Variable: Benefit_Balance

Benefit Balance

Description:

Deprecated 2026-01-06. This code system includes a selection of codes which convey information about the claim balance by benefit category.

Values

This variable is coded, and will contain one of the following values.

Value	Description
CLM_MDCR_IP_LRD_USE_CNT	Beneficiary Medicare Lifetime Reserve Days (LRD) Used Count
CLM_INSTNL_MDCR_COINS_DAY_CNT	Beneficiary Total Coinsurance Days Count
CLM_INSTNL_NCVRD_DAY_CNT	Claim Medicare Non Utilization Days Count
CLM_INSTNL_PER_DIEM_AMT	Claim Pass Thru Per Diem Amount
CLM_INSTNL_CVRD_DAY_CNT	Claim Medicare Utilization Day Count
CLM_MDCR_IP_PPS_DSPRPRTNT_AMT	Claim PPS Capital Disproportionate Share Amount
CLM_MDCR_IP_PPS_EXCPTN_AMT	Claim PPS Capital Exception Amount
CLM_MDCR_IP_PPS_CPTL_FSP_AMT	Claim PPS Capital Federal Specific Portion (FSP) Amount
CLM_MDCR_IP_PPS_CPTL_IME_AMT	Claim PPS Capital Indirect Medical Education (IME) Amount
CLM_MDCR_IP_PPS_OUTLIER_AMT	Claim PPS Capital Outlier Amount
CLM_MDCR_IP_PPS_CPTL_HRMLS_AMT	Claim PPS Old Capital Hold Harmless Amount
CLM_MDCR_IP_PPS_CPTL_TOT_AMT	Claim Total PPS Capital Amount
CLM_MDCR_INSTNL_PRMRY_PYR_AMT	Primary Payer (if not Medicare) Claim Paid Amount
CLM_INSTNL_PRFNL_AMT	Professional Component Charge Amount
CLM_INSTNL_DRG_OUTLIER_AMT	DRG Outlier Approved Payment Amount
CLM_MDCR_IP_BENE_DDCTBL_AMT	Beneficiary Inpatient (or other Part A) Deductible Amount
CLM_HIPPS_UNCOMPD_CARE_AMT	Claim Uncompensated Care Payment Amount
CLM_MDCR_INSTNL_BENE_PD_AMT	The amount paid, from the Medicare trust fund, to the beneficiary for the services reported on the claim.
CLM_PRVDR_PMT_AMT	The amount paid, from the Medicare trust fund, to the provider for the services reported on the claim.
CLM_MDCR_HOSPC_PRD_CNT	The count of the number of hospice period trailers present for the beneficiary's record.
CLM_MDCR_HHA_TOT_VISIT_CNT	The count of the number of HHA visits as derived by CMS.