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This variable is contained in the following files:
SAS Name
CANCER_BREAST
This variable indicates whether a beneficiary met the Chronic Conditions Warehouse (CCW) criteria for breast cancer (female or male) as of the end of the calendar year.
ResDAC Comments
From CY 2017 to CY 2021, the MBSF: Chronic Conditions segment also has a previous (CC27) version. The algorithm used to create the Breast Cancer End-of-Year Indicator variable in the CC27 version includes fewer DX codes and a reduced reference period.
| Code | Code value |
|---|---|
| 0 | Beneficiary did not meet claims criteria or have sufficient fee-for-service (FFS) coverage |
| 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 |
The CCW’s chronic condition indicator variables 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 skilled nursing facility (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 two-year reference period.
You can find more detailed information on the algorithm criteria on the CCW website: https://www.ccwdata.org/web/guest/condition-categories-chronic
Source: CCW (derived)