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Gross Drug Cost Above Out Of Pocket Threshold

CLM_LINE_GRS_ABOVE_THRSHLD_AMT

The gross drug cost amount that was covered by Part D's catastrophic coverage.

Field Metadata

FHIR Resource
ExplanationOfBenefit
FHIRPath 
ExplanationOfBenefit.item.adjudication.where(
  category.coding.system = 'https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication' and
    category.coding.code = 'CLM_LINE_GRS_ABOVE_THRSHLD_AMT'
).amount.value
Coverage / Claim Type
  • Pharmacy
Source View
V2_MDCR_CLM_LINE_RX
Source Column
CLM_LINE_GRS_ABOVE_THRSHLD_AMT
Sources
  • DDPS
Profiles
  • CMS

Example 

25

Mappings

CCW
  • GDC_ABV_OOPT_AMT

bluebutton.cms.gov

official website of the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services.

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