Evaluation and Management Primary Payer Amount

SAS Name

This variable indicates the total amount paid for evaluation and management (E&M) services by a primary payer other than Medicare for a given year. E & M claims are a subset of the claims in the Part B Carrier and DME data files, and a subset of physician claims.

The E & M claims are defined as those with a line BETOS code (BETOS_CD) where the first digit ='M' (but is not M1A or M1B – which are categorized as physician office care in this file – see PHYS_MDCR_PMT). The total Primary Payer Payments are calculated as the sum of the LINE_BENE_PRMRY_PYR_PD_AMT.


There are 11 cost/use categories from the Carrier Part B and DME data files – the ASC, Anesthesia, Part B Drug, Physician, E & M, dialysis, imaging, tests, other procedures, DME and other carrier claims.

Source: CCW (derived)