Dataset 2003 2002 2001 2000 1999
Carrier
Inpatient dgns_cd5 dgns_cd5 dgnscd5 dgnscd5 dgnscd5
Outpatient dgns_cd5 dgns_cd5 dgns_cd5 dgnscd5 dgnscd5

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10. NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code V Diagnosis Version Code (ICD-9 or ICD-10)

  • Short SAS Name: ICD_DGNS_VRSN_CD5

Variable Names

Dataset 2013 2012 2011 2010
Carrier icd_dgns_vrsn_cd5 icd_dgns_vrsn_cd5
Inpatient icd_dgns_vrsn_cd5 icd_dgns_vrsn_cd5 icd_dgns_vrsn_cd5 icd_dgns_vrsn_cd5
Outpatient icd_dgns_vrsn_cd5 icd_dgns_vrsn_cd5 icd_dgns_vrsn_cd5 icd_dgns_vrsn_cd5

Contained in

Effective with Version 'J', the code used to indicate if the diagnosis code is ICD-9 or ICD-10.

NOTE: With 5010, the diagnosis and procedure codes have bee expanded to accommodate ICD-10, even though ICD-10 is not scheduled for implementation until 10/2013.

Values

Code Code Value
9 ICD-9
0 ICD-10

Claim Diagnosis Code VI

  • Short SAS Name: ICD_DGNS_CD6
  • Long SAS Name: ICD_DGNS_CD6

Variable Names

Dataset 2013 2012 2011 2010 2009
Carrier icd_dgns_cd6 icd_dgns_cd6 icd_dgns_cd6 dgns_cd6
Inpatient icd_dgns_cd6 icd_dgns_cd6 icd_dgns_cd6 icd_dgns_cd6 dgnscd6
Outpatient icd_dgns_cd6 icd_dgns_cd6 icd_dgns_cd6 icd_dgns_cd6 dgnscd6
Dataset 2008 2007 2006 2005 2004
Carrier dgns_cd6 dgns_cd6 dgns_cd6
Inpatient dgnscd6 dgnscd6 dgnscd6 dgns_cd6 dgns_cd6
Outpatient dgnscd6 dgnscd6 dgnscd6 dgns_cd6 dgns_cd6
Dataset 2003 2002 2001 2000 1999
Carrier
Inpatient dgns_cd6 dgns_cd6 dgnscd6 dgnscd6 dgnscd6
Outpatient dgns_cd6 dgns_cd6 dgns_cd6 dgnscd6 dgnscd6

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10. NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code VI Diagnosis Version Code (ICD-9 or ICD-10)

  • Short SAS Name: ICD_DGNS_VRSN_CD6

Variable Names

Dataset 2013 2012 2011 2010
Carrier icd_dgns_vrsn_cd6 icd_dgns_vrsn_cd6
Inpatient icd_dgns_vrsn_cd6 icd_dgns_vrsn_cd6 icd_dgns_vrsn_cd6 icd_dgns_vrsn_cd6
Outpatient icd_dgns_vrsn_cd6 icd_dgns_vrsn_cd6 icd_dgns_vrsn_cd6 icd_dgns_vrsn_cd6

Contained in

Effective with Version 'J', the code used to indicate if the diagnosis code is ICD-9 or ICD-10.

NOTE: With 5010, the diagnosis and procedure codes have bee expanded to accommodate ICD-10, even though ICD-10 is not scheduled for implementation until 10/2013.

Values

Code Code Value
9 ICD-9
0 ICD-10

Claim Diagnosis Code VII

  • Short SAS Name: ICD_DGNS_CD7
  • Long SAS Name: ICD_DGNS_CD7

Variable Names

Dataset 2013 2012 2011 2010 2009
Carrier icd_dgns_cd7 icd_dgns_cd7 icd_dgns_cd7 dgns_cd7
Inpatient icd_dgns_cd7 icd_dgns_cd7 icd_dgns_cd7 icd_dgns_cd7 dgnscd7
Outpatient icd_dgns_cd7 icd_dgns_cd7 icd_dgns_cd7 icd_dgns_cd7 dgnscd7
Dataset 2008 2007 2006 2005 2004
Carrier dgns_cd7 dgns_cd7 dgns_cd7
Inpatient dgnscd7 dgnscd7 dgnscd7 dgns_cd7 dgns_cd7
Outpatient dgnscd7 dgnscd7 dgnscd7 dgns_cd7 dgns_cd7
Dataset 2003 2002 2001 2000 1999
Carrier
Inpatient dgns_cd7 dgns_cd7 dgnscd7 dgnscd7 dgnscd7
Outpatient dgns_cd7 dgns_cd7 dgns_cd7 dgnscd7 dgnscd7

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10. NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code VII Diagnosis Version Code (ICD-9 or ICD-10)

  • Short SAS Name: ICD_DGNS_VRSN_CD7

Variable Names

Dataset 2013 2012 2011 2010
Carrier icd_dgns_vrsn_cd7 icd_dgns_vrsn_cd7
Inpatient icd_dgns_vrsn_cd7 icd_dgns_vrsn_cd7 icd_dgns_vrsn_cd7 icd_dgns_vrsn_cd7
Outpatient icd_dgns_vrsn_cd7 icd_dgns_vrsn_cd7 icd_dgns_vrsn_cd7 icd_dgns_vrsn_cd7

Contained in

Effective with Version 'J', the code used to indicate if the diagnosis code is ICD-9 or ICD-10.

NOTE: With 5010, the diagnosis and procedure codes have bee expanded to accommodate ICD-10, even though ICD-10 is not scheduled for implementation until 10/2013.

Values

Code Code Value
9 ICD-9
0 ICD-10

Claim Diagnosis Code VIII

  • Short SAS Name: ICD_DGNS_CD8
  • Long SAS Name: ICD_DGNS_CD8

Variable Names

Dataset 2013 2012 2011 2010 2009
Carrier icd_dgns_cd8 icd_dgns_cd8 icd_dgns_cd8 dgns_cd8
Inpatient icd_dgns_cd8 icd_dgns_cd8 icd_dgns_cd8 icd_dgns_cd8 dgnscd8
Outpatient icd_dgns_cd8 icd_dgns_cd8 icd_dgns_cd8 icd_dgns_cd8 dgnscd8
Dataset 2008 2007 2006 2005 2004
Carrier dgns_cd8 dgns_cd8 dgns_cd8
Inpatient dgnscd8 dgnscd8 dgnscd8 dgns_cd8 dgns_cd8
Outpatient dgnscd8 dgnscd8 dgnscd8 dgns_cd8 dgns_cd8
Dataset 2003 2002 2001 2000 1999
Carrier
Inpatient dgns_cd8 dgns_cd8 dgnscd8 dgnscd8 dgnscd8
Outpatient dgns_cd8 dgns_cd8 dgns_cd8 dgnscd8 dgnscd8

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10. NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code VIII Diagnosis Version Code (ICD-9 or ICD-10)

  • Short SAS Name: ICD_DGNS_VRSN_CD8

Variable Names

Dataset 2013 2012 2011 2010
Carrier icd_dgns_vrsn_cd8 icd_dgns_vrsn_cd8
Inpatient icd_dgns_vrsn_cd8 icd_dgns_vrsn_cd8 icd_dgns_vrsn_cd8 icd_dgns_vrsn_cd8
Outpatient icd_dgns_vrsn_cd8 icd_dgns_vrsn_cd8 icd_dgns_vrsn_cd8 icd_dgns_vrsn_cd8

Contained in

Effective with Version 'J', the code used to indicate if the diagnosis code is ICD-9 or ICD-10.

NOTE: With 5010, the diagnosis and procedure codes have bee expanded to accommodate ICD-10, even though ICD-10 is not scheduled for implementation until 10/2013.

Values

Code Code Value
9 ICD-9
0 ICD-10

Claim Diagnosis Code X

  • Short SAS Name: ICD_DGNS_CD10
  • Long SAS Name: ICD_DGNS_CD10

Variable Names

Dataset 2013 2012 2011 2010 2009
Carrier icd_dgns_cd10 icd_dgns_cd10 icd_dgns_cd10
Inpatient icd_dgns_cd10 icd_dgns_cd10 icd_dgns_cd10 icd_dgns_cd10 dgnscd10
Outpatient icd_dgns_cd10 icd_dgns_cd10 icd_dgns_cd10 icd_dgns_cd10 dgnscd10
Dataset 2008 2007 2006 2005 2004
Carrier
Inpatient dgnscd10 dgnscd10 dgnscd10 dgns_cd10 dgns_cd10
Outpatient dgnscd10 dgnscd10 dgnscd10 dgns_cd10 dgns_cd10
Dataset 2003 2002 2001 2000 1999
Carrier
Inpatient dgns_cd10 dgns_cd10 dgnscd10 dgnscd10 dgnscd10
Outpatient dgns_cd10 dgns_cd10 dgns_cd10 dgnscd10 dgnscd10

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10. NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code X Diagnosis Version Code (ICD-9 or ICD-10)

  • Short SAS Name: ICD_DGNS_VRSN_CD10

Variable Names

Dataset 2013 2012 2011 2010
Carrier icd_dgns_vrsn_cd10 icd_dgns_vrsn_cd10
Inpatient icd_dgns_vrsn_cd10 icd_dgns_vrsn_cd10 icd_dgns_vrsn_cd10 icd_dgns_vrsn_cd10
Outpatient icd_dgns_vrsn_cd10 icd_dgns_vrsn_cd10 icd_dgns_vrsn_cd10 icd_dgns_vrsn_cd10

Contained in

Effective with Version 'J', the code used to indicate if the diagnosis code is ICD-9 or ICD-10.

NOTE: With 5010, the diagnosis and procedure codes have bee expanded to accommodate ICD-10, even though ICD-10 is not scheduled for implementation until 10/2013.

Values

Code Code Value
9 ICD-9
0 ICD-10

Claim Diagnosis Code XI

  • Short SAS Name: ICD_DGNS_CD11
  • Long SAS Name: ICD_DGNS_CD11

Variable Names

Dataset 2013 2012 2011 2010
Carrier icd_dgns_cd11 icd_dgns_cd11 icd_dgns_cd11
Inpatient icd_dgns_cd11 icd_dgns_cd11 icd_dgns_cd11 icd_dgns_cd11
Outpatient icd_dgns_cd11 icd_dgns_cd11 icd_dgns_cd11 icd_dgns_cd11

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10. NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code XI Diagnosis Version Code (ICD-9 or ICD-10)

  • Short SAS Name: ICD_DGNS_VRSN_CD11

Variable Names

Dataset 2013 2012 2011 2010
Carrier icd_dgns_vrsn_cd11 icd_dgns_vrsn_cd11
Inpatient icd_dgns_vrsn_cd11 icd_dgns_vrsn_cd11 icd_dgns_vrsn_cd11 icd_dgns_vrsn_cd11
Outpatient icd_dgns_vrsn_cd11 icd_dgns_vrsn_cd11 icd_dgns_vrsn_cd11 icd_dgns_vrsn_cd11

Contained in

Effective with Version 'J', the code used to indicate if the diagnosis code is ICD-9 or ICD-10.

NOTE: With 5010, the diagnosis and procedure codes have bee expanded to accommodate ICD-10, even though ICD-10 is not scheduled for implementation until 10/2013.

Values

Code Code Value
9 ICD-9
0 ICD-10

Claim Diagnosis Code XII

  • Short SAS Name: ICD_DGNS_CD12
  • Long SAS Name: ICD_DGNS_CD12

Variable Names

Dataset 2013 2012 2011 2010
Carrier icd_dgns_cd12 icd_dgns_cd12 icd_dgns_cd12
Inpatient icd_dgns_cd12 icd_dgns_cd12 icd_dgns_cd12 icd_dgns_cd12
Outpatient icd_dgns_cd12 icd_dgns_cd12 icd_dgns_cd12 icd_dgns_cd12

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10. NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code XII Diagnosis Version Code (ICD-9 or ICD-10)

  • Short SAS Name: ICD_DGNS_VRSN_CD12

Variable Names

Dataset 2013 2012 2011 2010
Carrier icd_dgns_vrsn_cd12 icd_dgns_vrsn_cd12
Inpatient icd_dgns_vrsn_cd12 icd_dgns_vrsn_cd12 icd_dgns_vrsn_cd12 icd_dgns_vrsn_cd12
Outpatient icd_dgns_vrsn_cd12 icd_dgns_vrsn_cd12 icd_dgns_vrsn_cd12 icd_dgns_vrsn_cd12

Contained in

Effective with Version 'J', the code used to indicate if the diagnosis code is ICD-9 or ICD-10.

NOTE: With 5010, the diagnosis and procedure codes have bee expanded to accommodate ICD-10, even though ICD-10 is not scheduled for implementation until 10/2013.

Values

Code Code Value
9 ICD-9
0 ICD-10

Claim Disposition Code

  • Short SAS Name: DISP_CD
  • Long SAS Name: CLM_DISP_CD

Contained in

Code indicating the disposition or outcome of the processing of the claim record.

Values

Code Code Value
1 Debit accepted
2 Debit accepted (automatic adjustment) applicable through 4/4/93
3 Cancel accepted
61 Conversion code used only during conversion period - 1/1/91 - 2/21/91: debit accepted
62 Conversion code used only during conversion period - 1/1/91 - 2/21/91: debit accepted (automatic adjustment)
63 Conversion code used only during conversion period - 1/1/91 - 2/21/91: cancel accepted

Claim From Date

  • Short SAS Name: FROM_DT
  • Long SAS Name: CLM_FROM_DT

Variable Names

Dataset 2013 2012 2011 2010 2009
Carrier from_dt from_dt from_dt from_dt
Inpatient from_dt from_dt from_dt from_dt from_dt
Outpatient from_dt from_dt from_dt from_dt from_dt
Dataset 2008 2007 2006 2005 2004
Carrier from_dt from_dt from_dt sfromdt sfromdt
Inpatient from_dt from_dt from_dt sfromdt sfromdt
Outpatient from_dt from_dt from_dt sfromdt sfromdt
Dataset 2003 2002 2001 2000 1999
Carrier sfromdt sfromdt from_dt from_dt bfromdt
Inpatient sfromdt sfromdt from_dt from_dt from_dt
Outpatient sfromdt sfromdt sfromdt from_dt from_dt

Contained in

The first day on the billing statement covering services rendered to the bene- ficiary (a.k.a. 'Statement Covers From Date').

NOTE: For Home Health PPS claims, the 'from' date and the 'thru' date on the RAP (initial claim) must always match.

Claim ID

  • Short SAS Name: CLM_ID
  • Long SAS Name: CLM_ID

Variable Names

Dataset 2013 2012 2011 2010 2009
Carrier clm_id clm_id clm_id clm_id
Inpatient clm_id clm_id clm_id clm_id clm_id
Outpatient clm_id clm_id clm_id clm_id clm_id
Dataset 2008 2007 2006 2005 2004
Carrier clm_id clm_id clm_id claimindex claimindex
Inpatient clm_id clm_id clm_id claimindex claimindex
Outpatient clm_id clm_id clm_id claimindex claimindex
Dataset 2003 2002 2001 2000 1999
Carrier claimindex claimindex carrcntl carrcntl bccn
Inpatient claimindex claimindex link_num link_num clm_cntl
Outpatient claimindex claimindex claimindex link_num link_num

Contained in

The Unique CCW indentifier for a base claim. Simple encryption applied for extracts. Non-encrypted if pulled directly from CCW Oracle.

Limitation

When pulled directly from CCW, this is a numeric column.

Claim Line Number

  • Short SAS Name: CLM_LN
  • Long SAS Name: CLM_LINE_NUM

Variable Names

Dataset 2013 2012 2011 2010 2009
Outpatient clm_ln clm_ln clm_ln clm_ln clm_ln
Dataset 2008 2007 2006 2005 2004
Outpatient clm_ln clm_ln clm_ln cntrindex cntrindex
Dataset 2003 2002 2001
Outpatient cntrindex cntrindex cntrindex

Contained in

The claim line number for detail revenue or part B line.

Claim Principal Diagnosis Code

  • Short SAS Name: PRNCPAL_DGNS_CD
  • Long SAS Name: PRNCPAL_DGNS_CD

Variable Names

Dataset 2012 2011 2010 2009 2008
Carrier prncpal_dgns_cd prncpal_dgns_cd prncpal_dgns_cd dgns_cd1 dgns_cd1
Dataset 2007 2006 2005 2004 2003
Carrier dgns_cd1 dgns_cd1 pdgns_cd pdgns_cd pdgns_cd
Dataset 2002 2001 2000 1999
Carrier pdgns_cd pdgns_cd pdgns_cd pdgns_cd

Contained in

The diagnosis code identifying the diagnosis, condition, problem or other reason for the admission/encounter/visit shown in the medical record to be chiefly responsible for the services provided.

NOTE: Effective with Version H, this data is also redundantly stored as the first occurrence of the diagnosis trailer.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10.

Claim Through Date

  • Short SAS Name: THRU_DT
  • Long SAS Name: CLM_THRU_DT

Variable Names

Dataset 2013 2012 2011 2010 2009
Carrier thru_dt thru_dt thru_dt thru_dt
Inpatient thru_dt thru_dt thru_dt thru_dt thru_dt
Inpatient thru_dt thru_dt thru_dt thru_dt thru_dt
Outpatient thru_dt thru_dt thru_dt thru_dt thru_dt
Dataset 2008 2007 2006 2005 2004
Carrier thru_dt thru_dt thru_dt sthrudt sthrudt
Inpatient thru_dt thru_dt thru_dt sthrudt sthrudt
Inpatient thru_dt thru_dt thru_dt srev_dt srev_dt
Outpatient thru_dt thru_dt thru_dt sthrudt sthrudt
Dataset 2003 2002 2001 2000 1999
Carrier sthrudt sthrudt thru_dt thru_dt bthrudt
Inpatient sthrudt sthrudt thru_dt thru_dt thru_dt
Inpatient srev_dt srev_dt rev_dt rev_dt rev_dt
Outpatient sthrudt sthrudt sthrudt thru_dt thru_dt

Contained in

The last day on the billing statement covering services rendered to the beneficiary (a.k.a 'Statement Covers Thru Date').

NOTE: For Home Health PPS claims, the 'from' date and the 'thru' date on the RAP (initial claim) must always match.

Clinical Trial Number

  • Short SAS Name: CCLTRNUM
  • Long SAS Name: CLM_CLNCL_TRIL_NUM

Contained in

Effective September 1, 2008 with the implementation of CR#3, the number used to identify all items and services provided to a beneficiary during their participation in a clinical trial.

NOTE: CMS is requesting the clinical trial number be voluntarily reported. The number is assigned by the National Library of Medicine (NLM) Clinical Trials Data Bank when a new study is registered.

County Code from Claim (SSA)

  • Short SAS Name: CNTY_CD
  • Long SAS Name: BENE_CNTY_CD

Variable Names

Dataset 2013 2012 2011 2010 2009
Carrier cnty_cd cnty_cd cnty_cd cnty_cd
Inpatient cnty_cd cnty_cd cnty_cd cnty_cd cnty_cd
MedPAR cnty_cd cnty_cd cnty_cd cnty_cd cnty_cd
Outpatient cnty_cd cnty_cd cnty_cd cnty_cd cnty_cd
Dataset 2008 2007 2006 2005 2004
Carrier cnty_cd cnty_cd cnty_cd county county
Inpatient cnty_cd cnty_cd cnty_cd county county
MedPAR cnty_cd cnty_cd cnty_cd county county
Outpatient cnty_cd cnty_cd cnty_cd county county
Dataset 2003 2002 2001 2000 1999
Carrier county county cnty_cd cnty_cd bcounty
Inpatient county county cnty_cd cnty_cd cnty_cd
MedPAR county county mcounty mcounty mcounty
Outpatient county county county cnty_cd cnty_cd

Contained in

The SSA standard county code of a beneficiary's residence.

DMERC Claim Ordering Physician NPI Number

  • Short SAS Name: RFR_NPI
  • Long SAS Name: RFR_PHYSN_NPI

Variable Names

Dataset 2012 2011 2010 2009 2008
Carrier rfr_npi rfr_npi rfr_npi rfr_npi rfr_npi
Dataset 2007 2006 2005 2004 2003
Carrier rfr_npi rfr_npi rfr_npi rfr_npi rfr_npi
Dataset 2002 2001 2000
Carrier rfr_npi rfr_npi rfr_npi

Contained in

A placeholder field (effective with Version H) for storing the NPI assigned to the physician ordering the Part B services/DMEPOS item.

DMERC Claim Ordering Physician UPIN Number

  • Short SAS Name: RFR_UPIN
  • Long SAS Name: RFR_PHYSN_UPIN

Variable Names

Dataset 2012 2011 2010 2009 2008
Carrier rfr_upin rfr_upin rfr_upin rfr_upin rfr_upin
Dataset 2007 2006 2005 2004 2003
Carrier rfr_upin rfr_upin rfr_upin rfr_upin rfr_upin
Dataset 2002 2001 2000 1999
Carrier rfr_upin rfr_upin rfr_upin brfrupin

Contained in

Effective with Version G, the unique physician identification number (UPIN) of the physician ordering the Part B services/DMEPOS item.

DMERC Line HCPCS Fourth Modifier Code

  • Short SAS Name: MDFR_CD4
  • Long SAS Name: HCPCS_4TH_MDFR_CD

Contained in

Prior to Version H this field was named: HCPCS_4TH_MDFR_CD.

DMERC Line HCPCS Third Modifier Code

  • Short SAS Name: MDFR_CD3
  • Long SAS Name: HCPCS_3RD_MDFR_CD

Contained in

Prior to Version H this field was named: HCPCS_3RD_MDFR_CD.

DMERC Line Item Supplier NPI Number

  • Short SAS Name: SUP_NPI
  • Long SAS Name: PRVDR_NPI

Contained in

The National Provider Identifier (NPI) assigned to the supplier of the Part B service/DMEPOS line item.

NOTE: Effective May 2007, the NPI will become the national standard identifier for covered health care providers. NPIs will replace the current legacy provider numbers (UPINs, PINs, OSCAR provider numbers, etc.) on the standard HIPPA claim transactions. (During the NPI transition phase (4/3/06 - 5/23/07) the capa- bility was there for the NCH to receive NPIs along with an existing legacy number (UPIN, NPIs OSCAR provider numbers, etc.).

NOTE1: CMS has determined that dual provider identifiers (legacy numbers and NPIs) must be available on the NCH. After the 5/07 NPI implementation, the standard system maintainers will add the legacy number to the claim when it is adjudicated. Effective May 2007, no NEW UPINs will be generated for NEW physicians (Part B and Outpatient claims) so there will only be NPIs sent in to the NCH for those phy- sicians.

DMERC Line Pricing State Code

  • Short SAS Name: PRCNG_ST
  • Long SAS Name: DMERC_LINE_PRCNG_STATE_CD

Contained in

Prior to Version H this field was named: CWFB_DME_PRCNG_STATE_CD.

Values

State Table.txt

DMERC Line Provider State Code

  • Short SAS Name: PRVSTATE
  • Long SAS Name: PRVDR_STATE_CD

Variable Names

Dataset 2012 2011 2010 2009 2008
Carrier prvstate prvstate prvstate prvstate prvstate
Dataset 2007 2006 2005 2004 2003
Carrier prvstate prvstate prvstate prvstate prvstate
Dataset 2002 2001 2000 1999
Carrier prvstate prvstate prvstate prvstate

Contained in

Effective with Version H, the two-digit numeric social security administration (SSA) state code where provider or facility is located.

NOTE: During the Version H conversion this field was populated with data throughout history (back to service year 1991).

Values

State Table.txt

DMERC Line Screen Savings Amount

  • Short SAS Name: SCRNSVGS
  • Long SAS Name: DMERC_LINE_SCRN_SVGS_AMT

Contained in

Prior to Version H this field was named: CWFB_DME_SCRN_SVGS_AMT and the field size was S9(5)V99.

Values

Code
XXX.XX

DMERC Line Supplier Provider Number

  • Short SAS Name: SUPLRNUM
  • Long SAS Name: PRVDR_NUM

Contained in

Effective with Version 'G', billing number assigned to the supplier of the Part B service/DMEPOS by the National Supplier Clearinghouse, as reported on the line item for the DMERC claim.

Different types of identifiers may be used.Refer to the variable called DMERC_LINE_SUPPLR_TYPE_CD to determine the type used for each line.

DMERC Line Supplier Type Code

  • Short SAS Name: SUP_TYPE
  • Long SAS Name: DMERC_LINE_SUPPLR_TYPE_CD

Contained in

Prior to Version H this field on the DMERC claim was named: CWFB_PRVDR_TYPE_CD.

Values

Code Code Value
0 Clinics, groups, associations, partnerships, or other entities for whom the carrier's own ID number has been assigned.
1 Physicians or suppliers billing as solo practitioners for who SSN's are shown in the physician ID code field.
2 Physicians or suppliers billing as solo practitioners for who the carrier's own physician ID code is shown.
3 Suppliers (other than sole proprietorship) or whom employer identification (EI) numbers are used in coding the ID field.
4 Suppliers (other than sole proprietorship) for who the carrier's own code has been shown.
5 Institutional providers and independent laboratories for whom employer identification (EI) numbers are used in coding the ID field.
6 Institutional providers and independent laboratories for whom the carrier's own ID number is shown.
7 Clinics, groups, associations, or partnerships for whom employer identification (EI) numbers are used in coding the ID field.
8 Other entities for whom employer identification (EI) numbers are used in coding the ID field or proprietorship for whom EI numbers are used in coding the ID field.

Date of Birth from Claim (Date)

  • Short SAS Name: DOB_DT
  • Long SAS Name: DOB_DT

Contained in

The beneficiary's date of birth.

Demo information text

  • Short SAS Name: DEMO_INFO_TXT
  • Long SAS Name: DEMO_INFO_TXT

Contained in

This is a text field that contains information related to the demonstration.For example, a claim involving a CHOICES demo id 05 would contain the MCO plan contract number in the first five positions of this text field.

When the Demo ID = 01 (RUGS) -- the text field will contain a 2, 3 or 4 to denote the RUGS phase. If RUGS phase is blank or not one of the above the text field will reflect 'INVALID'. NOTE: In Version 'G', RUGS phase was stored in redefined Claim Edit Group, 3rd occurrence, 4th position. Demo ID = 02 (Home Health demo) -- the text field will contain PROV#. When demo number not equal to 02 then text will reflect 'INVALID'. Demo ID = 03 (Telemedicine demo) -- text field will contain the HCPCS code. If the required HCPCS is not shown then the text field will reflect 'INVALID'. Demo ID = 04 (UMWA) -- text field will contain W0 denoting that condition code W0 was present. If condition code W0 not present then the text field will reflect 'INVALID'. Demo ID = 05 (CHOICES) -- the text field will contain the CHOICES plan number, if both of the following conditions are met: (1) CHOICES plan number present and PPS or Inpatient claim shows that 1st 3 positions of provider number as 210 and the admission date is within HMO effective/termination date; or non-PPS claim and the from date is within HMO effective/termination date and (2) CHOICES plan number matches the HMO plan number. If either condition is not met the text field will reflect 'INVALID CHOICES PLAN NUMBER'. When CHOICES plan number not present, text will reflect 'INVALID'. Demo ID = 15 (ESRD Managed Care) -- text field will contain the ESRD/MCO plan number. If ESRD/MCO plan number not present the field will reflect 'INVALID'. Demo ID = 38 (Physician Encounter Claims) -- text field will contain the MCO plan number. When MCO plan number not present the field will reflect 'INVALID'.

Demonstration number

  • Short SAS Name: DEMO_ID_NUM
  • Long SAS Name: DEMO_ID_NUM

Contained in

The number assigned to identify a CMS demonstration project.This field is also used to denote special processing (a.k.a. Special Processing Number, SPN).

Values

Code Code Value
1 Nursing Home Case-Mix and Quality: NHCMQ (RUGS) Demo – testing PPS for SNFs in 6 states, using a case-mix classification system based on resident characteristics and actual resources used. The claims carry a RUGS indicator and one or more revenue center codes in the 9,000 series.
2 National HHA Prospective Payment Demo -- testing PPS for HHAs in 5 states, using two alternate methods of paying HHAs: per visit by type of HHA visit and per episode of HH care.
3 Telemedicine Demo -- testing covering traditionally non-covered physician services for medical consultation furnished via two-way, interactive video systems (i.e. teleconsultation)in 4 states. The claims contain line items with 'QQ' HCPCS code.
4 United Mine Workers of America (UMWA) Managed Care Demo -- testing risk sharing for Part A services, paying special capitation rates for all UMWA beneficiaries residing in 13 designated counties in 3 states. Under the demo, UMWA will waive the 3-day qualifying hospital stay for a SNF admission. The claims contain TOB '18X','21X','28X' and '51X'; condition code = W0; claim MCO paid switch = not '0'; and MCO contract # = '90091'.
5 Medicare Choices (MCO encounter data) demo --testing expanding the type of Managed Care plans available and different payment methods at 16 MCOs in 9 states. The claims contain one of the specific MCO Plan Contract # assigned to the Choices Demo site. NOTE - this demonstration was terminated 12/31/2000.
6 Coronary Artery Bypass Graft (CABG) Demo --testing bundled payment (all-inclusive global pricing) for hospital + physician services related to CABG surgery in 7 hospitals in 7 states. The inpatient claims contain a DRG '106' or '107'. NOTE - this demonstration was terminated in 1998.
7 Virginia Cardiac Surgery Initiative (VCSI) (formerly referred to as Medicare Quality Partnerships Demo) -- this is a voluntary consortium of the cardiac surgery Medicare FFS Claims (Version K) Codebook 166 May 2017 physician groups and the non-Veterans Administration hospitals providing open heart surgical services in the Commonwealth of Virginia. The goal of the demo is to share data on quality and process innovations in an attempt to improve the care for all cardiac patients. The demonstration only affects those FIs that process claims from hospitals in Virginia and the carriers that process claims from physicians providing inpatient services at those hospitals. The hospitals will be reimbursed on a global payment basis for selected cardiac surgical diagnosis related groups (DRGs). The inpatient claims will contain a DRG '104', '105', '106', '107', '109'; the related physician/supplier claims will contain the claim payment denial reason code = 'D'. NOTE - The implementation date for this demonstration is 4/1/03.
8 Provider Partnership Demo -- testing per-case payment approaches for acute inpatient hospitalizations, making a lump-sum payment (combining the normal Part A PPS payment with the Part B allowed charges into a single fee schedule) to a Physician/Hospital Organization for all Part A and Part B services associated with a hospital admission. From 3 to 6 hospitals in the Northeast and Mid-Atlantic regions may participate in the demo.
15 ESRD Managed Care (MCO encounter data) -- testing open enrollment of ESRD beneficiaries and capitation rates adjusted for patient treatment needs at 3 MCOs in 3 States. The claims contain one of the specific MCO Plan Contract # assigned to the ESRD demo site.
30 Lung Volume Reduction Surgery (LVRS) or National Emphysema Treatment Trial (NETT) Clinical Study -- evaluating the effectiveness of LVRS and maximum medical therapy (including pulmonary rehab) for Medicare beneficiaries in last stages of emphysema at 18 hospitals nationally, in collaboration with NIH.
31 VA Pricing Special Processing (SPN) -- not really a demo but special request from VA due to court settlement; not Medicare services but VA inpatient and physician services submitted to FI 00400 and Carrier 00900 to obtain Medicare pricing -- NCH WILL PROCESS VA CLAIMS ANNOTATED WITH DEMO ID '31', BUT WILL NOT TRANSMIT TO HCFA (CMS) (not in Nearline File).
37 Medicare Coordinated Care Demonstration -- to test whether coordinated care services furnished to certain beneficiaries improves outcome of care and reduces Medicare expenditures under Part A and Part B. There will be at least 14 Coordinated Care Entities (CCEs). The selected entities will be assigned a provider number specifically for the demonstration services.
37 Medicare Disease Management (DMD) -- the purpose of this demonstration is to study the impact on costs and health outcomes of applying disease management services supplemented with coverage for prescription drugs for certain Medicare diagnosed, beneficiaries with advanced-stage congestive heart failure, diabetes, or coronary heart disease. Three demonstration sites will be used for this demonstration and it will last for 3 years. (Effective 4/1/2003).
38 Physician Encounter Claims - the purpose of this demo id is to identify the physician encounter claims being processed at the HCFA Data Center (HDC). This number will help EDS in making the claim go through the appropriate processing logic, which differs from that for fee-for-service. NOT IN NCH. NOTE - Effective October, 2000. Demo ids will not be assigned to Inpatient and Outpatient encounter claims.
39 Centralized Billing of Flu and PPV Claims -- The purpose of this demo is to facilitate the processing carrier, Trailblazers, paying flu and PPV claims based on payment localities. Providers will be giving the shots throughout the country and transmitting the claims to Trailblazers for processing. NOTE - Effective October, 2000 for carrier claims.
40 Payment of Physician and Non-physician Services in certain Indian Providers -- the purpose of this demo is to extend payment for services of physician and non-physician practitioners furnished in hospitals and ambulatory care clinics. Prior to the legislation change in BIPA, reimbursement for Medicare services provided in IHS facilities was limited to services provided in hospitals and skilled nursing facilities. This change will allow payment for IHS, Tribe and Tribal Organization providers under the Medicare physician fee schedule. NOTE - Effective July 1, 2001 for institutional and carrier claims.
48 Medical Adult Day-Care Services -- the purpose of this demonstration is to provide, as part of the episode of care for home health services, medical adult day care services to Medicare beneficiaries as a substitute for a portion of home health services that would otherwise be provided in the beneficiaries home. This demo would last approx. 3 years in not more than 5 sites. Payment for each home health service episode of care will be set at 95% of the amount that would otherwise be paid for home health services provided entirely in the home. NOTE - Effective July 5, 2005 for HHA claims.
49 Hemodialysis
53 Extended Stay
54 ACE Demo
58 used to identify the Multi-payer Advanced Primary Care Practice (MAPCP) demonstration. (eff. 7/2/12)
59 ACO Pioneer Demonstration (eff. 1/2014)
61 CLM-CARE-IMPRVMT-MODEL-1
62 CLM-CARE-IMPRVMT-MODEL-2
63 CLM-CARE-IMPRVMT-MODEL-3
64 CLM-CARE-IMPRVMT-MODEL-4
65 rebilled claims due to auditor denials -- code being implemented for a demonstration to determine the efficiency of allowing providers to rebill for all outpatient services, minus a penalty, when an inpatient claim is denied in full because of medical review because the beneficiary did not require inpatient services. (eff. 7/2/12)
66 rebilled claims due to provider self-audit after claim submission/payment -- code being implemented for a demonstration to determine the efficiency of allowing providers to rebill for all outpatient services, minus a penalty, when an inpatient claim is denied in full because of medical review because the beneficiary did not require inpatient services. (eff. 7/2/12)
67 rebilled claims due to provider self-audit after the patient has been discharged, but prior to payment -- code being implemented for a demonstration to determine the efficiency of allowing providers to rebill for all outpatient services, minus a penalty, when an inpatient claim is denied in full because of medical review because the beneficiary did not require inpatient services. (eff. 7/2/12)
68 NCH will not apply the 3-day hospital stay requirement when processing a SNF claim. (eff. 1/2014)
70 used for Electrical Workers Insurance Fund claims. (eff. 7/2/12)
74 unknown value
77 Shared Savings Program (eff. 10/2016)
78 Comprehensive Primary Care Plus (CPC+) (eff. 4/2017)

Demonstration sequence number

  • Short SAS Name: DEMO_ID_SQNC_NUM
  • Long SAS Name: DEMO_ID_SQNC_NUM

Contained in

The number of demonstration identification trailers present on the claim.

The demonstration sequence number is a sequential line number to distinguish distinct demonstration projects that affect the same claim.

Encrypted CCW Beneficiary ID

  • Short SAS Name: BENE_ID
  • Long SAS Name: BENE_ID

Variable Names

Dataset 2013 2012 2011 2010 2009
Carrier bene_id bene_id bene_id bene_id
Inpatient bene_id bene_id bene_id bene_id bene_id
MedPAR bene_id bene_id bene_id bene_id bene_id
Outpatient bene_id bene_id bene_id bene_id bene_id
Dataset 2008 2007 2006
Carrier bene_id bene_id bene_id
Inpatient bene_id bene_id bene_id
MedPAR bene_id bene_id bene_id
Outpatient bene_id bene_id bene_id

Contained in

The unique CCW indentifier for a beneficiary. The CCW assigns a unique beneficiary identification number to each individual who receives Medicare and/or Medicaid, and uses that number to identify an individual’s records in all CCW data files (e.g., Medicare claims, MAX claims, MDS assessment data). This number does not change during a beneficiary’s lifetime and each number is used only once. The BENE_ID is specific to the CCW and is not applicable to any other identification system or data source.

Gender Code from Claim

  • Short SAS Name: GNDR_CD
  • Long SAS Name: GNDR_CD

Contained in

The sex of a beneficiary.

Values

Code Code Value
1 Male
2 Female
0 Unknown

Health Care Common Procedure Coding System

  • Short SAS Name: HCPCS_CD
  • Long SAS Name: HCPCS_CD

Variable Names

Dataset 2013 2012 2011 2010 2009
Carrier hcpcs_cd hcpcs_cd hcpcs_cd hcpcs_cd
Inpatient hcpcs_cd hcpcs_cd hcpcs_cd hcpcs_cd hcpcs_cd
Outpatient hcpcs_cd hcpcs_cd hcpcs_cd hcpcs_cd hcpcs_cd
Dataset 2008 2007 2006 2005 2004
Carrier hcpcs_cd hcpcs_cd hcpcs_cd hcpcs_cd hcpcs_cd
Inpatient hcpcs_cd hcpcs_cd hcpcs_cd hcpcs_cd hcpcs_cd
Outpatient hcpcs_cd hcpcs_cd hcpcs_cd hcpcs_cd hcpcs_cd
Dataset 2003 2002 2001 2000 1999
Carrier hcpcs_cd hcpcs_cd hcpcs_cd hcpcs_cd bhcpcs
Inpatient hcpcs_cd hcpcs_cd hcpscd hcpscd hcpscd
Outpatient hcpcs_cd hcpcs_cd hcpcs_cd hcpscd hcpscd

Contained in

The Health Care Common Procedure Coding System (HCPCS) is a collection of codes that represent procedures, supplies, products and services which may be provided to Medicare beneficiaries and to individuals enrolled in private health insurance programs. The codes are divided into three levels, or groups as described below.

In the Institutional Claim Revenue Center Files, this variable can indicate the specific case-mix grouping that Medicare used to pay for skilled nursing facility (SNF), home health, or inpatient rehabilitation facility (IRF) services (see Note 2 below).

Level I

Codes and descriptors copyrighted by the American Medical Association's Current Procedural Terminology, Fourth Edition (CPT-4). These are 5-position numeric codes representing physician and non-physician services.

** Note 1: ** CPT-4 codes including both long and short descriptions shall be used in accordance with the CMS/AMA agreement. Any other use violates the AMA copyright.

Level II

Includes codes and descriptors copyrighted by the American Dental Association's Current Dental Terminology, Fifth Edition (CDT-5). These are 5-position alpha-numeric codes comprising the D series. All other level II codes and descriptors are approved and maintained jointly by the alpha- numeric editorial panel (consisting of CMS, the Health Insurance Association of America, and the Blue Cross and Blue Shield Association). These are 5-position alpha-numeric codes representing primarily items and non-physician services that are not represented in the level I codes.

Level III

Codes and descriptors developed by Medicare carriers (currently known as Medicare Administrative Contractors; MACs) for use at the local (MAC) level. These are 5-position alpha-numeric codes in the W, X, Y or Z series representing physician and non-physician services that are not represented in the level I or level II codes.

** Note 2: **

This field may contain information regarding case-mix grouping that Medicare used to pay for SNF, home health, or IRF services. These groupings are sometimes known as Health Insurance Prospective Payment System (HIPPS) codes. This field will contain a HIPPS code if the revenue center code (REV_CNTR) equals 0022 for SNF care, 0023 for home health, or 0024 for IRF care. For home health claims, please also see the revenue center APC/HIPPS code variable (`REV_CNTR_APC_HIPPS_CD`).

Hematocrit/Hemoglobin Test Results

  • Short SAS Name: HCTHGBRS
  • Long SAS Name: LINE_HCT_HGB_RSLT_NUM

Contained in

Effective September 1, 2008, with the implementation of CR#3, the number used to identify the most recent hematocrit or hemoglobin reading on the noninstitutional claim.

NOTE: The hematocrit/hemoglobin test result field is a redefined field. The field is being defined as X(3) and redefined as numeric (99V9). A numeric test on the alphanumeric field is needed. Whenever a user wants to use the field they must test the alphanumeric field for numerics and if it is numeric then the 99V9 definition would be used. The older data will cause an abend if trying to process numeric data with characters.

Hematocrit/Hemoglobin Test Type Code

  • Short SAS Name: HCTHGBTP
  • Long SAS Name: LINE_HCT_HGB_TYPE_CD

Contained in

Effective September 1, 2008 with the implementation of CR#3, the code used to identify which reading is reflected in the hematocrit/hemoglobin result number field on the noninstitutional claim.

Values

Code Code Value
R1 Hemoglobin Test
R2 Hematocrit Test

Line Allowed Charge Amount

  • Short SAS Name: LALOWCHG
  • Long SAS Name: LINE_ALOWD_CHRG_AMT

Variable Names

Dataset 2012 2011 2010 2009 2008
Carrier lalowchg lalowchg lalowchg lalowchg lalowchg
Dataset 2007 2006 2005 2004 2003
Carrier lalowchg lalowchg lalowchg lalowchg lalowchg
Dataset 2002 2001 2000 1999
Carrier lalowchg lalowchg lalowchg ballow

Contained in

The amount of allowed charges for the line item service on the noninstitutional claim. This charge is used to compute pay to providers or reimbursement to beneficiaries. **NOTE: The

Note1: The amount includes beneficiary-paid amounts (i.e., deductible and coinsurance).

Note2: The allowed charge is determined by the lower of three charges: prevailing, customary or actual.

Line Beneficiary Part B Deductible Amount

  • Short SAS Name: LDEDAMT
  • Long SAS Name: LINE_BENE_PTB_DDCTBL_AMT

Variable Names

Dataset 2012 2011 2010 2009 2008
Carrier ldedamt ldedamt ldedamt ldedamt ldedamt
Dataset 2007 2006 2005 2004 2003
Carrier ldedamt ldedamt ldedamt ldedamt ldedamt
Dataset 2002 2001 2000 1999
Carrier ldedamt ldedamt ldedamt blnbded

Contained in

The amount of money for which the carrier has determined that the beneficiary is liable for the Part B cash deductible for the line item service on the noninstitutional claim.

Line Beneficiary Payment Amount

  • Short SAS Name: LBENPMT
  • Long SAS Name: LINE_BENE_PMT_AMT

Contained in

Effective with Version H, the payment (reim- bursement) made to the beneficiary related to the line item service on the noninstitu- tional claim.

NOTE: Beginning with NCH weekly process date 10/3/97 this field was populated with data. Claims processed prior to 10/3/97 will contain zeroes in this field.

Line Beneficiary Primary Payer Code

  • Short SAS Name: LPRPAYCD
  • Long SAS Name: LINE_BENE_PRMRY_PYR_CD

Contained in

The code specifying a federal non-Medicare program or other source that has primary responsibility for the payment of the Medicare beneficiary's medical bills relating to the line item service on the noninstitutional claim.

Values

Values C, M, N, Y, Z and BLANK indicate Medicare is primary payer. (values Z and Y were used prior to 12/90. BLANK was supposed to be effective after 12/90, but may have been used prior to that date.)

Code Code Value
A Working aged bene/spouse with employer group health plan (EGHP)
B End stage renal disease (ESRD) beneficiary in the 18 month coordination period with an employer group health plan
C Conditional payment by Medicare; future reimbursement expected
D Automobile no-fault (eff. 4/97; Prior to 3/94, also included any liability insurance)
E Workers' compensation
F Public Health Service or other federal agency (other than Dept. of Veterans Affairs)
G Working disabled bene (under age 65 with LGHP)
H Black Lung
I Dept. of Veterans Affairs
J Any liability insurance (eff. 3/94 - 3/97)
L Any liability insurance (eff. 4/97) (eff. 12/90 for carrier claims and 10/93 for FI claims; obsoleted for all claim types 7/1/96)
M Override code: EGHP services involved (eff. 12/90 for carrier claims and 10/93 for FI claims; obsoleted for all claim types 7/1/96)
N Override code: non-EGHP services involved (eff. 12/90 for carrier claims and 10/93 for FI claims; obsoleted for all claim types 7/1/96)
BLANK Medicare is primary payer (not sure of effective date: in use 1/91, if not earlier)

Prior to 12/90

Code Code Value
Y Other secondary payer investigation shows Medicare as primary payer
Z Medicare is primary payer

Line Beneficiary Primary Payer Paid Amount

  • Short SAS Name: LPRPDAMT
  • Long SAS Name: LINE_BENE_PRMRY_PYR_PD_AMT

Variable Names

Dataset 2012 2011 2010 2009 2008
Carrier lprpdamt lprpdamt lprpdamt lprpdamt lprpdamt
Dataset 2007 2006 2005 2004 2003
Carrier lprpdamt lprpdamt lprpdamt lprpdamt lprpdamt
Dataset 2002 2001 2000 1999
Carrier lprpdamt lprpdamt lprpdamt PRPAYAMT

Contained in

The amount of a payment made on behalf of a Medicare beneficiary by a primary payer other than Medicare, that the provider is applying to covered Medicare charges for to the line ITEM SERVICE ON THE NONINSTITUTIONAL.

Line Coinsurance Amount

  • Short SAS Name: COINAMT
  • Long SAS Name: LINE_COINSRNC_AMT

Variable Names

Dataset 2012 2011 2010 2009 2008
Carrier coinamt coinamt coinamt coinamt coinamt
Dataset 2007 2006 2005 2004 2003
Carrier coinamt coinamt coinamt coinamt coinamt
Dataset 2002 2001 2000 1999
Carrier coinamt coinamt coinamt COINAMT

Contained in

Effective with Version H, the beneficiary coinsurance liability amount for this line item service on the noninstitutional claim.

NOTE: Beginning with NCH weekly process date 10/3/97 this field was populated with data. Claims processed prior to 10/3/97 will contain zeroes in this field.

Line DME Purchase Price Amount

  • Short SAS Name: DME_PURC
  • Long SAS Name: LINE_DME_PRCHS_PRICE_AMT

Contained in

Effective 5/92, the amount representing the lower of fee schedule for purchase of new or used DME, or actual charge. In case of rental DME, this amount represents the purchase cap; rental payments can only be made until the cap is met. This line item field is applicable to non-institutional claims involving DME, prosthetic, orthotic and supply items, immunosuppressive drugs, pen, ESRD and oxygen items referred to as DMEPOS.

Values

Code
XXX.XX

Line Diagnosis Code

  • Short SAS Name: LINE_ICD_DGNS_CD
  • Long SAS Name: LINE_ICD_DGNS_CD

Variable Names

Dataset 2012 2011 2010 2009 2008
Carrier line_icd_dgns_cd line_icd_dgns_cd line_icd_dgns_cd linedgns linedgns
Dataset 2007 2006 2005 2004 2003
Carrier linedgns linedgns linedgns linedgns linedgns
Dataset 2002 2001 2000 1999
Carrier linedgns linedgns linedgns blndx

Contained in

The code indicating the diagnosis supporting this line item procedure/service on the noninstitutional claim.

Line Diagnosis Code Diagnosis Version Code (ICD-9 or ICD-10)

  • Short SAS Name: LINE_ICD_DGNS_VRSN_CD
  • Long SAS Name: LINE_ICD_DGNS_VRSN_CD

Contained in

Effective with Version 'J', the code used to indicate if the diagnosis code is ICD-9 or ICD-10.

NOTE: With 5010, the diagnosis and procedure codes have been expanded to accomodate ICD-10, even though ICD-10 is not scheduled for implementation until 10/2013.

Values

Code Code Value
9 ICD-9
0 ICD-10

Line First Expense Date

  • Short SAS Name: EXPNSDT1
  • Long SAS Name: LINE_1ST_EXPNS_DT

Variable Names

Dataset 2012 2011 2010 2009 2008
Carrier expnsdt1 expnsdt1 expnsdt1 expnsdt1 expnsdt1
Dataset 2007 2006 2005 2004 2003
Carrier expnsdt1 expnsdt1 sexpndt1 sexpndt1 sexpndt1
Dataset 2002 2001 2000 1999
Carrier sexpndt1 expnsdt1 expnsdt1 bexpdt1

Contained in

Beginning date (1st expense) for this line item service on the noninstitutional claim.

Line HCFA Provider Specialty Code

  • Short SAS Name: HCFASPCL
  • Long SAS Name: PRVDR_SPCLTY

Variable Names

Dataset 2012 2011 2010 2009 2008
Carrier hcfaspcl hcfaspcl hcfaspcl hcfaspcl hcfaspcl
Dataset 2007 2006 2005 2004 2003
Carrier hcfaspcl hcfaspcl hcfaspcl hcfaspcl hcfaspcl
Dataset 2002 2001 2000 1999
Carrier hcfaspcl hcfaspcl hcfaspcl bspec

Contained in

CMS specialty code used for pricing the line item service on the noninstitutional claim.

Values

HCFA Provider Specialty Table.txt

Line HCFA Type Service Code

  • Short SAS Name: TYPSRVCB
  • Long SAS Name: LINE_CMS_TYPE_SRVC_CD

Variable Names

Dataset 2012 2011 2010 2009 2008
Carrier typsrvcb typsrvcb typsrvcb typsrvcb typsrvcb
Dataset 2007 2006 2005 2004 2003
Carrier typsrvcb typsrvcb typsrvcb typsrvcb typsrvcb
Dataset 2002 2001 2000 1999
Carrier typsrvcb typsrvcb typsrvcb btos

Contained in

Code indicating the type of service, as defined in the CMS Medicare Carrier Manual, for this line item on the non-institutional claim.

Values

CMS Type of Service Table.txt

Line HCPCS Initial Modifier Code

  • Short SAS Name: MDFR_CD1
  • Long SAS Name: HCPCS_1ST_MDFR_CD

Variable Names

Dataset 2013 2012 2011 2010 2009
Carrier mdfr_cd1 mdfr_cd1 mdfr_cd1 mdfr_cd1
Outpatient mdfr_cd1 mdfr_cd1 mdfr_cd1 mdfr_cd1 mdfr_cd1
Dataset 2008 2007 2006 2005 2004
Carrier mdfr_cd1 mdfr_cd1 mdfr_cd1 mdfr_cd1 mdfr_cd1
Outpatient mdfr_cd1 mdfr_cd1 mdfr_cd1 mdfr_cd1 mdfr_cd1
Dataset 2003 2002 2001 2000 1999
Carrier mdfr_cd1 mdfr_cd1 mdfr_cd1 mdfr_cd1 bhmod1
Outpatient mdfr_cd1 mdfr_cd1 mdfr_cd1 mdfcd1_ mdfcd1_

Contained in

A first modifier to the HCPCS procedure code to enable a more specific procedure identification for the line item service on the noninstitutional claim.

Line HCPCS Second Modifier Code

  • Short SAS Name: MDFR_CD2
  • Long SAS Name: HCPCS_2ND_MDFR_CD

Variable Names

Dataset 2013 2012 2011 2010 2009
Carrier mdfr_cd2 mdfr_cd2 mdfr_cd2 mdfr_cd2
Outpatient mdfr_cd2 mdfr_cd2 mdfr_cd2 mdfr_cd2 mdfr_cd2
Dataset 2008 2007 2006 2005 2004
Carrier mdfr_cd2 mdfr_cd2 mdfr_cd2 mdfr_cd2 mdfr_cd2
Outpatient mdfr_cd2 mdfr_cd2 mdfr_cd2 mdfr_cd2 mdfr_cd2
Dataset 2003 2002 2001 2000 1999
Carrier mdfr_cd2 mdfr_cd2 mdfr_cd2 mdfr_cd2 bhmod2
Outpatient mdfr_cd2 mdfr_cd2 mdfr_cd2 mdfcd2_ mdfcd2_

Contained in

A second modifier to the HCPCS procedure code to make it more specific than the first modifier code to identify the line item procedures for this claim.

Line Last Expense Date

  • Short SAS Name: EXPNSDT2
  • Long SAS Name: LINE_LAST_EXPNS_DT

Variable Names

Dataset 2012 2011 2010 2009 2008
Carrier expnsdt2 expnsdt2 expnsdt2 expnsdt2 expnsdt2
Dataset 2007 2006 2005 2004 2003
Carrier expnsdt2 expnsdt2 sexpndt2 sexpndt2 sexpndt2
Dataset 2002 2001 2000 1999
Carrier sexpndt2 expnsdt2 expnsdt2 bexpdt2

Contained in

The ending date (last expense) for the line item service on the noninstitutional claim.

Line NCH BETOS Code

  • Short SAS Name: BETOS
  • Long SAS Name: BETOS_CD

Variable Names

Dataset 2012 2011 2010 2009 2008
Carrier betos betos betos betos betos
Dataset 2007 2006 2005 2004 2003
Carrier betos betos betos betos betos
Dataset 2002 2001 2000 1999
Carrier betos betos betos betos

Contained in

Effective with Version H, the Berenson-Eggers type of service (BETOS) for the procedure code based on generally agreed upon clinically meaningful groupings of procedures and services. This field is included as a line item on the noninstitutional claim.

NOTE: During the Version H conversion this field was populated with data throughout history (back to service year 1991).

Derivation

Match the HCPCS on the claim to the HCPCS on the HCPCS Master File to obtain the BETOS code.

Values

BETOS Table.txt

Line National Drug Code

  • Short SAS Name: LNNDCCD
  • Long SAS Name: LINE_NDC_CD

Contained in

Effective 1/1/94 on the DMERC claim, the National Drug Code identifying the oral anti-cancer drugs. Effective with Version H, this line item field was added as a placeholder on the carrier claim.

Line Other Applied Amount for 1st Code

  • Short SAS Name: LINE_OTHR_APLD_AMT1
  • Long SAS Name: LINE_OTHR_APLD_AMT1

Contained in

The field used to identify amounts that were used to adjust the amount payable when processing the line item.

See the associated line other applied indicator code in the LINE_OTHR_APLD_IND_CD{#} field. There are up to 7 of these line applied amount fields (LINE_OTHR_APLD_AMT1 - LINE_OTHR_APLD_AMT7).

Values

Code
XXX.XX

Line Other Applied Amount for 2nd Code

  • Short SAS Name: LINE_OTHR_APLD_AMT2
  • Long SAS Name: LINE_OTHR_APLD_AMT2

Contained in

The field used to identify amounts that were used to adjust the amount payable when processing the line item.

See the associated line other applied indicator code in the LINE_OTHR_APLD_IND_CD{#} field. There are up to 7 of these line applied amount fields (LINE_OTHR_APLD_AMT1 - LINE_OTHR_APLD_AMT7).

Values

Code
XXX.XX

Line Other Applied Amount for 3rd Code

  • Short SAS Name: LINE_OTHR_APLD_AMT3
  • Long SAS Name: LINE_OTHR_APLD_AMT3

Contained in

The field used to identify amounts that were used to adjust the amount payable when processing the line item.

See the associated line other applied indicator code in the LINE_OTHR_APLD_IND_CD{#} field. There are up to 7 of these line applied amount fields (LINE_OTHR_APLD_AMT1 - LINE_OTHR_APLD_AMT7).

Values

Code
XXX.XX

Line Other Applied Amount for 4th Code

  • Short SAS Name: LINE_OTHR_APLD_AMT4
  • Long SAS Name: LINE_OTHR_APLD_AMT4

Contained in

The field used to identify amounts that were used to adjust the amount payable when processing the line item.

See the associated line other applied indicator code in the LINE_OTHR_APLD_IND_CD{#} field. There are up to 7 of these line applied amount fields (LINE_OTHR_APLD_AMT1 - LINE_OTHR_APLD_AMT7).

Values

Code
XXX.XX

Line Other Applied Amount for 5th Code

  • Short SAS Name: LINE_OTHR_APLD_AMT5
  • Long SAS Name: LINE_OTHR_APLD_AMT5

Contained in

The field used to identify amounts that were used to adjust the amount payable when processing the line item.

See the associated line other applied indicator code in the LINE_OTHR_APLD_IND_CD{#} field. There are up to 7 of these line applied amount fields (LINE_OTHR_APLD_AMT1 - LINE_OTHR_APLD_AMT7).

Values

Code
XXX.XX

Line Other Applied Amount for 6th Code

  • Short SAS Name: LINE_OTHR_APLD_AMT6
  • Long SAS Name: LINE_OTHR_APLD_AMT6

Contained in

The field used to identify amounts that were used to adjust the amount payable when processing the line item.

See the associated line other applied indicator code in the LINE_OTHR_APLD_IND_CD{#} field. There are up to 7 of these line applied amount fields (LINE_OTHR_APLD_AMT1 - LINE_OTHR_APLD_AMT7).

Values

Code
XXX.XX

Line Other Applied Amount for 7th Code

  • Short SAS Name: LINE_OTHR_APLD_AMT7
  • Long SAS Name: LINE_OTHR_APLD_AMT7

Contained in

The field used to identify amounts that were used to adjust the amount payable when processing the line item.

See the associated line other applied indicator code in the LINE_OTHR_APLD_IND_CD{#} field. There are up to 7 of these line applied amount fields (LINE_OTHR_APLD_AMT1 - LINE_OTHR_APLD_AMT7).

Values

Code
XXX.XX

Line Other Applied Indicator 1st Code

  • Short SAS Name: LINE_OTHR_APLD_IND_CD1
  • Long SAS Name: LINE_OTHR_APLD_IND_CD1

Contained in

The code used to identify the reason the claim payment amount was adjusted during claims processing.

See the associated amounts in the LINE_OTHR_APLD_AMT{#} field. There are up to 7 of these line applied indicator fields (LINE_OTHR_APLD_IND_CD1 - LINE_OTHR_APLD_IND_CD7).

Values

LINE_OTHR_APLD_IND_CD_TB.txt

Line Other Applied Indicator 2nd Code

  • Short SAS Name: LINE_OTHR_APLD_IND_CD2
  • Long SAS Name: LINE_OTHER_APLD_IND_CD2

Contained in

The code used to identify the reason the claim payment amount was adjusted during claims processing.

See the associated amounts in the LINE_OTHR_APLD_AMT{#} field. There are up to 7 of these line applied indicator fields (LINE_OTHR_APLD_IND_CD1 - LINE_OTHR_APLD_IND_CD7).

Values

LINE_OTHR_APLD_IND_CD_TB.txt

Line Other Applied Indicator 3rd Code

  • Short SAS Name: LINE_OTHR_APLD_IND_CD3
  • Long SAS Name: LINE_OTHR_APLD_IND_CD3

Contained in

The code used to identify the reason the claim payment amount was adjusted during claims processing.

See the associated amounts in the LINE_OTHR_APLD_AMT{#} field. There are up to 7 of these line applied indicator fields (LINE_OTHR_APLD_IND_CD1 - LINE_OTHR_APLD_IND_CD7).

Values

LINE_OTHR_APLD_IND_CD_TB.txt

Line Other Applied Indicator 4th Code

  • Short SAS Name: LINE_OTHR_APLD_IND_CD4
  • Long SAS Name: LINE_OTHR_APLD_IND_CD4

Contained in

The code used to identify the reason the claim payment amount was adjusted during claims processing.

See the associated amounts in the LINE_OTHR_APLD_AMT{#} field. There are up to 7 of these line applied indicator fields (LINE_OTHR_APLD_IND_CD1 - LINE_OTHR_APLD_IND_CD7).

Values

LINE_OTHR_APLD_IND_CD_TB.txt

Line Other Applied Indicator 5th Code

  • Short SAS Name: LINE_OTHR_APLD_IND_CD5
  • Long SAS Name: LINE_OTHR_APLD_IND_CD5

Contained in

The code used to identify the reason the claim payment amount was adjusted during claims processing.

See the associated amounts in the LINE_OTHR_APLD_AMT{#} field. There are up to 7 of these line applied indicator fields (LINE_OTHR_APLD_IND_CD1 - LINE_OTHR_APLD_IND_CD7).

Values

LINE_OTHR_APLD_IND_CD_TB.txt

Line Other Applied Indicator 6th Code

  • Short SAS Name: LINE_OTHR_APLD_IND_CD6
  • Long SAS Name: LINE_OTHR_APLD_IND_CD6

Contained in

The code used to identify the reason the claim payment amount was adjusted during claims processing.

See the associated amounts in the LINE_OTHR_APLD_AMT{#} field. There are up to 7 of these line applied indicator fields (LINE_OTHR_APLD_IND_CD1 - LINE_OTHR_APLD_IND_CD7).

Values

LINE_OTHR_APLD_IND_CD_TB.txt

Line Other Applied Indicator 7th Code

  • Short SAS Name: LINE_OTHR_APLD_IND_CD7
  • Long SAS Name: LINE_OTHR_APLD_IND_CD7

Contained in

The code used to identify the reason the claim payment amount was adjusted during claims processing.

See the associated amounts in the LINE_OTHR_APLD_AMT{#} field. There are up to 7 of these line applied indicator fields (LINE_OTHR_APLD_IND_CD1 - LINE_OTHR_APLD_IND_CD7).

Values

LINE_OTHR_APLD_IND_CD_TB.txt

Line Payment 80%/100% Code

  • Short SAS Name: PMTINDSW
  • Long SAS Name: LINE_PMT_80_100_CD

Contained in

The code indicating that the amount shown in the payment field on the noninstitutional line item represents either 80% or 100% of the allowed charges less any deductible, or 100% limitation of liability only.

Line Place Of Service Code

  • Short SAS Name: PLCSRVC
  • Long SAS Name: LINE_PLACE_OF_SRVC_CD

Variable Names

Dataset 2012 2011 2010 2009 2008
Carrier plcsrvc plcsrvc plcsrvc plcsrvc plcsrvc
Dataset 2007 2006 2005 2004 2003
Carrier plcsrvc plcsrvc plcsrvc plcsrvc plcsrvc
Dataset 2002 2001 2000 1999
Carrier plcsrvc plcsrvc plcsrvc bplacsv

Contained in

The code indicating the place of service, as defined in the Medicare Carrier Manual, for this line item on the noninstitutional claim.

Values

List obtained from [here](https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set.html) Place of Service Table.txt

Line Primary Payer Allowed Charge Amount

  • Short SAS Name: PRPYALOW
  • Long SAS Name: LINE_PRMRY_ALOWD_CHRG_AMT

Contained in

Effective with Version H, the primary payer allowed charge amount for the line item service on the noninstitutional claim. 

If there is a primary payer other than Medicare, there may be an allowed payment for the provider; if so, this field is populated. 

NOTE: Beginning with NCH weekly process date 10/3/97 this field was populated with data. Claims processed prior to 10/3/97 will contain zeroes in this field.

Line Processing Indicator Code

  • Short SAS Name: PRCNGIND
  • Long SAS Name: LINE_PRCSG_IND_CD

Contained in

The code on a noninstitutional claim indicating to whom payment was made or if the claim was denied.

NOTE1: Effective with Version 'J', the field has been expanded on the NCH record to 2 bytes, With this expansion, the NCH will no longer use the character values to represent the official two byte values sent in by CWF since 4/2002. During the Version J conversion, all character values were converted to the two byte values.

NOTE2: Effective 4/1/02, this field was expanded to two bytes to accommodate new values. The NCH Nearline file did not expand the current 1-byte field but instituted a crosswalk of the 2-byte field to the 1-byte character value. See table of code for the crosswalk.

Values

Line Processing Indicator Table.txt

Line Provider Participating Indicator Code

  • Short SAS Name: PRTCPTG
  • Long SAS Name: PRTCPTNG_IND_CD

Contained in

Code indicating whether or not a provider is participating or accepting assignment for this line item service on the noninstitutional claim.

Values

Code Code Value
1 Participating
2 All or some covered and allowed expenses applied to deductible Participating
3 Assignment accepted/non-participating
4 Assignment not accepted/non-participating
5 Assignment accepted but all or some covered and allowed expenses applied to deductible Non-participating.
6 Assignment not accepted and all covered and allowed expenses applied to deductible non-participating.
7 Participating provider not accepting assignment.

Line Provider Tax Number

  • Short SAS Name: TAX_NUM
  • Long SAS Name: TAX_NUM

Variable Names

Dataset 2012 2011 2010 2009 2008
Carrier tax_num tax_num tax_num tax_num tax_num
Dataset 2007 2006 2005 2004 2003
Carrier tax_num tax_num tax_num tax_num tax_num
Dataset 2002 2001 2000 1999
Carrier tax_num tax_num tax_num bprovid

Contained in

Social security number or employee identification number of physician/supplier used to identify to whom payment is made for the line item service on the noninstitutional claim.

Line Service Count

  • Short SAS Name: SRVC_CNT
  • Long SAS Name: LINE_SRVC_CNT

Variable Names

Dataset 2012 2011 2010 2009 2008
Carrier srvc_cnt srvc_cnt srvc_cnt srvc_cnt srvc_cnt
Dataset 2007 2006 2005 2004 2003
Carrier srvc_cnt srvc_cnt srvc_cnt srvc_cnt srvc_cnt
Dataset 2002 2001 2000 1999
Carrier srvc_cnt srvc_cnt srvc_cnt bsrvct

Contained in

The count of the total number of services processed for the line item on the non-institutional claim.

Line Service Deductible Indicator Switch

  • Short SAS Name: DED_SW
  • Long SAS Name: LINE_SERVICE_DEDUCTIBLE

Contained in

Switch indicating whether or not the line item service on the noninstitutional claim is subject to a deductible.

Values

Code Code Value
0 SERVICE SUBJECT TO DEDUCTIBLE
1 SERVICE NOT SUBJECT TO DEDUCTIBLE

Line Submitted Charge Amount

  • Short SAS Name: LSBMTCHG
  • Long SAS Name: LINE_SBMTD_CHRG_AMT

Variable Names

Dataset 2012 2011 2010 2009 2008
Carrier lsbmtchg lsbmtchg lsbmtchg lsbmtchg lsbmtchg
Dataset 2007 2006 2005 2004 2003
Carrier lsbmtchg lsbmtchg lsbmtchg lsbmtchg lsbmtchg
Dataset 2002 2001 2000 1999
Carrier lsbmtchg lsbmtchg lsbmtchg bsubchg

Contained in

The amount of submitted charges for the line item service on the noninstitutional claim.

NCH Carrier Claim Allowed Charge Amount*

  • Short SAS Name: ALOWCHRG
  • Long SAS Name: NCH_CARR_CLM_ALOWD_AMT

Variable Names

Dataset 2012 2011 2010 2009 2008
Carrier alowchrg alowchrg alowchrg alowchrg alowchrg
Dataset 2007 2006 2005 2004 2003
Carrier alowchrg alowchrg alowchrg alowchrg alowchrg
Dataset 2002 2001 2000 1999
Carrier alowchrg alowchrg alowchrg alowchrg

Contained in

Effective with Version H, the total allowed charges on the claim (the sum of line item allowed charges).

NOTE1: The amount includes beneficiary-paid amounts (i.e., deductible and coinsurance).

NOTE2: During the Version H conversion this field was populated with data throughout history (back to service year 1991).

NCH Carrier Claim Submitted Charge Amount*

  • Short SAS Name: SBMTCHRG
  • Long SAS Name: NCH_CARR_CLM_SBMTD_CHRG_AMT

Contained in

Effective with Version H, the total submitted charges on the claim (the sum of line item submitted charges).

NOTE: During the Version H conversion this field was populated with data throughout history (back to service year 1991).

NCH Claim Beneficiary Payment Amount*

  • Short SAS Name: BENE_PMT
  • Long SAS Name: NCH_CLM_BENE_PMT_AMT

Contained in

Effective with Version H, the total payments made to the beneficiary for this claim (sum of line payment amounts to the beneficiary.)

NOTE: Beginning with NCH weekly process date 10/3/97 this field was populated with data. Claims processed prior to 10/3/97 will contain zeroes in this field.

NCH Claim Provider Payment Amount*

  • Short SAS Name: PROV_PMT
  • Long SAS Name: NCH_CLM_PRVDR_PMT_AMT

Contained in

Effective with Version H, the total payments made to the provider for this claim (sum of line item provider payment amounts.) 

NOTE: Beginning with NCH weekly process date 10/3/97 this field was populated with data. Claims processed prior to 10/3/97 will contain zeroes in this field.

NCH Claim Type Code

  • Short SAS Name: CLM_TYPE
  • Long SAS Name: NCH_CLM_TYPE_CD

Variable Names

Dataset 2012 2011 2010 2009 2008
Carrier clm_type clm_type clm_type clm_type clm_type
Dataset 2007 2006 2005 2004 2003
Carrier clm_type clm_type clm_type clm_type clm_type
Dataset 2002 2001 2000 1999
Carrier clm_type clm_type clm_type clm_type

Contained in

The code used to identify the type of claim record being processed in NCH.

NOTE1: During the Version H conversion this field was populated with data throughout history (back to service year 1991).

NOTE2: During the Version I conversion this field was expanded to include inpatient 'full' encounter claims (for service dates after 6/30/97).

NOTE3: Effective with Version 'J', 3 new code values have been added to include a type code for the Medicare Advantage claims (IME/GME, no-pay and paid as FFS). During the Version 'J' conversion, these type codes were populated throughout history.

Derivation

FFS CLAIM TYPE CODES DERIVED FROM: NCH CLM_NEAR_LINE_RIC_CD NCH PMT_EDIT_RIC_CD NCH CLM_TRANS_CD NCH PRVDR_NUM INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM: (Pre-HDC processing -- AVAILABLE IN NCH) CLM_MCO_PD_SW CLM_RLT_COND_CD MCO_CNTRCT_NUM MCO_OPTN_CD MCO_PRD_EFCTV_DT MCO_PRD_TRMNTN_DT DERIVATION RULES: SET CLM_TYPE_CD TO 10 (HHA CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'V','W' OR 'U' 2. PMT_EDIT_RIC_CD EQUAL 'F' 3. CLM_TRANS_CD EQUAL '5' SET CLM_TYPE_CD TO 20 (SNF NON-SWING BED CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'V' 2. PMT_EDIT_RIC_CD EQUAL 'C' OR 'E' 3. CLM_TRANS_CD EQUAL '0' OR '4' 4. POSITION 3 OF PRVDR_NUM IS NOT 'U', 'W', 'Y' OR 'Z' SET CLM_TYPE_CD TO 30 (SNF SWING BED CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'V' 2. PMT_EDIT_RIC_CD EQUAL 'C' OR 'E' 3. CLM_TRANS_CD EQUAL '0' OR '4' 4. POSITION 3 OF PRVDR_NUM EQUAL 'U', 'W', 'Y' OR 'Z' SET CLM_TYPE_CD TO 40 (OUTPATIENT CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'W' 2. PMT_EDIT_RIC_CD EQUAL 'D' 3. CLM_TRANS_CD EQUAL '6' SET CLM_TYPE_CD TO 50 (HOSPICE CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'V' 2. PMT_EDIT_RIC_CD EQUAL 'I' 3. CLM_TRANS_CD EQUAL 'H' SET CLM_TYPE_CD TO 60 (INPATIENT CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'V' 2. PMT_EDIT_RIC_CD EQUAL 'C' OR 'E' 3. CLM_TRANS_CD EQUAL '1' '2' OR '3' SET CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER CLAIM - PRIOR TO HDC PROCESSING - AFTER 6/30/97 - 12/4/00) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_MCO_PD_SW = '1' 2. CLM_RLT_COND_CD = '04' 3. MCO_CNTRCT_NUM MCO_OPTN_CD = 'C' CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT ENROLLMENT PERIODS SET_CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER CLAIM -- EFFECTIVE WITH HDC PROCESSING) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'V' 2. PMT_EDIT_RIC_CD EQUAL 'C' OR 'E' 3. CLM_TRANS_CD EQUAL '1' '2' OR '3' 4. FI_NUM = 80881 SET CLM_TYPE_CD TO 62 (Medicare Advantage IME/GME CLAIMS - 10/1/05 - FORWARD) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_MCO_PD_SW = '0' 2. CLM_RLT_COND_CD = '04' & '69' 3. MCO_CNTRCT_NUM MCO_OPTN_CD = 'C' CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT ENROLLMENT PERIODS SET CLM_TYPE_CD TO 63 (HMO NO-PAY CLAIMS) WHERE THE FOLLOWING CONDITIONS ARE MET: CLAIMS PROCESSED ON OR AFTER 10/6/08 1. CLM_THRU_DT ON OR AFTER 10/1/06 2. CLM_MCO_PD_SW = '1' 3. CLM_RLT_COND_CD = '04' 4. MCO_CNTRCT_NUM MCO_OPTN_CD = 'A', 'B' OR 'C' CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT ENROLLMENT PERIODS 5. ZERO REIMBURSEMENT (CLM_PMT_AMT) SET CLM_TYPE_CD TO 63 (HMO NO-PAY CLAIMS) WHERE THE FOLLOWING CONDITIONS ARE MET: CLAIMS PROCESSED PRIOR to 10/6/08 1. MCO_CNTRCT_NUM MCO_OPTN_CD = 'A', 'B' OR 'C' CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT ENROLLMENT PERIODS 2. ZERO REIMBURSEMENT (CLM_PMT_AMT) SET CLM_TYPE_CD TO 64 (HMO CLAIMS PAID AS FFS) WHERE THE FOLLOWING CONDITIONS ARE MET: CLAIMS PROCESSED PRIOR to 10/6/08 1. MCO_CNTRCT_NUM MCO_OPTN_CD = '1', '2' OR '4' CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT ENROLLMENT PERIODS SET CLM_TYPE_CD TO 64 (HMO CLAIMS PAID AS FFS) WHERE THE FOLLOWING CONDITIONS ARE MET: CLAIMS PROCESSED on or after 10/6/08 1. CLM_RLT_COND_CD = '04' 2. MCO_CNTRCT_NUM MCO_OPTN_CD = '1', '2' OR '4' CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT ENROLLMENT PERIODS SET CLM_TYPE_CD TO 71 (RIC O non-DMEPOS CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'O' 2. HCPCS_CD not on DMEPOS table SET CLM_TYPE_CD TO 72 (RIC O DMEPOS CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'O' 2. HCPCS_CD on DMEPOS table (NOTE: if one or more line item(s) match the HCPCS on the DMEPOS table). SET CLM_TYPE_CD TO 81 (RIC M non-DMEPOS DMERC CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'M' 2. HCPCS_CD not on DMEPOS table SET CLM_TYPE_CD TO 82 (RIC M DMEPOS DMERC CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'M' 2. HCPCS_CD on DMEPOS table (NOTE: if one or more line item(s) match the HCPCS on the DMEPOS table).

Values

Code Code Value
10 HHA claim
20 Non swing bed SNF claim
30 Swing bed SNF claim
40 Outpatient claim
50 Hospice claim
60 Inpatient claim
61 Inpatient 'Full-Encounter' claim
62 Medicare Advantage IME/GME claims
63 Medicare Advantage (no-pay) claims
64 Medicare Advantage (paid as FFS) claim
71 RIC O local carrier non-DMEPOS claim
72 RIC O local carrier DMEPOS claim
81 RIC M DMERC non-DMEPOS claim
82 RIC M DMERC DMEPOS claim

NCH Near Line Record Identification Code

  • Short SAS Name: RIC_CD
  • Long SAS Name: NCH_NEAR_LINE_REC_IDENT_CD

Contained in

A code defining the type of claim record being processed.

Values

Code Code Value
O Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)
V Part A institutional claim record (inpatient (IP), skilled nursing facility (SNF), christian science (CS), home health agency (HHA), or hospice)
W Part B institutional claim record (outpatient (OP), HHA)
U Both Part A and B institutional home health agency (HHA) claim records -- due to HHPPS and HHA A/B split. (effective 10/00)
M Part B DMEPOS claim record (processed by DME Regional Carrier) (effective 10/93)

NCH Weekly Claim Processing Date

  • Short SAS Name: WKLY_DT
  • Long SAS Name: NCH_WKLY_PROC_DT

Contained in

The date the weekly NCH database load process cycle begins, during which the claim records are loaded into the Nearline file. This date will always be a Friday, although the claims will actually be appended to the database subsequent to the date.

Primary Claim Diagnosis Code Diagnosis Version Code (ICD-9 or ICD-10)

  • Short SAS Name: PRNCPAL_DGNS_VRSN_CD
  • Long SAS Name: PRNCPAL_DGNS_VRSN_CD

Contained in

Effective with Version 'J', the code used to indicate if the diagnosis is ICD-9 or ICD-10.

NOTE: With 5010, the diagnosis and procedure codes have been expanded to accommodate ICD-10, even though ICD-10 is not scheduled for implementation until 10/2013.

Values

Code Code Value
9 ICD-9
0 ICD-10

Race Code from Claim

  • Short SAS Name: RACE_CD
  • Long SAS Name: BENE_RACE_CD

Contained in

The race of a beneficiary.

Values

Code Code Value
0 Unknown
1 White
2 Black
3 Other
4 Asian
5 Hispanic
6 North American Native

State Code from Claim (SSA)

  • Short SAS Name: STATE_CD
  • Long SAS Name: BENE_STATE_CD

Variable Names

Dataset 2013 2012 2011 2010 2009
Carrier state_cd state_cd state_cd state_cd
Inpatient state_cd state_cd state_cd state_cd state_cd
MedPAR state_cd state_cd state_cd state_cd state_cd
Outpatient state_cd state_cd state_cd state_cd state_cd
Dataset 2008 2007 2006 2005 2004
Carrier state_cd state_cd state_cd state state
Inpatient state_cd state_cd state_cd state state
MedPAR state_cd state_cd state_cd state state
Outpatient state_cd state_cd state_cd state state
Dataset 2003 2002 2001 2000 1999
Carrier state state state_cd state_cd bstate
Inpatient state state state_cd state_cd state_cd
MedPAR state state mstate mstate mstate
Outpatient state state state state_cd state_cd

Contained in

The SSA standard state code of a beneficiary's residence.

Values

Code Code Value
1 Alabama
2 Alaska
3 Arizona
4 Arkansas
5 California
6 Colorado
7 Connecticut
8 Delaware
9 District of Columbia
10 Florida
11 Georgia
12 Hawaii
13 Idaho
14 Illinois
15 Indiana
16 Iowa
17 Kansas
18 Kentucky
19 Louisiana
20 Maine
21 Maryland
22 Massachusetts
23 Michigan
24 Minnesota
25 Mississippi
26 Missouri
27 Montana
28 Nebraska
29 Nevada
30 New Hampshire
31 New Jersey
32 New Mexico
33 New York
34 North Carolina
35 North Dakota
36 Ohio
37 Oklahoma
38 Oregon
39 Pennsylvania
40 Puerto Rico
41 Rhode Island
42 South Carolina
43 South Dakota
44 Tennessee
45 Texas
46 Utah
47 Vermont
48 Virgin Islands
49 Virginia
50 Washington
51 West Virginia
52 Wisconsin
53 Wyoming
54 Africa
55 Asia
56 Canada
57 Central America and West Indies
58 Europe
59 Mexico
60 Oceania
61 Philippines
62 South America
63 U.S. Possessions
97 Saipan - MP
98 Guam
99 American Samoa

Zip Code of Residence from Claim

  • Short SAS Name: ZIP_CD
  • Long SAS Name: BENE_MLG_CNTCT_ZIP_CD

Variable Names

Dataset 2013 2012 2011 2010 2009
Carrier zip_cd zip_cd zip_cd zip_cd
Inpatient zip_cd zip_cd zip_cd zip_cd zip_cd
Outpatient zip_cd zip_cd zip_cd zip_cd zip_cd
Dataset 2008 2007 2006 2005 2004
Carrier zip_cd zip_cd zip_cd zipcode zipcode
Inpatient zip_cd zip_cd zip_cd zipcode zipcode
Outpatient zip_cd zip_cd zip_cd zipcode zipcode
Dataset 2003 2002 2001 2000 1999
Carrier zipcode zipcode bene_zip bene_zip bzip
Inpatient zipcode zipcode bene_zip bene_zip bene_zip
Outpatient zipcode zipcode zipcode bene_zip bene_zip

Contained in

The ZIP code of the mailing address where the beneficiary may be contacted.

ResDAC variable note: The zip code variable in the claims data appears as a 9-digit variable. However, the field only presents the 5-digit zip code followed by trailing zeros. For example, a zip code of 55455 would appear as 554550000 in the data.