Table of Contents
Introduction
This data dictionary describes columns present in the claims, episode, participant, and summary data files that RO participants participating in the RO Model may request from CMS. The following table lists the possible selections of baseline data in the Data Sharing Agreement and Data Request and Attestation (DRA) form, the corresponding zip files that RO participants may receive in the RO Model Secure Data Portal, and data files included under each data request selection.
| DRA Selection for Baseline Data | Data Portal File Name | Data File(s) | Data File Description |
|---|---|---|---|
1. Baseline Beneficiary Line-Level Claims Data | Baseline Beneficiary Claims Data.zip | Beneficiary Line-Level Claims File | This displays service-level information for RO services on physician and Outpatient Department (OPD) claims, including RO payment amount. |
| Substance Abuse and Mental Health (SAMH) Excluded Claims Summary | This displays a summary by claim type of the number of claims omitted from each RO participant's claims files and total RO payments associated with an RO participant's episodes on omitted claims. | ||
1.a. Baseline Raw Claims Data | Baseline Raw Claims Data.zip | Inpatient Claim Header File | This displays raw inpatient claims header records for all inpatient records for beneficiaries in an RO participant's episode-level file during the 90-day baseline episode period. Please note that header claim files can be linked to associated revenue center files and/or line item files by using the CLM_ID variable. |
| Outpatient Claim Header File | This displays raw outpatient claims header records for all Outpatient Prospective Payment System (OPPS) claims for beneficiaries in an RO participant's episode-level file during the 180-day data period associated with each beneficiary’s episode, which encompasses the 90-day pre-episode period and 90-day episode period. Please note that header claim files can be linked to associated revenue center files and/or line item files by using the CLM_ID variable. | ||
| Outpatient Revenue Center File | This displays raw outpatient revenue center records for all OPPS claims for beneficiaries in an RO participant's episode-level file during the 180-day data period associated with each beneficiary's episode. | ||
| Physician Claim Header File | This displays raw carrier claims header records for all carrier claims for beneficiaries in an RO participant's episode-level file during the 180-day data period associated with each beneficiary's episode. | ||
| Physician Line File | This displays raw carrier claims line records for all carrier claims for patients in an RO participant's episode-level file during the 180-day data period associated with each beneficiary's episode. | ||
| Durable Medical Equipment (DME) Line File | This displays raw DME line records for all DME claims for beneficiaries in an RO participant's episode-level file during the 90-day baseline episode period. | ||
| Prescription Drug Event (PDE) Claim | This displays raw Part D PDE records for all PDE claims for beneficiaries in an RO participant's episode-level file during the 90-day baseline episode period. Please note that PED claims are limited to final action claims with chemotherapy codes. For a list of chemotherapy codes, see https://innovation.cms.gov/innovation-models/radiation-oncology-archived-materials. | ||
2. Baseline Episode-Level Data | Baseline Episode Data.zip | Episode-Level File | This displays episode-level data for all episodes attributed to the RO participant during the baseline period. Please note that the episode-level file excludes episodes that do not have an included cancer type, do not have a positive payment for the professional component or technical component, or occurred outside of the participating ZIP codes. |
3. Baseline Participant-Level Data | Baseline Participant Data.zip | Participant-Level File | This displays participant-level data that summarize the characteristics of an RO participant’s baseline episodes and the beneficiaries associated with those episodes. |
Description of Data Dictionary Tables
The tables below describe the variables that are included in each file. The columns in these tables are:
- Variable Name
- The name of the variable as it appears in the distributed file.
- Type
- How the values of this variable should be interpreted. We define only three data types, described below.
- Description
- A brief text description of the variable's meaning or purpose.
- Details
- A longer, more detailed text description of the variable's meaning or purpose.
Data Types
The file format does not itself specify the format or representation of values. We therefore define the following types which we use throughout this dictionary:
- Num
- A numeric variable. There are two types of numeric variables: integer and decimal. Integers are whole-numbered values, and can be zero or negative (e.g. 0, 1, -2, etc.). 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.).
- 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
Beneficiary Line-Level File
| Variable Name | Type | Description | Details |
|---|---|---|---|
BENE_ID | NUM | Encrypted CCW Beneficiary ID | Beneficiary ID |
EPISODE_ID | NUM | Episode Identification Number | Unique number identifying each episode |
CLM_ID | NUM | Claim ID | Unique number identifying a claim |
LINE_NUM | NUM | Claim Line Number | This variable identifies an individual line number on a claim |
DATE | DATE | Line First Expense Date/Revenue Center Date | The Line First Expense Date for the carrier claim line or Revenue Center Date for the revenue center record |
HCPCS_CD | CHAR | Healthcare Common Procedure Coding System (HCPCS) Code | The HCPCS code representing the procedure, supply, product, and/or service provided to the beneficiary |
HCPCS_1ST_MDFR_CD | CHAR | HCPCS Initial Modifier Code | A first modifier to the HCPCS procedure code to enable a more specific procedure identification for the revenue center or line item service for the claim. |
HCPCS_2ND_MDFR_CD | CHAR | HCPCS Second Modifier Code | A second modifier to the HCPCS procedure code to make it more specific than the first modifier code to identify the revenue center or line item service for the claim |
RADONC_SERVICE_CAT | CHAR | HCPCS Radiation Oncology Service Category | Values include: Treatment Planning Treatment Management Radiation Treatment Delivery Radiation Treatment Delivery (Guidance) Medical Radiation Physics, Dosimetry, Treatment Devices, Special Services |
| CHAR | Radiation Oncology Modifier Code | 26 = Professional service TC = Technical service OP = Technical service blank = Global service | |
RADONC_MOD | CHAR | Radiation Oncology Modifier Label | PRO = Professional TECH = Technical |
RADONC_PROV | CHAR | Radiation Oncology Provider/Supplier | Taxpayer Identification Number (TIN) or CMS Certification Number (CCN) |
PAY_UNITS | NUM | Line Service Count | Count of the total number of services processed for the line item on the non-institutional claim |
OUTLIER_RATIO | NUM | Outlier Ratio | The ratio between standardized allowed amount and standardized allowed amount without outliers for the claim (CLM_STD_ALOWD_AMT/CLM_NO_OUTLIER_ALOWD_AMT) |
NO_CARRIER_RATE | NUM | Carrier Payment Rate Not Found | Payment rate not found on the Medicare Physician Fee Schedule for carrier claims |
NO_OPPS_RATE | NUM | Outpatient Payment Rate Not Found | Payment rate not found on the Outpatient Prospective Payment System (OPPS) Fee Schedule for outpatient claims |
STANDARDIZED_AMOUNT | NUM | Standardized Payment Amount | Payment amount in standardized dollars for the claim line (wage factors removed, not prorated) |
ALLOWED_CHARGE | NUM | Allowed Charge Amount | Allowed charge amount used to calculate Medicare Payment Amount (MCARE_PAY) for an Outpatient Department (OPD) claim |
MCARE_PAY | NUM | Medicare Payment Amount | Medicare Payment amount used to determine Radiation Oncology Payment Amount (RANDONC_PAY) for the line item |
RADONC_PAY | NUM | Radiation Oncology Payment Amount | Payment amount used to calculate national base rates for the line item |
NPI_CARRIER_SERVICE | CHAR | Carrier Line Performing National Provider Identifier (NPI) Number | PRF_PHYSN_NPI if a carrier line; blank if an OPD line. |
ZIP_CODE5 | CHAR | Line Place of Service ZIP Code/ Claim Service Facility ZIP Code | 5-digit ZIP code for the service location |
SAMH Excluded Claims Summary
| Variable Name | Type | Description | Details |
|---|---|---|---|
| CHAR | Type of Service | DME = Durable medical equipment INP = Inpatient OUT = Outpatient PHY = Physician | |
CLM_COUNT_RAW | NUM | Count of Claim Header Records Dropped | Number of claim records dropped from the HEADER dataset (all revenue centers, line items, and value codes corresponding to the claim will also have been excluded) |
CLM_COUNT_ATTRI | NUM | Count of Claim Header Records Dropped from the Beneficiary Line-Level Claims File | Number of claim records dropped from the HEADER dataset (all revenue centers, line items, and value codes corresponding to the claim will also have been excluded) that are in the Beneficiary Line-Level Claims file. |
DROPPED_EXP_ATTRI | NUM | Sum of Expenditures Dropped from the Beneficiary Line-Level Claims File | Sum of the RADONC_PAY variable on the Beneficiary Line-Level Claims File records that were dropped. |
Inpatient Claim Header File
| Variable Name | Type | Description |
|---|---|---|
BENE_ID | NUM | Encrypted CCW Beneficiary ID |
CLM_ID | NUM | Claim ID |
NCH_CLM_TYPE_CD | CHAR | NCH Claim Type Code |
CLM_FROM_DT | DATE | Claim From Date |
CLM_THRU_DT | DATE | Claim Through Date |
NCH_WKLY_PROC_DT | DATE | NCH Weekly Claim Processing Date |
FI_CLM_PROC_DT | DATE | FI Claim Process Date |
PRVDR_NUM | CHAR | Provider Number |
CLM_FAC_TYPE_CD | CHAR | Claim Facility Type Code |
CLM_FREQ_CD | CHAR | Claim Frequency Code |
CLM_MDCR_NON_PMT_RSN_CD | CHAR | Claim Medicare Non Payment Reason Code |
CLM_PMT_AMT | NUM | Claim (Medicare) Payment Amount |
NCH_PRMRY_PYR_CLM_PD_AMT | NUM | NCH Primary Payer (if not Medicare) Claim Paid Amount |
NCH_PRMRY_PYR_CD | CHAR | NCH Primary Payer Code (if not Medicare) |
PRVDR_STATE_CD | CHAR | NCH Provider SSA State Code |
ORG_NPI_NUM | CHAR | Organization NPI Number |
AT_PHYSN_NPI | CHAR | Claim Attending Physician NPI Number |
OP_PHYSN_NPI | CHAR | Claim Operating Physician NPI Number |
CLM_MCO_PD_SW | CHAR | Claim MCO Paid Switch |
PTNT_DSCHRG_STUS_CD | CHAR | Patient Discharge Status Code |
CLM_PPS_IND_CD | CHAR | Claim PPS Indicator Code |
CLM_TOT_CHRG_AMT | NUM | Claim Total Charge Amount |
CLM_ADMSN_DT | DATE | Claim Admission Date |
CLM_IP_ADMSN_TYPE_CD | CHAR | Claim Inpatient Admission Type Code |
CLM_SRC_IP_ADMSN_CD | CHAR | Claim Source Inpatient Admission Code |
CLM_PASS_THRU_PER_DIEM_AMT | NUM | Claim Pass Thru Per Diem Amount |
NCH_BENE_IP_DDCTBL_AMT | NUM | NCH Beneficiary Inpatient (or other Part A) Deductible Amount |
NCH_BENE_PTA_COINSRNC_LBLTY_AM | NUM | NCH Beneficiary Part A Coinsurance Liability Amount |
NCH_BENE_BLOOD_DDCTBL_LBLTY_AM | NUM | NCH Beneficiary Blood Deductible Liability Amount |
CLM_TOT_PPS_CPTL_AMT | NUM | Claim Total PPS Capital Amount |
CLM_PPS_CPTL_OUTLIER_AMT | NUM | Claim PPS Capital Outlier Amount |
CLM_PPS_CPTL_DSPRPRTNT_SHR_AMT | NUM | Claim PPS Capital Disproportionate Share Amount |
CLM_PPS_CPTL_IME_AMT | NUM | Claim PPS Capital Indirect Medical Education (IME) Amount |
CLM_UTLZTN_DAY_CNT | NUM | Claim Medicare Utilization Day Count |
NCH_BENE_DSCHRG_DT | DATE | NCH Beneficiary Discharge Date |
CLM_DRG_CD | CHAR | Claim Diagnosis Related Group Code (or MS-DRG Code) |
CLM_DRG_OUTLIER_STAY_CD | CHAR | Claim Diagnosis Related Group Outlier Stay Code |
NCH_DRG_OUTLIER_APRVD_PMT_AMT | NUM | NCH DRG Outlier Approved Payment Amount |
ADMTG_DGNS_CD | CHAR | Claim Admitting Diagnosis Code |
PRNCPAL_DGNS_CD | CHAR | Claim Principal Diagnosis Code |
ICD_DGNS_CD1 | CHAR | Claim Diagnosis Code I |
ICD_DGNS_CD2 | CHAR | Claim Diagnosis Code II |
ICD_DGNS_CD3 | CHAR | Claim Diagnosis Code III |
ICD_DGNS_CD4 | CHAR | Claim Diagnosis Code IV |
ICD_DGNS_CD5 | CHAR | Claim Diagnosis Code V |
ICD_DGNS_CD6 | CHAR | Claim Diagnosis Code VI |
ICD_DGNS_CD7 | CHAR | Claim Diagnosis Code VII |
ICD_DGNS_CD8 | CHAR | Claim Diagnosis Code VIII |
ICD_DGNS_CD9 | CHAR | Claim Diagnosis Code IX |
ICD_DGNS_CD10 | CHAR | Claim Diagnosis Code X |
ICD_DGNS_CD11 | CHAR | Claim Diagnosis Code XI |
ICD_DGNS_CD12 | CHAR | Claim Diagnosis Code XII |
ICD_DGNS_CD13 | CHAR | Claim Diagnosis Code XIII |
ICD_DGNS_CD14 | CHAR | Claim Diagnosis Code XIV |
ICD_DGNS_CD15 | CHAR | Claim Diagnosis Code XV |
ICD_DGNS_CD16 | CHAR | Claim Diagnosis Code XVI |
ICD_DGNS_CD17 | CHAR | Claim Diagnosis Code XVII |
ICD_DGNS_CD18 | CHAR | Claim Diagnosis Code XVIII |
ICD_DGNS_CD19 | CHAR | Claim Diagnosis Code XIX |
ICD_DGNS_CD20 | CHAR | Claim Diagnosis Code XX |
ICD_DGNS_CD21 | CHAR | Claim Diagnosis Code XXI |
ICD_DGNS_CD22 | CHAR | Claim Diagnosis Code XXII |
ICD_DGNS_CD23 | CHAR | Claim Diagnosis Code XXIII |
ICD_DGNS_CD24 | CHAR | Claim Diagnosis Code XXIV |
ICD_DGNS_CD25 | CHAR | Claim Diagnosis Code XXV |
ICD_PRCDR_CD1 | CHAR | Claim Procedure Code I |
PRCDR_DT1 | NUM | Claim Procedure Code I Date |
ICD_PRCDR_CD2 | CHAR | Claim Procedure Code II |
PRCDR_DT2 | NUM | Claim Procedure Code II Date |
ICD_PRCDR_CD3 | CHAR | Claim Procedure Code III |
PRCDR_DT3 | NUM | Claim Procedure Code III Date |
ICD_PRCDR_CD4 | CHAR | Claim Procedure Code IV |
PRCDR_DT4 | NUM | Claim Procedure Code IV Date |
ICD_PRCDR_CD5 | CHAR | Claim Procedure Code V |
PRCDR_DT5 | NUM | Claim Procedure Code V Date |
ICD_PRCDR_CD6 | CHAR | Claim Procedure Code VI |
PRCDR_DT6 | NUM | Claim Procedure Code VI Date |
ICD_PRCDR_CD7 | CHAR | Claim Procedure Code VII |
PRCDR_DT7 | NUM | Claim Procedure CodeVII Date |
ICD_PRCDR_CD8 | CHAR | Claim Procedure Code VIII |
PRCDR_DT8 | NUM | Claim Procedure Code VIII Date |
ICD_PRCDR_CD9 | CHAR | Claim Procedure Code IX |
PRCDR_DT9 | NUM | Claim Procedure Code IX Date |
ICD_PRCDR_CD10 | CHAR | Claim Procedure Code X |
PRCDR_DT10 | NUM | Claim Procedure Code X Date |
ICD_PRCDR_CD11 | CHAR | Claim Procedure Code XI |
PRCDR_DT11 | NUM | Claim Procedure Code XI Date |
ICD_PRCDR_CD12 | CHAR | Claim Procedure Code XII |
PRCDR_DT12 | NUM | Claim Procedure Code XII Date |
ICD_PRCDR_CD13 | CHAR | Claim Procedure Code XIII |
PRCDR_DT13 | NUM | Claim Procedure Code XIII Date |
ICD_PRCDR_CD14 | CHAR | Claim Procedure Code XIV |
PRCDR_DT14 | NUM | Claim Procedure Code XIV Date |
ICD_PRCDR_CD15 | CHAR | Claim Procedure Code XV |
PRCDR_DT15 | NUM | Claim Procedure Code XV Date |
ICD_PRCDR_CD16 | CHAR | Claim Procedure Code XVI |
PRCDR_DT16 | NUM | Claim Procedure Code XVI Date |
ICD_PRCDR_CD17 | CHAR | Claim Procedure Code XVII |
PRCDR_DT17 | NUM | Claim Procedure Code XVII Date |
ICD_PRCDR_CD18 | CHAR | Claim Procedure Code XVIII |
PRCDR_DT18 | NUM | Claim Procedure Code XVIII Date |
ICD_PRCDR_CD19 | CHAR | Claim Procedure Code XIX |
PRCDR_DT19 | NUM | Claim Procedure Code XIX Date |
ICD_PRCDR_CD20 | CHAR | Claim Procedure Code XX |
PRCDR_DT20 | NUM | Claim Procedure Code XX Date |
ICD_PRCDR_CD21 | CHAR | Claim Procedure Code XXI |
PRCDR_DT21 | NUM | Claim Procedure Code XXI Date |
ICD_PRCDR_CD22 | CHAR | Claim Procedure Code XXII |
PRCDR_DT22 | NUM | Claim Procedure Code XXII Date |
ICD_PRCDR_CD23 | CHAR | Claim Procedure Code XXIII |
PRCDR_DT23 | NUM | Claim Procedure Code XXIII Date |
ICD_PRCDR_CD24 | CHAR | Claim Procedure Code XXIV |
PRCDR_DT24 | NUM | Claim Procedure Code XXIV Date |
ICD_PRCDR_CD25 | CHAR | Claim Procedure Code XXV |
PRCDR_DT25 | NUM | Claim Procedure Code XXV Date |
IME_OP_CLM_VAL_AMT | NUM | Operating Indirect Medical Education (IME) Amount |
DSH_OP_CLM_VAL_AMT | NUM | Operating Disproportionate Share Amount |
CLM_MDCL_REC | CHAR | Claim Medical Record Number |
CLM_SRVC_CLSFCTN_TYPE_CD | CHAR | Claim Service Classification Type Code |
Outpatient Claim Header File
| Variable Name | Type | Description |
|---|---|---|
BENE_ID | NUM | Encrypted CCW Beneficiary ID |
CLM_ID | NUM | Claim ID |
NCH_CLM_TYPE_CD | CHAR | NCH Claim Type Code |
CLM_FROM_DT | DATE | Claim From Date |
CLM_THRU_DT | DATE | Claim Through Date |
NCH_WKLY_PROC_DT | DATE | NCH Weekly Claim Processing Date |
FI_CLM_PROC_DT | DATE | FI Claim Process Date |
PRVDR_NUM | CHAR | Provider Number |
CLM_FAC_TYPE_CD | CHAR | Claim Facility Type Code |
CLM_MDCR_NON_PMT_RSN_CD | CHAR | Claim Medicare Non Payment Reason Code |
CLM_PMT_AMT | NUM | Claim (Medicare) Payment Amount |
NCH_PRMRY_PYR_CLM_PD_AMT | NUM | NCH Primary Payer (if not Medicare) Claim Paid Amount |
NCH_PRMRY_PYR_CD | CHAR | NCH Primary Payer Code (if not Medicare) |
ORG_NPI_NUM | CHAR | Organization NPI Number |
AT_PHYSN_NPI | CHAR | Claim Attending Physician NPI Number |
OP_PHYSN_NPI | CHAR | Claim Operating Physician NPI Number |
CLM_MCO_PD_SW | CHAR | Claim MCO Paid Switch |
PTNT_DSCHRG_STUS_CD | CHAR | Patient Discharge Status Code |
PRNCPAL_DGNS_CD | CHAR | Claim Principal Diagnosis Code |
ICD_DGNS_CD1 | CHAR | Claim Diagnosis Code I |
ICD_DGNS_CD2 | CHAR | Claim Diagnosis Code II |
ICD_DGNS_CD3 | CHAR | Claim Diagnosis Code III |
ICD_DGNS_CD4 | CHAR | Claim Diagnosis Code IV |
ICD_DGNS_CD5 | CHAR | Claim Diagnosis Code V |
ICD_DGNS_CD6 | CHAR | Claim Diagnosis Code VI |
ICD_DGNS_CD7 | CHAR | Claim Diagnosis Code VII |
ICD_DGNS_CD8 | CHAR | Claim Diagnosis Code VIII |
ICD_DGNS_CD9 | CHAR | Claim Diagnosis Code IX |
ICD_DGNS_CD10 | CHAR | Claim Diagnosis Code X |
ICD_DGNS_CD11 | CHAR | Claim Diagnosis Code XI |
ICD_DGNS_CD12 | CHAR | Claim Diagnosis Code XII |
ICD_DGNS_CD13 | CHAR | Claim Diagnosis Code XIII |
ICD_DGNS_CD14 | CHAR | Claim Diagnosis Code XIV |
ICD_DGNS_CD15 | CHAR | Claim Diagnosis Code XV |
ICD_DGNS_CD16 | CHAR | Claim Diagnosis Code XVI |
ICD_DGNS_CD17 | CHAR | Claim Diagnosis Code XVII |
ICD_DGNS_CD18 | CHAR | Claim Diagnosis Code XVIII |
ICD_DGNS_CD19 | CHAR | Claim Diagnosis Code XIX |
ICD_DGNS_CD20 | CHAR | Claim Diagnosis Code XX |
ICD_DGNS_CD21 | CHAR | Claim Diagnosis Code XXI |
ICD_DGNS_CD22 | CHAR | Claim Diagnosis Code XXII |
ICD_DGNS_CD23 | CHAR | Claim Diagnosis Code XXIII |
ICD_DGNS_CD24 | CHAR | Claim Diagnosis Code XXIV |
ICD_DGNS_CD25 | CHAR | Claim Diagnosis Code XXV |
ICD_PRCDR_CD1 | CHAR | Claim Procedure Code I |
PRCDR_DT1 | NUM | Claim Procedure Code I Date |
ICD_PRCDR_CD2 | CHAR | Claim Procedure Code II |
PRCDR_DT2 | NUM | Claim Procedure Code II Date |
ICD_PRCDR_CD3 | CHAR | Claim Procedure Code III |
PRCDR_DT3 | NUM | Claim Procedure Code III Date |
ICD_PRCDR_CD4 | CHAR | Claim Procedure Code IV |
PRCDR_DT4 | NUM | Claim Procedure Code IV Date |
ICD_PRCDR_CD5 | CHAR | Claim Procedure Code V |
PRCDR_DT5 | NUM | Claim Procedure Code V Date |
ICD_PRCDR_CD6 | CHAR | Claim Procedure Code VI |
PRCDR_DT6 | NUM | Claim Procedure Code VI Date |
ICD_PRCDR_CD7 | CHAR | Claim Procedure Code VII |
PRCDR_DT7 | NUM | Claim Procedure CodeVII Date |
ICD_PRCDR_CD8 | CHAR | Claim Procedure Code VIII |
PRCDR_DT8 | NUM | Claim Procedure Code VIII Date |
ICD_PRCDR_CD9 | CHAR | Claim Procedure Code IX |
PRCDR_DT9 | NUM | Claim Procedure Code IX Date |
ICD_PRCDR_CD10 | CHAR | Claim Procedure Code X |
PRCDR_DT10 | NUM | Claim Procedure Code X Date |
ICD_PRCDR_CD11 | CHAR | Claim Procedure Code XI |
PRCDR_DT11 | NUM | Claim Procedure Code XI Date |
ICD_PRCDR_CD12 | CHAR | Claim Procedure Code XII |
PRCDR_DT12 | NUM | Claim Procedure Code XII Date |
ICD_PRCDR_CD13 | CHAR | Claim Procedure Code XIII |
PRCDR_DT13 | NUM | Claim Procedure Code XIII Date |
ICD_PRCDR_CD14 | CHAR | Claim Procedure Code XIV |
PRCDR_DT14 | NUM | Claim Procedure Code XIV Date |
ICD_PRCDR_CD15 | CHAR | Claim Procedure Code XV |
PRCDR_DT15 | NUM | Claim Procedure Code XV Date |
ICD_PRCDR_CD16 | CHAR | Claim Procedure Code XVI |
PRCDR_DT16 | NUM | Claim Procedure Code XVI Date |
ICD_PRCDR_CD17 | CHAR | Claim Procedure Code XVII |
PRCDR_DT17 | NUM | Claim Procedure Code XVII Date |
ICD_PRCDR_CD18 | CHAR | Claim Procedure Code XVIII |
PRCDR_DT18 | NUM | Claim Procedure Code XVIII Date |
ICD_PRCDR_CD19 | CHAR | Claim Procedure Code XIX |
PRCDR_DT19 | NUM | Claim Procedure Code XIX Date |
ICD_PRCDR_CD20 | CHAR | Claim Procedure Code XX |
PRCDR_DT20 | NUM | Claim Procedure Code XX Date |
ICD_PRCDR_CD21 | CHAR | Claim Procedure Code XXI |
PRCDR_DT21 | NUM | Claim Procedure Code XXI Date |
ICD_PRCDR_CD22 | CHAR | Claim Procedure Code XXII |
PRCDR_DT22 | NUM | Claim Procedure Code XXII Date |
ICD_PRCDR_CD23 | CHAR | Claim Procedure Code XXIII |
PRCDR_DT23 | NUM | Claim Procedure Code XXIII Date |
ICD_PRCDR_CD24 | CHAR | Claim Procedure Code XXIV |
PRCDR_DT24 | NUM | Claim Procedure Code XXIV Date |
ICD_PRCDR_CD25 | CHAR | Claim Procedure Code XXV |
PRCDR_DT25 | NUM | Claim Procedure Code XXV Date |
CLM_MDCL_REC | CHAR | Claim Medical Record Number |
CLM_SRVC_CLSFCTN_TYPE_CD | CHAR | Claim Service Classification Type Code |
CLM_FREQ_CD | CHAR | Claim Frequency Code |
CLM_NO_OUTLIER_ALOWD_AMT | NUM | Claim (Medicare) No Outlier Allowed Amount, standardized |
CLM_STD_ALOWD_AMT | NUM | Claim (Medicare) Allowed Amount, standardized |
Outpatient Revenue Center File
| Variable Name | Type | Description |
|---|---|---|
BENE_ID | NUM | Encrypted CCW Beneficiary ID |
CLM_ID | NUM | Claim ID |
CLM_THRU_DT | DATE | Claim Through Date |
CLM_LINE_NUM | NUM | Claim Line Number |
REV_CNTR | CHAR | Revenue Center Code |
REV_CNTR_DT | DATE | Revenue Center Date |
REV_CNTR_APC_HIPPS_CD | CHAR | Revenue Center APC or HIPPS Code |
HCPCS_CD | CHAR | Healthcare Common Procedure Coding System (HCPCS) Code |
HCPCS_1ST_MDFR_CD | CHAR | HCPCS Initial Modifier Code |
HCPCS_2ND_MDFR_CD | CHAR | HCPCS Second Modifier Code |
REV_CNTR_PMT_MTHD_IND_CD | CHAR | Revenue Center Payment Method Indicator Code |
REV_CNTR_IDE_NDC_UPC_NUM | CHAR | Revenue Center IDE, NDC, or UPC Number |
REV_CNTR_UNIT_CNT | NUM | Revenue Center Unit Count |
REV_CNTR_PTNT_RSPNSBLTY_PMT | NUM | Revenue Center Patient Responsibility Payment Amount |
REV_CNTR_PMT_AMT_AMT | NUM | Revenue Center (Medicare) Payment Amount |
REV_CNTR_NDC_QTY | NUM | Revenue Center National Drug Code (NDC) Quantity |
REV_CNTR_NDC_QTY_QLFR_CD | CHAR | Revenue Center NDC Quantity Qualifier Code |
REV_CNTR_TOT_CHRG_AMT | NUM | Revenue Center Total Charge Amount |
REV_CNTR_NCVRD_CHRG_AMT | NUM | Revenue Center Non-Covered Charge Amount |
CLM_LINE_NO_OUTLIER_ALOWD_AMT | NUM | Line NCH Medicare No Outlier Allowed Amount, standardized |
Physician Claim Header File
| Variable Name | Type | Description |
|---|---|---|
BENE_ID | NUM | Encrypted CCW Beneficiary ID |
CLM_ID | NUM | Claim ID |
CLM_FROM_DT | DATE | Claim From Date |
CLM_THRU_DT | DATE | Claim Through Date |
NCH_WKLY_PROC_DT | DATE | NCH Weekly Claim Processing Date |
CARR_NUM | CHAR | Carrier or MAC Number |
CARR_CLM_PMT_DNL_CD | CHAR | Carrier Claim Payment Denial Code |
CLM_PMT_AMT | NUM | Claim (Medicare) Payment Amount |
CARR_CLM_PRMRY_PYR_PD_AMT | NUM | NCH Primary Payer (if not Medicare) Claim Paid Amount |
CARR_CLM_PRVDR_ASGNMT_IND_SW | CHAR | Carrier Claim Provider Assignment Indicator Switch |
NCH_CARR_CLM_ALOWD_AMT | NUM | NCH Carrier Claim Allowed Charge Amount (sum of all line-level allowed charges) |
PRNCPAL_DGNS_CD | CHAR | Claim Principal Diagnosis Code |
CLM_CLNCL_TRIL_NUM | CHAR | Clinical Trial Number |
BENE_CNTY_CD | CHAR | County Code from Claim (SSA) |
BENE_STATE_CD | CHAR | Beneficiary Residence (SSA) State Code |
BENE_MLG_CNTCT_ZIP_CD | CHAR | ZIP Code of Residence from Claim |
ICD_DGNS_CD1 | CHAR | Claim Diagnosis Code I |
ICD_DGNS_CD2 | CHAR | Claim Diagnosis Code II |
ICD_DGNS_CD3 | CHAR | Claim Diagnosis Code III |
ICD_DGNS_CD4 | CHAR | Claim Diagnosis Code IV |
ICD_DGNS_CD5 | CHAR | Claim Diagnosis Code V |
ICD_DGNS_CD6 | CHAR | Claim Diagnosis Code VI |
ICD_DGNS_CD7 | CHAR | Claim Diagnosis Code VII |
ICD_DGNS_CD8 | CHAR | Claim Diagnosis Code VIII |
ICD_DGNS_CD9 | CHAR | Claim Diagnosis Code IX |
ICD_DGNS_CD10 | CHAR | Claim Diagnosis Code X |
ICD_DGNS_CD11 | CHAR | Claim Diagnosis Code XI |
ICD_DGNS_CD12 | CHAR | Claim Diagnosis Code XII |
Physician Line File
| Variable Name | Type | Description |
|---|---|---|
BENE_ID | NUM | Encrypted CCW Beneficiary ID |
CLM_ID | NUM | Claim ID |
LINE_NUM | NUM | Claim Line Number |
CLM_THRU_DT | DATE | Claim Through Date |
PRF_PHYSN_NPI | CHAR | Carrier Line Performing NPI Number |
TAX_NUM | CHAR | Line Provider Tax Number |
PRVDR_SPCLTY | CHAR | Line CMS Provider Specialty Code |
LINE_SRVC_CNT | NUM | Line Service Count |
LINE_CMS_TYPE_SRVC_CD | CHAR | Line CMS Type Service Code |
LINE_PLACE_OF_SRVC_CD | CHAR | Line Place Of Service Code |
CARR_LINE_PRCNG_LCLTY_CD | CHAR | Carrier Line Pricing Locality Code |
LINE_1ST_EXPNS_DT | DATE | Line First Expense Date |
LINE_LAST_EXPNS_DT | DATE | Line Last Expense Date |
HCPCS_CD | CHAR | Healthcare Common Procedure Coding System (HCPCS) Code |
HCPCS_1ST_MDFR_CD | CHAR | HCPCS Initial Modifier Code |
HCPCS_2ND_MDFR_CD | CHAR | HCPCS Second Modifier Code |
BETOS_CD | CHAR | Line Berenson-Eggers Type of Service (BETOS) Code |
LINE_NCH_PMT_AMT | NUM | Line NCH Medicare Payment Amount |
LINE_PRVDR_PMT_AMT | NUM | Line Provider Payment Amount |
LINE_ALOWD_CHRG_AMT | NUM | Line Allowed Charge Amount |
LINE_PRCSG_IND_CD | CHAR | Line Processing Indicator Code |
CARR_LINE_MTUS_CNT | NUM | Carrier Line Miles/Time/Units/Services (MTUS) Count |
CARR_LINE_MTUS_CD | CHAR | Carrier Line Miles/Time/Units/Services (MTUS) Indicator Code |
LINE_ICD_DGNS_CD | CHAR | Line Diagnosis Code |
CLM_LINE_STD_ALOWD_AMT | NUM | Line NCH Medicare Allowed Amount, standardized |
DME Line File
| Variable Name | Type | Description |
|---|---|---|
BENE_ID | NUM | Encrypted CCW Beneficiary ID |
CLM_ID | NUM | Claim ID |
LINE_NUM | NUM | Claim Line Number |
CLM_THRU_DT | DATE | Claim Through Date |
TAX_NUM | CHAR | Line Provider Tax Number |
PRVDR_SPCLTY | CHAR | Line CMS Provider Specialty Code |
LINE_SRVC_CNT | NUM | Line Service Count |
LINE_CMS_TYPE_SRVC_CD | CHAR | Line CMS Type Service Code |
LINE_PLACE_OF_SRVC_CD | CHAR | Line Place Of Service Code |
LINE_1ST_EXPNS_DT | DATE | Line First Expense Date |
LINE_LAST_EXPNS_DT | DATE | Line Last Expense Date |
HCPCS_CD | CHAR | Healthcare Common Procedure Coding System (HCPCS) Code |
HCPCS_1ST_MDFR_CD | CHAR | HCPCS Initial Modifier Code |
HCPCS_2ND_MDFR_CD | CHAR | HCPCS Second Modifier Code |
BETOS_CD | CHAR | Line Berenson-Eggers Type of Service (BETOS) Code |
LINE_NCH_PMT_AMT | NUM | Line NCH Medicare Payment Amount |
LINE_ALOWD_CHRG_AMT | NUM | Line Allowed Charge Amount |
LINE_PRCSG_IND_CD | CHAR | Line Processing Indicator Code |
LINE_ICD_DGNS_CD | CHAR | Line Diagnosis Code |
PRVDR_NPI | CHAR | DMERC Line Item Supplier NPI Number |
LINE_NDC_CD | CHAR | Line National Drug Code (NDC) |
PDE Claim File
| Variable Name | Type | Description |
|---|---|---|
PDE_ID | NUM | CCW Encrypted Part D Event Number |
BENE_ID | NUM | CCW Encrypted Beneficiary ID |
PROD_SRVC_ID | CHAR | Product Service ID |
PRSCRBR_ID | CHAR | Prescriber Identification Number |
SRVC_DT | DATE | RX Date of Service (DOS) |
FILL_NUM | NUM | Fill Number |
QTY_DSPNSD_NUM | NUM | Quantity Dispensed |
DAYS_SUPLY_NUM | NUM | Days Supply |
GDC_BLW_OOPT_AMT | NUM | Gross Drug Cost Below Out-of-Pocket Threshold (GDCB) |
GDC_ABV_OOPT_AMT | NUM | Gross Drug Cost Above Out-of-Pocket Threshold (GDCA) |
LICS_AMT | NUM | Low Income Cost Sharing Subsidy Amount (LICS) |
TOT_RX_CST_AMT | NUM | Gross Drug Cost |
NDC_CODE | CHAR | The first nine digits of product service ID |
Episode-Level File
| Variable Name | Type | Description | Details |
|---|---|---|---|
BENE_ID | NUM | Encrypted CCW Beneficiary ID | Beneficiary ID |
EPISODE_ID | NUM | Episode Identification Number | Unique number identifying each episode |
EPISODE_START_DATE | DATE | Episode Beginning Date | Date the episode begins (i.e., the treatment planning date) |
EPISODE_END_DATE | DATE | Episode Ending Date | Date the episode ends (i.e., the 90th day of the episode) |
EPISODE_YEAR | NUM | Episode Beginning Year | This indicates the calendar year in which the baseline episode began. This variable is used to adjust baseline episode payment amounts to 2019 dollars |
CANCER_TYPE | CHAR | Cancer Type | There are 15 cancer types included in the baseline episodes, each consisting of a specific bundle of International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) diagnosis codes. For a list of included cancer ICD-10 codes, see https://innovation.cms.gov/innovation-models/radiation-oncology-model. Example value: Bladder |
CANCER_TYPE_SERVICE_COUNT | NUM | Count of Service Lines with CANCER_TYPE | Count of claim lines with assigned CANCER_TYPE coded |
COUNT_CEB | NUM | Count of Conventional External Beam (CEB) Services | Count of the number of radiation treatment delivery services furnished during the baseline episode for CEB |
COUNT_IMRT | NUM | Count of Intesity-Modulated Radiation Therapy (IMRT) Services | Count of the number of radiation treatment delivery services furnished during the baseline episode for IMRT |
COUNT_PROTON | NUM | Count of Proton Beam Therapy (PBT) Services | Count of the number of radiation treatment delivery services furnished during the baseline episode for PBT |
COUNT_SRS | NUM | Count of Stereotactic Radiosurgery (SRS) Services | Count of the number of radiation treatment delivery services furnished during the baseline episode for SRS |
COUNT_SBRT | NUM | Count of Stereotactic Body Radiation Therapy (SBRT) Services | This provides a count of the number of radiation treatment delivery services furnished during the baseline episode for SBRT |
RADONC_TECH_PROVIDER | CHAR | Taxpayer Identification Number (TIN) or CMS Certification Number (CCN) of Attributed Provider/Supplier for Technical Services | Attributed technical provider number |
RADONC_TECH_PROV_TYPE | CHAR | Type of Attributed Technical Provider | The type of provider (hospital outpatient department or freestanding radiation therapy center) that was attributed the technical component of the episode. Example values: OPD = Outpatient, FREE= Freestanding |
RADONC_TECH_TOTAL_PAY | NUM | Radiation Oncology Episode Total Technical Payment | Sum of RADONC_PAY for technical services during episode |
RADONC_PRO_PROVIDER | CHAR | TIN of Attributed Supplier for Professional Services | Attributed professional provider number |
RADONC_PRO_TOTAL_PAY | NUM | Radiation Oncology Episode Total Professional Payment | Sum of RADONC_PAY for professional services during episode |
PRO_PAY_WINSOR | NUM | Radiation Oncology Episode Winsorized Professional Payment | Winsorized payment amount for professional services furnished in the episode, in 2019 dollars. It is provided for all baseline episodes, with Winsorization based on the 1st and 99th percentiles of baseline episodes in the outpatient setting. This variable is used to calculate the historical experience adjustments for all RO participants. |
TECH_PAY_WINSOR | NUM | Radiation Oncology Episode Winsorized Technical Payment | Winsorized payment amount for technical services furnished in the episode, in 2019 dollars. It is provided for all baseline episodes, with Winsorization based on the 1st and 99th percentiles of baseline episodes in the outpatient setting. This variable is used to calculate the historical experience adjustments for all RO participants. |
NUM_CASES_MISSING_CARRIER_RATE | NUM | Count of Claims Lines from the Beneficiary Line-Level Claims File Where No Carrier Payment Rate | Count of claims lines from the Beneficiary Line-Level Claims File for which there was no carrier PAYMENT_RATE |
NUM_CASES_MISSING_OPPS_RATE | NUM | Count of Claims Lines from the Beneficiary Line-Level Claims File Where No Outpatient Payment Rate | Count of claims lines from the Beneficiary Line-Level Claims File for which there was no OPD PAYMENT_RATE |
MAJOR_PROCEDURE_FLAG | NUM | Major Procedure Flag | Whether a major procedure occurred within 90 days before episode start date through episode end date. 1 = Yes, 0 = No |
CHEMO_FLAG | NUM | Chemotherapy Flag | Whether chemotherapy was given within 90 days before episode start date through episode end date. 1 = Yes, 0 = No |
ANY_TECH_OPD | NUM | Technical Services Provided in Outpatient Facility Flag | Whether any technical services were at an outpatient facility during episode. 1 = Yes, 0 = No |
ANY_TECH_FREE | NUM | Technical Services Provided in Freestanding Facility Flag | Whether any technical services were at a freestanding facility during episode. 1 = Yes, 0 = No |
TREATMENT_SETTING | CHAR | Primary Radiation Treatment Facility Setting | The setting in which the majority of radiation treatment delivery services were furnished during the episode, excluding radiation treatment delivery (guidance). OUTPATIENT if more technical services were billed in outpatient facility FREESTANDING if more technical services were billed in freestanding facility BOTH if equal number of technical services were billed in outpatient and freestanding facilities |
BENE_BIRTH_DT | DATE | Benficiary Date of Birth | Beneficiary date of birth |
BENE_DEATH_DT | DATE | Beneficiary Date of Death | Beneficiary date of death |
AGE | NUM | Beneficiary Age on First Day of Episode | Beneficiary's age |
BENE_SEX_IDENT_CD | CHAR | Beneficiary Sex | Beneficiary sex, determined from Medicare enrollment records. 1 = Male, 2 = Female |
STATE | CHAR | Beneficiary's State of Residence | State of the beneficiary's place of residence |
COUNTY | CHAR | Beneficiary's County of Residence | County of the beneficiary's place of residence |
ZIP_CODE | CHAR | Beneficiary's ZIP Code of Residence | ZIP code of the beneficiary's place of residence |
HOSPICE_DAYS | NUM | Number of Days in Hospice | Number of days during the episode that the beneficiary was enrolled in hospice |
ESRD | NUM | End Stage Renal Disease (ESRD) Flag | Beneficiary has ESRD at the beginning of the episode |
Participant-Level File
| Variable Name | Type | Description | Details |
|---|---|---|---|
CANCER | CHAR | RO Episode Cancer Type | Each file has cases for the 15 included cancer types plus "ALL CANCERS" with values of 0 if the RO participant had no attributed episodes with that cancer diagnosis |
MCARE_PMT_N | NUM | Number of Episodes | Total number of episodes for which RO participant is the attributed technical or attributed professional provider, or both. If the RO participant is both the attributed professional provider and the attributed technical provider for an episode, the episode counts only once |
MCARE_PMT_PRO_MEAN | NUM | Mean RO Professional Payment | Mean RO Medicare professional payment for the RO participant's episodes |
MCARE_PMT_TECH_MEAN | NUM | Mean RO Technical Payment | Mean RO Medicare technical payment for the RO participant's episodes |
MCARE_PMT_PRO_ATTRI_MEAN | NUM | Mean RO Professional Payment When Part is Attributed Professional Provider | Mean RO Medicare professional payment when RO participant was attributed professional provider for the RO participant's episodes |
MCARE_PMT_TECH_ATTRI_MEAN | NUM | Mean RO Technical Payment When Part is Attributed Technical Provider | Mean RO Medicare technical payment when RO participant was attributed technical provider for the RO participant's episodes |
AGE_MEAN | NUM | Mean Patient Age Among Episodes | Mean age of beneficiaries for the RO participant's episodes |
FEMALE_PCT | NUM | Percent Patients Female Among Episodes | Percent of beneficiaries who are female for the RO participant's episodes |
CHEMO_PCT | NUM | Percent Patients with Chemo Among Episodes | Percent of beneficiaries with chemotherapy during episode for the RO participant's episodes. For a list of chemotherapy codes, see https://innovation.cms.gov/innovation-models/radiation-oncology-archived-materials |
HOSPICE_PCT | NUM | Percent Patients with Hospice Among Episodes | Percent of beneficiaries with hospice services during episode for the RO participant's episodes |
MAJOR_PROCEDURE_PCT | NUM | Percent Patients with Major Procedure Among Episodes | Percent of beneficiaries with major medical procedure during episode for the RO participant's episodes. For a list of major procedure codes, see https://innovation.cms.gov/innovation-models/radiation-oncology-archived-materials |
DEATH_PCT | NUM | Percent Episodes End in Death | Percent of RO participant's episodes that end with a beneficiary death (before 90th day) |
CEB_MEAN | NUM | Mean of Conventional External Beam (CEB) Services Count | Mean of CEB services count of the RO participant's episodes |
IMRT_MEAN | NUM | Mean of Intensity-Modulated Radiation Therapy (IMRT) Services Count | Mean of IMRT services count of the RO participant's episodes |
PROTON_MEAN | NUM | Mean of Proton Beam Therapy (PBT) Services Count | Mean of PBT services count of the RO participant's episodes |
SRS_MEAN | NUM | Mean of Stereotactic Radiosurgery (SRS) Services Count | Mean of SRS services count of the RO participant's episodes |
SBRT_MEAN | NUM | Mean of Stereotactic Body Radiation Therapy (SBRT) Services Count | Mean of SBRT services count of the RO participant's episodes |
Code Value Reference
The following tables list the possible values selected categorical variables can take and their meanings. All of the following tables have the same two columns:
- Code
- The possible values the particular variable can take.
- Value
- Describes the meaning of the given code for the given variable.
Not all variables listed in the above data dictionary are represented in these tables, only certain select categorical variables.
MOD
The header MOD is present in the file Beneficiary Line-Level File
| Code | Value |
|---|---|
| 26 | Professional Service |
| blank | Global Service |
| OP | Technical Service |
| TC | Technical Service |
SERVICE
The header SERVICE is present in the file SAMH Excluded Claims Summary
| Code | Value |
|---|---|
| DME | Durable Medical Equipment |
| INP | Inpatient |
| OUT | Outpatient |
| PHY | Physician |
Acronyms
Below is a list of acronyms used in the data files.
| Acronym | Definition |
|---|---|
APC | Ambulatory Payment Classifications |
BETOS | Berenson-Eggers Type of Service |
CCN | CMS Certification Number |
CCW | Chronic Conditions Warehouse |
CEB | Conventional External Beam |
DME | Durable Medical Equipment |
DOS | Date of Service |
DRG | Diagnosis Related Group |
ESRD | End-stage Renal Disease |
GDCA | Gross Drug Cost Below |
GDCB | Gross Drug Cost Above |
HCPCS | Healthcare Common Procedure Coding System |
HIPPS | Health Insurance Prospective Payments System |
ICD-10 | International Statistical Classification of Diseases and Related Health Problems, 10th Revision |
IDE | Investigational Device Exemption |
IME | Indirect Medical Education |
IMRT | Intesity-Modulated Radiation Therapy |
LICS | Low Income Cost-sharing Subsidy |
MAC | Medicare Administrative Contractor |
MCO | Managed Care Organization |
MTUS | Miles/Time/Units/Services |
NCH | National Claims History |
NDC | National Drug Code |
NPI | National Provider Identifier |
OPD | Outpatient Department |
OPPS | Outpatient Prospective Payment System |
PBT | Proton Beam Therapy |
PDE | Prescription Drug Event |
PPS | Prospective Payment Systems |
RO | Radiation Oncology |
SAMH | Substance Abuse and Mental Health |
SBRT | Stereotactic Body Radiation Therapy |
SRS | Stereotactic Radiosurgery |
TIN | Taxpayer Identification Number |