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Medicare Data File Descriptions

RIF Data Available

  • Standard Analytical Files - [data dictionaries and sas input statements]

    • The Standard Analytical Files (SAFs) contain information collected by Medicare to pay for health care services provided to a Medicare beneficiary. SAFs are available for each institutional (inpatient, outpatient, skilled nursing facility, hospice, or home health agency) and non-institutional (physician and durable medical equipment providers) claim type. The record unit of SAFs is the claim (some episodes of care may have more than one claim).

    Data Available: SAFs are calendar year files and are available for the years 1999 and forward. The most current file available is 2008.



  • Medicare Provider and Analysis Review File (MedPAR) Files

    • The MedPAR File contains inpatient hospital and skilled nursing facility (SNF) final action stay records. Each MedPAR record represents a stay in an inpatient hospital or SNF. An inpatient "stay" record summarizes all services rendered to a beneficiary from the time of admission to a facility through discharge. Each MedPAR record may represent one claim or multiple claims, depending on the length of a beneficiary's stay and the amount of inpatient services used throughout the stay.

    Data Available: Annual MedPAR files are available for calendar years 1999 forward.



  • Medicare enrollment and vital statistics files:

LDS Data Available

  • LDS Standard Analytical Files - [pricing, record layout, and sas input statements]

    The Standard Analytical Files (SAFs) contain information collected by Medicare to pay for health care services provided to a Medicare beneficiary. SAFs are available for each institutional (inpatient, outpatient, skilled nursing facility, hospice, or home health agency) and non-institutional (physician and durable medical equipment providers) claim type. The record unit of SAFs is the claim (some episodes of care may have more than one claim). The LDS files do not contain specific service dates. All dates are presented as a quarter and year; age is presented as a 5-year age range; physician UPIN is encrypted; and, the lowest level of geographic identification in the LDS SAF is the county.

    Data Available: LDS SAFs are calendar year files and are available for the years 2000 and forward. The most current file available is 2007

    • Inpatient (5% and 100%)
    • Skilled Nursing Facility (5% and 100%)
    • Outpatient (5% and 100%)
    • Home Health Agency (5% and 100%)
    • Hospice (5% and 100%)
    • Carrier (formerly Physician/Supplier Part B) (5%)
    • Durable Medical Equipment (5%)

  • LDS MEDPAR Files

    The National MedPAR Files contain inpatient hospital final action stay records. The Long Term Care Hospital (LTCH) MedPAR is a subset of the National MedPAR and contains only long term care hospital discuarges. The Skilled Nursing Facility (SNF) MedPAR File contains SNF final action stay records.

    Each MedPAR record represents a stay in an inpatient hospital or SNF. An inpatient "stay" record summarizes all services rendered to a beneficiary from the time of admission to a facility through discharge. Each MedPAR record may represent one claim or multiple claims, depending on the length of a beneficiary's stay and the amount of inpatient services used throughout the stay. The lowest level of geographic identification in the LDS MedPAR File is the state.

    Data Available:


  • LDS Denominator File - [pricing and record layout]

    The LDS Denominator File is available as 5% and 100% segments. The Denominator File contains demographic and enrollment information about each beneficiary enrolled in Medicare during a calendar year. The Denominator File is used to determine beneficiary demographic characteristics, entitlement, and beneficiary participation in Medicare Managed Care Organizations.

    Data Available: The Denominator Files are calendar year files and are available for the years 1999 and forward. The most current file available is 2008.

  • LDS Outpatient Hospital PPS -[pricing and record layout]

    The HOPPS file contains select claim level data from the Hospital Outpatient PPS claims. The file contains claims for services paid under the OPPS. This File is often used to evaluate outpatient service payment rates and ambulatory payment classification (APC) rates. Note, as of 4/3/2009, the previously classified identifiable version of the OPPS file is now classified as an LDS file. This version of the file includes bill type, principal and other diagnosis, outlier payments, and the APC payment.

    Data Available: There are two files available each year, the Proposed Rule File and the Final Rule File. The file for the Proposed Rule is usually available May/June and the file for the Final Rule is usually available in October.

  • LDS Outpatient PPS Partial Hospitalization Program - [pricing and record layout]

    This file contains select claim level data and is derived from partial hospitalization program (PHP) services. Partial Hospitalization programs include services for treatment of mental illness and substance abuse disorders. This file includes records for PHP services furnished by hospitals and community mental health centers (CMHCs) that were paid under the OPPS. Note, the LDS version of this file does not contain five variables that are found in the identifiable version of the file: bill type, principal and other diagnosis, outlier payments, and the APC payment.

    Data Available: There are two files available each year, the Proposed Rule File and the Final Rule File. The file for the Proposed Rule is usually available May/June and the file for the Final Rule is usually available in October.


  • LDS End Stage Renal Disease Composite Rate Payment System File - [pricing and record layout]

    This file contains select claim level data and is derived from ESRD facility outpatient claims, updated through December 31 of the most recent year, that is, claims with dates of service from January 1 through December 31 of the most recent year that were received, processed, paid, and passed to the National Claims History file by December 31 of the most recent year.

    Data Available: There are two files available each year, the Proposed Rule File and the Final Rule File. The file for the Proposed Rule is usually available May/June and the file for the Final Rule is usually available in October.

  • Ambulatory Surgical Center (ASC) Payment System - [pricing and record layout]

    This file contains a summary of service utilization by ASC supplier and is derived from 2007 ASC line item level data, updated through March 2008, that is, line items for services furnished on or after January 1, 2007 through December 31, 2007 that were received, processed, paid, and passed to the National Claims History file by March 31, 2008.

    This file does not contain data elements such as diagnosis codes, bill type, outlier payments, and service revenue payments that might permit identification of beneficiaries.

    Data Available: This file will be available twice a year. The file for the proposed rule for the annual OPPS/ASC update should be available by late spring/early summer, and the file for the final rule should be ready for release within a month of publication of the final rule.

Non-identifiable Data Available

  • Medicare cost reports

    Medicare-certified institutional providers are required to submit an annual cost report to a Fiscal Intermediary (FI). The cost report contains provider information such as facility characteristics, utilization data, cost and charges by cost center (in total and for Medicare), Medicare settlement data, and financial statement data. CMS maintains the cost report data in the Healthcare Provider Cost Reporting Information System (HCRIS).

    Data Available: Data are available for download for federal fiscal years 1996 through current. The files are also available for purchase.

  • HCIS [pricing and readme file]

    The data was derived from the Health Care Information System (HCIS), which contains Medicare Part A (Inpatient, Skilled Nursing Facility, Home Health Agency (Part A & B) and Hospice) and Medicare Part B (Outpatient) based on the type and State of the institutional provider. Data in HCIS is summarized from the Standard Analytical Files.

    Data Available: Data are available for calendar years 2000 through current. The most recent year available is 2007.

  • Part B Extract Summary System (BESS) Carrier Data File [pricing and readme file]

    The data sets are summarized at the carrier level by meaningful Healthcare Common Procedure Coding/Current Procedural Terminology, (HCPC/CPT), code ranges. Each data set displays the allowed services, allowed charges, payment amounts by HCPCS/CPT codes and prominent modifiers.

    Data Available: Data are available for calendar years 2004 through current. The most recent year available is 2007.

  • Part B Extract Summary System (BESS) Data File [pricing and readme file]

    The data sets are summarized by meaningful Healthcare Common Procedure Coding/Current Procedural Terminology, (HCPC/CPT), code ranges. Each data set displays the allowed services, allowed charges, payment amounts by HCPCS/CPT codes and prominent modifiers.

    Data Available: Data are available for calendar years 2000 through current. The most recent year available is 2007.

  • Provider of Services File [pricing and readme file]

    The Provider of Services (POS) Extract is created from the Online Survey and Certification Reporting System (OSCAR) database. These data include provider number, name, and address and characterize the participating institutional providers.

    Data Available: Data are available for calendar years 1991 through current calendar quarter.

  • Hospital Service Area File [pricing and readme file]

    This file is derived from the calendar year inpatient claims data. The records contain number of discharges, length of stay, and total charges summarized by provider number and ZIP code of the Medicare beneficiary.

    Data Available: Data are available for calendar years 1992 through current. The most recent year available is 2007.

  • Physician/Supplier Procedure Summary Master File [pricing and readme file]

    This file is a 100% summary of all Part B Carrier and DMERC Claims processed through the Common Working File and stored in the National Claims History Repository. The file is arrayed by carrier, pricing locality, Healthcare Common Procedure Coding (HCPC), modifier 1, modifier 2, specialty, type of service and place of service. The summarized fields are total submitted services and charges, total allowed services and charges, total denied services and charges, and total payment amounts.

    Data Available: Data are available for calendar years 1991 through current. The most recent year available is 2007.

  • Unique Physician Identification Number (UPIN) Directory [pricing and readme file]

    The Unique Physician Identification Number (UPIN) Directory contains selected information on physicians, doctors of Osteopathy, limited licensed practitioners and some non-physician practitioners who are enrolled in the Medicare Program. The data elements in the file (UPIN, full name, specialty, Physician License State Code, zip code, Medicare provider billing number and State) are extracted from the UPIN Database and are approved for public release in the Centers for Medicare & Medicaid Services (CMS) System of Records.

    Data Available: Data are available as an annual file from 2003-2007. The last update of this file was Quarter 2, 2007.

  • Unique Physician Identification Number (UPIN) Group File [pricing and readme file]

    The Group Unique Physician Identifier Number (UPIN) File is the business entity file that contains the group practice UPIN and descriptive information. It does NOT associate individual physicians within the practice. Additionally, group practice UPINs are not used in Medicare claims processing. In other words, the UPIN on the Carrier SAF is the UPIN of the individual physician, not the group practice. As a result, you would not be able to link the UPIN Group File with the Carrier SAF.

    Data Available: Data are available as an annual file from 2004 through 2007. The last updat of this file was Quarter 2, 2007.

  • Medicaid Drug Claims Statistics [pricing and readme file]

    The data in the Medicaid Drug Claims Statistics CD are derived from the Medicaid Clinical Services Mart and are divided into sixteen groups based upon Medi-Span's Therapeutic Classification System. Each group summarizes the number of claims that Medicaid paid for each drug under a particular group. The claim counts are broken out by quarter and include an annual count.

    Data Available: Data are available for 2003.

  • Prescription Drug Plan Formulary and Pharmacy Network Files [pricing and readme file]

    This public use file contains formulary and pharmacy network data for Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug Plans (with the exception of employer and PACE plans). This file will be updated monthly with updates being available at the end of the first complete week of each month.

    Data Available: The file is updated monthly. Please note that this file has special terms and conditions of use. Data are available from 2005-2008.

Last Modified September 11, 2009