Opioid-Related Hospitalization or ED - Medicare Only Claims

SAS Name

This variable indicates whether a beneficiary met the criteria for Opioid-Related Hospitalization or emergency department (ED) visits as of the end of the calendar year.


The condition variable requires beneficiaries to satisfy both claims criteria (a minimum number/type of Medicare claims that have the proper diagnosis codes and occurred within a specified time period) and coverage criteria (Medicare FFS Part A and Part B coverage during the entire specified time period).

For opioid-related hospitalization or ED visits, beneficiaries must have at least one Medicare inpatient claim or one emergency department claim with a related code in any position during the 2-year reference period.

You can find more detailed information on the criteria on the CCW website: https://www.ccwdata.org/web/guest/condition-categories

Source: CCW (derived)

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