Search Data Variables

Chronic Obstructive Pulmonary Disease End-of-Year Indicator

This variable indicates whether a beneficiary met the Chronic Condition Data Warehouse (CCW) criteria for chronic obstructive pulmonary disease (COPD) and bronchiectasis as of the end of the calendar year.

Chronic Obstructive Pulmonary Disease Indicator - Combined Data

This code specifies whether the enrollee met the chronic condition algorithm criteria, considering both Medicare and Medicaid data, for having Chronic Obstructive Pulmonary Disease.

Chronic Obstructive Pulmonary Disease Indicator - Medicaid-Only Data

This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicaid data, for having Chronic Obstructive Pulmonary Disease.

Chronic Obstructive Pulmonary Disease Indicator - Medicare-Only Data

This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicare data, for having Chronic Obstructive Pulmonary Disease.

Chronic Obstructive Pulmonary Disease Mid-Year Indicator

This variable indicates whether a beneficiary met the Chronic Condition Data Warehouse (CCW) criteria for chronic obstructive pulmonary disease (COPD) and bronchiectasis on July 1 of the specified reference period.

Chronic Pain, Fatigue, and Fibromyalgia - Combined Medicare & Medicaid Claims

This code specifies whether the enrollee met the chronic condition algorithm criteria, considering both Medicare and Medicaid data, for having Chronic Pain, Fatigue, and Fibromyalgia.

Chronic Pain, Fatigue, and Fibromyalgia - Medicaid Only Claims

This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicaid data, for having Chronic Pain, Fatigue, and Fibromyalgia.

Chronic Pain, Fatigue, and Fibromyalgia - Medicare Only Claims

This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicare data, for having Chronic Pain, Fatigue, and Fibromyalgia.

CKD_COMBINED

Chronic Kidney Disease - Combined Medicare & Medicaid Claims

CKD_COMBINED_EVER

Chronic Kidney Disease - Combined Medicare & Medicaid Claims, First Ever Occurrence Date

CKD_MEDICAID

Chronic Kidney Disease - Medicaid Only Claims

CKD_MEDICAID_EVER

Chronic Kidney Disease - Medicaid Only Claims, First Ever Occurrence Date

CKD_MEDICARE

Chronic Kidney Disease - Medicare Only Claims

CKD_MEDICARE_EVER

Chronic Kidney Disease - Medicare Only Claims, First Ever Occurrence Date

Claim (Medicare) Payment Amount

The Medicare claim payment amount.

For hospital services, this amount does not include the claim pass-through per diem payments made by Medicare. To obtain the total amount paid by Medicare for the claim, the pass-through amount (which is the daily per diem amount) must be multiplied by the number of Medicare-covered days (i.e., multiply the CLM_PASS_THRU_PER_DIEM_AMT by the CLM_UTLZTN_DAY_CNT), and then added to the claim payment amount (this field).

For non-hospital services (SNF, home health, hospice, and hospital outpatient) and for other non-institutional services (Carrier and DME), this variable equals the total actual Medicare payment amount, and pass-through amounts do not apply.

For Part B non-institutional services (Carrier and DME), this variable equals the sum of all the line item-level Medicare payments (variable called the LINE_NCH_PMT_AMT).

Claim Accountable Care Organization (ACO) Identification Number

The field identifies the Accountable Care Organization (ACO) Identification Number.

Claim Adjustment Code

Code indicating the type of adjustment record.

Claim Adjustment Group Code

Claim adjustment group code used to categorize a payment adjustment for a claim or claim line. This field is currently only populated for Direct Contracting (DC), Comprehensive Kidney Care Contracting (CKCC) and Kidney Care First (KCF) model claims.

Claim Adjustment Reason Code

Claim Adjustment Reason Code used to describe why a claim or claim line was paid differently than billed. This field is currently only populated for Direct Contracting (DC), Comprehensive Kidney Care Contracting (CKCC) and Kidney Care First (KCF) model claims.

This is not a comprehensive list of values; refer to website below for current values and descriptions:

Claim Admission Date (Encounter)

On an institutional claim, the date the beneficiary was admitted to the hospital, skilled nursing facility, or religious non- medical health care institution.

For home health services, this is the date care started for the HH services reported on the encounter record.

Claim Admission Date (FFS)

On an institutional claim, the date the beneficiary was admitted to the hospital, skilled nursing facility, or religious non-medical health care institution, and starting October 2023 this field is added to reflect the admission date for hospice or to a home health agency (HHA).

Claim Admitting Diagnosis Code (Encounter)

A diagnosis code on the institutional encounter indicating the beneficiary's initial diagnosis at admission.

This diagnosis code may not be confirmed after the patient is evaluated; it may be different than the eventual diagnoses (e.g., as in PRNCPAL_DGNS_CD or ICD_DGNS_CD1-25).

Claim Admitting Diagnosis Code (FFS)

A diagnosis code on the institutional claim indicating the beneficiary's initial diagnosis at admission.

This diagnosis code may not be confirmed after the patient is evaluated; it may be different than the eventual diagnoses (e.g., as in PRNCPAL_DGNS_CD or ICD_DGNS_CD1-25).

Claim Attending Physician NPI Number (Encounter)

On an institutional claim, the national provider identifier (NPI) number assigned to uniquely identify the physician who has overall responsibility for the beneficiary's care and treatment.

Claim Attending Physician NPI Number (FFS)

On an institutional claim, the national provider identifier (NPI) number assigned to uniquely identify the physician who has overall responsibility for the beneficiary's care and treatment.

NPIs replaced UPINs as the standard provider identifiers beginning in 2007. The UPIN is almost never populated after 2009.

Claim Attending Physician Specialty Code

This variable is the code used to identify the CMS specialty code corresponding to the attending physician.

Claim Attending Physician Taxonomy Code

The health care provider taxonomy (HCPT) code used to indicate the attending provider's specialty. This is a unique identifier for a classification of health care specialty at a specialized level of defined medical activity within a medical field as created by the National Uniform Claim Committee (NUCC).

Claim Attending Physician UPIN Number

On an institutional claim, the unique physician identification number (UPIN) of the physician who would normally be expected to certify and recertify the medical necessity of the services rendered and/or who has primary responsibility for the beneficiary's medical care and treatment (attending physician).

NPIs replaced UPINs as the standard provider identifiers beginning in 2007. The UPIN is almost never populated after 2009.

Claim Base Operating DRG Amount

The amount of the wage-adjusted DRG operating payment plus the technology add-on payment.

Claim Beginning Date of Service

The date the service covered by this claim began. For capitation premium payments, the date on which the period of coverage related to this payment began.

Claim Beneficiary Identifier Type Code

This field identifies whether the claim was submitted by the provider, during the transition period, with a HICN or MBI (For CMS Internal Use).

Claim Billing Provider Secondary Specialty Code 1

The CMS secondary specialty code(s) assigned to the billing provider’s National Provider Identifier (NPI). These specialty codes apply to the carrier claim billing NPI number (CARR_CLM_BLG_NPI_NUM).

Claim Billing Provider Secondary Specialty Code 2

Claim Billing Provider Secondary Specialty Code 3

Claim Billing Provider Taxonomy Code

The taxonomy code assigned to the billing provider’s National Provider Identifier (NPI). A taxonomy code is a unique 10-character code that assigns a provider's classification and specialization. Providers use this code when applying for a National Provider Identifier (NPI).This taxonomy code applies to the carrier claim billing NPI number (CARR_CLM_BLG_NPI_NUM).

Claim Bundled Adjustment Payment Amount

This field represents the amount the claim was reduced for those hospitals participating in Model 1 of the Bundled Payments for Care Improvement initiative (BPCI, Model 1).

Claim Bundled Model 1 Discount Percent

This field identifies the discount percentage which will be applied to payment for all participating hospitals' DRG over the lifetime of the Bundled Payments for Care Improvement initiative (BPCI, Model 1).

Claim Care Improvement Model 1 Code (bundled payment)

This code is used to identify that the care improvement model 1 is being used for bundling payments. The initiative if referred to as the Bundled Payments for Care Improvement initiative (BPCI, Model 1).

Claim Care Improvement Model 2 Code

This code is used to identify that the care improvement model 2 is being used for payments.

Claim Care Improvement Model 3 Code

This code is used to identify that the care improvement model 3 is being used for payments.

Claim Care Improvement Model 4 Code

This code is used to identify that the care improvement model 4 is being used for payments.

Claim Chart Review Switch

This variable is used to indicate whether the encounter record is a chart review record. Chart reviews are a type of encounter data record that allow Medicare Advantage Organizations (MAOs) to add or remove diagnoses that they identified through medical record reviews that were not initially reported on encounter data records.

Claim Control Number

The claim control number is an identifier assigned by the processing system (i.e., the Encounter Data System Contractor) to a claim.

This is the field that, in combination with the original claim control number, identifies a unique version of a service record.

Claim count (MAX TOS 01)