Back to top
Short SAS Name
SAS Name

This variable indicates whether a beneficiary met the criteria for Opioid-Related Hospitalization or emergency department (ED) visits 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 opioid-related hospitalization or ED visits, beneficiaries must have at least one Medicare inpatient claim or one emergency department claim with a related code in any position during the 2-year reference period.

You can find more detailed information on the criteria on the CCW website:

Source: CCW (derived)

CodeCode value
Beneficiary did not meet claims criteria or have sufficient fee-for-service (FFS) coverage
Beneficiary met claims criteria but did not have sufficient FFS coverage
Beneficiary did not meet claims criteria but had sufficient FFS coverage
Beneficiary met claims criteria and had sufficient FFS coverage