Acute Inpatient Medicare Payments

SAS Name

This variable is the sum of the Medicare claim payment amounts (CLM_PMT_AMT from each claim) in the acute inpatient hospital setting for a given year. To obtain the total acute hospital Medicare payments, take this variable and add in the annual per diem payment amount (ACUTE_MDCR_PMT + ACUTE_PERDIEM_AMT).


Acute inpatient hospital claims are a subset of the claims in the IP data file consisting of data from both acute hospitals and critical access hospitals (CAH). These facilities are those where either the 3rd digit of the provider number (SAS variable PRVDR_NUM) = 0 or the 3rd and 4th digits of PRVDR_NUM = 13.

ACUTE_PERDIEM_PMT must be added to this field to obtain the total acute hospital Medicare payments for the year. The annual per diem variable was new in 2010; it will always be null/missing in earlier files.

There are 2 cost/use categories from the IP data files: Acute and the OIP.

Medicare payments are described in detail in a series of Medicare Payment Advisory Commission (MedPAC) documents called “Payment Basics” (see:

Also in the Medicare Learning Network (MLN) “Payment System Fact Sheet Series” (see the list of MLN publications at: Publications.html)

Source: CCW (derived)