Part B Physician Beneficiary Payments

SAS Name

This variable is the sum of coinsurance and deductible payments for the part B physician office services (PHYS) for a given year. The total Beneficiary payments are calculated as the sum of LINE_COINSRNC_AMT + LINE_BENE_PTB_DDCTBL_AMT for the relevant lines.

Physician office claims are a subset of the claims in the Part B Carrier and DME data files, and a subset of physician evaluation and management claims (note that E&M are tabulated separately in this data file). The PHYS claims are defined as those with a line BETOS code (BETOS_CD) where the first three digits =M1A or M1B (the remainder of physician services which occur in different settings appear in EM_MDCR_PMT).


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)