Search Data Variables

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).

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).

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).

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).

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). 

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).

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).

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

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

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

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.

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.

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF FEE-FOR-SERVICE CLAIMS FOR THE RECIPIENT DURING THE CALENDAR YEAR FOR THIS TYPE OF SERVICE. THIS DATA ELEMENT IS REPORTEDFOR ALL TYPES OF SERVICE, EXCEPT TOS = 20, 21, 22, AND 23.

(SAS USERS: ZONED DECIMAL - ZD5)

The diagnosis code identifying the beneficiary's principal diagnosis. 

The present on admission (POA) indicator code associated with the diagnosis codes (principal and secondary).   

In response to the Deficit Reduction Act of 2005, CMS began to distinguish between hospitalization diagnoses that occurred prior to versus during the admission.  The objective was to eventually not pay hospitals more if the patient acquired a condition (e.g., infection) during the admission.   

This present on admission (POA) field is used to indicate whether the 1st diagnosis was present on admission.   

Effective with Version 'J', the code used to indicate if the diagnosis code is ICD-9/ICD-10.

The diagnosis code in the 10th position identifying the condition(s) for which the beneficiary is receiving care.

The present on admission (POA) indicator code associated with the diagnosis codes (principal and secondary).   

In response to the Deficit Reduction Act of 2005, CMS began to distinguish between hospitalization diagnoses that occurred prior to versus during the admission.  The objective was to eventually not pay hospitals more if the patient acquired a condition (e.g., infection) during the admission.   

This present on admission (POA) field is used to indicate whether the 10th diagnosis was present on admission. 

Effective with Version 'J', the code used to indicate if the diagnosis code is ICD-9/ICD-10.

The diagnosis code in the 11th position identifying the condition(s) for which the beneficiary is receiving care.