BSA Carrier Line Items PUF

This release contains the Basic Stand Alone (BSA) Carrier Line Items Public Use File (PUF) named “CMS 2008 BSA Carrier Line Items PUF” with information from 2008 Medicare Carrier claims. The CMS 2008 BSA Carrier Line Items PUF is a line item level file in which each record is a line item of a Carrier claim incurred by a 5% sample of Medicare beneficiaries. Some demographic and line item related variables are provided in this PUF as detailed below. However, as beneficiary identities are not provided, it is not possible to link claims that belong to the same beneficiary in the CMS 2008 BSA Carrier Line Items PUF. It is also not possible to link line items that belong to the same claim.

The Carrier claims file was originally called the Physician/Supplier Part B file. This file contains final action claims data submitted by non-institutional providers. Each record in the Carrier claims file is a claim. Each carrier claim must include at least one Health Care Procedure Classification Code (HCPCS code) to describe the nature of the billed service. Each HCPCS code on the carrier bill must be accompanied by a line item ICD-9 diagnosis code, providing a reason for the service. In addition, each line item has the fields for the dates of service, reimbursement amount, provider numbers (e.g., NPI), and beneficiary demographic data. Each claim is comprised of up to 13 line items, each of which corresponds to one HCPCS code and its accompanying information.

The CMS 2008 BSA Carrier Line Items PUF originates from a 5% simple random sample of beneficiaries drawn (without replacement) from the 100% Beneficiary Summary File for reference year 2008. The sample that is used for the CMS 2008 BSA Carrier Line Items PUF is disjoint from the existing 5% CMS research sample. That is, there is no overlap in terms of the beneficiaries in the CMS 2008 BSA Carrier Line Items PUF and the 5% CMS research sample. It is also disjoint from the other BSA PUFs (i.e., CMS 2008 Inpatient Claims PUF, CMS 2008 DME Line Items PUF, CMS 2008 PDE PUF, CMS 2008 Hospice Beneficiary PUF, CMS 2008 Outpatient Procedures PUF, CMS 2008 SNF Beneficiary PUF, and CMS 2008 HHA Beneficiary PUF) that have been released so far. This property prevents users from linking data across multiple files for identification purposes.

CMS 2008 BSA Carrier Line Items PUF contains eleven (11) variables. A primary record (i.e., line item) key indexing the line items and ten (10) analytic variables, listed below.

• Gender (BENE_SEX_IDENT_CD), (1) male or (2) female.
• Age (BENE_AGE_CAT_CD), the beneficiary's age, reported in six categories: (1) under 65, (2) 65 - 69, (3) 70 - 74, (4) 75-79, (5) 80-84, (6) 85 and older.
• ICD-9 primary diagnosis code (CAR_LINE_ICD9_DGNS_CD): “International Classification of Diseases” version 9. This is a three-digit code (four-digit for “E” ICD-9 diagnosis codes). In the PUF, 923 such codes are observed.
• HCPCS code (CAR_LINE_HCPCS_CD): These are HCPCS codes (HCPCS Level I and Level II) and take on 4,736 possible values in the CMS 2008 BSA Carrier Line Items PUF. It identifies physician and non-physician services.
• BETOS code (CAR_LINE_BETOS_CD): The Berenson-Eggers type of service for the procedure code based on generally agreed upon clinically meaningful groupings of procedures and service. In the PUF, 99 such codes are observed.
• Count of services (CAR_LINE_SRVC_CNT) is a count of the total number of services associated with the line item, ranging from 1 to 999.
• Provider Type Code (CAR_LINE_PRVDR_TYPE_CD) corresponds to a code identifying the type of provider furnishing the service. Examples of provider types are clinics, physicians, independent laboratories, etc. In the PUF, 6 such codes are observed.
• Type of Service Code (CAR_LINE_CMS_TYPE_SRVC_CD) is the code indicating type of service. Examples of types of service are medical care, surgery, consultation, etc. In the PUF, 22 such codes are observed.
• Place of Service Code (CAR_LINE_PLACE_OF_SRVC_CD) is the code indicating the place of service. Examples of places of service are office, independent laboratory, inpatient hospital, outpatient hospital, emergency room, etc. In the PUF, 27 such codes are observed.
• Medicare Payment Amount (CAR_LINE_PMT_AMT): Medicare payment is rounded according to the certain rounding rules. Note that a payment amount between $0 and $2.49 is rounded to $0 according to the rounding rules.

In addition to the General documentation file, there are two documentation files for the Carrier Line Items PUF:

1. The data dictionary and codebook file contains information about each variable on the file and its values, as well as formatted frequencies for each variable on the data file.
2. A data users document which gives the file layout for the downloadable CSV file, as well as SAS program code for creating a SAS dataset with variable formats.