Variable: CLM_LTC_DSPNSNG_MTHD_CD

Submission clarification code

Description:

For beneficiaries living in long-term care (LTC) facilities, this variable indicates how many days' supply of the medication was dispensed by the long-term care pharmacy and provides some details about the dispensing event. This variable is only populated when beneficiary lives in an LTC facility (i.e., when the CLM_PTNT_RSDNC_CD variable equals 03)

Values

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

Value	Description
00	(Unknown value – rarely populated)
05	Therapy change. Physician determined that a change in therapy was required – either the medication was used faster than expected, or a different dosage form is needed.
07	Emergency supply of non-formulary drugs (or formulary drugs which typically require step therapy or prior authorization). Medication has been determined by the physician to be medically necessary.
08	Process compound for approved ingredients
14	LTC leave of absence – short fill required for take-home use
16	LTC emergency box (e box) /automated dispensing machine
17	LTC emergency supply remainder (remainder of drug from the emergency supply)
18	LTC patient admit/readmission indicator. This status required new dispensing of medication.
19	Split billing. The quantity dispensed is the remainder billed to a subsequent payer after Medicare Part A benefits expired (partial payment under Part A).
21	LTC dispensing rule for <=14 day supply is not applicable due to CMS exclusion or the fact that the manufacturer’s packaging does not allow for special dispensing
22	LTC dispensing, 7-day supply
23	LTC dispensing, 4-day supply
24	LTC dispensing, 3-day supply
25	LTC dispensing, 2-day supply
26	LTC dispensing, 1-day supply
27	LTC dispensing, 4-day supply, then 3-day supply
28	LTC dispensing, 2-day supply, then 2-day supply, then 3-day supply
29	LTC dispensing, daily during the week then multiple days (3) for weekend
30	LTC dispensing, per shift (multiple medication passes)
31	LTC dispensing, per medication pass
32	LTC dispensing, PRN on demand
33	LTC dispensing, other <=7 day cycle
34	LTC dispensing, 14-day supply
35	LTC dispensing, other 8-14 day dispensing not listed above
36	LTC dispensing, outside short cycle, determined to be Part D after originally submitted to another payer
42	The prescriber ID submitted has been validated and is active (rarely populated)
43	For the prescriber ID submitted, the associated DEA number has been renewed or the renewal is in progress (rarely populated)
44	(Unknown value – rarely populated)
45	For the prescriber ID submitted, the associated DEA number is a valid hospital DEA number with suffix (rarely populated)