Evaluation and Management Beneficiary Payments

This variable is contained in the following files:

Master Beneficiary Summary File (MBSF): Cost and Use Segment

SAS Name

EM_BENE_PMT

This variable is the sum of coinsurance and deductible payments for the part B evaluation and management (E&M) services for a given year. The total Beneficiary payments are calculated as the sum of LINE_COINSRNC_AMT + LINE_BENE_PTB_DDCTBL_AMT for the relevant lines.

E & M claims are a subset of the claims in the Part B Carrier and DME data files, and a subset of physician claims. The E & M claims are defined as those with a line BETOS code (BETOS_CD) where the first digit ='M' (but is not M1A or M1B – which are categorized as physician office care in this file – see PHYS_MDCR_PMT).

Comments

There are 11 cost/use categories from the Carrier Part B and DME data files – the ASC, Anesthesia, Part B Drug, Physician, E & M, dialysis, imaging, tests, other procedures, DME and other carrier claims.

Source: CCW (derived)