This variable indicates whether a beneficiary met the Chronic Condition Data Warehouse (CCW) criteria for breast cancer (female or male) on July 1 of the specified reference period.
The CCW’s chronic condition flags require beneficiaries to satisfy both claims criteria (a minimum number/type of claims that have the proper diagnosis codes and occurred within a specified time period) and coverage criteria (FFS Part A and Part B coverage during the entire specified time period).
For breast cancer, beneficiaries must have at least one inpatient or SNF claim, or two Part B (institutional or non-institutional) claims that are at least one day apart with a breast cancer code in any position during the 1-year reference period. When 2 claims are required, they must occur at least one day apart.
The CCW’s criteria were developed after reviewing validated algorithms from the research literature and criteria used by other federal data sources. You can find more detailed information on the criteria on the CCW website: https://www.ccwdata.org/web/guest/condition-categories
Source: CCW (derived)
From CY 2017 to CY 2021, the MBSF: Chronic Conditions segment also has a newer (CC30) version. Mid-year indicators are not available in the CC30 version.
|0||Beneficiary did not meet claims criteria or have sufficient fee-for-service (FFS)
|1||Beneficiary met claims criteria but did not have sufficient FFS coverage|
|2||Beneficiary did not meet claims criteria but had sufficient FFS coverage|
|3||Beneficiary met claims criteria and had sufficient FFS coverage|