Submission clarification code

SAS Name

For beneficiaries living in long-term care (LTC) facilities, this variable indicates how many days’ supply of the medication was dispensed by the long-term care pharmacy and provides some details about the dispensing event.  

This variable is only populated when beneficiary lives in an LTC facility (i.e., when the PTNT_RSDNC_CD variable equals 03).  

Code Code value
00 (Unknown value – rarely populated)
05 Therapy change. Physician determined that a change in therapy was required – either the medication was used faster than expected, or a different dosage form is needed.
07 Emergency supply of non-formulary drugs (or formulary drugs which typically require step therapy or prior authorization). Medication has been determined by the physician to be medically necessary.
08 Process compound for approved ingredients
14 LTC leave of absence – short fill required for take-home use
16 LTC emergency box (e box) /automated dispensing machine
17 LTC emergency supply remainder (remainder of drug from the emergency supply)
18 LTC patient admit/readmission indicator. This status required new dispensing of medication.
19 Split billing. The quantity dispensed is the remainder billed to a subsequent payer after Medicare Part A benefits expired (partial payment under Part A).
21 LTC dispensing rule for <=14 day supply is not applicable due to CMS exclusion or the fact that the manufacturer’s packaging does not allow for special dispensing
22 LTC dispensing, 7-day supply