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codebook-ffs-claims.xml
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codebook-ffs-claims.xml
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<?xml version="1.0" encoding="UTF-8" standalone="yes"?>
<codebook name="Medicare Fee-For-Service Claims (for Version K)" version="December 2017, Version 1.4">
<variable id="ACO_ID_NUM" label="Claim Accountable Care Organization (ACO) Identification Number" length="10" longName="ACO_ID_NUM" shortName="ACO_ID_NUM" source="NCH" type="CHAR">
<description>
<p>The field identifies the Accountable Care Organization (ACO) Identification Number.</p>
</description>
</variable>
<variable id="ADMTG_DGNS_CD" label="Claim Admitting Diagnosis Code" length="7" longName="ADMTG_DGNS_CD" shortName="ADMTG_DGNS_CD" source="NCH" type="CHAR">
<description>
<p>A diagnosis code on the institutional claim indicating the beneficiary's initial diagnosis at admission.</p>
<p>This diagnosis code may not be confirmed after the patient is evaluated; it may be different than the eventual diagnoses (e.g., as in PRNCPAL_DGNS_CD or ICD_DGNS_CD1-25).</p>
</description>
</variable>
<variable id="ADMTG_DGNS_VRSN_CD" label="Claim Admitting Diagnosis Version Code (ICD-9 or ICD-10)" length="1" longName="ADMTG_DGNS_VRSN_CD" shortName="ADMTG_DGNS_VRSN_CD" source="NCH" type="CHAR">
<comment>
<p>On October 1, 2015 the conversion from the 9th version of the International Classification of Diseases (ICD-9-CM) to version 10 (ICD-10-CM) occurred.</p>
</comment>
<description>
<p>Effective with Version 'J', the code used to indicate if the diagnosis code is ICD-9/ICD-10.</p>
</description>
<valueGroups>
<valueGroup>
<value code="Blank">ICD-9</value>
<value code="9">ICD-9</value>
<value code="0">ICD-10</value>
</valueGroup>
</valueGroups>
</variable>
<variable id="ASGMNTCD" label="Carrier Claim Provider Assignment Indicator Switch" length="1" longName="CARR_CLM_PRVDR_ASGNMT_IND_SW" shortName="ASGMNTCD" source="NCH" type="CHAR">
<description>
<p>Variable indicates whether or not the provider accepts assignment for the non-institutional claim.</p>
</description>
<valueGroups>
<valueGroup>
<value code="A">Assigned claim</value>
<value code="N">Non-assigned claim</value>
</valueGroup>
</valueGroups>
</variable>
<variable id="AT_PHYSN_NPI" label="Claim Attending Physician NPI Number" length="10" longName="AT_PHYSN_NPI" shortName="AT_NPI" source="NCH" type="CHAR">
<description>
<p>On an institutional claim, the national provider identifier (NPI) number assigned to uniquely identify the physician who has overall responsibility for the beneficiary's care and treatment.</p>
<p>NPIs replaced UPINs as the standard provider identifiers beginning in 2007. The UPIN is almost never populated after 2009.</p>
</description>
</variable>
<variable id="AT_PHYSN_SPCLTY_CD" label="Claim Attending Physician Specialty Code" length="2" longName="AT_PHYSN_SPCLTY_CD" shortName="AT_PHYSN_SPCLTY_CD" source="NCH" type="CHAR">
<description>
<p>This variable is the code used to identify the CMS specialty code corresponding to the attending physician.</p>
</description>
<valueGroups>
<valueGroup>
<value code="00">Carrier wide</value>
<value code="01">General practice</value>
<value code="02">General surgery</value>
<value code="03">Allergy/immunology</value>
<value code="04">Otolaryngology</value>
<value code="05">Anesthesiology</value>
<value code="06">Cardiology</value>
<value code="07">Dermatology</value>
<value code="08">Family practice</value>
<value code="09">Interventional Pain Management (IPM) (eff. 4/1/03)</value>
<value code="10">Gastroenterology</value>
<value code="11">Internal medicine</value>
<value code="12">Osteopathic manipulative therapy</value>
<value code="13">Neurology</value>
<value code="14">Neurosurgery</value>
<value code="15">Speech / language pathology</value>
<value code="16">Obstetrics/gynecology</value>
<value code="17">Hospice and Palliative Care</value>
<value code="18">Ophthalmology</value>
<value code="19">Oral surgery (dentists only)</value>
<value code="20">Orthopedic surgery</value>
<value code="21">Cardiac Electrophysiology</value>
<value code="22">Pathology</value>
<value code="24">Plastic and reconstructive surgery</value>
<value code="25">Physical medicine and rehabilitation</value>
<value code="26">Psychiatry</value>
<value code="27">General Psychiatry</value>
<value code="28">Colorectal surgery (formerly proctology)</value>
<value code="29">Pulmonary disease</value>
<value code="30">Diagnostic radiology</value>
<value code="31">Intensive cardiac rehabilitation</value>
<value code="32">Anesthesiologist Assistants (eff. 4/1/03—previously grouped with Certified Registered Nurse Anesthetists (CRNA))</value>
<value code="33">Thoracic surgery</value>
<value code="34">Urology</value>
<value code="35">Chiropractic</value>
<value code="36">Nuclear medicine</value>
<value code="37">Pediatric medicine</value>
<value code="38">Geriatric medicine</value>
<value code="39">Nephrology</value>
<value code="40">Hand surgery</value>
<value code="41">Optometrist</value>
<value code="42">Certified nurse midwife</value>
<value code="43">Certified Registered Nurse Anesthetist (CRNA) (Anesthesiologist Assistants were removed from this specialty 4/1/03)</value>
<value code="44">Infectious disease</value>
<value code="45">Mammography screening center</value>
<value code="46">Endocrinology</value>
<value code="47">Independent Diagnostic Testing Facility (IDTF)</value>
<value code="48">Podiatry</value>
<value code="49">Ambulatory surgical center (formerly miscellaneous)</value>
<value code="50">Nurse practitioner</value>
<value code="51">Medical supply company with certified orthotist (certified by American Board for Certification in Prosthetics and Orthotics)</value>
<value code="52">Medical supply company with certified prosthetist (certified by American Board for Certification in Prosthetics and Orthotics)</value>
<value code="53">Medical supply company with certified prosthetist-orthotist (certified by American Board for Certification in Prosthetics and Orthotics)</value>
<value code="54">Medical supply company for DMERC (and not included in 51-53)</value>
<value code="55">Individual certified orthotist</value>
<value code="56">Individual certified prosthetist</value>
<value code="57">Individual certified prosthetist-orthotist</value>
<value code="58">Medical supply company with registered pharmacist</value>
<value code="59">Ambulance service supplier, (e.g., private ambulance companies, funeral homes, etc.)</value>
<value code="60">Public health or welfare agencies (federal, state, and local)</value>
<value code="61">Voluntary health or charitable agencies (e.g. National Cancer Society, National Heart Association, Catholic Charities)</value>
<value code="62">Psychologist (billing independently)</value>
<value code="63">Portable X-ray supplier</value>
<value code="64">Audiologist (billing independently)</value>
<value code="65">Physical therapist (private practice added 4/1/03) (independently practicing removed 4/1/03)</value>
<value code="66">Rheumatology</value>
<value code="67">Occupational therapist (private practice added 4/1/03) (independently practicing removed 4/1/03)</value>
<value code="68">Clinical psychologist</value>
<value code="69">Clinical laboratory (billing independently)</value>
<value code="70">Multispecialty clinic or group practice</value>
<value code="71">Registered Dietician/Nutrition Professional (eff. 1/1/02)</value>
<value code="72">Pain Management (eff. 1/1/02)</value>
<value code="73">Mass Immunization Roster Biller</value>
<value code="74">Radiation Therapy Centers (prior to 4/2003 this included Independent Diagnostic Testing Facilities (IDTF)</value>
<value code="75">Slide Preparation Facilities (added to differentiate them from Independent Diagnostic Testing Facilities (IDTFs -- eff. 4/1/03)</value>
<value code="76">Peripheral vascular disease</value>
<value code="77">Vascular surgery</value>
<value code="78">Cardiac surgery</value>
<value code="79">Addiction medicine</value>
<value code="80">Licensed clinical social worker</value>
<value code="81">Critical care (intensivists)</value>
<value code="82">Hematology</value>
<value code="83">Hematology/oncology</value>
<value code="84">Preventive medicine</value>
<value code="85">Maxillofacial surgery</value>
<value code="86">Neuropsychiatry</value>
<value code="87">All other suppliers (e.g. drug and department stores)</value>
<value code="88">Unknown supplier/provider specialty</value>
<value code="89">Certified clinical nurse specialist</value>
<value code="90">Medical oncology</value>
<value code="91">Surgical oncology</value>
<value code="92">Radiation oncology</value>
<value code="93">Emergency medicine</value>
<value code="94">Interventional radiology</value>
<value code="95">Competitive Acquisition Program (CAP) Vendor (eff. 07/01/06). Prior to 07/01/06, known as Independent physiological laboratory</value>
<value code="96">Optician</value>
<value code="97">Physician assistant</value>
<value code="98">Gynecologist/oncologist</value>
<value code="99">Unknown physician specialty</value>
<value code="A0">Hospital (DMERCs only)</value>
<value code="A1">SNF (DMERCs only)</value>
<value code="A2">Intermediate care nursing facility (DMERCs only)</value>
<value code="A3">Nursing facility, other (DMERCs only)</value>
<value code="A4">Home Health Agency (DMERCs only)</value>
<value code="A5">Pharmacy (DMERC)</value>
<value code="A6">Medical supply company with respiratory therapist (DMERCs only)</value>
<value code="A7">Department store (DMERC)</value>
<value code="A8">Grocery store (DMERC)</value>
<value code="A9">Indian Health Service (IHS), tribe and tribal organizations (non-hospital or non-hospital based facilities, eff. 1/2005)</value>
<value code="B1">Supplier of oxygen and/or oxygen related equipment (eff. 10/2/07)</value>
<value code="B2">Pedorthic Personnel (eff. 10/2/07)</value>
<value code="B3">Medical Supply Company with pedorthic personnel (eff. 10/2/07)</value>
<value code="B4">Does not meet definition of health care provider (e.g., Rehabilitation agency, organ procurement organizations, histocompatibility labs) (eff. 10/2/07)</value>
<value code="B5">Ocularist</value>
<value code="C0">Sleep medicine</value>
<value code="C1">Centralized flu</value>
<value code="C2">Indirect payment procedure</value>
<value code="C3">Interventional cardiology</value>
<value code="C5">Dentist (eff. 7/2016)</value>
</valueGroup>
</valueGroups>
</variable>
<variable id="AT_PHYSN_UPIN" label="Claim Attending Physician UPIN Number" length="6" longName="AT_PHYSN_UPIN" shortName="AT_UPIN" source="NCH" type="CHAR">
<description>
<p>On an institutional claim, the unique physician identification number (UPIN) of the physician who would normally be expected to certify and recertify the medical necessity of the services rendered and/or who has primary responsibility for the beneficiary's medical care and treatment (attending physician).</p>
<p>NPIs replaced UPINs as the standard provider identifiers beginning in 2007. The UPIN is almost never populated after 2009.</p>
</description>
</variable>
<variable id="BENE_CNTY_CD" label="County Code from Claim (SSA)" length="3" longName="BENE_CNTY_CD" shortName="CNTY_CD" source="SSA/EDB" type="CHAR">
<comment>
<p>A listing of county codes can be found on the US Census website; also CMS has core-based statistical area (CBSA) crosswalk files available on their website, which include state and county SSA codes.</p>
</comment>
<description>
<p>The 3-digit social security administration (SSA) standard county code of a beneficiary's residence.</p>
</description>
</variable>
<variable id="BENE_HOSPC_PRD_CNT" label="Beneficiary's Hospice Period Count" length="1" longName="BENE_HOSPC_PRD_CNT" shortName="HOSPCPRD" source="NCH" type="NUM">
<comment>
<p>Medicare payments are described in detail in a series of Medicare Payment Advisory Commission (MedPAC) documents called “Payment Basics” (see: http://www.medpac.gov/payment_basics.cfm).</p>
<p>Also in the Medicare Learning Network (MLN) “Payment System Fact Sheet Series” (see: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-Publications.html).</p>
</comment>
<description>
<p>The count of the number of hospice period trailers present for the beneficiary's record.</p>
<p>Medicare covers hospice benefit periods which may consist of 2 initial 90 day periods followed by an unlimited number of 60 day periods.</p>
<p>Hospice benefits are generally in lieu of standard Part A hospital benefits for treating the terminal condition.</p>
</description>
</variable>
<variable id="BENE_ID" label="Encrypted CCW Beneficiary ID" length="15" longName="BENE_ID" shortName="BENE_ID" source="CCW" type="CHAR">
<description>
<p>The unique CCW identifier for a beneficiary.</p>
<p>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).</p>
<p>This number does not change during a beneficiary’s lifetime and each number is used only once.</p>
<p>The BENE_ID is specific to the CCW and is not applicable to any other identification system or data source.</p>
</description>
</variable>
<variable id="BENE_LRD_USED_CNT" label="Beneficiary Medicare Lifetime Reserve Days (LRD) Used Count" length="3" longName="BENE_LRD_USED_CNT" shortName="LRD_USE" source="NCH" type="NUM">
<description>
<p>The number of lifetime reserve days that the beneficiary has elected to use during the period covered by the institutional claim.</p>
<p>Under Medicare, each beneficiary has a one-time reserve of sixty additional days of inpatient hospital coverage that can be used after 90 days of inpatient care have been provided in a single benefit period.</p>
<p>This count is used to subtract from the total number of lifetime reserve days that a beneficiary has available.</p>
</description>
</variable>
<variable id="BENE_MLG_CNTCT_ZIP_CD" label="ZIP Code of Residence from Claim" length="9" longName="BENE_MLG_CNTCT_ZIP_CD" shortName="ZIP_CD" source="EDB" type="CHAR">
<description>
<p>The ZIP code of the mailing address where the beneficiary may be contacted.</p>
</description>
</variable>
<variable id="BENE_RACE_CD" label="Beneficiary Race Code" length="1" longName="BENE_RACE_CD" shortName="RACE_CD" source="SSA" type="CHAR">
<description>
<p>Race code from claim</p>
</description>
<valueGroups>
<valueGroup>
<value code="0">Unknown</value>
<value code="1">White</value>
<value code="2">Black</value>
<value code="3">Other</value>
<value code="4">Asian</value>
<value code="5">Hispanic</value>
<value code="6">North American Native</value>
</valueGroup>
</valueGroups>
</variable>
<variable id="BENE_STATE_CD" label="Beneficiary Residence (SSA) State Code" length="2" longName="BENE_STATE_CD" shortName="STATE_CD" source="SSA/EDB" type="CHAR">
<description>
<p>The social security administration (SSA) standard 2-digit state code of a beneficiary's residence.</p>
</description>
<valueGroups>
<valueGroup>
<value code="01">Alabama</value>
<value code="02">Alaska</value>
<value code="03">Arizona</value>
<value code="04">Arkansas</value>
<value code="05">California</value>
<value code="06">Colorado</value>
<value code="07">Connecticut</value>
<value code="08">Delaware</value>
<value code="09">District of Columbia</value>
<value code="10">Florida</value>
<value code="11">Georgia</value>
<value code="12">Hawaii</value>
<value code="13">Idaho</value>
<value code="14">Illinois</value>
<value code="15">Indiana</value>
<value code="16">Iowa</value>
<value code="17">Kansas</value>
<value code="18">Kentucky</value>
<value code="19">Louisiana</value>
<value code="20">Maine</value>
<value code="21">Maryland</value>
<value code="22">Massachusetts</value>
<value code="23">Michigan</value>
<value code="24">Minnesota</value>
<value code="25">Mississippi</value>
<value code="26">Missouri</value>
<value code="27">Montana</value>
<value code="28">Nebraska</value>
<value code="29">Nevada</value>
<value code="30">New Hampshire</value>
<value code="31">New Jersey</value>
<value code="32">New Mexico</value>
<value code="33">New York</value>
<value code="34">North Carolina</value>
<value code="35">North Dakota</value>
<value code="36">Ohio</value>
<value code="37">Oklahoma</value>
<value code="38">Oregon</value>
<value code="39">Pennsylvania</value>
<value code="40">Puerto Rico</value>
<value code="41">Rhode Island</value>
<value code="42">South Carolina</value>
<value code="43">South Dakota</value>
<value code="44">Tennessee</value>
<value code="45">Texas</value>
<value code="46">Utah</value>
<value code="47">Vermont</value>
<value code="48">Virgin Islands</value>
<value code="49">Virginia</value>
<value code="50">Washington</value>
<value code="51">West Virginia</value>
<value code="52">Wisconsin</value>
<value code="53">Wyoming</value>
<value code="54">Africa</value>
<value code="55">California</value>
<value code="56">Canada & Islands</value>
<value code="57">Central America and West Indies</value>
<value code="58">Europe</value>
<value code="59">Mexico</value>
<value code="60">Oceania</value>
<value code="61">Philippines</value>
<value code="62">South America</value>
<value code="63">U.S. Possessions</value>
<value code="64">American Samoa</value>
<value code="65">Guam</value>
<value code="66">Commonwealth of the Northern Marianas Islands</value>
<value code="67">Texas</value>
<value code="68">Florida (eff. 10/2005)</value>
<value code="69">Florida (eff. 10/2005)</value>
<value code="70">Kansas (eff. 10/2005)</value>
<value code="71">Louisiana (eff. 10/2005)</value>
<value code="72">Ohio (eff. 10/2005)</value>
<value code="73">Pennsylvania (eff. 10/2005)</value>
<value code="74">Texas (eff. 10/2005)</value>
<value code="80">Maryland (eff. 8/2000)</value>
<value code="97">Northern Marianas</value>
<value code="98">Guam</value>
<value code="99">With 000 county code is American Samoa; otherwise unknown</value>
</valueGroup>
</valueGroups>
</variable>
<variable id="BENE_TOT_COINSRNC_DAYS_CNT" label="Beneficiary Total Coinsurance Days Count" length="3" longName="BENE_TOT_COINSRNC_DAYS_CNT" shortName="COIN_DAY" source="NCH" type="NUM">
<description>
<p>The count of the total number of coinsurance days involved with the beneficiary's stay in a facility.</p>
<p>During each benefit period (calendar year) the beneficiary is responsible for coinsurance for particular days of inpatient care (no coinsurance from day 1 through day 60, then for days 61 through 90 there is 25% coinsurance), SNF care (no coinsurance until day 21, then is 1/8 of inpatient hospital deductible amount through 100th day of SNF).</p>
<p>Different rules apply for lifetime reserve days, etc.</p>
</description>
</variable>
<variable id="BETOS_CD" label="Line Berenson-Eggers Type of Service (BETOS) Code" length="3" longName="BETOS_CD" shortName="BETOS" source="NCH" type="CHAR">
<description>
<p>The Berenson-Eggers type of service (BETOS) for the procedure code based on generally agreed upon clinically meaningful groupings of procedures and services.</p>
<p>This field is included as a line item on the non-institutional claim.</p>
</description>
<valueGroups>
<valueGroup>
<value code="M1A">Office visits - new</value>
<value code="M1B">Office visits - established</value>
<value code="M2A">Hospital visit - initial</value>
<value code="M2B">Hospital visit - subsequent</value>
<value code="M2C">Hospital visit - critical care</value>
<value code="M3">Emergency room visit</value>
<value code="M4A">Home visit</value>
<value code="M4B">Nursing home visit</value>
<value code="M5A">Specialist - pathology</value>
<value code="M5B">Specialist - psychiatry</value>
<value code="M5C">Specialist - ophthalmology</value>
<value code="M5D">Specialist - other</value>
<value code="M6">Consultations</value>
<value code="P0">Anesthesia</value>
<value code="P1A">Major procedure - breast</value>
<value code="P1B">Major procedure - colectomy</value>
<value code="P1C">Major procedure - cholecystectomy</value>
<value code="P1D">Major procedure - turp</value>
<value code="P1E">Major procedure - hysterectomy</value>
<value code="P1F">Major procedure - explor/decompr/excisdisc</value>
<value code="P1G">Major procedure - Other</value>
<value code="P2A">Major procedure, cardiovascular-CABG</value>
<value code="P2B">Major procedure, cardiovascular-Aneurysm repair</value>
<value code="P2C">Major Procedure, cardiovascular-Thromboendarterectomy</value>
<value code="P2D">Major procedure, cardiovascualr-Coronary angioplasty (PTCA)</value>
<value code="P2E">Major procedure, cardiovascular-Pacemaker insertion</value>
<value code="P2F">Major procedure, cardiovascular-Other</value>
<value code="P3A">Major procedure, orthopedic - Hip fracture repair</value>
<value code="P3B">Major procedure, orthopedic - Hip replacement</value>
<value code="P3C">Major procedure, orthopedic - Knee replacement</value>
<value code="P3D">Major procedure, orthopedic - other</value>
<value code="P4A">Eye procedure - corneal transplant</value>
<value code="P4B">Eye procedure - cataract removal/lens insertion</value>
<value code="P4C">Eye procedure - retinal detachment</value>
<value code="P4D">Eye procedure - treatment of retinal lesions</value>
<value code="P4E">Eye procedure - other</value>
<value code="P5A">Ambulatory procedures - skin</value>
<value code="P5B">Ambulatory procedures - musculoskeletal</value>
<value code="P5C">Ambulatory procedures - inguinal hernia repair</value>
<value code="P5D">Ambulatory procedures - lithotripsy</value>
<value code="P5E">Ambulatory procedures - other</value>
<value code="P6A">Minor procedures - skin</value>
<value code="P6B">Minor procedures - musculoskeletal</value>
<value code="P6C">Minor procedures - other (Medicare fee schedule)</value>
<value code="P6D">Minor procedures - other (non-Medicare fee schedule)</value>
<value code="P7A">Oncology - radiation therapy</value>
<value code="P7B">Oncology - other</value>
<value code="P8A">Endoscopy - arthroscopy</value>
<value code="P8B">Endoscopy - upper gastrointestinal</value>
<value code="P8C">Endoscopy - sigmoidoscopy</value>
<value code="P8D">Endoscopy - colonoscopy</value>
<value code="P8E">Endoscopy - cystoscopy</value>
<value code="P8F">Endoscopy - bronchoscopy</value>
<value code="P8G">Endoscopy - laparoscopic cholecystectomy</value>
<value code="P8H">Endoscopy - laryngoscopy</value>
<value code="P8I">Endoscopy - other</value>
<value code="P9A">Dialysis services (Medicare fee schedule)</value>
<value code="P9B">Dialysis services (non-Medicare fee schedule)</value>
<value code="I1A">Standard imaging - chest</value>
<value code="I1B">Standard imaging - musculoskeletal</value>
<value code="I1C">Standard imaging - breast</value>
<value code="I1D">Standard imaging - contrast gastrointestinal</value>
<value code="I1E">Standard imaging - nuclear medicine</value>
<value code="I1F">Standard imaging - other</value>
<value code="I2A">Advanced imaging - CAT/CT/CTA: brain/head/neck</value>
<value code="I2B">Advanced imaging - CAT/CT/CTA: other</value>
<value code="I2C">Advanced imaging - MRI/MRA: brain/head/neck</value>
<value code="I2D">Advanced imaging - MRI/MRA: other</value>
<value code="I3A">Echography/ultrasonography - eye</value>
<value code="I3B">Echography/ultrasonography - abdomen/pelvis</value>
<value code="I3C">Echography/ultrasonography - heart</value>
<value code="I3D">Echography/ultrasonography - carotid arteries</value>
<value code="I3E">Echography/ultrasonography - prostate, transrectal</value>
<value code="I3F">Echography/ultrasonography - other</value>
<value code="I4A">Imaging/procedure - heart including cardiac catheterization</value>
<value code="I4B">Imaging/procedure - other</value>
<value code="T1A">Lab tests - routine venipuncture (non-Medicare fee schedule)</value>
<value code="T1B">Lab tests - automated general profiles</value>
<value code="T1C">Lab tests - urinalysis</value>
<value code="T1D">Lab tests - blood counts</value>
<value code="T1E">Lab tests - glucose</value>
<value code="T1F">Lab tests - bacterial cultures</value>
<value code="T1G">Lab tests - other (Medicare fee schedule)</value>
<value code="T1H">Lab tests - other (non-Medicare fee schedule)</value>
<value code="T2A">Other tests - electrocardiograms</value>
<value code="T2B">Other tests - cardiovascular stress tests</value>
<value code="T2C">Other tests - EKG monitoring</value>
<value code="T2D">Other tests - other</value>
<value code="D1A">Medical/surgical supplies</value>
<value code="D1B">Hospital beds</value>
<value code="D1C">Oxygen and supplies</value>
<value code="D1D">Wheelchairs</value>
<value code="D1E">Other DME</value>
<value code="D1F">Prosthetic/Orthotic devices</value>
<value code="D1G">Drugs Administered through DME</value>
<value code="O1A">Ambulance</value>
<value code="O1B">Chiropractic</value>
<value code="O1C">Enteral and parenteral</value>
<value code="O1D">Chemotherapy</value>
<value code="O1E">Other drugs</value>
<value code="O1F">Hearing and speech services</value>
<value code="O1G">Immunizations/Vaccinations</value>
<value code="Y1">Other - Medicare fee schedule</value>
<value code="Y2">Other - non-Medicare fee schedule</value>
<value code="Z1">Local codes</value>
<value code="Z2">Undefined codes</value>
</valueGroup>
</valueGroups>
</variable>
<variable id="CARR_CLM_BLG_NPI_NUM" label="Carrier Claim Billing NPI Number" length="10" longName="CARR_CLM_BLG_NPI_NUM" shortName="CARR_CLM_BLG_NPI_NUM" source="NCH" type="CHAR">
<description>
<p>The CMS National Provider Identifier (NPI) number assigned to the billing provider</p>
</description>
</variable>
<variable id="CARR_CLM_CASH_DDCTBL_APLD_AMT" label="Carrier Claim Cash Deductible Applied Amount (sum of all line-level deductible amounts)" length="12" longName="CARR_CLM_CASH_DDCTBL_APLD_AMT" shortName="DEDAPPLY" source="NCH" type="NUM" valueFormat="XXX.XX">
<comment>
<p>Costs to beneficiaries are described in detail on the Medicare.gov website. There is a CMS publication called "Your Medicare Benefits", which explains the deductibles.</p>
</comment>
<description>
<p>The amount of the cash deductible as submitted on the claim.</p>
<p>This variable is the beneficiary’s liability under the annual Part B deductible for all line items on the claim; it is the sum of all line-level deductible amounts. (variable called LINE_BENE_PTB_DDCTBL_AMT) The Part B deductible applies to both institutional (e.g., HOP) and non-institutional (e.g., Carrier and DME) services.</p>
</description>
</variable>
<variable id="CARR_CLM_ENTRY_CD" label="Carrier Claim Entry Code" length="1" longName="CARR_CLM_ENTRY_CD" shortName="ENTRY_CD" source="NCH" type="CHAR">
<description>
<p>Carrier-generated code describing whether the Part B claim is an original debit, full credit, or replacement debit.</p>
</description>
<valueGroups>
<valueGroup>
<value code="1">Original debit; void of original debit (If CLM_DISP_CD = 3, code 1 means voided original debit)</value>
<value code="3">Full credit</value>
<value code="5">Replacement debit</value>
<value code="9">Accrete bill history only</value>
</valueGroup>
</valueGroups>
</variable>
<variable id="CARR_CLM_HCPCS_YR_CD" label="Claim Healthcare Common Procedure Coding System (HCPCS) Year Code" length="1" longName="CARR_CLM_HCPCS_YR_CD" shortName="HCPCS_YR" source="NCH" type="CHAR">
<description>
<p>The terminal digit of the Healthcare Common Procedure Coding System (HCPCS) version used to code the claim.</p>
</description>
<valueGroups>
<valueGroup>
<value code="1">2011</value>
<value code="2">2012</value>
<value code="3">2013</value>
<value code="4">2014 etc.</value>
</valueGroup>
</valueGroups>
</variable>
<variable id="CARR_CLM_PMT_DNL_CD" label="Carrier Claim Payment Denial Code" length="2" longName="CARR_CLM_PMT_DNL_CD" shortName="PMTDNLCD" source="NCH" type="CHAR">
<comment>
<p>Effective with Version 'J', the field was expanded on the NCH record to 2 bytes, With his expansion, the NCH will no longer use the character values to represent the official two byte values sent in by NCH since 4/2002. During the Version J conversion, all character values were converted to the two byte values.</p>
<p>On 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.</p>
</comment>
<description>
<p>The code on a non-institutional claim indicating to whom payment was made or if the claim was denied.</p>
</description>
<valueGroups>
<valueGroup>
<description>
<p>Only one-byte was used until 1/2011 (currently, either 1 or 2-byte values may be used, symbols not currently allowed)</p>
</description>
<value code="0">Denied</value>
<value code="1">Physician/supplier</value>
<value code="2">Beneficiary</value>
<value code="3">Both physician/supplier and beneficiary</value>
<value code="4">Hospital (hospital based physicians)</value>
<value code="5">Both hospital and beneficiary</value>
<value code="6">Group practice prepayment plan</value>
<value code="7">Other entries (e.g. Employer, union)</value>
<value code="8">Federally funded</value>
<value code="9">PA service</value>
<value code="A">Beneficiary under limitation of liability</value>
<value code="B">Physician/supplier under limitation of liability</value>
<value code="D">Denied due to demonstration involvement</value>
<value code="E">MSP cost avoided IRS/SSA/HCFA Data Match (after 01/2001 is First Claim Development)</value>
<value code="F">MSP cost avoided HMO Rate Cell (after 1/2001 is Trauma Code Development)</value>
<value code="G">MSP cost avoided Litigation Settlement (after 1/2001 is Secondary Claims Investigation)</value>
<value code="H">MSP cost avoided Employer Voluntary Reporting (after 1/2001 is Self-Reports)</value>
<value code="J">MSP cost avoided Insurer Voluntary Reporting (eff. 7/3/00)</value>
<value code="K">MSP cost avoided Initial Enrollment Questionnaire (eff. 7/3/00)</value>
<value code="P">Physician ownership denial</value>
<value code="Q">MSP cost avoided - voluntary agreements including with employer</value>
<value code="T">MSP cost avoided - Initial Enrollment Questionnaire</value>
<value code="U">MSP cost avoided - HMO rate cell adjustment</value>
<value code="V">MSP cost avoided - litigation settlement</value>
<value code="X">MSP cost avoided – generic</value>
<value code="Y">MSP cost avoided - IRS/SSA data match</value>
<value code="00">MSP cost avoided - COB Contractor</value>
<value code="12">MSP cost avoided - BC/BS Voluntary Data Sharing Agreements (VDSA)</value>
<value code="13">MSP cost avoided - Office of Personnel Management (OPM) Data Match</value>
<value code="14">MSP cost avoided - Workman's Compensation (WC) Data Match</value>
<value code="15">MSP cost avoided - Workman's Compensation Insurer Voluntary Data Sharing Agreements (WC VDSA)</value>
<value code="16">MSP cost avoided - Liability Insurer VDSA</value>
<value code="17">MSP cost avoided - No-Fault Insurer VDSA</value>
<value code="18">MSP cost avoided - Pharmacy Benefit Manager Data Sharing Agreement</value>
<value code="21">MSP cost avoided - MIR Group Health Plan</value>
<value code="22">MSP cost avoided - MIR non-Group Health Plan</value>
<value code="25">MSP cost avoided - Recovery Audit Contractor – California</value>
<value code="26">MSP cost avoided - Recovery Audit Contractor – Florida</value>
<value code="41">MSP cost avoided - non-Group Health Plan non-Ongoing responsibility for medical (ORM)</value>
<value code="43">MSP cost avoided - Medicare Part C/Medicare Advantage</value>
</valueGroup>
<valueGroup>
<description>
<p>Prior to 2011, the following 1-byte character codes were also valid (these characters preceded use of 2-byte codes, above):</p>
</description>
<value code="!">MSP cost avoided - COB Contractor (converted to '00' 2-byte code)</value>
<value code="@">MSP cost avoided - BC/BS Voluntary Agreements (converted to '12' 2-byte code)</value>
<value code="#">MSP cost avoided - Office of Personnel Management (converted to '13' 2-byte code)</value>
<value code="$">MSP cost avoided - Workman's Compensation (WC) Datamatch (converted to '14' 2-byte code)</value>
<value code="*">MSP cost avoided - Workman's Compensation Insurer Voluntary Data Sharing Agreements (WC VDSA) (eff. 4/2006) (converted to '15' 2-byte code)</value>
<value code="(">MSP cost avoided - Liability Insurer VDSA (eff. 4/2006) (converted to '16' 2-byte code)</value>
<value code=")">MSP cost avoided - No-Fault Insurer VDSA (eff. 4/2006) (converted to '17' 2-byte code)</value>
<value code="+">MSP cost avoided - Pharmacy Benefit Manager Data Sharing Agreement (eff. 4/2006) (converted to '18' 2 -byte code)</value>
<value code="<">MSP cost avoided - MIR Group Health Plan (eff. 1/2009) (converted to '21' 2-byte code)</value>
<value code=">">MSP cost avoided - MIR non-Group Health Plan (eff. 1/2009) (converted to '22' 2-byte code)</value>
<value code="%">MSP cost avoided - Recovery Audit Contractor - California (eff. 10/2005) (converted to '25' 2-byte code)</value>
<value code="&">MSP cost avoided - Recovery Audit Contractor - Florida (eff. 10/2005) (converted to '26' 2-byte code)</value>
</valueGroup>
</valueGroups>
</variable>
<variable id="CARR_CLM_RFRNG_PIN_NUM" label="Carrier Claim Referring Provider ID Number (PIN)" length="14" longName="CARR_CLM_RFRNG_PIN_NUM" shortName="RFR_PRFL" source="NCH" type="CHAR">
<comment>
<p>CMS identifies providers using the National Provider Identifier (NPI; effective May 1, 2007), which replaces legacy numbers (UPINs, PINs, etc.) on the standard HIPPA claim transactions.</p>
</comment>
<description>
<p>The provider identification number (PIN) of the physician/supplier (assigned by the MAC) who referred the beneficiary to the physician who ordered these services.</p>
</description>
</variable>
<variable id="CARR_LINE_ANSTHSA_UNIT_CNT" label="Carrier Line Anesthesia Unit Count" length="2" longName="CARR_LINE_ANSTHSA_UNIT_CNT" shortName="CARR_LINE_ANSTHSA_UNIT_CNT" source="NCH" type="NUM">
<comment>
<p>Prior to Version 'J', this field was S9(3), Length 7.3.</p>
</comment>
<description>
<p>The base number of units assigned to the line item anesthesia procedure on the carrier claim (non-DMERC).</p>
</description>
</variable>
<variable id="CARR_LINE_CL_CHRG_AMT" label="Carrier Line Clinical Lab Charge Amount" length="12" longName="CARR_LINE_CL_CHRG_AMT" shortName="CARR_LINE_CL_CHRG_AMT" source="NCH" type="NUM" valueFormat="XXX.XX">
<description>
<p>Clinical lab charge amount on the Carrier line.</p>
</description>
</variable>
<variable id="CARR_LINE_CLIA_LAB_NUM" label="Clinical Laboratory Improvement Amendments (CLIA) monitored laboratory number" length="10" longName="CARR_LINE_CLIA_LAB_NUM" shortName="CARR_LINE_CLIA_LAB_NUM" source="NCH" type="CHAR">
<description>
<p>The identification number assigned to the clinical laboratory providing services for the line item on the carrier claim (non-DMERC).</p>
</description>
</variable>
<variable id="CARR_LINE_MTUS_CD" label="Carrier Line Miles/Time/Units/Services (MTUS) Indicator Code" length="1" longName="CARR_LINE_MTUS_CD" shortName="MTUS_IND" source="NCH" type="CHAR">
<description>
<p>Code indicating the units associated with services needing unit reporting on the line item for the carrier claim (non-DMERC).</p>
</description>
<valueGroups>
<valueGroup>
<value code="0">Values reported as zero (no allowed activities)</value>
<value code="1">Transportation (ambulance) miles</value>
<value code="2">Anesthesia time units</value>
<value code="3">Services</value>
<value code="4">Oxygen units</value>
<value code="5">Units of blood</value>
</valueGroup>
</valueGroups>
</variable>
<variable id="CARR_LINE_MTUS_CNT" label="Carrier Line Miles/Time/Units/Services (MTUS) Count" length="5" longName="CARR_LINE_MTUS_CNT" shortName="MTUS_CNT" source="NCH" type="NUM">
<comment>
<p>For anesthesia (MTUS Indicator = 2) this field should be reported in time unit intervals, i.e. 15 minute intervals or fraction thereof.</p>
</comment>
<description>
<p>The count of the total units associated with services needing unit reporting such as transportation, miles, anesthesia time units, number of services, volume of oxygen or blood units.</p>
<p>This is a line item field on the carrier claim (non-DMERC) and is used for both allowed and denied services.</p>
</description>
</variable>
<variable id="CARR_LINE_PRCNG_LCLTY_CD" label="Carrier Line Pricing Locality Code" length="2" longName="CARR_LINE_PRCNG_LCLTY_CD" shortName="LCLTY_CD" source="NCH" type="CHAR">
<description>
<p>Code denoting the carrier-specific locality used for pricing the service for this line item on the carrier claim (non-DMERC).</p>
</description>
<valueGroups>
<valueGroup>
<description>
<p>Medicare Localities There are currently 89 total PFS localities; 34 localities are statewide areas (that is, only one locality for the entire state).</p>
<p>There are 52 localities in the other 16 states, with 10 states having 2 localities, 2 states having 3 localities, 1 state having 4 localities, and 3 states having 5 or more localities.</p>
<p>The District of Columbia, Maryland, and Virginia suburbs, Puerto Rico, and the Virgin Islands are additional localities that make up the remainder of the total of 89 localities.</p>
</description>
<value code="1">ALABAMA</value>
<value code="2">ALASKA</value>
<value code="3">ARIZONA</value>
<value code="4">ARKANSAS</value>
<value code="5">ANAHEIM/SANTA ANA, CA</value>
<value code="6">LOS ANGELES, CA</value>
<value code="7">MARIN/NAPA/SOLANO, CA</value>
<value code="8">OAKLAND/BERKELEY, CA</value>
<value code="9">REST OF CALIFORNIA</value>
<value code="10">SAN FRANCISCO, CA</value>
<value code="11">SAN MATEO, CA</value>
<value code="12">SANTA CLARA, CA</value>
<value code="13">VENTURA, CA</value>
<value code="14">COLORADO</value>
<value code="15">CONNECTICUT</value>
<value code="16">DC + MD/VA SUBURBS</value>
<value code="17">DELAWARE</value>
<value code="18">FORT LAUDERDALE, FL</value>
<value code="19">MIAMI, FL</value>
<value code="20">REST OF FLORIDA</value>
<value code="21">ATLANTA, GA</value>
<value code="22">REST OF GEORGIA</value>
<value code="23">HAWAII</value>
<value code="24">IDAHO</value>
<value code="25">CHICAGO, IL</value>
<value code="26">EAST ST. LOUIS, IL</value>
<value code="27">REST OF ILLINOIS</value>
<value code="28">SUBURBAN CHICAGO, IL</value>
<value code="29">INDIANA</value>
<value code="30">IOWA</value>
<value code="31">KANSAS</value>
<value code="32">KENTUCKY</value>
<value code="33">NEW ORLEANS, LA</value>
<value code="34">REST OF LOUISIANA</value>
<value code="35">REST OF MAINE</value>
<value code="36">SOUTHERN MAINE</value>
<value code="37">BALTIMORE/SURR. CNTYS, MD</value>
<value code="38">REST OF MARYLAND</value>
<value code="39">METROPOLITAN BOSTON</value>
<value code="40">REST OF MASSACHUSETTS</value>
<value code="41">DETROIT, MI</value>
<value code="42">REST OF MICHIGAN</value>
<value code="43">MINNESOTA</value>
<value code="44">MISSISSIPPI</value>
<value code="45">METROPOLITAN KANSAS CITY, MO</value>
<value code="46">METROPOLITAN ST. LOUIS, MO</value>
<value code="47">REST OF MISSOURI</value>
<value code="48">MONTANA</value>
<value code="49">NEBRASKA</value>
<value code="50">NEVADA</value>
<value code="51">NEW HAMPSHIRE</value>
<value code="52">NORTHERN NJ</value>
<value code="53">REST OF NEW JERSEY</value>
<value code="54">NEW MEXICO</value>
<value code="55">MANHATTAN, NY</value>
<value code="56">NYC SUBURBS/LONG I., NY</value>
<value code="57">POUGHKPSIE/N NYC SUBURBS, NY</value>
<value code="58">QUEENS, NY</value>
<value code="59">REST OF NEW YORK</value>
<value code="60">NORTH CAROLINA</value>
<value code="61">NORTH DAKOTA</value>
<value code="62">OHIO</value>
<value code="63">OKLAHOMA</value>
<value code="64">PORTLAND, OR</value>
<value code="65">REST OF OREGON</value>
<value code="66">METROPOLITAN PHILADELPHIA, PA</value>
<value code="67">REST OF PENNSYLVANIA</value>
<value code="68">PUERTO RICO</value>
<value code="69">RHODE ISLAND</value>
<value code="70">SOUTH CAROLINA</value>
<value code="71">SOUTH DAKOTA</value>
<value code="72">TENNESSEE</value>
<value code="73">AUSTIN, TX</value>
<value code="74">BEAUMONT, TX</value>
<value code="75">BRAZORIA, TX</value>
<value code="76">DALLAS, TX</value>
<value code="77">FORT WORTH, TX</value>
<value code="78">GALVESTON, TX</value>
<value code="79">HOUSTON, TX</value>
<value code="80">REST OF TEXAS</value>
<value code="81">UTAH</value>
<value code="82">VERMONT</value>
<value code="83">VIRGIN ISLANDS</value>
<value code="84">VIRGINIA</value>
<value code="85">REST OF WASHINGTON</value>
<value code="86">SEATTLE (KING CNTY), WA</value>
<value code="87">WEST VIRGINIA</value>
<value code="88">WISCONSIN 89 WYOMING</value>
</valueGroup>
</valueGroups>
</variable>
<variable id="CARR_LINE_PRVDR_TYPE_CD" label="Carrier Line Provider Type Code" length="1" longName="CARR_LINE_PRVDR_TYPE_CD" shortName="PRV_TYPE" source="NCH" type="CHAR">
<description>
<p>Code identifying the type of provider furnishing the service for this line item on the carrier claim.</p>
</description>
<valueGroups>
<valueGroup>
<description>
<p>For Physician/Supplier Claims:</p>
</description>
<value code="0">Clinics, groups, associations, partnerships, or other entities</value>
<value code="1">Physicians or suppliers reporting as solo practitioners</value>
<value code="2">Suppliers (other than sole proprietorship)</value>
<value code="3">Institutional provider</value>
<value code="4">Independent laboratories</value>
<value code="5">Clinics (multiple specialties)</value>
<value code="6">Groups (single specialty)</value>
<value code="7">Other entities</value>
</valueGroup>
<valueGroup>
<description>
<p>NOTE: PRIOR TO VERSION H, DME claims also used this code; the following were valid code VALUES:</p>
</description>
<value code="0">Clinics, groups, associations, partnerships, or other entities for whom the carrier's own ID number has been assigned.</value>
<value code="1">Physicians or suppliers billing as solo practitioners for whom SSN's are shown in the physician ID code field.</value>
<value code="2">Physicians or suppliers billing as solo practitioners for whom the carrier's own physician ID code is shown.</value>
<value code="3">Suppliers (other than sole proprietorship) for whom EI numbers are used in coding the ID field.</value>
<value code="4">Suppliers (other than sole proprietorship) for whom the carrier's own code has been shown.</value>
<value code="5">Institutional providers and independent laboratories for whom EI numbers are used in coding the ID field.</value>
<value code="6">Institutional providers and independent laboratories for whom the carrier's own ID number is shown.</value>
<value code="7">Clinics, groups, associations, or partnerships for whom EI numbers are used in coding the ID field.</value>
<value code="8">Other entities for whom EI numbers are used in coding the ID field or proprietorship for whom EI numbers are used in coding the ID field.</value>
</valueGroup>
</valueGroups>
</variable>
<variable id="CARR_LINE_RDCD_PMT_PHYS_ASTN_C" label="Carrier Line Reduced Payment Physician Assistant Code" length="1" longName="CARR_LINE_RDCD_PMT_PHYS_ASTN_C" shortName="ASTNT_CD" source="NCH" type="CHAR">
<description>
<p>The code on the carrier (non-DMERC) line item that identifies the line items that have been paid a reduced fee schedule amount (65%, 75% or 85%) because a physician's assistant performed the service.</p>
</description>
<valueGroups>
<valueGroup>
<value code="BLANK">Adjustment situation (where CLM_DISP_CD equal 3)</value>
<value code="0">N/A</value>
<value code="1">65% of payment. Either physician assistants assisting in surgery or nurse midwives</value>
<value code="2">75% of payment. Either physician assistants performing services in a hospital (other than assisting surgery) or nurse practitioners/clinical nurse specialist performing services in rural areas or clinical social worker services</value>
<value code="3">85% of payment. Either physician assistant services for other than assisting surgery or other hospital services or nurse practitioners services (not in rural areas)</value>
</valueGroup>
</valueGroups>
</variable>
<variable id="CARR_NUM" label="Carrier or MAC Number" length="5" longName="CARR_NUM" shortName="CARR_NUM" source="NCH" type="CHAR">
<comment>
<p>Prior to Version H this field was named: FICARR_IDENT_NUM.</p>
</comment>
<description>
<p>The identification number assigned by CMS to a carrier authorized to process claims from a physician or supplier.</p>
<p>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.</p>
</description>
<valueGroups>
<valueGroup>
<value code="00510">Alabama - CAHABA</value>
<value code="00511">Georgia - CAHABA</value>
<value code="00512">Mississippi - CAHABA (eff. 2000)</value>
<value code="00520">Arkansas BC/BS</value>
<value code="00521">New Mexico - Arkansas BC/BS (term. 2008) (replaced by MAC #04202)</value>
<value code="00522">Oklahoma - Arkansas BC/BS (term. 2008) (replaced by MAC #04302)</value>
<value code="00523">Missouri East - Arkansas BC/BS (term. 2008) (replaced by MAC #05392)</value>
<value code="00524">Rhode Island - Arkansas BC/BS (eff. 2004)</value>
<value code="00528">Louisiana - Arkansas BS</value>
<value code="00590">Florida - First Coast</value>
<value code="00591">Connecticut - First Coast (eff. 2000)</value>
<value code="00630">Indiana - Administar</value>
<value code="00635">DMERC-B - Administar (replaced by MAC #17003)</value>
<value code="00640">Iowa - Wellmark, Inc.</value>
<value code="00645">Nebraska - Iowa BS</value>
<value code="00650">Kansas BCBS (term. 2008) (replaced by MAC #05202)</value>
<value code="00655">Nebraska - Kansas BC/BS (term. 2008) (replaced by MAC #05402)</value>
<value code="00660">Kentucky - Administar</value>
<value code="00740">Western Missouri - Kansas BS (term.2008) (replaced by MAC #05302)</value>
<value code="00751">Montana BC/BS (replaced by MAC # 03202)</value>
<value code="00801">New York - Healthnow</value>
<value code="00803">New York - Empire BS</value>
<value code="00805">New Jersey - Empire BS</value>
<value code="00811">DMERC (A) - Healthnow (eff. 2000) (replaced by MAC #16003)</value>
<value code="00820">North Dakota - Noridian (replaced by MAC #03302)</value>
<value code="00823">Utah - Noridian (eff. 12/1/2005) (replaced by MAC #03502)</value>
<value code="00824">Colorado - Noridian (term. 2008) (replaced by MAC #04102)</value>
<value code="00825">Wyoming - Noridian (replaced by MAC #03602)</value>
<value code="00826">Iowa - Noridian (term. 2008) (replaced by MAC #05102)</value>
<value code="00831">Alaska - Noridian</value>
<value code="00832">Arizona - Noridian (replaced by MAC # 03102)</value>
<value code="00833">Hawaii - Noridian</value>
<value code="00834">Nevada - Noridian</value>
<value code="00835">Oregon - Noridian</value>
<value code="00836">Washington - Noridian</value>
<value code="00865">Pennsylvania - Highmark</value>
<value code="00870">Rhode Island BS (term. 2004)</value>
<value code="00880">South Carolina - Palmetto</value>
<value code="00882">RRB - South Carolina PGBA (eff. 2000)</value>
<value code="00883">Ohio - Palmetto (eff. 2002)</value>
<value code="00884">West Virginia - Palmetto (eff. 2002)</value>
<value code="00885">DMERC C - Palmetto (replaced by MAC #18003)</value>
<value code="00889">South Dakota - Noridian (eff. 4/1/2006) (replaced by MAC # 03402)</value>
<value code="00900">Texas - Trailblazer (term. 2008) (replaced by MAC # 04402)</value>
<value code="00901">Maryland - Trailblazer</value>
<value code="00902">Delaware - Trailblazer</value>
<value code="00903">District of Columbia - Trailblazer</value>
<value code="00904">Virginia - Trailblazer (eff. 2000)</value>
<value code="00910">Utah BS</value>
<value code="00951">Wisconsin - Wisconsin Phy Svc</value>
<value code="00952">Illinois - Wisconsin Phy Svc</value>
<value code="00953">Michigan - Wisconsin Phy Svc</value>
<value code="00954">Minnesota - Wisconsin Phy Svc (eff. 2000)</value>
<value code="00973">Puerto Rico - Triple S, Inc.</value>
<value code="00974">Triple-S, Inc. - Virgin Islands</value>
<value code="02050">California - TOLIC (term. 2000)</value>
<value code="05130">Idaho - CIGNA</value>
<value code="05302">Western Missouri (eff. 3/2008)</value>
<value code="05440">Tennessee - CIGNA</value>
<value code="05535">North Carolina - CIGNA</value>
<value code="05655">DMERC-D Alaska - CIGNA (replaced by MAC #19003)</value>
<value code="10071">Railroad Board Travelers (term. 2000)</value>
<value code="10230">Connecticut - Metra Health (term. 2000)</value>
<value code="10240">Minnesota - Metra Health (term. 2000)</value>
<value code="10250">Mississippi - Metra Health (term. 2000)</value>
<value code="10490">Virginia - Metra Health (term. 2000)</value>
<value code="10555">DMERC A - Travelers Insurance Co. (term. 2000)</value>
<value code="14330">New York - GHI</value>
<value code="16360">Ohio - Nationwide Insurance Co. (term. 2002)</value>
<value code="16510">West Virginia - Nationwide Insur Co. (term. 2002)</value>
<value code="31140">N. California - National Heritage Ins.</value>
<value code="31142">Maine - National Heritage Ins.</value>
<value code="31143">Massachusetts - National Heritage Ins.</value>
<value code="31144">New Hampshire - National Heritage Ins.</value>
<value code="31145">Vermont - National Heritage Ins.</value>
<value code="31146">So. California - NHIC (eff. 2000)</value>
<value code="80884">Contractor ID for Physician Risk Adjustment Data (data not sent through NCH, but through Palmetto) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Medicare Administrative Contractors (MACs) JURISDICTION 3 -- Part B MACs</value>
<value code="03102">Arizona (eff. 12/1/06) (replaces carrier #00832)</value>
<value code="03202">Montana (eff. 12/1/06) (replaces carrier #00751)</value>
<value code="03302">N. Dakota (eff. 12/1/06) (replaces carrier #00820)</value>
<value code="03402">S. Dakota (eff. 12/1/06) (replaces carrier #00889)</value>
<value code="03502">Utah (eff. 12/1/06) (replaces carrier #00823)</value>
<value code="03602">Wyoming (eff. 12/1/06) (replaces carrier #00825) JURISDICTION 4 -- Part B MACs</value>
<value code="04102">Colorado (eff. 3/24/08) (replaces carrier #00824)</value>
<value code="04202">New Mexico (eff. 3/1/08 (replaces carrier #00521)</value>
<value code="04302">Oklahoma (eff. 3/1/08) (replaces carrier #00522)</value>
<value code="04402">Texas (eff. 6/13/08) (replaces carrier #00900) JURISDICTION 5 -- Part B MACs</value>
<value code="05102">Iowa (eff.2/1/08) (replaces carrier #00826)</value>
<value code="05202">Kansas (eff. 3/1/08) (replaces carrier #00650)</value>
<value code="05302">W. Missouri (eff. 3/1/08) (replaces carrier #00651 or 00740)</value>
<value code="05392">E. Missouri (eff. 6/1/08) (replaces carrier #00523)</value>
<value code="05402">Nebraska (eff. 3/1/08) (replaces carrier #00655) Durable Medical Equipment (DME) MACs</value>
<value code="16003">National Heritage Insur Co (NHIC) (eff. 7/1/06) (replaces carrier #00811)</value>
<value code="17003">Administar Federal, Inc. (eff. 7/1/06) (replaces carrier # 00635)</value>
<value code="18003">Palmetto GBA, LLC (eff. 6/1/07) (replaces carrier #00885)</value>
<value code="19003">Noridan Administrative Services (eff. 10/1/06) (replaces carrier #05655)</value>
</valueGroup>
</valueGroups>
</variable>
<variable id="CARRXNUM" label="Carrier Line RX Number" length="30" longName="CARR_LINE_RX_NUM" shortName="CARRXNUM" source="NCH" type="CHAR">
<comment>
<p>The prescription order number consists of: --Vendor ID Number (positions 1 - 4) --HCPCS Code (positions 5 - 9) --Vendor Controlled Prescription Number (positions 10 - 30) The Medicare Modernization Act (MMA) required CMS to implement at a competitive acquisition program (CAP) for Part B drugs and biologicals not paid on a cost or PPS basis. Physicians have a choice between buying and billing these drugs under the average sales price (ASP) or obtaining these drugs from an approved CAP vendor. The prescription number is needed to identify which claims were submitted for CAP drugs and their administration.</p>
</comment>
<description>
<p>The number used to identify the prescription order number for drugs and biologicals purchased through the competitive acquisition program (CAP).</p>
</description>
</variable>
<variable id="CARR_PRFRNG_PIN_NUM" label="Carrier Line Performing Provider ID Number (PIN)" length="15" longName="CARR_PRFRNG_PIN_NUM" shortName="PRF_PRFL" source="NCH" type="CHAR">
<comment>
<p>CMS identifies providers using the National Provider Identifier (NPI; effective May 1, 2007), which replaces legacy numbers (UPINs, PINs, etc.) on the standard HIPPA claim transactions.</p>
</comment>
<description>
<p>The provider identification number (PIN) of the physician/supplier (assigned by the Medicare Administrative Contractor [MAC]) who performed the service for this line item.</p>
</description>
</variable>
<variable id="CLAIM_QUERY_CD" label="Claim Query Code" length="1" longName="CLAIM_QUERY_CODE" shortName="QUERY_CD" source="NCH" type="CHAR">
<description>
<p>Code indicating the type of claim record being processed with respect to payment (debit/credit indicator; interim/final indicator).</p>
</description>
<valueGroups>
<valueGroup>
<value code="1">Interim bill</value>
<value code="3">Final bill</value>
<value code="5">Debit adjustment</value>
</valueGroup>
</valueGroups>
</variable>
<variable id="CLM_ADMSN_DT" label="Claim Admission Date" length="8" longName="CLM_ADMSN_DT" shortName="ADMSN_DT" source="NCH" type="DATE">
<comment>
<p>In HHA claims, this is the date the home health plan was established or last reviewed.</p>
<p>This field is not well populated in HHA until after 2011.</p>
</comment>
<description>
<p>On an institutional claim, the date the beneficiary was admitted to the hospital, skilled nursing facility, or religious non-medical health care institution. When this variable appears in the HHA claims (Short Name = HHSTRTDT), it is the date the care began for the HHA services reported on the claim.</p>
<p>The date in this variable may precede the claim from date (CLM_FROM_DT) if this claim is for a beneficiary who has been continuously under care.</p>
</description>
</variable>
<variable id="CLM_BASE_OPRTG_DRG_AMT" label="Claim Base Operating DRG Amount" length="12" longName="CLM_BASE_OPRTG_DRG_AMT" shortName="CLM_BASE_OPRTG_DRG_AMT" source="NCH" type="NUM">
<comment>
<p>This variable was new in 2011.</p>
<p>It is populated only for Inpatient claims.</p>
</comment>
<description>
<p>The amount of the wage-adjusted DRG operating payment plus the technology add-on payment.</p>
</description>
</variable>
<variable id="CLM_BENE_PD_AMT" label="Carrier Claim Beneficiary Paid Amount" length="12" longName="CLM_BENE_PD_AMT" shortName="CLM_BENE_PD_AMT" source="NCH" type="NUM" valueFormat="XXX.XX">
<description>
<p>The amount paid by the beneficiary for the non-institutional Part B (carrier, or DMERC) claim.</p>
</description>
</variable>
<variable id="CLM_BNDLD_ADJSTMT_PMT_AMT" label="Claim Bundled Adjustment Payment Amount" length="12" longName="CLM_BNDLD_ADJSTMT_PMT_AMT" shortName="CLM_BNDLD_ADJSTMT_PMT_AMT" source="NCH" type="NUM" valueFormat="XXX.XX">
<comment>
<p>The hospital must be participating in the Model 1 of the Bundled Payments for Care Improvement initiative (refer to CLM_CARE_IMPRVMT_MODEL_CD1). The percentage of the discount that this amount represents is in the field called CLM_BNDLD_MODEL_1_DSCNT_PCT.</p>
<p>This field was new in 2013, and is null/missing for all previous years.</p>
</comment>
<description>
<p>This field represents the amount the claim was reduced for those hospitals participating in Model 1 of the Bundled Payments for Care Improvement initiative (BPCI, Model 1).</p>
</description>
</variable>
<variable id="CLM_BNDLD_MODEL_1_DSCNT_PCT" label="Claim Bundled Model 1 Discount Percent" length="8" longName="CLM_BNDLD_MODEL_1_DSCNT_PCT" shortName="CLM_BNDLD_MODEL_1_DSCNT_PCT" source="NCH" type="NUM" valueFormat="X.XX">
<comment>
<p>The hospital must be participating in the Model 1 of the BPCI (refer to CLM_CARE_IMPRVMT_MODEL_CD1). The dollar amount of the payment reduction for the service is in the field called CLM_BNDLD_ADJSTMT_PMT_AMT.</p>
<p>This field was new in 2013, and is null/missing for all previous years.</p>
</comment>
<description>
<p>This field identifies the discount percentage which will be applied to payment for all participating hospitals' DRG over the lifetime of the Bundled Payments for Care Improvement initiative (BPCI, Model 1).</p>
</description>
</variable>
<variable id="CLM_CARE_IMPRVMT_MODEL_CD1" label="Claim Care Improvement Model 1 Code (bundled payment)" length="2" longName="CLM_CARE_IMPRVMT_MODEL_CD1" shortName="CLM_CARE_IMPRVMT_MODEL_CD1" source="NCH" type="CHAR" valueFormat="61 = Care Improvement Model 1 is used">
<comment>
<p>There are 4 of these Care Improvement Model fields (CLM_CARE_IMPRVMT_MODEL_CD1-CLM_CARE_IMPRVMT_MODEL_CD4).</p>
<p>This field was new in 2013, and is null/missing for all previous years.</p>
</comment>
<description>
<p>This code is used to identify that the care improvement model 1 is being used for bundling payments. The initiative if referred to as the Bundled Payments for Care Improvement initiative (BPCI, Model 1).</p>
</description>
</variable>
<variable id="CLM_CARE_IMPRVMT_MODEL_CD2" label="Claim Care Improvement Model 2 Code" length="2" longName="CLM_CARE_IMPRVMT_MODEL_CD2" shortName="CLM_CARE_IMPRVMT_MODEL_CD2" source="NCH" type="CHAR" valueFormat="62 = Care Improvement Model 2 is used">
<comment>
<p>There are 4 of these Care Improvement Model fields (CLM_CARE_IMPRVMT_MODEL_CD1-CLM_CARE_IMPRVMT_MODEL_CD4).</p>
<p>This field was new in 2013, and is null/missing for all previous years.</p>
</comment>
<description>
<p>This code is used to identify that the care improvement model 2 is being used for payments.</p>
</description>
</variable>
<variable id="CLM_CARE_IMPRVMT_MODEL_CD3" label="Claim Care Improvement Model 3 Code" length="2" longName="CLM_CARE_IMPRVMT_MODEL_CD3" shortName="CLM_CARE_IMPRVMT_MODEL_CD3" source="NCH" type="CHAR" valueFormat="63 = Care Improvement Model 3 is used">
<comment>
<p>There are 4 of these Care Improvement Model fields (CLM_CARE_IMPRVMT_MODEL_CD1-CLM_CARE_IMPRVMT_MODEL_CD4).</p>
<p>This field was new in 2013, and is null/missing for all previous years.</p>
</comment>
<description>
<p>This code is used to identify that the care improvement model 3 is being used for payments.</p>
</description>
</variable>
<variable id="CLM_CARE_IMPRVMT_MODEL_CD4" label="Claim Care Improvement Model 4 Code" length="2" longName="CLM_CARE_IMPRVMT_MODEL_CD4" shortName="CLM_CARE_IMPRVMT_MODEL_CD4" source="NCH" type="CHAR" valueFormat="64 = Care Improvement Model 4 is used">
<comment>
<p>There are 4 of these Care Improvement Model fields (CLM_CARE_IMPRVMT_MODEL_CD1-CLM_CARE_IMPRVMT_MODEL_CD4).</p>
<p>This field was new in 2013, and is null/missing for all previous years.</p>
</comment>
<description>
<p>This code is used to identify that the care improvement model 4 is being used for payments.</p>
</description>
</variable>
<variable id="CLM_CLNCL_TRIL_NUM" label="Clinical Trial Number" length="8" longName="CLM_CLNCL_TRIL_NUM" shortName="CCLTRNUM" source="NCH" type="CHAR">
<comment>
<p>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.</p>
<p>Effective September 1, 2008 with the implementation of CR#3.</p>
</comment>
<description>
<p>The number used to identify all items and line item services provided to a beneficiary during their participation in a clinical trial.</p>
</description>
</variable>
<variable id="CLM_DISP_CD" label="Claim Disposition Code" length="2" longName="CLM_DISP_CD" shortName="DISP_CD" source="NCH" type="CHAR" valueFormat="01 = Debit accepted">
<description>
<p>Code indicating the disposition or outcome of the processing of the claim record.</p>
<p>In the source CMS National Claims History (NCH), claims are transactional records and several iterations of the claim may exist (e.g., original claim, an edited/updated version -which also cancels the original claim, etc.).</p>
<p>The final reconciled version of the claim is contained in CCW-produced data files, unless otherwise requested. For final claims (at least those that are final at the time of the data file), this value will always be '01'.</p>
</description>
</variable>
<variable id="CLM_DRG_CD" label="Claim Diagnosis Related Group Code (or MS-DRG Code)" length="3" longName="CLM_DRG_CD" shortName="DRG_CD" source="NCH" type="CHAR">
<comment>
<p>GROUPER is the software that determines the DRG from data elements reported by the hospital.</p>
<p>Once determined, the DRG code is one of the elements used to determine the price upon which to base the reimbursement to the hospitals under prospective payment.</p>
<p>Nonpayment claims (zero reimbursement) may not have a DRG present.</p>
</comment>
<description>
<p>The diagnostic related group to which a hospital claim belongs for prospective payment purposes.</p>
</description>
</variable>
<variable id="CLM_DRG_OUTLIER_STAY_CD" label="Claim Diagnosis Related Group Outlier Stay Code" length="1" longName="CLM_DRG_OUTLIER_STAY_CD" shortName="OUTLR_CD" source="NCH" type="CHAR">
<description>