Data Dictionary for CJR Baseline, Monthly, Target Price, and Reconciliation Reports

Introduction

Acronyms
Key Terms
A Note About Episode IDs and Patient Identifiers
A Note About Dollar Values
The CSV File Format

Description of Data Dictionary Tables

Data Types

Data Dictionary For Each File

ACO Program overlap for beneficiaries within CJR episodes.
BDUAL Dual eligibility for beneficiaries within CJR episodes.
BPCIEXCL BPCI episodes that overlap with CJR episodes.
BXREF Beneficiary ID cross-reference.
CURRPRC Hospital-specific CJR target prices for episodes with anchor stays beginning April 1, 2016 to September 30, 2016 by DRG and fracture code.
DENOM Enrollment information for beneficiaries within CJR episodes.
DMDTL Details of durable medical equipment claims.
DMHDR Episode header (summary) information for durable medical equipment (DME) claims.
DXPX Diagnosis and procedure codes for claims and line items.
EPI Episode summaries for each CJR episode.
EPIEXC Summaries of episodes excluded from CJR.
HHDTL Details of home health care claims.
HHHDR Episode header (summary) information for home health care claims.
HOSP_RECON_SUM Quality-adjusted target prices and episode totals.
HSHDR Header (summary) information for hospice claims.
IPDTL Details of inpatient claims.
IPHDR Episode header (summary) information for inpatient claims.
IPVAL Value codes and amounts for inpatient claims.
NCBP Episode non-claims-based payment information.
OPDTL Details of outpatient claims.
OPHDR Episode header (summary) information for outpatient claims.
PBDTL Details of Carrier and Part-B claims.
PBHDR Episode header (summary) information for Carrier and Part-B claims.
QM Quality measures used to adjust target prices.
RECON_AMT Reconciliation payment amounts.
REGION# Region-specific descriptive statistics of CJR episodes.
SNDTL Details of skilled nursing claims.
SNHDR Episode header (summary) information for skilled nursing claims.
SUM Hospital-specific descriptive statistics of CJR episodes.
TP Hospital-specific CJR target prices by DRG and fracture code.

Code Value Reference

Introduction

This data dictionary describes columns present in the target price, summary, and beneficiary files that are regularly distributed to hospitals participating in the CMS Comprehensive Care for Joint Replacement (CJR) model. Each table in this file describes columns present in one of the files contained in the zip file distributed to participating CJR hospitals.

Please note that, because participating hospitals can choose which reports to receive, some of the files listed here may not be included in each hospital's zip file.

Acronyms

Below is a list of acronyms used in the specification or “spec” PDF files which are found in the README folder.

Acronym	Definition
ACO	Accountable Care Organization
BPCI	Bundled Payments for Care Improvement
CARR	Carrier
CMMI	Center for Medicare & Medicaid Innovation
CCN	CMS Certification Number
CJR	Comprehensive Care for Joint Replacement
CAH	Critical Access Hospital
DRG or MS-DRG	Diagnosis-Related Group
DM or DME	Durable Medical Equipment
ESRD	End-Stage Renal Disease
FFS	Fee-for-Service
FY	Fiscal Year
HH or HHA	Home Health
HHRG	Home Health Resource Group
HS or HSP	Hospice
IP	Inpatient
IPPS	Inpatient Prospective Payment System
IPF	Inpatient Psychiatric Facility
IRF	Inpatient Rehabilitation Facility
IDR	Integrated Data Repository
ICD	International Classification of Diseases
LOS	Length of Stay
LTCH	Long-Term Care Hospital
LEJR	Lower-Extremity Joint Replacement
MCO	Managed Care Organization
MEI	Medicare Economic Index
MSA	Metropolitan Statistical Area
NCBP	Non-claims based payments
OP	Outpatient
OPPS	Outpatient Prospective Payment System
PB	Part B
RUG	Resource Utilization Group
SN or SNF	Skilled Nursing Facility
SAMHSA	Substance Abuse and Mental Health Services Administration
UMWA	United Mine Workers of America

Key Terms

Below is a list of key terms used in the specification or “spec” PDF files which are found in the README folder.

Key Terms	Definition
Accountable care organization	Group of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve.
Acute care hospitalization	Medicare inpatient stay at hospitals paid under IPPS with the last 4 digits of CCNs between 0001-0899, and where the first two digits are not for Maryland.
Anchor stay	Acute hospitalization for LEJR procedure that begins an episode. The anchor stay spans the admission date to discharge date for the LEJR hospitalization. It excludes transfers to acute hospitals that are immediately after the initial stay with one exception: when the transfer precedes a LEJR procedure. In that case, the latest LEJR stay on record is the anchor stay.
Anchor factor	Translates pooled target prices to MS-DRG/fracture status target prices. Defined at the national level, based on episodes attributed to any CJR eligible hospital.
Anchor weight	Translates a hospital or region’s unweighted episode mean to the pooled, historical mean (see pooled episode payments definition below). Defined at the hospital and regional level.
Baseline period	Three year period during which time occurs the last day of the episodes whose claims data are used to calculate the episode target prices. Synonymous with historical period.
Blending	Process of combining hospital and regional payments in the baseline period.
CJR regional hospitals	Acute care hospitals paid under IPPS (with last 4 digits of CCN between 0001-0899) in CJR regions. Note: Acute care hospitals participating in BPCI Models 1, 2, or 4 are included in this definition, as well as hospitals where an anchor hospitalization for a Model 2 or Model 3 physician group practice or post-acute care provider BPCI episode occurred.
CJR regions	Nine groups of states (and the District of Columbia) based on U.S. Census Divisions that are used to determine target prices. See REGION# for values.
Clinical episode	Corresponds to a LEJR episode in the context of the CJR model. Note that this terms is rarely used in CJR documentation.
CJR Model	CMMI episode payment model that bundles LEJR procedure claims into an episode payment to the relevant hospital.
Discount percentage	The amount of reduction applied to baseline prices in order to establish target prices. Note that hospitals may experience a different discount percentage at reconciliation due to changes their composite quality score.
Episode	Period of time that begins with an acute hospitalization assigned MS-DRG 469 or 470 and ends 89 days after the hospitalization discharge date.
Episode initiator	Acute care hospital in one of the CJR MSAs where an anchor stay for an LEJR procedure takes place. Note that it must not be participating in the BPCI model.
Episode payment	Total standardized Medicare Part A and B spending for included services during a CJR episode.
Fracture status	Whether or not anchor stays have an ICD-9-CM or ICD-10-CM diagnosis code for hip fracture in the principal position on the inpatient claim. The diagnosis codes that identify fracture cases are listed in the tracking system.
National growth factor	“Trends” or adjusts episode payments in the first two years of the baseline period to align with the final year of the baseline period.
High-cost outlier	Episode whose total spending is more than two standard deviations above the mean for the same combination of region, MS-DRG, and fracture status.
Historical period	Synonymous with baseline period (see above).
LEJR episode	Synonymous with episode (see above).
Performance year	Year in which the CJR model payment reconciliation occurs. Performance years for the model correspond to calendar years with the exception of performance year 1, which is April 1, 2016 through December 31, 2016.
Pooled episode payments	The sum of all capped trended episode payments at a hospital divided by the number of episodes that occurred. Note that the total includes all MS-DRG and fracture status combinations.
Post-discharge period	90 days after the anchor stay (including the discharge date).
Sequestration	2% reduction of all Medicare Part A and B claims and line items on or after 4/1/2013.
Standardized payment	Medicare Part A and B claim or line item payment amount that has had geographic wage differences and incentive payments removed via the CMS Standardization Method (available on the IDR).
Target price	Amount of reimbursement for an episode payment that is based on a blend of standardized payments at the hospital and in the region during the historical period. A separate price is calculated for each DRG-fracture combination. They are updated at least twice a year to account for payment system updates.
Trending	Process of inflating dollars to align with the last year of the baseline period. Note: this works differently than in BPCI, where trending moves payments to the performance period dollars.
Update factor	Inflates baseline prices for a specific service to a particular performance year. Update factors are created for six types of service: inpatient acute services, physician, IRF, SNF, HHA, and other.
Volume threshold	Number of episodes which hospitals must record in order to have a hospital-specific pricing component. Hospitals with fewer than 20 CJR episodes in the baseline period will use the regional-only target prices for that performance year.
Wage factor	Variable used to convert standardized dollars to real dollars. It is defined in the CJR final rule as an average of the hospital’s wage index from the IPPS impact file.

A Note About Episode IDs and Patient Identifiers

The variable labeled EPI_ID acts as a key to uniquely identify CJR episodes. As of January 2017, the structure of the EPI_ID variable is changing to an 18-digit alphanumeric field. The first two digits indicate the model (CJR is code 75), and the final 16 digits are a randomly-assigned hexidecimal number. Beginning with the January 2017 data update, the EPI_ID value will consistently identify the same episode in all future data files (i.e., EPI_ID will uniquely identify CJR episodes both within the same update of data files and across future updates). To link episodes from the January 2017 data update onward to those from the previously delivered files, use the intersection of the three variables BENE_SK, ANCHOR_BEG_DT, and CCN as a unique key.

Due to the transition to the Medicare Beneficiary ID (MBI), the BENE_HIC_NUM and CLM_HIC_NUM were removed from all files other than the episode and episode exclusion files as of August 2018.

A Note About Dollar Values

Dollar values listed in these files are either "raw dollars," meaning actual dollar amounts paid or collected, or "standardized dollars," meaning dollar amounts that exclude geographic and other localized payment adjustments. The first category describes the so-called "allowed payments," which are actual payments on Medicare including copays, deductibles, and amounts paid by secondary payers.

Any variable within these files that represents dollar amounts will have in its description whether the values are in "raw dollars" or "standardized dollars."

The CSV File Format

The files are in comma-separated value (CSV) format, though not all are named with a ".CSV" extension to the file name. Each CSV file is a plain-text, ASCII-formatted (using Windows codepage 1252) file which represents a structured table of data. They can be read natively by many data-analysis programs and spreadsheet applications (for example, Microsoft Excel). The remainder of this section is dedicated to describing the specifics of the CSV file format used for the distributed data. This section can be skipped unless the details of the file format are needed to write a custom file reader for analysis purposes.

Each line of a CSV file represents one row of the table, and is terminated by a carriage-return and line feed character combination (ASCII character codes 13 "carriage return" and 10 "line feed", respectively). Rows are separated into columns by comma characters (ASCII character code 44 "comma"). Whitespace before and after the column-separating comma characters are ignored, but whitespace characters present between non-whitespace characters within a value are not ignored.

In rare cases when a value within the table contains a comma character (for instance, the name of a hospital), the entire value will be enclosed in quotation marks (ASCII character code 34 "quotation mark") which are not to be construed as a part of the value. In rare cases when a value within the table contains a quotation mark character or backslash character (ASCII character codes 34 "quotation mark" and 92 "reverse solidus", respectively), these characters will be preceeded by a backslash character. The initial backslash character is not to be construed as part of the value.

The first line of every file lists the names of the columns of the table, and should not be interpreted as data. All values within the file are represented as ASCII text.

The following text is an example of a CSV-formatted file demonstrating some of the possible values that could be encountered when reading a CSV file:

        Column A,Column B,Column C
        123,text data,"quoted text data"
        456,"text, with comma",text with \"quote\" characters and \\backslash
        789,,   text with    whitespace

This CSV file represents the following example table:

An example data table
Column A	Column B	Column C
123	text data	quoted text data
456	text, with comma	text with "quote" characters and \backslash
789		text with whitespace

The CSV file format allows for values to be empty or missing, as the example demonstrates in Column B of the third row of the table.

Description of Data Dictionary Tables

The tables below describe the variables that are included in each file. The columns in these tables are:

Header Name

The name of the variable as it appears in the distributed file. The first line of each CSV file should be a comma-separated list of these header names.

Description

A brief text description of the variable's meaning or purpose.

Data Type

How the values of this variable should be interpreted. We define only five data types, described below.

IDR Header Name

If the variable can be directly connected to a variable in the CMS integrated data repository (IDR), then the name of that variable is given in this column. Variables that cannot be directly linked to an IDR variable are labeled with a single dash ("-"). Some distributed files do not contain any IDR variables--to simplify the dictionary, tables that do not contain and IDR Header Name column.

Report Types

This column indicates in which file(s) a given variable appears: a baseline file (B, B12, B34), a monthly data distribution file (M), and/or a reconciliation file (R). Note on baseline files:

"B" indicates that a variable is available in both the PY1/PY2 and PY3/PY4 baseline files.
"B12" indicates that a variable is only available in a PY1/PY2 baseline file.
"B34" indicates that a variable is only available in a PY3/PY4 baseline file.

For example:

A value of "M R" in this column means the variable is present in monthly and reconciliation files (not in baseline files).
A value of "B M R" means the variable is present in monthly and reconciliation files, as well as both the PY1/PY2 and PY3/PY4 baseline files.

Data Types

The CSV file format does not itself specify the format or representation of values. We therefore define the following types which we use throughout this dictionary:

Int: An integer numeric variable. Integers are whole-numbered values, and can be zero or negative (e.g. 0, 1, -2, etc.)
Dec: A decimal numeric variable (sometimes called "real" or "floating-point"). Decimal variables can take any numeric value, including fractions of whole numbers, negative and positive values, and zero (e.g. 3.14, -2.72, etc.)
Bool: A Boolean variable (sometimes called "flag" or "switch"). Boolean variables can only take one of two values: false (represented by either 0) or true (represented by either 1). The description field will explain the meaning of false or true in the context of the variable.
Char: A character (or "string") variable. These can contain any combination of letters, numbers, or symbols in their values. Categorical variables (sometimes called "codes") are also designated with this data type, regardless of whether the categories are represented by numbers or letters and symbols. This means that some variables which are labeled with type "Char" only contain numerals as values. This is intentional, as these values express categorical information rather than numeric information.
Date: A date in "DDMMMYYYY" format, where "DD" represents the two-digit (zero-padded) day of the month, "MMM" represents the three-character month abbreviation, "YYYY" represents the four-digit year. For example, a value of "01JAN2016" should be interpreted as January 1, 2016.

Data Dictionary For Each File

ACO

This file contains information about LEJR episodes where the beneficiary is assigned to one of the following ACO models or program: the Pioneer ACO model, Next Generation ACO model, Medicare Shared Savings Program, or the Comprehensive ESRD Care Initiative.

Data dictionary for ACO
Header Name	Description	Data Type	Report Types
BENE_SK	IDR system variable - unique beneficiary ID	Char	M R
ORG_ID	Identifies participating organization	Char	M R
PERIOD_END_DT	Date beneficiary's assignment to ACO model or program ended	Date	M R
PERIOD_START_DT	Date beneficiary was assigned to ACO model or program	Date	M R
PROGRAM_ID	Identifies Medicare Program	Char	M R
TRACK	ACO model risk track to which beneficiary is assigned (only applicable to the Medicare Shared Savings Program and the Comprehensive ESRD Care Initiative)	Dec	M R

Header Name	Description	Data Type	IDR Header Name	Report Types
BENE_DUAL_INST	Identifies if the beneficiary spent the entire span of eligibility for the given month and year institutionalized	Char	BENE_DUAL_INSTNL_STUS_IND_SW	B M R
BENE_DUAL_MDCD	Indicator of whether the beneficiary was eligible for Medicaid for the eligibility month/year	Char	BENE_DUAL_MDCD_ELGBL_STUS_SW	B M R
BENE_DUAL_STUS_CD	Entitlement status for the dual eligible beneficiary	Char	BENE_DUAL_STUS_CD	B M R
BENE_SK	IDR system variable - unique beneficiary ID	Char	BENE_SK	B M R
CALENDAR_MO_ELIG	Calendar year and month of eligibility, formatted as "YYYYMM" (Note: the column comments for CLNDR_MO_ELGBL_SK and CLNDR_MO_FIL_SK are swapped in the IDR)	Int	CLNDR_MO_ELGBL_SK	B M R
CALENDAR_MO_FIL	Calendar year and month in which the data were received, formatted as "YYYYMM" (Note: the column comments for CLNDR_MO_ELGBL_SK and CLNDR_MO_FIL_SK are swapped in the IDR)	Int	CLNDR_MO_FIL_SK	B M R

Header Name	Description	Data Type	Report Types
ANCHOR_BEG_DT	Admission date of the anchor inpatient stay for the BPCI episode	Date	R
ANCHOR_DRG_CD	Medicare Severity-Diagnosis Related Group of the anchor hospitalization	Char	R
ANCHOR_END_DT	Discharge date of anchor inpatient stay	Date	R
BENE_SK	IDR system variable - unique beneficiary ID	Char	R
EPI_ID	System-generated episode case ID. Identifier will allow for linkage to EPIEXCL.	Char	R
INDEX_PROVIDER	CMS Certification Number for provider of the index hospital stay for the episode (Model 3)	Char	R
MODEL	Indicator of the specific BPCI Model	Char	R
POST_DSCH_BEG_DT	Post-discharge period beginning date	Date	R
POST_DSCH_END_DT	Post-discharge period ending date	Date	R
PROVIDER	CMS Certification Number for provider where the episode was attributed	Char	R

Header Name	Description	Data Type	Report Types
BENE_SK	In this file, this field contains any current or previous BENE_SK (Beneficiary Link Key)	Char	M R
BENE_XREF_EFCTV_SK	In this file, this field contains the current BENE_SK	Char	M R

Header Name	Description	Data Type	Report Types
CCN	Anchor hospital CMS Certification Number (uniquely identifies provider)	Char	B
CURRENT_TARGET_PRICE	Hospital's individual target price for CJR episodes initiated between April 1, 2016 and September 30, 2016. This is the maximum of the NEW_TARGET_PRICE and OLD_TARGET_PRICE for each DRG/FRACTURE combination.	Dec	B
DRG	Medicare Severity-Diagnosis Related Group of the anchor hospitalization (469 or 470)	Char	B
FRACTURE	A value of 1 indicates anchor stays with hip fractures	Bool	B
HOSP_NAME	Hospital name	Char	B
NEW_TARGET_PRICE	Hospital's individual target price for CJR episodes initiated between April 1, 2016 and September 30, 2016 based on updated data that corrects for unassigned claims	Dec	B
OLD_TARGET_PRICE	Hospital's individual target price for CJR episodes initiated between April 1, 2016 and September 30, 2016 sent in March 2016 (does not account for unassigned claims)	Dec	B
REGION	CJR region number to which the hospital is assigned	Char	B

Header Name	Description	Data Type	IDR Header Name	Report Types
AGE	The age of the beneficiary at the end of the year preceding the reference year of the Denominator File	Int	bene_age_num	B M R
BENE_1ST_NAME	The first name of the Medicare beneficiary	Char	BENE_1ST_NAME	B M R
BENE_DOB	The date of birth of the Medicare beneficiary	Date	BENE_BRTH_DT	B M R
BENE_LAST_NAME	The last name (surname) of the Medicare beneficiary including any following titles	Char	BENE_LAST_NAME	B M R
BENE_MIDL_NAME	The middle initial of the Medicare beneficiary middle name	Char	BENE_MIDL_NAME	B M R
BENE_SK	IDR system variable - unique beneficiary ID	Char	BENE_SK	B M R
BUYIN[01-12]	A value of 1 indicates that the beneficiary was not fully in Parts A and B for that month. A null values indicates that the beneficary was fully bought in.	Char	bene_entlmt_buyin_ind	B M R
COUNTY_CD	The Social Security Administration standard county code of beneficiary's residence	Char	geo_ssa_cnty_cd	B M R
CREC	The reason for the beneficiary's current entitlement to Medicare benefits	Char	bene_crnt_entlmt_rsn_cd	B M R
DOD	Beneficiary date of death	Date	bene_death_dt	B M R
HMO[01-12]	A value of a indicates that the beneficiary had HMO coverage for the given month, a null value indicates no HMO coverage	Char	bene_hmo_cvrg_ind	B M R
MSCD[01-12]	Monthly beneficiary medicare status code	Char	bene_mdcr_stus_cd	B M R
OREC	The reason for the beneficiary's original entitlement to Medicare benefits (when the beneficiary first enrolled in the Medicare program)	Char	bene_orgnl_entlmt_rsn_cd	B M R
RACE	A code that identifies the beneficiary's race as determined by a one-time-only survey that was mailed to certain beneficiaries in 1995	Char	bene_race_cd	B M R
REF_YEAR	Denominator reference year	Int	bene_dnmtr_fil_rfrnc_yr_num	B M R
SEX	Represents the sex of the Medicare beneficiary	Char	bene_sex_cd	B M R
STATE_CD	The Social Security Administration standard state code of beneficiary's residence	Char	geo_ssa_state_cd	B M R
VDOD	A value of Y indicates that the beneficiary's date of death has been validated, a value of N or ~ indicates it has not been validated	Char	bene_dod_vldtd_sw	B M R
ZIP_CD	The zip code of residence of beneficiary (obtained from beneficiary's cash benefit remittance mailing address or other mailing address)	Char	bene_zip_cd	B M R

Header Name	Description	Data Type	IDR Header Name	Report Types
ALLOWED_AMT_EPI	Line-level allowed payment included in episode total in raw dollars	Dec	-	B M R
BETOS	Berenson-Eggers type of service code for HCPCS procedure code	Char	-	B M R
CLM_DT_SGNTR_SK	IDR system variable - 4-part-key to identify a claim	Char	CLM_DT_SGNTR_SK	B M R
CLM_LINE_NUM	Claim line number	Int	CLM_LINE_NUM	B M R
CLM_LINE_STD_ALOWD_AMT	Line-level allowed payment from the IDR in standardized dollars (wage factors removed, not prorated)	Dec	-	B M R
CLM_NUM_SK	IDR system variable - 4-part-key to identify a claim	Char	CLM_NUM_SK	B M R
CLM_TYPE_CD	IDR system variable - 4-part-key to identify a claim	Char	CLM_TYPE_CD	B M R
COSTINC	A value of 1 indicates that the claim line payment amount is included in the episode patment	Bool	-	B M R
DGNS_CD	Line diagnosis code	Char	CLM_LINE_DGNS_CD	B M R
DGNS_PRCDR_ICD_IND	Indicator of ICD version used for diagnosis codes	Char	DGNS_PRCDR_ICD_IND	B34 M R
EPI_ID	System-generated episode case ID	Char	-	B M R
EXCLUSION_CODE	Reason why a claim line's payment was excluded from the episode total	Char	-	B M R
EXPNSDT[1-2]	Line first/last expense date	Date	CLM_LINE_FROM_DT	B M R
GEO_BENE_SK	IDR system variable - 4-part-key to identify a claim	Char	GEO_BENE_SK	B M R
HCFASPCL	Line HCFA provider specialty code	Char	CLM_RNDRG_FED_PRVDR_SPCLTY_CD	B M R
HCPCS_CD	Line HCFA common procedure coding system	Char	CLM_LINE_HCPCS_CD	B M R
LALOWCHG	Line allowed charge amount in raw dollars	Dec	CLM_LINE_ALOWD_CHRG_AMT	B M R
LCLTY_CD	Carrier line pricing locality code as described in the Medicare Physician Fee Schedule	Char	CLM_PRCNG_LCLTY_CD	B M R
MDFR_CD[1-2]	Line HCPCS modifier codes	Char	HCPCS_1_MDFR_CD	B M R
MTUS_CNT	Carrier line miles/time/units/services count	Int	CLM_LINE_PRFNL_MTUS_CNT	B M R
MTUS_IND	Carrier line miles/time/units/services indicator code	Char	CLM_MTUS_IND_CD	B M R
NON_STD_SUB	Reason why the standardized allowed payment amount (STD_AMT_EPI) is imputed (if applicable)	Char	-	B M R
PDGNS_CD	Primary claim diagnosis code	Char	CLM_DGNS_CD	B34 M R
PLCSRVC	Line place of service code	Char	CLM_POS_CD	B M R
PRCNGIND	Line processing indicator code	Char	CLM_PRCSG_IND_CD	B M R
PRFNPI	Carrier line rendering/ordering NPI number	Char	CLM_RNDRG_PRVDR_NPI_NUM	B M R
PRORATED	A value of 1 indicates that the claim line payment amount is prorated	Bool	-	B M R
SRVC_CNT	Line service count	Int	CLM_LINE_SRVC_UNIT_QTY	B M R
STD_AMT_EPI	Line-level allowed payment included in episode total in standardized dollars (wage factors removed)	Dec	-	B M R
TYPE_OF_SERVICE	Type of service	Char	-	B M R
TYPSRVCB	Line HCFA type service code	Char	CLM_FED_TYPE_SRVC_CD	B M R

Header Name	Description	Data Type	IDR Header Name	Report Types
ALOWCHRG	NCH carrier claim allowed charge amount in raw dollars	Dec	CLM_ALOWD_CHRG_AMT	B M R
ASGMNTCD	A value of 1 indicates the provider accepts assignment for the noninstitutional claim	Char	CLM_MDCR_PRFNL_PRVDR_ASGNMT_SW	B M R
BENE_SK	IDR system variable - unique beneficiary ID	Char	BENE_SK	B M R
CLM_CARR_PMT_DNL_CD	Carrier claim payment denial code	Char	CLM_CARR_PMT_DNL_CD	B M R
CLM_DT_SGNTR_SK	IDR system variable - 4-part-key to identify a claim	Char	CLM_DT_SGNTR_SK	B M R
CLM_FROM_DT	Claim from date	Date	CLM_FROM_DT	B M R
CLM_NUM_SK	IDR system variable - 4-part-key to identify a claim	Char	CLM_NUM_SK	B M R
CLM_PD_DT	The date the claim was paid	Date	CLM_PD_DT	B M R
CLM_THRU_DT	Claim through date	Date	CLM_THRU_DT	B M R
CLM_TYPE_CD	IDR system variable - 4-part-key to identify a claim	Char	CLM_TYPE_CD	B M R
DGNS_PRCDR_ICD_IND	Indicator of ICD version used for diagnosis codes	Char	DGNS_PRCDR_ICD_IND	B34 M R
EPI_ID	System-generated episode case ID	Char	-	B M R
GEO_BENE_SK	IDR system variable - 4-part-key to identify a claim	Char	GEO_BENE_SK	B M R
PDGNS_CD	Primary claim diagnosis code	Char	CLM_DGNS_CD	B M R
PMT_AMT	Claim payment amount in raw dollars	Dec	CLM_PMT_AMT	B M R
PRPAYAMT	NCH primary payer claim paid amount (the payment amount made on behalf of a Medicare beneficiary by a primary payer other than Medicare that the provider is applying to covered Medicare charges, a value of 0 indicates Medicare is the primary payer)	Dec	CLM_MDCR_PRFNL_PRMRY_PYR_AMT	B M R

Header Name	Description	Data Type	Report Types
ACO_OVERLAP	A value of 1 indicates the beneficiary is aligned with a risk-bearing ACO (Pioneer, CEC, SSP, or NextGen). This variable will be populated for PY2 forward.	Bool	M R
ANCHOR_AT_NPI	NPI of attending physician during anchor stay only	Char	B M R
ANCHOR_BEG_DT	Admission date of anchor inpatient stay	Date	B M R
ANCHOR_END_DT	Discharge date of anchor inpatient stay	Date	B M R
ANCHOR_LOS	Length of anchor stay in days	Int	B M R
ANCHOR_OP_NPI	NPI of operating physician during anchor stay only	Char	B M R
ANCHOR_STUS_CD	Anchor stay patient discharge status code	Char	B34 M R
BENE_SK	IDR system variable - unique beneficiary ID	Char	B M R
BPCI_OVERLAP	A value of 1 indicates that there is an overlap with BPCI based on attending or operating physician, hospital, or PAC provider	Bool	B34 M R
CCN	Anchor hospital CMS Certification Number (uniquely identifies provider)	Char	B M R
CLM_BENE_MBI_ID	Medicare Beneficiary Identification number, this field is populated if claim(s) in the anchor stay contained a populated CLM_BENE_MBI_ID	Char	B M R
CLM_HIC_NUM	Beneficiary identification code, this field is populated if the claim(s) in the anchor stay were not populated with the CLM_BENE_MBI_ID	Char	B M R
DISASTER_FLAG	A value of 1 indicates that the episode was during a disaster period. This variable will be populated for PY2 forward.	Bool	M R
DRG_CD	Medicare Severity-Diagnosis Related Group of the anchor hospitalization (469 or 470)	Char	B M R
EPI_ANCHOR	Total spending for the anchor stay in standardized dollars	Dec	B M R
EPI_DMFILE	Sum of included payments in the Durable Medical Equipment (DM) claim file in standardized dollars	Dec	B M R
EPI_HH_PPS	Home health payments in standardized dollars (wage factors removed)	Dec	B M R
EPI_HH_PPS_ALLOWED	Home health allowed payments in raw dollars	Dec	B M R
EPI_HHFILE	Sum of included payments in the Home Heath (HH) claim file in standardized dollars	Dec	B M R
EPI_HSFILE	Sum of included payments in the Hospice (HS) claim file in standardized dollars	Dec	B M R
EPI_ID	System-generated episode case ID	Char	B M R
EPI_IPFILE	Sum of included payments in the Inpatient (IP) claim file in standardized dollars	Dec	B M R
EPI_IPPS	Acute care hospital payments in standardized dollars (wage factors removed)	Dec	B M R
EPI_IPPS_ALLOWED	Acute care allowed payments in raw dollars	Dec	B M R
EPI_IRF	Inpatient rehab facility payments in standardized dollars (wage factors removed)	Dec	B M R
EPI_IRF_ALLOWED	Inpatient rehab facility allowed payments in raw dollars	Dec	B M R
EPI_NCBP	Non-claims based payments included in episode spending. Included in EPI_TOTAL.	Dec	B34 M R
EPI_OPFILE	Sum of included payments in the Outpatient (OP) claim file in standardized dollars	Dec	B M R
EPI_OTHER	Payments not falling into the above categories in standardized dollars (wage factors removed).	Dec	B M R
EPI_OTHER_ALLOWED	Allowed payments not falling into the above categories in raw dollars.	Dec	B M R
EPI_PB_ANES	Part B (anesthesiology) payments in standardized dollars (wage factors removed)	Dec	B M R
EPI_PB_ANES_ALLOWED	Part B (anesthesiology) allowed payments in raw dollars	Dec	B M R
EPI_PB_PHYS	Part B (physician) payments in standardized dollars (wage factors removed)	Dec	B M R
EPI_PB_PHYS_ALLOWED	Part B (physician) allowed payments in raw dollars	Dec	B M R
EPI_PBFILE	Sum of included payments in the Part B physician/anesthesiology services (PB) claim file in standardized dollars	Dec	B M R
EPI_RECON_BPCI	BPCI Reconciliation Payment	Dec	B34
EPI_RECON_CJR	CJR Reconciliation Payment	Dec	B34
EPI_SNF_PPS	Skilled nursing facility payments in standardized dollars (wage factors removed)	Dec	B M R
EPI_SNF_PPS_ALLOWED	Skilled nursing facility allowed payments in raw dollars	Dec	B M R
EPI_SNFILE	Sum of included payments in the Skilled Nursing Facility (SN) claim file in standardized dollars	Dec	B M R
EPI_TOTAL	Total of payment during episode in standardized dollars (wage factors removed)	Dec	B M R
EPI_TOTAL_ALLOWED	Total of allowed payments during episode in raw dollars	Dec	B M R
FRACTURE	A value of 1 indicates anchor stays with hip fractures	Bool	B M R
HAC_FIX	A value of 1 indicates the inpatient standardized payment during the episode was adjusted for HAC. This variable is currently available through PY2 and input data is updated annually.	Bool	M R
HAS_READMIT	A value of 1 indicates that an episode included one or more readmissions	Bool	B M R
IMPUTATION	A value of 1 indicates that at least one claim in the episode total was imputed	Bool	B M R
PERF_YEAR	Indicator specifying the performance year	Char	M R
POST_DSCH_BEG_DT	Post-discharge period beginning date	Date	B M R
POST_DSCH_END_DT	Post-discharge period ending date	Date	B M R
POSTEPI_HH_PPS	Home health payments during the post-episode period in standardized dollars (wage factors removed)	Dec	B M R
POSTEPI_HH_PPS_ALLOWED	Home health allowed payments during the post-episode period in raw dollars	Dec	B M R
POSTEPI_IPPS	Acute care hospital payments during the post-episode period in standardized dollars (wage factors removed)	Dec	B M R
POSTEPI_IPPS_ALLOWED	Acute care hospital allowed payments during the post-episode period in raw dollars	Dec	B M R
POSTEPI_IRF	Inpatient rehab facility payments during the post-episode period in standardized dollars (wage factors removed)	Dec	B M R
POSTEPI_IRF_ALLOWED	Inpatient rehab facility allowed payments during the post-episode period in raw dollars	Dec	B M R
POSTEPI_NCBP	Non-claims based payments included in post-episode spending. Included in POSTEPI_TOTAL.	Dec	B34 M R
POSTEPI_OTHER	Payments not falling into the above categories during the post-episode period in standardized dollars (wage factors removed)	Dec	B M R
POSTEPI_OTHER_ALLOWED	Allowed payments not falling into the above categories during the post-episode period in raw dollars	Dec	B M R
POSTEPI_PB_ANES	Part B (anesthesiology) payments during the post-episode period in standardized dollars (wage factors removed)	Dec	B M R
POSTEPI_PB_ANES_ALLOWED	Part B (anesthesiology) allowed payments during the post-episode period in raw dollars	Dec	B M R
POSTEPI_PB_PHYS	Part B (physician) payments during the post-episode period in standardized dollars (wage factors removed)	Dec	B M R
POSTEPI_PB_PHYS_ALLOWED	Part B (physician) allowed payments during the post-episode period in raw dollars	Dec	B M R
POSTEPI_SNF_PPS	Skilled nursing facility payments during the post-episode period in standardized dollars (wage factors removed)	Dec	B M R
POSTEPI_SNF_PPS_ALLOWED	Skilled nursing facility allowed payments during the post-episode period in raw dollars	Dec	B M R
POSTEPI_TOTAL	Total of payment during post-episode period in standardized dollars (wage factors removed)	Dec	B M R
POSTEPI_TOTAL_ALLOWED	Total of allowed payments during post-episode period in raw dollars	Dec	B M R

Header Name	Description	Data Type	IDR Header Name	Report Types
APCHIPPS	Revenue center APC/HIPPS code	Char	CLM_REV_APC_HIPPS_CD	B M R
CLM_DT_SGNTR_SK	IDR system variable - 4-part-key to identify a claim	Char	CLM_DT_SGNTR_SK	B M R
CLM_LINE_NUM	Claim line number	Int	CLM_LINE_NUM	B M R
CLM_NUM_SK	IDR system variable - 4-part-key to identify a claim	Char	CLM_NUM_SK	B M R
CLM_TYPE_CD	IDR system variable - 4-part-key to identify a claim	Char	CLM_TYPE_CD	B M R
EPI_ID	System-generated episode case ID	Char	-	B M R
GEO_BENE_SK	IDR system variable - 4-part-key to identify a claim	Char	GEO_BENE_SK	B M R
HCPCS_CD	Revenue center HCFA Common Procedure Coding System code	Char	CLM_LINE_HCPCS_CD	B M R
PMTMTHD	Revenue center payment method indicator code	Char	CLM_REV_PMT_MTHD_CD	B M R
REV_CHRG	Revenue center total charge amount in dollars	Dec	CLM_LINE_SBMT_CHRG_AMT	B M R
REV_CTR	Revenue center code	Char	CLM_LINE_REV_CTR_CD	B M R
REV_DT	Revenue center date	Date	CLM_LINE_INSTNL_REV_CTR_DT	B M R
REV_UNIT	Revenue center unit count	Int	CLM_LINE_SRVC_UNIT_QTY	B M R
REVPMT	Revenue center payment amount in dollars	Dec	CLM_LINE_CVRD_PD_AMT	B M R

Header Name	Description	Data Type	IDR Header Name	Report Types
ALLOWED_AMT_EPI	Allowed payment of claim included in episode total in raw dollars	Dec	-	B M R
AT_NPI	Claim attending physician NPI number	Char	CLM_ATNDG_PRVDR_NPI_NUM	B M R
BENE_SK	IDR system variable - unique beneficiary ID	Char	BENE_SK	B M R
BPCI_PAC	A value of 1 indicates an overlap with BPCI based on CCN	Bool	-	B34 M R
CLM_DT_SGNTR_SK	IDR system variable - 4-part-key to identify a claim	Char	CLM_DT_SGNTR_SK	B M R
CLM_FROM_DT	Claim from date	Date	CLM_FROM_DT	B M R
CLM_MDCL_REC	Claim medical record number	Char	CLM_PTNT_MDCL_REC_NUM	B M R
CLM_NUM_SK	IDR system variable - 4-part-key to identify a claim	Char	CLM_NUM_SK	B M R
CLM_PD_DT	The date the claim was paid	Date	CLM_PD_DT	B M R
CLM_PROVIDER	CMS Certification Number (uniquely identifies claim provider)	Char	CLM_BLG_PRVDR_OSCAR_NUM	B M R
CLM_PTNT_CNTL	Patient control number	Char	CLM_PTNT_CNTL_NUM	B M R
CLM_STD_ALOWD_AMT	Allowed payment from the IDR in standardized dollars (wage factors removed, not prorated)	Dec	CLM_STD_ALOWD_AMT	B M R
CLM_THRU_DT	Claim through date	Date	CLM_THRU_DT	B M R
CLM_TYPE_CD	IDR system variable - 4-part-key to identify a claim	Char	CLM_TYPE_CD	B M R
COSTINC	A value of 1 indicates that the claim payment amount is included in the episode total	Bool	-	B M R
DGNS_PRCDR_ICD_IND	Indicator of ICD version used for diagnosis codes	Char	DGNS_PRCDR_ICD_IND	B34 M R
EPI_ID	System-generated episode case ID	Char	-	B M R
EXCLUSION_CODE	Reason why a claim's payment was excluded from the episode total	Char	-	B M R
GEO_BENE_SK	IDR system variable - 4-part-key to identify a claim	Char	GEO_BENE_SK	B M R
NON_STD_SUB	Reason why the standardized allowed payment (STD_AMT_EPI) is imputed (if applicable)	Char	-	B M R
OP_NPI	Claim operating physician NPI number	Char	CLM_OPRTG_PRVDR_NPI_NUM	B M R
ORGNPINM	Organization NPI Number	Char	CLM_BLG_PRVDR_NPI_NUM	B M R
PDGNS_CD	Primary claim diagnosis code	Char	CLM_DGNS_CD	B M R
PMT_AMT	Claim payment amount in raw dollars	Dec	CLM_PMT_AMT	B M R
PRORATED	A value of 1 indicates that the claim payment amount is prorated	Bool	-	B M R
PRPAYAMT	NCH primary payer claim paid amount (the payment amount made on behalf of a Medicare beneficiary by a primary payer other than Medicare that the provider is applying to covered Medicare charges, a value of 0 indicates Medicare is the primary payer)	Dec	CLM_MDCR_INSTNL_PRMRY_PYR_AMT	B M R
PRPAYCD	NCH primary payer code	Char	CLM_NCH_PRMRY_PYR_CD	B M R
PRVDR_NAME	Provider name	Char	PRVDR_NAME	B M R
STD_AMT_EPI	Allowed payment of claim included in episode total in standardized dollars (wage factors removed)	Dec	-	B M R
STUS_CD	Patient discharge status code	Char	BENE_PTNT_STUS_CD	B M R
TOT_CHRG	Claim Total Charge Amount in raw dollars	Dec	CLM_SBMT_CHRG_AMT	B M R
TYPE_OF_SERVICE	Type of service	Char	-	B M R
VISITCNT	Claim HHA Total Visit Count	Int	CLM_MDCR_HHA_TOT_VISIT_CNT	B M R

Data dictionary for QM
Header Name	Description	Data Type	Report Types
CCN	Anchor hospital CMS Certification Number (uniquely identifies provider)	Char	R
COMP_MEASURE_DECILE	THA/TKA Complications measure performance decile	Dec	R
COMP_MEASURE_IMP_SCORE	THA/TKA Complications measure quality improvement points	Dec	R
COMP_MEASURE_INT_SCORE	THA/TKA Complications measure initial performance score (without quality improvement points)	Dec	R
COMP_MEASURE_PERF_PERIOD	THA/TKA Complications measure current performance period	Date	R
COMP_MEASURE_RESULT	THA/TKA Complications measure result	Dec	R
COMPOSITE_SCORE	Quality composite score	Dec	R
HCAHPS_MEASURE_DECILE	HCAHPS measure performance decile	Dec	R
HCAHPS_MEASURE_IMP_SCORE	HCAHPS measure quality improvement points	Dec	R
HCAHPS_MEASURE_INT_SCORE	HCAHPS measure initial performance score (without quality improvement points)	Dec	R
HCAHPS_MEASURE_PERF_PERIOD	HCAHPS measure current performance period	Date	R
HCAHPS_MEASURE_RESULT	HCAHPS measure result	Dec	R
HOSP_NAME	Hospital name	Char	R
PERF_YEAR	Performance year	Char	R
PERFORMANCE_CATEGORY	Quality performance category	Char	R
PRO_COLLECTION_PERIOD	THA/TKA patient reported outcomes (PRO) data collection period	Date	R
PRO_SUBMISSION_SCORE	THA/TKA patient reported outcomes (PRO) data successful submission points	Dec	R
QA_DISCOUNT	Discount rate for reconciliation based on the hospital's quality performance category.	Dec	R

Table of values for ANCHOR_DRG_CD
Code	Value
469	Major joint replacement or reattachment of lower extremity with MCC
470	Major joint replacement or reattachment of lower extremity without MCC

Table of values for ANCHOR_STUS_CD
Code	Value
00	Unknown Value (but present in data)
01	Discharged to home/self care (routine charge)
02	Discharged/transferred to other short term general hospital for inpatient care
03	Discharged/transferred to skilled nursing facility (SNF) with Medicare certification in anticipation of covered skilled care
04	Discharged/transferred to intermediate care facility (ICF)
05	Discharged/transferred to another type of institution for inpatient care (including distinct parts)
06	Discharged/transferred to home care of organized home health service organization
07	Left against medical advice or discontinued care
08	Discharged/transferred to home under care of a home IV drug therapy provider
09	Admitted as an inpatient to this hospital (in situations where a patient is admitted before midnight of the third day following the day of an outpatient service, the outpatient services are considered inpatient)
20	Expired (did not recover - Christian Science patient)
21	Discharged/transferred to Court/Law Enforcement
30	Still patient
40	Expired at home (hospice claims only)
41	Expired in a medical facility such as hospital, SNF, ICF, or freestanding hospice. (Hospice claims only)
42	Expired - place unknown (Hospice claims only)
43	Discharged/transferred to a federal hospital
50	Hospice - home
51	Hospice - medical facility
61	Discharged/transferred within this institution to a hospital-based Medicare approved swing bed
62	Discharged/transferred to an inpatient rehabilitation facility including distinct parts units of a hospital
63	Discharged/transferred to a long term care hospitals
64	Discharged/transferred to a nursing facility certified under Medicaid but not under Medicare
65	Discharged/Transferred to a psychiatric hospital or psychiatric distinct unit of a hospital
66	Discharged/transferred to a Critical Access Hospital (CAH)
69	Discharged/transferred to a designated disaster alternative care site (eff. 10/2013)
70	Discharged/transferred to another type of health care institution not defined elsewhere in code list
81	Discharged to home or self-care with a planned acute care hospital readmission (eff. 10/2013)
82	Discharged/transferred to a short term general hospital for inpatient care with a planned acute care hospital inpatient readmission (eff. 10/2013)
83	Discharged/transferred to a skilled nursing facility (SNF) with Medicare certification with a planned acute care hospital inpatient readmission (eff. 10/2013)
84	Discharged/transferred to a facility that provides custodial or supportive care with a planned acute care hospital inpatient readmission (eff. 10/2013)
85	Discharged/transferred to a designated cancer center or children's hospital with a planned acute care hospital inpatient readmission (eff. 10/2013)
86	Discharged/transferred to home under care of organized home health service organization with a planned acute care hospital inpatient readmission (eff. 10/2013)
87	Discharged/transferred to court/law enforcement with a planned acute care hospital inpatient readmission (eff. 10/2013)
88	Discharged/transferred to a federal health care facility with a planned acute care hospital inpatient readmission (eff. 10/2013)
89	Discharged/transferred to a hospital-based Medicare approved swing bed with a planned acute care hospital inpatient readmission (eff. 10/2013)
90	Discharged/transferred to an inpatient rehabilitation facility (IRF) including rehabilitation distinct part units of a hospital with a planned acute care hospital inpatient readmission (eff. 10/2013)
91	Discharged/transferred to a Medicare certified long term care hospital (LTCH) with a planned acute care hospital inpatient readmission (eff. 10/2103)
92	Discharged/transferred to nursing facility certified under Medicaid but not certified under Medicare with a planned acute care hospital inpatient readmission (eff. 10/2013)
93	Discharged/transferred to a psychiatric hospital/distinct part unit of a hospital with a planned acute care hospital inpatient readmission (eff. 10/2013)

Table of values for ASGMNTCD
Code	Value
A	Assigned claim
N	Non-assigned claim

Header Name	Description	Data Type	Report Types
CCN	Anchor hospital CMS Certification Number (uniquely identifies provider)	Char	R
COUNT_EPISODES	Number of episodes for a particular EPISODE PERIOD/DRG/FRACTURE combination	Int	R
DRG	Medicare Severity-Diagnosis Related Group of the anchor hospitalization (469 or 470)	Char	R
EPISODE_PERIOD	Indicates the anchor start date range applicable to the target price	Date	R
FRACTURE	A value of 1 indicates anchor stays with hip fractures	Bool	R
HIGH_COST_THRESHOLD	Calculated regional threshold value for a given DRG and fracture status combination	Dec	R
NAME	Hospital name	Char	R
PERF_YEAR	Indicator specifying the performance year	Char	R
QA_DISCOUNT	Discount rate for reconciliation based on the hospital's quality performance category. See QM file for performance category information	Dec	R
QA_DISCOUNT_RP	Discount rate for repayment based on the hospital’s quality performance category. See QM file for performance category information. Applicable for PY2 forward.	Dec	R
QA_STD_TP	Quality-adjusted, standardized target price for reconciliation associated with the EPISODE PERIOD/DRG/FRACTURE combination of the episode. This is presented in standardized dollars (wage factors removed)	Dec	R
QA_STD_TP_RP	Quality-adjusted, standardized target price for repayment associated with the EPISODE PERIOD/DRG/FRACTURE combination of the episode. This is presented in standardized dollars (wage factors removed). Applicable for PY2 forward.	Dec	R
RECONCILIATION_ELIGIBLE	Indicates whether repayment discount percentages and target prices were used for a given performance year. Determined based on positive or negative FINAL_NPRA. Applicable for PY2 forward.	Char	R
REGION	CJR region number to which the hospital is assigned	Char	R
SUM_CAPPED_EPI_TOTAL	Sum of capped episode spending for a particular EPISODE PERIOD/DRG/FRACTURE combination	Dec	R
SUM_EPI_TOTAL	Sum of uncapped episode spending for a particular EPISODE PERIOD/DRG/FRACTURE combination	Dec	R
SUM_NPRA	The Net Payment Reconciliation amount for a particular EPISODE PERIOD/DRG/FRACTURE combination (standardized dollars). This is calculated as the difference between SUM_QA_STD_TP and SUM_CAPPED_EPI_TOTAL	Dec	R
SUM_NPRA_RP	The Net Payment Repayment amount for a particular EPISODE PERIOD/DRG/FRACTURE combination in real dollars. This is calculated as the difference between W_SUM_QA_STD_TP_RP and W_SUM_CAPPED_EPI_TOTAL. Applicable for PY2 forward.	Dec	R
SUM_QA_STD_TP	Sum of target price spending for reconciliation for a particular EPISODE PERIOD/DRG/FRACTURE combination. This is calculated as QA_STD_TP multiplied by COUNT_EPISODES	Dec	R
SUM_QA_STD_TP_RP	Sum of target price spending for repayment for a particular EPISODE PERIOD/DRG/FRACTURE combination. This is calculated as QA_STD_TP_RP multiplied by COUNT_EPISODES. Applicable for PY2 forward.	Dec	R
W_SUM_CAPPED_EPI_TOTAL	Sum of capped episode spending for a particular EPISODE PERIOD/DRG/FRACTURE combination, in real dollars (wage factors added)	Dec	R
W_SUM_NPRA	The Net Payment Reconciliation amount for a particular EPISODE PERIOD/DRG/FRACTURE combination in real dollars (wage factors added). This is calculated as the difference between W_SUM_QA_STD_TP and W_SUM_CAPPED_EPI_TOTAL	Dec	R
W_SUM_NPRA_RP	The Net Payment Repayment amount for a particular EPISODE PERIOD/DRG/FRACTURE combination in real dollars (wage factors added). This is calculated as the difference between W_SUM_QA_STD_TP_RP and W_SUM_CAPPED_EPI_TOTAL. Applicable for PY2 forward.	Dec	R
W_SUM_QA_STD_TP	Sum of target price spending for reconciliation for a particular EPISODE PERIOD/DRG/FRACTURE combination, in real dollars (wage factors added)	Dec	R
W_SUM_QA_STD_TP_RP	Sum of target price spending for repayment for a particular EPISODE PERIOD/DRG/FRACTURE combination, in real dollars (wage factors added). Applicable for PY2 forward.	Dec	R
WAGE_FACTOR	Hospital-specific wage factor	Dec	R
DISASTER_CAPPED_CNT	Count of episodes where episode spending was capped during the disaster period. Applicable for PY2 forward.	Int	R
DISASTER_CNT	Count of episodes during the disaster period. Applicable for PY2 forward.	Int	R
DISASTER_CAPPED_SPENDING	Total spending for episodes that were capped during the disaster period. Applicable for PY2 forward.	Dec	R

Header Name	Description	Data Type	IDR Header Name	Report Types
ADMSN_DT	Claim admission date	Date	CLM_ACTV_CARE_FROM_DT	B M R
ADMTG_DGNS_CD	Claim admitting diagnosis code	Char	CLM_DGNS_CD	B M R
ALLOWED_AMT_EPI	Allowed payment of claim included in episode total in raw dollars	Dec	-	B M R
ANCHOR	A value of 1 indicates that the claim is part of an anchor stay	Bool	-	B M R
AT_NPI	Claim attending physician NPI number	Char	CLM_ATNDG_PRVDR_NPI_NUM	B M R
BENE_SK	IDR system variable - unique beneficiary ID	Char	BENE_SK	B M R
BLDDEDAM	NCH beneficiary blood deductible liability amount in raw dollars	Dec	CLM_BLOOD_LBLTY_AMT	B M R
BPCI_PAC	A value of 1 indicates an overlap with IRF receiving LEJR patients under BPCI	Bool	-	B34 M R
BPCI_PGP_AT	A value of 1 indicates an overlap with an NPI performing LEJRs under BPCI	Bool	-	B34 M R
BPCI_PGP_OP	A value of 1 indicates an overlap with an NPI performing LEJRs under BPCI	Bool	-	B34 M R
BPCI_PROV	A value of 1 indicates an overlap with an IPPS hospital performing LEJRs under BPCI	Bool	-	B34 M R
CHARGAMT	Claim total charge amount in raw dollars	Dec	CLM_MDCR_INSTNL_TOT_CHRG_AMT	B M R
CLM_CNTL	FI document claim control number	Char	CLM_CNTL_NUM	B M R
CLM_DT_SGNTR_SK	IDR system variable - 4-part-key to identify a claim	Char	CLM_DT_SGNTR_SK	B M R
CLM_FROM_DT	Claim from date	Date	CLM_FROM_DT	B M R
CLM_MDCL_REC	Claim medical record number	Char	CLM_PTNT_MDCL_REC_NUM	B M R
CLM_NO_OUTLIER_ALOWD_AMT	Allowed payment of claim without outliers from the IDR in standardized dollars (wage factors removed, not prorated)	Dec	CLM_NO_OUTLIER_ALOWD_AMT	B M R
CLM_NUM_SK	IDR system variable - 4-part-key to identify a claim	Char	CLM_NUM_SK	B M R
CLM_PD_DT	The date the claim was paid	Date	CLM_PD_DT	B M R
CLM_PROVIDER	CMS Certification Number (uniquely identifies claim provider)	Char	CLM_BLG_PRVDR_OSCAR_NUM	B M R
CLM_PTNT_CNTL	Patient control number	Char	CLM_PTNT_CNTL_NUM	B M R
CLM_STD_ALOWD_AMT	Allowed payment of claim from the IDR in standardized dollars (wage factors removed, not prorated)	Dec	CLM_STD_ALOWD_AMT	B M R
CLM_THRU_DT	Claim through date	Date	CLM_THRU_DT	B M R
CLM_TYPE_CD	IDR system variable - 4-part-key to identify a claim	Char	CLM_TYPE_CD	B M R
COIN_AMT	NCH beneficiary Part A coinsurance liability amount in raw dollars	Dec	CLM_MDCR_COINSRNC_AMT	B M R
COSTINC	A value of 1 indicates that the claim payment amount is included in the episode total	Bool	-	B M R
DED_AMT	NCH beneficiary inpatient deductible amount in raw dollars	Dec	CLM_MDCR_IP_BENE_DDCTBL_AMT	B M R
DGNS_PRCDR_ICD_IND	Indicator of ICD version used for diagnosis codes (PDGNS_CD and ADMTG_DGNS_CD)	Char	DGNS_PRCDR_ICD_IND	B34 M R
DRG_CD	Medicare Severity-Diagnosis Related Group of the inpatient claim	Char	DGNS_DRG_CD	B M R
DSCHRGDT	Claim discharge date	Date	CLM_DSCHRG_DT	B M R
EPI_ID	System-generated episode case ID	Char	-	B M R
EXCLUSION_CODE	Reason why a claim's payment was excluded from the episode total	Char	-	B M R
FAC_TYPE	Claim facility type code	Char	CLM_BILL_FAC_TYPE_CD	B M R
FREQ_CD	Claim frequency code	Char	CLM_BILL_FREQ_CD	B M R
GEO_BENE_SK	IDR system variable - 4-part-key to identify a claim	Char	GEO_BENE_SK	B M R
HAC_FIX	A value of 1 indicates the inpatient standardized payment during the episode was adjusted for HAC. This variable is currently available through PY2 and input data is updated annually.	Bool	-	M R
MCOPDSW	A value of 1 indicates a Managed Care Organization has paid the provider for an institutional claim	Bool	CLM_MDCR_INSTNL_MCO_PD_SW	B M R
NON_STD_SUB	Reason why the standardized allowed payment of claim (STD_AMT_EPI) is imputed (if applicable)	Char	-	B M R
OP_NPI	Claim operating physician NPI number	Char	CLM_OPRTG_PRVDR_NPI_NUM	B M R
OUTLR_CD	Claim DRG outlier stay code	Char	DGNS_DRG_OUTLIER_CD	B M R
OUTLRPMT	NCH DRG outlier approved payment amount in raw dollars	Dec	CLM_INSTNL_DRG_OUTLIER_AMT	B M R
PDGNS_CD	Primary claim diagnosis code	Char	CLM_DGNS_CD	B M R
PER_DIEM	Claim pass thru per diem amount in raw dollars	Dec	CLM_INSTNL_PER_DIEM_AMT	B M R
PMT_AMT	Claim payment amount in raw dollars	Dec	CLM_PMT_AMT	B M R
PPS_CPTL	Claim total PPS capital amount in raw dollars	Dec	CLM_MDCR_IP_PPS_CPTL_TOT_AMT	B M R
PRORATED	A value of 1 indicates that the claim payment amount is prorated	Bool	-	B M R
PROV	Type of provider	Char	-	B M R
PRPAYAMT	NCH primary payer claim paid amount (the payment amount made on behalf of a Medicare beneficiary by a primary payer other than Medicare that the provider is applying to covered Medicare charges, a value of 0 indicates Medicare is the primary payer)	Dec	CLM_MDCR_INSTNL_PRMRY_PYR_AMT	B M R
PRPAYCD	NCH primary payer code	Char	CLM_NCH_PRMRY_PYR_CD	B M R
PRSTATE	NCH provider state code	Char	GEO_BLG_SSA_STATE_CD	B M R
PRVDR_NAME	Provider name	Char	PRVDR_NAME	B M R
SRC_ADMS	Claim source inpatient admission code	Char	CLM_ADMSN_SRC_CD	B M R
STD_AMT_EPI	Allowed payment of claim included in episode total in standardized dollars (wage factors removed)	Dec	-	B M R
STUS_CD	Patient discharge status code	Char	BENE_PTNT_STUS_CD	B M R
TYPE_ADM	Claim inpatient admission type code	Char	CLM_ADMSN_TYPE_CD	B M R
TYPE_OF_SERVICE	Type of service	Char	-	B M R
UNCOMPD_CARE_AMT	Claim inpatient uncompensated care payment amount in raw dollars	Dec	CLM_HIPPS_UNCOMPD_CARE_AMT	B M R
UTIL_DAY	Claim utilization day count	Char	CLM_INSTNL_CVRD_DAY_CNT	B M R

Header Name	Description	Data Type	Report Types
ACO_RECOUPMENT	The net reconciliation amount that has been recouped due to participation in a CMS ACO program. Only applicable to final reconciliation.	Dec	R
AF_NPRA	The Almost-Final Net Payment Reconciliation Amount (with excess post-episode spending, ACO recoupment, and stop gain/loss incorporated)	Dec	R
CCN	Anchor hospital CMS Certification Number (uniquely identifies provider)	Char	R
FINAL_NPRA	The Final Net Payment Reconciliation Amount (with excess post-episode spending, ACO recoupment, stop gain/loss incorporated, and performance category limitations incorporated)	Dec	R
HIGH_SPEND_POSTEPI_AMT	The hospital's excess post-episode spending amount in standardized dollars. Only applicable to final reconciliation.	Dec	R
NAME	Hospital name	Char	R
OVERALL_WCEPI_TOTAL	Total actual episode spending in real dollars (wage factors added). This is calculated as the sum of all values for W_SUM_CAPPED_EPI_TOTAL	Dec	R
PERF_YEAR	Indicator specifying the performance year	Char	R
PREV_RECONCILIATION_AMT	Reconciliation amount after adjusting AF_NPRA quality performance, in real dollars (wage factors added). This is the value from initial reconciliation and will only be populated for final reconciliation.	Dec	R
RECONCILIATION_AMT	Reconciliation amount after adjusting AF_NPRA for the absence of downside risk in PY1 and quality performance, in real dollars (wage factors added).	Dec	R
RECONCILIATION_ELIGIBLE	Indicates whether repayment discount percentages and target prices were used for a given performance year. Determined based on positive or negative FINAL_NPRA. Applicable for PY2 forward.	Char	R
REGION	CJR region number to which the hospital is assigned	Char	R
REPAYMENT_AMT	Repayment amount after adjusting AF_NPRA quality performance, in real dollars (wage factors added)	Dec	R
RURAL	Indicates whether stop-loss for rural hospitals was applied for PY2.	Bool	R
STOP_GAIN	The stop-gain limit in real dollars (wage factors added).	Dec	R
STOP_LOSS	The stop-loss limit in real dollars (wage factors added).	Dec	R
W_HIGH_SPEND_POSTEPI_AMT	The hospital's excess post-episode spending amount in real dollars (wage factors added). Only applicable to final reconciliation.	Dec	R
W_OVERALL_SPEND	Total target price spending for reconciliation in real dollars (wage factors added). This is calculated as the sum of all values for W_SUM_QA_STD_TP	Dec	R
W_OVERALL_SPEND_RP	Total target price spending for reconciliation in real dollars (wage factors added). This is calculated as the sum of all values for W_SUM_QA_STD_TP_RP. Applicable for PY2 forward.	Dec	R
W_WAGE_FACTOR	The hospital's weighted wage factor. This is calculated as the ratio of the sum of post-episode spending in real dollars to the sum of post-episode spending in standardized dollars	Dec	R
WI_NPRA	Initial Net Payment Reconciliation Amount in real dollars (wage factors added). This is calculated as the difference between W_OVERALL_STD_SPEND and OVERALL_WCEPI_TOTAL	Dec	R

Header Name	Description	Data Type	Report Types
COUNT_EPISODES	Number of CJR episodes in region	Int	B M R
COUNT_HH_PPS	Number of episodes with home health payments	Int	B M R
COUNT_HOSPITALS	Number of hospitals in region with CJR episodes	Int	B M R
COUNT_IPPS	Number of episodes with acute care payments	Int	B M R
COUNT_IRF	Number of episodes with inpatient rehab facility payments	Int	B M R
COUNT_PB_ANES	Number of episodes with Part B payments for anesthesia services	Int	B M R
COUNT_PB_PHYS	Number of episodes with Part B payments for physician services	Int	B M R
COUNT_READMIT	Number of episodes with readmissions	Int	B M R
COUNT_SNF_PPS	Number of episodes with skilled nursing facilities payments	Int	B M R
DRG	Medicare Severity-Diagnosis Related Group of the anchor hospitalization (469 or 470)	Char	B M R
FRACTURE	A value of 1 indicates anchor stays with hip fractures	Bool	B M R
MEAN_EPI_TOTAL	Mean of total episode spending during historical period in standardized dollars	Dec	B
MEAN_HH_PPS	Mean of home health payments paid under the Home Health Prospective Payment System in standardized dollars	Dec	B12
MEAN_IPPS	Mean of acute care payments paid under the Inpatient Prospective Payment System in standardized dollars	Dec	B12
MEAN_IRF	Mean of inpatient rehab facility payments in standardized dollars	Dec	B12
MEAN_PB_ANES	Mean of Part B payments for anesthesia services in standardized dollars	Dec	B12
MEAN_PB_PHYS	Mean of Part B payments for physician services in standardized dollars	Dec	B12
MEAN_POSTEPI_TOTAL	Mean of total post-episode spending in standardized dollars	Dec	B M R
MEAN_SNF_PPS	Mean of skilled nursing facility payments paid under the Skilled Nursing Facility Prospective Payment System in standardized dollars	Dec	B12
MEDIAN_EPI_TOTAL	Median of total episode spending during historical period in standardized dollars	Dec	B
PCT_HH_PPS	Percent of total episode spending attributable to home health payments paid under the Home Health Prospective Payment System	Dec	B12
PCT_IPPS	Percent of total episode spending attributable to acute care payments paid under the Inpatient Prospective Payment System	Dec	B12
PCT_IRF	Percent of total episode spending attributable to Inpatient Rehab Facility payments	Dec	B12
PCT_PB_ANES	Percent of total episode spending attributable to Part B payments for anesthesia services	Dec	B12
PCT_PB_PHYS	Percent of total episode spending attributable to Part B payments for physician services	Dec	B12
PCT_SNF_PPS	Percent of total episode spending attributable to skilled nursing facilities payments paid under the Skilled Nursing Facility Prospective Payment System	Dec	B12
REGION	CJR region number to which the hospital is assigned	Char	B M R
REGION_NAME	Name of CJR region to which the hospital is assigned	Char	B M R
SD_EPI_TOTAL	Standard deviation of total episode spending during historical period in standardized dollars	Dec	B

Header Name	Description	Data Type	Report Types
CCN	Anchor hospital CMS Certification Number (uniquely identifies provider)	Char	B
DISCOUNT	National discount rate	Dec	B
DRG	Medicare Severity-Diagnosis Related Group of the anchor hospitalization (469 or 470)	Char	B
FAC	National anchor factor for a given DRG and fracture status combination	Dec	B
FRACTURE	A value of 1 indicates anchor stays with hip fractures	Bool	B
GROWTHFAC_2012	National growth factor for episodes beginning in 2012 for a given DRG and fracture status combination (used in performance year 1/2)	Dec	B
GROWTHFAC_2013	National growth factor for episodes beginning in 2013 for a given DRG and fracture status combination (used in performance year 1/2)	Dec	B
GROWTHFAC_2014	National growth factor for episodes beginning in 2014 for a given DRG and fracture status combination (used in performance year 3/4)	Dec	B
GROWTHFAC_2015	National growth factor for episodes beginning in 2015 for a given DRG and fracture status combination (used in performance year 3/4)	Dec	B
HIGHCOST	Regional threshold value for a given DRG and fracture status combination	Dec	B
LOW_VOLUME	A value of 1 indicates that there are fewer than 20 CJR episodes in historical period	Bool	B
NAME	Hospital name	Char	B
NO_HISTORY	A value of 1 indicates that there are no CJR episodes in the historical period	Bool	B
PERIOD_ABBREV	Target Price period abbreviation	Char	B
REG_UP_PMT	Regional updated pooled historical payment	Dec	B
REGION	CJR region number to which the hospital is assigned	Char	B
STD_TARGET_PRICE	Hospital's individual target price in standardized dollars (wage factors removed). Note: the April - September 2016 target prices shown are the "current" price (the higher of the April and August releases).	Dec	B
TARGET_PRICE	Hospital's individual target price for a particular DRG-fracture combination in raw dollars. Note: the April - September 2016 target prices shown are the current price (the higher of the April and August releases).	Dec	B
TP_EFF_END_DT	Target Prices effective end date	Date	B
TP_EFF_ST_DT	Target Prices effective start date	Date	B
UPDATE_FACTOR_CCN	Hospital-specific update factor	Dec	B
WAGE_FACTOR	Hospital-specific wage factor	Dec	B

Code	Value
1	Beneficiary institutionalized
2	Beneficiary not institutionalized
3	Home and Community Based Services
9	Institutionalization Status Unknown

Code	Value
N	Indicates the beneficiary was not eligible for Medicaid for the eligibility month/year
Y	Indicates the beneficiary was eligible for Medicaid for the eligibility month/year

Code	Value
01	QMB only
02	QMB and Medicaid coverage including RX
03	SLMB only
04	SLMB and Medicaid coverage including RX
05	QDWI
06	Qualifying Individuals
08	Other (Non QMB, SLMB, QWDI or Qi) w/MDCD Cvrg Including RX
09	Other but without Medicaid Coverage
99	Unknown
U	(obsolete) Unknown

Code	Value
(empty)	Unassigned
D1A	Medical/Surgical Supplies
D1B	Hospital Beds
D1C	Oxygen And Supplies
D1D	Wheelchairs
D1E	Other DME
D1F	Orthotic Devices
D1G	Drugs Administered Through DME
I1A	Standard Imaging - Chest
I1B	Standard Imaging - Musculoskeletal
I1C	Standard Imaging - Breast
I1D	Standard Imaging - Contrast Gastrointestinal
I1E	Standard Imaging - Nuclear Medicine
I1F	Standard Imaging - Other
I2A	Advanced Imaging - CAT: Head
I2B	Advanced Imaging - CAT: Other
I2C	Advanced Imaging - MRI: Brain
I2D	Advanced Imaging - MRI: Other
I3A	Echography - Eye
I3B	Echography - Abdomen/Pelvis
I3C	Echography - Heart
I3D	Echography - Carotid Arteries
I3E	Echography - Prostate, Transrectal
I3F	Echography - Other
I4A	Imaging/Procedure - Heart, Including Cardiac Catheterization
I4B	Imaging/Procedure - Other
M1A	Office Visits - New
M1B	Office Visits - Established
M2A	Hospital Visit - Initial
M2B	Hospital Visit - Subsequent
M2C	Hospital Visit - Critical Care
M3	Emergency Room Visit
M4A	Home Visit
M4B	Nursing Home Visit
M5A	Specialist - Pathology
M5B	Specialist - Psychiatry
M5C	Specialist - Ophthalmology
M5D	Specialist - Other
M6	Consultations
O1A	Ambulance
O1B	Chiropractic
O1C	Enteral And Parenteral
O1D	Chemotherapy
O1E	Other Drugs
O1F	Vision, Hearing And Speech Services
O1G	Influenza Immunization
P0	Anesthesia
P1A	Major Procedure - Breast
P1B	Major Procedure - Colectomy
P1C	Major Procedure - Cholecystectomy
P1D	Major Procedure - TURP
P1E	Major Procedure - Hysterectomy
P1F	Major Procedure - Explor/Decompr/Excisdisc
P1G	Major Procedure - Other
P2A	Major Procedure, Cardiovascular - CABG
P2B	Major Procedure, Cardiovascular - Aneurysm Repair
P2C	Major Procedure, Cardiovascular - Thromboendarterectomy
P2D	Major Procedure, Cardiovascular - Coronary Angioplasty (PTCA)
P2E	Major Procedure, Cardiovascular - Pacemaker Insertion
P2F	Major Procedure, Cardiovascular - Other
P3A	Major Procedure, Orthopedic - Hip Fracture Repair
P3B	Major Procedure, Orthopedic - Hip Replacement
P3C	Major Procedure, Orthopedic - Knee Replacement
P3D	Major Procedure, Orthopedic - Other
P4A	Eye Procedure - Corneal Transplant
P4B	Eye Procedure - Cataract Removal/Lens Insertion
P4C	Eye Procedure - Retinal Detachment
P4D	Eye Procedure - Treatment Of Retinal Lesions
P4E	Eye Procedure - Other
P5A	Ambulatory Procedures - Skin
P5B	Ambulatory Procedures - Musculoskeletal
P5C	Ambulatory Procedures - Inguinal Hernia Repair
P5D	Ambulatory Procedures - Lithotripsy
P5E	Ambulatory Procedures - Other
P6A	Minor Procedures - Skin
P6B	Minor Procedures - Musculoskeletal
P6C	Minor Procedures - Other (Medicare Fee Schedule)
P6D	Minor Procedures - Other (Non-Medicare Fee Schedule)
P7A	Oncology - Radiation Therapy
P7B	Oncology - Other
P8A	Endoscopy - Arthroscopy
P8B	Endoscopy - Upper Gastrointestinal
P8C	Endoscopy - Sigmoidoscopy
P8D	Endoscopy - Colonoscopy
P8E	Endoscopy - Cystoscopy
P8F	Endoscopy - Bronchoscopy
P8G	Endoscopy - Laparoscopic Cholecystectomy
P8H	Endoscopy - Laryngoscopy
P8I	Endoscopy - Other
P9A	Dialysis Services (Medicare Fee Schedule)
P9B	Dialysis Services (Non-Medicare Fee Schedule)
T1A	Lab Tests - Routine Venipuncture (Non Medicare Fee Schedule)
T1B	Lab Tests - Automated General Profiles
T1C	Lab Tests - Urinalysis
T1D	Lab Tests - Blood Counts
T1E	Lab Tests - Glucose
T1F	Lab Tests - Bacterial Cultures
T1G	Lab Tests - Other (Medicare Fee Schedule)
T1H	Lab Tests - Other (Non-Medicare Fee Schedule)
T2A	Other Tests - Electrocardiograms
T2B	Other Tests - Cardiovascular Stress Tests
T2C	Other Tests - EKG Monitoring
T2D	Other Tests - Other
Y1	Other - Medicare Fee Schedule
Y2	Other - Non-Medicare Fee Schedule
Z1	Local Codes
Z2	Undefined Codes

Code	Value
1	Not fully bought into Part A and B
Blank	Fully bought into Part A and Part B

Data Dictionary

Last updated December 21, 2018

for CJR Baseline, Monthly, Target Price, and Reconciliation Reports

Table of Contents

Introduction

Acronyms

Key Terms

A Note About Episode IDs and Patient Identifiers

A Note About Dollar Values

The CSV File Format

Description of Data Dictionary Tables

Data Types

Data Dictionary For Each File

ACO

BDUAL

BPCIEXCL

BXREF

CURRPRC

DENOM

DMDTL

DMHDR

DXPX

EPI

EPIEXC

HHDTL

HHHDR

HOSP_RECON_SUM

HSHDR

IPDTL

IPHDR

IPVAL

NCBP

OPDTL

OPHDR

PBDTL

PBHDR

QM

RECON_AMT

REGION#

SNDTL

SNHDR

SUM

TP

Code Value Reference

ANCHOR_DRG_CD

ANCHOR_STUS_CD

ASGMNTCD

BENE_DUAL_INST

BENE_DUAL_MDCD

BENE_DUAL_STUS_CD

BETOS

BUYIN[01-12]

CLM_CARR_PMT_DNL_CD

CLM_POA_IND

CLM_PROD_TYPE_CD

CLM_TYPE_CD

CLM_VAL_SQNC_NUM

DGNS_PRCDR_ICD_IND

DRG

DROPREASON

EXCLUSION_CODE

FAC_TYPE

FREQ_CD

HCFASPCL

HCP_CD/OFT_CD

HMO[01-12]

MODEL

MSCD[01-12]

MTUS_IND

NON_STD_SUB

OREC/CREC

OUTLR_CD

PAY_TYPE

PERF_YEAR

PERIOD_ABBREV

PLCSRVC

PMTMTHD

PRCNGIND

PROGRAM_ID

PROV

Code	Value
00	MSP cost avoided - COB Contractor
0	Denied
1	Physician/supplier
2	Beneficiary
3	Both physician/supplier and beneficiary
4	Hospital (hospital based physicians)
5	Both hospital and beneficiary
6	Group practice prepayment plan
7	Other entries (e.g. Employer, union)
8	Federally funded
9	PA service
12	MSP cost avoided - BC/BS Voluntary Agreements
13	MSP cost avoided - Office of Personnel Management
14	MSP cost avoided - Workman's Compensation (WC) Datamatch
15	MSP cost avoided - Workman's Compensation Insurer Voluntary Data Sharing Agreements (WC VDSA)
16	MSP cost avoided - Liability Insurer VDSA
17	MSP cost avoided - No-Fault Insurer VDSA
18	MSP cost avoided - Pharmacy Benefit Manager Data Sharing Agreement
19	Workers' Compensation Medicare Set-Aside Arrangement
21	MSP cost avoided - MIR Group Health Plan
22	MSP cost avoided - MIR non-Group Health Plan
25	MSP cost avoided - Recovery Audit Contractor - California
26	MSP cost avoided - Recovery Audit Contractor - Florida
41	MSP cost avoided - non-Group Health Plan non-Ongoing responsibility for medical (ORM)
42	MSP cost avoided - non-Group Health Plan ORM Recovery number 11142.
A	Beneficiary under limitation of liability
B	Physician/supplier under limitation of liability
D	Denied due to demonstration involvement
D	Denied due to demonstration involvement
E	MSP cost avoided IRS/SSA/HCFA Data Match
F	MSP cost avoided HMO Rate Cell
F	MSP cost avoided HMO Rate Cell (after 1/2001 is Trauma Code Development)
G	MSP cost avoided Litigation Settlement
G	MSP cost avoided Litigation Settlement (after 1/2001 is Secondary Claims Investigation)
H	MSP cost avoided Employer Voluntary Reporting
H	MSP cost avoided Employer Voluntary Reporting (after 1/2001 is Self Reports)
J	MSP cost avoided Insurer Voluntary Reporting
J	MSP cost avoided Insurer Voluntary Reporting (eff. 7/3/00)
K	MSP cost avoided Initial Enrollment Questionnaire
P	Physician ownership denial
Q	MSP cost avoided - (Contractor #88888) voluntary agreement
Q	MSP cost avoided - voluntary agreements including with employer
T	MSP cost avoided - Initial Enrollment Questionnaire
V	MSP cost avoided - litigation settlement
X	MSP cost avoided - generic
X	MSP cost avoided - generic
Y	MSP cost avoided - IRS/SSA data match

Code	Value
0	No POA reported
1	Unreported/not used - exempt from POA reporting
N	Diagnosis was not present at the time of admission
U	Documentation is insufficient to determine if condition was present on admission
W	Provider is unable to clinically determine whether condition was present on admission
X	Denotes the end of the POA indicators in special data processing situations that may be identified by CMS in the future.
Y	Diagnosis was present at the time of admission (POA)
Z	Denotes the end of the POA indicators
~	Unreported/not used - exempt from POA reporting

Code	Value
D	Claim Diagnosis Code
E	Claim Diagnosis E Code
S	Claim Procedure Code

Code	Value
10	HHA claim
20	Non swing bed SNF claim
30	Swing bed SNF claim
40	Outpatient claim
50	Hospice claim
60	Inpatient claim
61	Inpatient 'Full-Encounter' claim
62	Medicare Advantage IME/GME claims
63	Medicare Advantage (no-pay) claims
64	Medicare Advantage (paid as FFS) claim
71	RIC O local carrier non-DMEPOS claim
72	RIC O local carrier DMEPOS claim
81	RIC M DMERC non-DMEPOS claim
82	RIC M DMERC DMEPOS claim

Code	Value
0	Diagnosis codes are ICD-10 codes
9	Diagnosis codes are ICD-9 codes

Code	Value
1	MC pay switch exclusion
2	MC total equal IME exclusion
3	LOS longer than 365 days
4	Duplicate claims
5	Last interim claim Discharge status still patient
6	ESRD exclusion
7	HMO exclusion
8	Part A/B Buyin Code exclusion
9	Date of Death exclusion
10	Non-IPPS provider
11	Medicare Secondary Payer
12	Post Discharge period beyond cutoff date
13	Transferred from another hospital
15	Subsequent CJR Readmission within 90 days
22	Subsequent CJR Readmission to a CJR participant hospital within 90 days
23	Total payment after removing DSH, IME, Tech add, and Hemophiliac payments is 0 or negative
24	Overlap with BPCI episode (claims-based approach)

Code	Value
0	No Exclusion
1	Non-positive allowed amount
2	Denied claim
3	Denied claim or physician ownership denial processing indicator
4	Non-hospital service on anchor begin date
5	ICD-9 exclusion code
6	ICD-9 exclusion code occuring in post-discharge period
7	OPPS pass-through amount for devices
8	DRG exclusion for LTCH stay before anchor began
9	DRG exclusion for IPF stay in post-discharge period
10	DRG exclusion for LTCH or IPF stay beginning on or before anchor begin
11	DRG exclusion at acute, critical access, children's, cancer, or Texas research hospital (but not anchor stay)
13	OP claim began during anchor stay
14	Claim starts before anchor ends
15	Claim starts in post-episode period
16	Claim perfectly overlaps with anchor begin and end
17	LTCH, IRF, or IPF stay within the anchor begin and end
18	Acute, critical access, children's, cancer, or Texas research hospital stay starts before anchor end date
19	Transfer from non-IPPS hospital into anchor stay
20	Occurred in the post-episode period
21	Did not occur in the anchor, post-discharge, or post-episode period
22	Medicare secondary payer claim
23	Medicare secondary payer claim (claim begins during episode)
24	Claim ends on or before anchor begin date
25	Excluded demonstration payment
26	Oncology Care Model PBPM
27	Medicare Care Choices Model PBPM

Code	Value
1	Hospital
2	Skilled nursing facility (SNF)
3	Home health agency (HHA)
4	Religious nonmedical hospital
5	(obsolete) Religious nonmedical extended care
6	Intermediate care
7	Clinic or hospital-based renal dialysis facility
8	Special facility or ambulatory surgical center (ASC)
9	Reserved

Code	Value
0	Non-payment/zero claims
1	Admit thru discharge claim
2	Interim - first claim
3	Interim - continuing claim (not valid for PPS claims)
4	Interim - last claim (not valid for PPS claims)
5	Late charge(s) only claim
6	Adjustment of prior claim
7	Replacement of prior claim - provider debit
8	Void/cancel prior claim - provider cancel
9	Final claim
A	Admission election notice - hospice NOE only
B	Hospice/Medicare Coordinated Care Demonstration/RNCHI - Termination/Revocation Notice - hospice NOE only
C	Hospice change of provider notice - hospice NOE only
D	Hospice/Medicare Coordinated Care Demonstration/RNHCI - void/cancel - hospice NOE only
E	Hospice change of ownership - hospice NOE only
F	Beneficiary initiated adjustment claim
G	CWF generated adjustment claim
H	CMS generated adjustment claim
I	Misc adjustment claim (other than PRO or provider)
J	Other adjustment request
K	OIG initiated adjustment
M	MSP adjustment
P	Adjustment required by Quality Improvement Organization (QIO)
Q	Request for reopened claim
X	Special adjustment processing

Code	Value
00	Carrier wide
01	General practice
02	General surgery
03	Allergy/immunology
04	Otolaryngology
05	Anesthesiology
06	Cardiology
07	Dermatology
08	Family practice
09	Interventional Pain Management (IPM)
10	Gastroenterology
11	Internal medicine
12	Osteopathic manipulative therapy
13	Neurology
14	Neurosurgery
15	Speech / language pathology
16	Obstetrics/gynecology
17	Hospice and Palliative Care
18	Ophthalmology
19	Oral surgery (dentists only)
20	Orthopedic surgery
21	Cardiac Electrophysiology
22	Pathology
23	Physician/Sports Medicine
24	Plastic and reconstructive surgery
25	Physical medicine and rehabilitation
26	Psychiatry
27	General Psychiatry
28	Colorectal surgery (formerly proctology)
29	Pulmonary disease
30	Diagnostic radiology
31	Intensive cardiac rehabilitation
32	Anesthesiologist Assistants
33	Thoracic surgery
34	Urology
35	Chiropractic
36	Nuclear medicine
37	Pediatric medicine
38	Geriatric medicine
39	Nephrology
40	Hand surgery
41	Optometrist
42	Certified nurse midwife
43	Certified Registered Nurse Anesthetist (CRNA)
44	Infectious disease
45	Mammography screening center
46	Endocrinology
47	Independent Diagnostic Testing Facility (IDTF)
48	Podiatry
49	Ambulatory surgical center (formerly miscellaneous)
50	Nurse practitioner
51	Medical supply company with certified orthotist (certified by American Board for Certification in Prosthetics and Orthotics)
52	Medical supply company with certified prosthetist (certified by American Board for Certification in Prosthetics and Orthotics)
53	Medical supply company with certified prosthetist-orthotist (certified by American Board for Certification in Prosthetics and Orthotics)
54	Medical supply company for DMERC (and not included in 51-53)
55	Individual certified orthotist
56	Individual certified prosthetist
57	Individual certified prosthetist-orthotist
58	Medical supply company with registered pharmacist
59	Ambulance service supplier, (e.g., private ambulance companies, funeral homes, etc.)
60	Public health or welfare agencies (federal, state, and local)
61	Voluntary health or charitable agencies (e.g. National Cancer Society, National Heart Association, Catholic Charities)
62	Psychologist (billing independently)
63	Portable X-ray supplier
64	Audiologist (billing independently)
65	Physical therapist
66	Rheumatology
67	Occupational therapist
68	Clinical psychologist
69	Clinical laboratory (billing independently)
70	Multispecialty clinic or group practice
71	Registered Dietician/Nutrition Professional
72	Pain Management
73	Mass Immunization Roster Biller
74	Radiation Therapy Centers
75	Slide Preparation Facilities (added to differentiate them from Independent Diagnostic Testing Facilites (IDTFs)
76	Peripheral vascular disease
77	Vascular surgery
78	Cardiac surgery
79	Addiction medicine
80	Licensed clinical social worker
81	Critical care (intensivists)
82	Hematology
83	Hematology/oncology
84	Preventive medicine
85	Maxillofacial surgery
86	Neuropsychiatry
87	All other suppliers (e.g. drug and department stores)
88	Unknown supplier/provider specialty
89	Certified clinical nurse specialist
90	Medical oncology
91	Surgical oncology
92	Radiation oncology
93	Emergency medicine
94	Interventional radiology
95	Competative Acquisition Program (CAP) Vendor
96	Optician
97	Physician assistant
98	Gynecologist/oncologist
99	Unknown physician specialty
A0	Hospital (DMERCs only)
A1	SNF (DMERCs only)
A2	Intermediate care nursing facility (DMERCs only)
A3	Nursing facility, other (DMERCs only)
A4	Home Health Agency (DMERCs only)
A5	Pharmacy (DMERC)
A6	Medical supply company with respiratory therapist (DMERCs only)
A7	Department store (DMERC)
A8	Grocery store (DMERC)
A9	Indian Health Service (IHS), tribe and tribal organizations (non-hospital or non-hospital based facilities)
B1	Supplier of oxygen and/or oxygen related equipment
B2	Pedorthic Personnel
B3	Medical Supply Company with pedorthic personnel
B4	Does not meet definition of health care provider (e.g., Rehabilitation agency, organ procurement organizations, histocompatibility labs)
B5	Ocularist
C0	Sleep medicine
C1	Centralized flu
C2	Indirect payment procedure
C3	Interventional cardiology
C5	Dentist
C6	Hospitalist
C7	Advanced Heart Failure and Transplant Cardiology
C8	Medical Toxicology
C9	Hematopoietic Cell Transplantation and Cellular Therapy