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1 1 RecordType varchar(1) 1 1 B = Details for new V21 PTC MOR C = Details for new V22 PTC MOR D = for Details for new 2017 PTC model MOR - non-pace and non-esrd benes 2 HICN varchar(12) 2 13 Alphanumeric This is the Health Insurance Claim Number (known as HICN) identifying the primary Medicare Beneficiary under the SSA or RRB programs. The HICN, consisting of Beneficiary Claim Number along with the Beneficiary Identification Code uniquely identifies a Medicare Beneficiary. For the RRB program, the claim account number is a 12-byte account number. 3 BeneficiaryLastName varchar(12) Alphanumeric First 12 bytes of the Beneficiary Last Name Beneficiary Last Name 4 BeneficiaryFirstName varchar(7) Alphanumeric First 7 bytes of the Beneficiary First Name Beneficiary First Name 5 BeneficiaryMI varchar(1) Alphanumeric 1-byte Initial Beneficiary Initial 6 DOB varchar(8) Alphanumeric Formatted as yyyymmdd The date of birth of the Medicare Beneficiary 7 Gender varchar(1) Alphanumeric 0=unknown, 1=male, 2=female Represents the sex of the Medicare Beneficiary. Examples include Male and Female. 8 SSN varchar(9) Alphanumeric The beneficiary's current identification number that is assigned by the Social Security dministration. 9 RASESRDInd varchar(1) Y = ESRD N = not ESRD The beneficiary's ESRD status as of the model run. Also indicates if the beneficiary was processed by the ESRD models in the model run. 10 FAgeGroup0_34 varchar(1) ages 0 and 34, inclusive 11 FAgeGroup35_44 varchar(1) ages 35 and 44, inclusive 12 FAgeGroup45_54 varchar(1) ages 45 and 54, inclusive 13 FAgeGroup55_59 varchar(1) ages 55 and 59, inclusive 14 FAgeGroup60_64 varchar(1) ages 60 and 64, inclusive 15 FAgeGroup65_69 varchar(1) ages 65 and 69, inclusive 16 FAgeGroup70_74 varchar(1) ages 70 and 74, inclusive 17 FAgeGroup75_79 varchar(1) ages 75 and 79, inclusive 18 FAgeGroup80_84 varchar(1) ages 80 and 84, inclusive 19 FAgeGroup85_89 varchar(1) ages 85 and 89, inclusive 20 FAgeGroup90_94 varchar(1) ages 90 and 94, inclusive
2 21 FAgeGroup95_GT varchar(1) ages 95 or greater 22 MAgeGroup0_34 varchar(1) ages 0 and 34, inclusive 23 MAgeGroup35_44 varchar(1) ages 35 and 44, inclusive 24 MAgeGroup45_54 varchar(1) ages 45 and 54, inclusive 25 MAgeGroup55_59 varchar(1) ages 55 and 59, inclusive 26 MAgeGroup60_64 varchar(1) ages 60 and 64, inclusive 27 MAgeGroup65_69 varchar(1) ages 65 and 69, inclusive 28 MAgeGroup70_74 varchar(1) ages 70 and 74, inclusive 29 MAgeGroup75_79 varchar(1) ages 75 and 79, inclusive 30 MAgeGroup80_84 varchar(1) ages 80 and 84, inclusive 31 MAgeGroup85_89 varchar(1) ages 85 and 89, inclusive 32 MAgeGroup90_94 varchar(1) ages 90 and 94, inclusive 33 MAgeGroup95_GT varchar(1) ages 95 or greater 34 MedicaidFemaleDisab varchar(1) Set to "1" if applicable, otherwise "0" led Beneficiary is a female disabled and also entitled to Medicaid. 35 MedicaidFemaleAged varchar(1) Set to "1" if applicable, otherwise "0" Beneficiary is a female aged (> 64) and also entitled to Medicaid. 36 MedicaidMaleDisable d varchar(1) Set to "1" if applicable, otherwise "0" Beneficiary is a male disabled and also entitled to Medicaid. 37 MedicaidMaleAged varchar(1) Set to "1" if applicable, otherwise "0" Beneficiary is a male aged (> 64) and also entitled to Medicaid. 38 OriginallyDisabledFe male varchar(1) Set to "1" if applicable, otherwise "0" Beneficiary is a female and original Medicare entitlement was due to disability. 39 OriginallyDisabledMal e varchar(1) Set to "1" if applicable, otherwise "0" Beneficiary is a male and original Medicare entitlement was due to disability. 40 HCC001 varchar(1) Alphanumeric HIV/AIDS 41 HCC002 varchar(1) Alphanumeric Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock 42 HCC006 varchar(1) Alphanumeric Opportunistic Infections 43 HCC008 varchar(1) Alphanumeric Metastatic Cancer and Acute Leukemia 44 HCC009 varchar(1) Alphanumeric Lung and Other Severe Cancers
3 45 HCC010 varchar(1) Alphanumeric Lymphoma and Other Cancers 46 HCC011 varchar(1) Alphanumeric Colorectal, Bladder, and Other Cancers 47 HCC012 varchar(1) Alphanumeric Breast, Prostate, and Other Cancers and Tumors 48 HCC017 varchar(1) Alphanumeric Diabetes with Acute Complications 49 HCC018 varchar(1) Alphanumeric Diabetes with Chronic Complications 50 HCC019 varchar(1) Alphanumeric Diabetes without Complication 51 HCC021 varchar(1) Alphanumeric Protein-Calorie Malnutrition 52 HCC022 varchar(1) Alphanumeric Morbid Obesity 53 HCC023 varchar(1) Alphanumeric Other Significant Endocrine and Metabolic Disorders 54 HCC027 varchar(1) Alphanumeric End-Stage Liver Disease 55 HCC028 varchar(1) Alphanumeric Cirrhosis of Liver 56 HCC029 varchar(1) Alphanumeric Chronic Hepatitis 57 HCC033 varchar(1) Alphanumeric Intestinal Obstruction/Perforation 58 HCC034 varchar(1) Alphanumeric Chronic Pancreatitis 59 HCC035 varchar(1) Alphanumeric Inflammatory Bowel Disease 60 HCC039 varchar(1) Alphanumeric Bone/Joint/Muscle Infections/Necrosis 61 HCC040 varchar(1) Alphanumeric Rheumatoid Arthritis and Inflammatory Connective Tissue Disease 62 HCC046 varchar(1) Alphanumeric Severe Hematological Disorders 63 HCC047 varchar(1) Alphanumeric Disorders of Immunity 64 HCC048 varchar(1) Alphanumeric Coagulation Defects and Other Specified Hematological Disorders 65 HCC051 varchar(1) Alphanumeric Dementia With Complications 66 HCC052 varchar(1) Alphanumeric Dementia Without Complications
4 67 HCC054 varchar(1) Alphanumeric Drug/Alcohol Psychosis 68 HCC055 varchar(1) Alphanumeric Drug/Alcohol Dependence 69 HCC057 varchar(1) Alphanumeric Schizophrenia 70 HCC058 varchar(1) Alphanumeric Major Depressive, Bipolar, and Paranoid Disorders 71 HCC070 varchar(1) Alphanumeric Quadriplegia 72 HCC071 varchar(1) Alphanumeric Paraplegia 73 HCC072 varchar(1) Alphanumeric Spinal Cord Disorders/Injuries 74 HCC073 varchar(1) Alphanumeric Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease 75 HCC074 varchar(1) Alphanumeric Cerebral Palsy 76 HCC075 varchar(1) Alphanumeric Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy 77 HCC076 varchar(1) Alphanumeric Muscular Dystrophy 78 HCC077 varchar(1) Alphanumeric Multiple Sclerosis 79 HCC078 varchar(1) Alphanumeric Parkinsons and Huntingtons Diseases 80 HCC079 varchar(1) Alphanumeric Seizure Disorders and Convulsions 81 HCC080 varchar(1) Alphanumeric Coma, Brain Compression/Anoxic Damage 82 HCC082 varchar(1) Alphanumeric Respirator Dependence/Tracheostomy Status 83 HCC083 varchar(1) Alphanumeric Respiratory Arrest 84 HCC084 varchar(1) Alphanumeric Cardio-Respiratory Failure and Shock 85 HCC085 varchar(1) Alphanumeric Congestive Heart Failure 86 HCC086 varchar(1) Alphanumeric Acute Myocardial Infarction 87 HCC087 varchar(1) Alphanumeric Unstable Angina and Other Acute Ischemic Heart Disease 88 HCC088 varchar(1) Alphanumeric Angina Pectoris
5 89 HCC096 varchar(1) Alphanumeric Specified Heart Arrhythmias 90 HCC099 varchar(1) Alphanumeric Cerebral Hemorrhage 91 HCC100 varchar(1) Alphanumeric Ischemic or Unspecified Stroke 92 HCC103 varchar(1) Alphanumeric Hemiplegia/Hemiparesis 93 HCC104 varchar(1) Alphanumeric Monoplegia, Other Paralytic Syndromes 94 HCC106 varchar(1) Alphanumeric Atherosclerosis of the Extremities with Ulceration or Gangrene 95 HCC107 varchar(1) Alphanumeric Vascular Disease with Complications 96 HCC108 varchar(1) Alphanumeric Vascular Disease 97 HCC110 varchar(1) Alphanumeric Cystic Fibrosis 98 HCC111 varchar(1) Alphanumeric Chronic Obstructive Pulmonary Disease 99 HCC112 varchar(1) Alphanumeric Fibrosis of Lung and Other Chronic Lung Disorders 100 HCC114 varchar(1) Alphanumeric Aspiration and Specified Bacterial Pneumonias 101 HCC115 varchar(1) Alphanumeric Pneumococcal Pneumonia, Emphysema, Lung Abscess 102 HCC122 varchar(1) Alphanumeric Proliferative Diabetic Retinopathy and Vitreous Hemorrhage 103 HCC124 varchar(1) Alphanumeric Exudative Macular Degeneration 104 HCC134 varchar(1) Alphanumeric Dialysis Status 105 HCC135 varchar(1) Alphanumeric Acute Renal Failure 106 HCC136 varchar(1) Alphanumeric Chronic Kidney Disease, Stage HCC137 varchar(1) Alphanumeric Chronic Kidney Disease, Severe, Stage HCC138 varchar(1) Alphanumeric Chronic Kidney Disease, Moderate, Stage HCC139 varchar(1) Alphanumeric Chronic Kidney Disease, Mild or Unspecified, Stages 1-2 or Unspecified 110 HCC140 varchar(1) Alphanumeric Unspecified Renal Failure
6 111 HCC141 varchar(1) Alphanumeric Nephritis 112 HCC157 varchar(1) Alphanumeric Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone 113 HCC158 varchar(1) Alphanumeric Pressure Ulcer of Skin with Full Thickness Skin Loss 114 HCC159 varchar(1) Alphanumeric Pressure Ulcer of Skin with Partial Thickness Skin Loss 115 HCC160 varchar(1) Alphanumeric Pressure Pre-Ulcer Skin Changes or Unspecified Stage 116 HCC161 varchar(1) Alphanumeric Chronic Ulcer of Skin, Except Pressure 117 HCC162 varchar(1) Alphanumeric Severe Skin Burn or Condition 118 HCC166 varchar(1) Alphanumeric Severe Head Injury 119 HCC167 varchar(1) Alphanumeric Major Head Injury 120 HCC169 varchar(1) Alphanumeric Vertebral Fractures without Spinal Cord Injury 121 HCC170 varchar(1) Alphanumeric Hip Fracture/Dislocation 122 HCC173 varchar(1) Alphanumeric Traumatic Amputations and Complications 123 HCC176 varchar(1) Alphanumeric Complications of Specified Implanted Device or Graft 124 HCC186 varchar(1) Alphanumeric Major Organ Transplant or Replacement Status 125 HCC188 varchar(1) Alphanumeric Artificial Openings for Feeding or Elimination 126 HCC189 varchar(1) Alphanumeric Amputation Status, Lower Limb/Amputation Complications 127 DisabledDiseaseHCC 006 varchar(1) Alphanumeric Disabled, Opportunistic Infections 128 DisabledDiseaseHCC DisabledDiseaseHCC DisabledDiseaseHCC DisabledDiseaseHCC DisabledDiseaseHCC 110 varchar(1) Alphanumeric Chronic Pancreatitis varchar(1) Alphanumeric Severe Hematological Disorders varchar(1) Alphanumeric Drug/Alcohol Psychosis varchar(1) Alphanumeric Drug/Alcohol Dependence varchar(1) Alphanumeric Cystic Fibrosis
7 133 DisabledDiseaseHCC 176 varchar(1) Alphanumeric Complications of Specified Implanted Device or Graft 134 DiseaseInteractions_ HCC47_gCancer varchar(1) Alphanumeric Immune Disorders and Cancer Group 135 DiseaseInteractions_ HCC85_gCopdCF 136 DiseaseInteractions_ HCC85_gRenal 137 DiseaseInteractions_ grespdepandarre_g CopdCF 138 DiseaseInteractions_ HCC85_gDiabetesMe llit 139 Sepsis_Card_Resp_F ail 140 DiseaseInteractions_ CHF_Specified Heart Arrhythmias varchar(1) Alphanumeric Congestive Heart Failure and Chronic Obstructive Pulmonary Disease Group varchar(1) Alphanumeric Congestive Heart Failure and Renal Group varchar(1) Alphanumeric Cardiorespiratory Failure Group and Chronic Obstructive Pulmonary Disease Group varchar(1) Alphanumeric Congestive Heart Failure and Diabetes Group varchar(1) Alphanumeric Sepsis*Cardioresporatory Failure and Shock varchar(1) Alphanumeric Congestive Heart Failure*Specified Heart Arrhythmias 141 DiseaseInteractions_ gsubstanceabuse_gp sychiatric varchar(1) Alphanumeric Substance Abuse Group and Psychiatric Group 142 Medicaid varchar(1) Alphanumeric Beneficiary is entitled to Medicaid 143 OriginallyDisabled varchar(1) Alphanumeric Beneficiary original Medicare entitlement is due to disability 144 DisabledDiseaseHCC DisabledDiseaseHCC DisabledDiseaseHCC DisabledDiseaseHCC Disabled_Pressure_U lcer 149 ART_Openings_Pres sure_ulcer 150 ASP_Spec_Bact_Pne um_pres_ulc 151 COPD_Asp_Spec_Ba ct_pneum varchar(1) Alphanumeric Disabled, Bone/Joint Muscle Infections/Necrosis varchar(1) Alphanumeric Disabled, Multiple Sclerosis varchar(1) Alphanumeric Disabled, Congestive Heart Failure varchar(1) Alphanumeric Disabled, Chronic Ulcer of the Skin, Except Pressure Ulcer varchar(1) Alphanumeric Disabled and Pressure Ulcer varchar(1) Alphanumeric Artificial Openings for Feeding or Eliminating and Pressure Ulcer varchar(1) Alphanumeric Aspiration and Specified Bacterial Pneumonias and Pressure Ulcer varchar(1) Alphanumeric Chronic Obstructive Pulmonary Disease and Aspiration and Specified Bacterial Pneumonias 152 Schizophrenia_CHF varchar(1) Alphanumeric Schizophrenia and Congestive Heart Failure 153 Schizophrenia_COPD varchar(1) Alphanumeric Schizophrenia and Chronic Obstructive Pulmonary Disease
8 154 Schizophrenia_Siezur es varchar(1) Alphanumeric Schizophrenia and Seizure Disorders and Convulsions 155 Sepsis_Artif_Opening s varchar(1) Alphanumeric Sepsis and Artificial Openings for Feeding or Elimination 156 Sepsis_Asp_Spec_Ba ct_pneum 157 Sepsis_Pressure_Ulc er varchar(1) Alphanumeric Sepsis and Aspiration and Specified Bacterial Pneumonias varchar(1) Alphanumeric Sepsis and Pressure Ulcers
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