This variable indicates whether a beneficiary met the condition criteria for spinal cord injury 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 spinal cord injury, beneficiaries must have at least one Medicare inpatient claim or two other non-drug claims of any service type with a related code in any position during the 2-year reference period. When 2 claims are required, they must occur at least one day apart.
You can find more detailed information on the criteria on the CCW website: https://www.ccwdata.org/web/guest/condition-categories
Source: CCW (derived)
|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|