| Code | Code value |
|---|---|
|
0
|
Beneficiary did not meet claims criteria or have sufficient fee-for-service (FFS) coverage
|
|
1
|
Beneficiary met claims criteria but did not have sufficient FFS coverage
|
|
2
|
Beneficiary did not meet claims criteria but had sufficient FFS coverage
|
|
3
|
Beneficiary met claims criteria and had sufficient FFS coverage
|
This variable is contained in the following files: Master Beneficiary Summary File (MBSF): Other Chronic or Potentially Disabling Conditions Segment
Short SAS Name
MULSCL_MEDICARE
SAS Name
MULSCL_MEDICARE
This variable indicates whether a beneficiary met the condition criteria for multiple sclerosis and transverse myelitis as of the end of the calendar year.
The condition variable requires beneficiaries to satisfy both claims criteria (a minimum number/type of Medicare claims that have the proper diagnosis codes and occurred within a specified time period) and coverage criteria (Medicare FFS Part A and Part B coverage during the entire specified time period).
For multiple sclerosis and transverse myelitis, beneficiaries must have at least one Medicare inpatient claim or two other non-drug claims of any service type with a related code in any position during the 2-year reference period. When 2 claims are required, they must occur at least one day apart.
You can find more detailed information on the criteria on the CCW website: https://www.ccwdata.org/web/guest/condition-categories
Source: CCW (derived)