Other Procedures Medicare Payments

SAS Name
OPROC_MDCR_PMT

This variable is the total Medicare payments for services considered part B other procedures (i.e., not anesthesia or dialysis) for a given year. Claims for other procedures are a subset of the claims, and a subset of procedures in the Part B Carrier data file.

These other procedure claims are defined as those with a line BETOS code (BETOS_CD) where the first 2 digits are ('P1','P2','P3','P4','P5','P6','P7', or 'P8').

The total Medicare payments are calculated as the sum of LINE_NCH_PMT_AMT where the LINE_PRCSG_IND_CD was ('A','R', or 'S') - for all relevant lines.

Comments

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)