Chronic Conditions
The CCW contains two versions of the Chronic Conditions: 30 CCW Chronic Conditions (2017 forward) and 27 CCW Chronic Conditions (1999–2021). CMS developed the 27 CCW Chronic Condition variables from algorithms validated from the research literature and criteria used by other federal sources. In 2020, CMS contracted an expert panel to refine and enhance these algorithms, resulting in the 30 CCW Chronic Condition algorithms.
The Chronic Conditions File Enhancement White Paper document provides more detail on the differences between the two versions and recommendations for researchers.
30 CCW Chronic Conditions (2017 forward)
There are 30 CCW Chronic Condition categories, available for file years 2017 forward. These reference only ICD-10 diagnosis codes and have modified look-back periods, qualifying claims, and codes.
All variables listed here are currently available in the Master Beneficiary Summary File (MBSF) in the MBSF_CHRONIC_YYYY file.
| Algorithms | Reference Period | Valid ICD-10 Codes1 | Number/Type of Claims to Qualify2 |
|---|---|---|---|
| Acute Myocardial Infarction | 1 year | I21.01, I21.02, I21.09, I21.11, I21.19, I21.21, I21.29, I21.3, I21.4, I21.9, I21.A1, I21.A9, I21.B, I22.0, I22.1, I22.2, I22.8, I22.9, I23.0, I23.1, I23.2, I23.3, I23.4, I23.5, I23.6, I23.7, I23.8 (any DX on the claim) | At least 1 inpatient claim with DX codes |
| Alzheimer's Disease | 2 years | G30.0, G30.1, G30.8, G30.9 (any DX on the claim) | At least 1 inpatient/SNF/HHA claim OR 2 HOP/carrier claims with DX codes |
| Anemia | 2 years | C94.6, D46.0, D46.1, D46.20, D46.21, D46.22, D46.4, D46.9, D46.A, D46.B, D46.C, D46.Z, D47.4, D50.0, D50.1, D50.8, D50.9, D51.0, D51.1, D51.2, D51.3, D51.8, D51.9, D52.0, D52.1, D52.8, D52.9, D53.0, D53.1, D53.2, D53.8, D53.9, D55.0, D55.1, D55.2, D55.21, D55.29, D55.3, D55.8, D55.9, D56.0, D56.1, D56.2, D56.3, D56.4, D56.5, D56.8, D56.9, D57.00, D57.01, D57.02, D57.03, D57.04, D57.09, D57.1, D57.20, D57.211, D57.212, D57.213, D57.214, D57.218, D57.219, D57.3, D57.40, D57.411, D57.412, D57.413, D57.414, D57.418, D57.419, D57.42, D57.431, D57.432, D57.433, D57.434, D57.438, D57.439, D57.44, D57.451, D57.452, D57.453, D57.454, D57.458, D57.459, D57.80, D57.811, D57.812, D57.813, D57.814, D57.818, D57.819, D58.0, D58.1, D58.2, D58.8, D58.9, D59.0, D59.1, D59.10, D59.11, D59.12, D59.13, D59.19, D59.2, D59.3, D59.30, D59.31, D59.32, D59.39, D59.4, D59.5, D59.6, D59.8, D59.9, D60.0, D60.1, D60.8, D60.9, D61.01, D61.02, D61.09, D61.1, D61.2, D61.3, D61.810, D61.811, D61.818, D61.82, D61.89, D61.9, D63.0, D63.1, D63.8, D64.0, D64.1, D64.2, D64.3, D64.4, D64.81, D64.89, D64.9, D75.81 (any DX on the claim) | At least 1 inpatient/SNF/HHA claim OR 2 HOP/carrier claims with DX codes |
| Asthma | 2 years | J45.20, J45.21, J45.22, J45.30, J45.31, J45.32, J45.40, J45.41, J45.42, J45.50, J45.51, J45.52, J45.901, J45.902, J45.909, J45.990, J45.991, J45.998 (any DX on the claim) | At least 1 inpatient/SNF/HHA claim OR 2 HOP/carrier claims with DX codes |
| Atrial Fibrillation and Flutter | 2 years | I48.0, I48.1, I48.11, I48.19, I48.2, I48.20, I48.21, I48.3, I48.4, I48.91 (any DX on the claim) | At least 1 inpatient/SNF/HHA claim OR 2 HOP/carrier claims with DX codes |
| Benign Prostatic Hyperplasia | 2 years | N40.0, N40.1, N40.2, N40.3 (any DX on the claim) EXCLUSION: If any of the qualifying claims also have an ICD-10 diagnosis of D29.1, then EXCLUDE |
At least 1 inpatient/SNF/HHA claim OR 2 HOP/carrier claims with DX codes |
| Cancer, Breast | 2 years | C50.011, C50.012, C50.019, C50.021, C50.022, C50.029, C50.111, C50.112, C50.119, C50.121, C50.122, C50.129, C50.211, C50.212, C50.219, C50.221, C50.222, C50.229, C50.311, C50.312, C50.319, C50.321, C50.322, C50.329, C50.411, C50.412, C50.419, C50.421, C50.422, C50.429, C50.511, C50.512, C50.519, C50.521, C50.522, C50.529, C50.611, C50.612, C50.619, C50.621, C50.622, C50.629, C50.811, C50.812, C50.819, C50.821, C50.822, C50.829, C50.911, C50.912, C50.919, C50.921, C50.922, C50.929, D05.00, D05.01, D05.02, D05.10, D05.11, D05.12, D05.80, D05.81, D05.82, D05.90, D05.91, D05.92, Z17.0, Z17.1, Z19.1, Z19.2, Z85.3, Z86.000 (any DX on the claim) | At least 1 inpatient/SNF claim OR 2 HOP/carrier claims with DX codes |
| Cancer, Colorectal | 2 years | C18.0, C18.1, C18.2, C18.3, C18.4, C18.5, C18.6, C18.7, C18.8, C18.9, C19, C20, C49.A4, C49.A5, D01.0, D01.1, D01.2, Z85.030, Z85.038, Z85.040, Z85.048 (any DX on the claim) | At least 1 inpatient/SNF claim OR 2 HOP/carrier claims with DX codes |
| Cancer, Endometrial | 2 years | C54.0, C54.1, C54.2, C54.3, C54.8, C54.9, D07.0, Z85.42 (any DX on the claim) | At least 1 inpatient/SNF claim OR 2 HOP/carrier claims with DX codes |
| Cancer, Lung | 2 years | C34.00, C34.01, C34.02, C34.10, C34.11, C34.12, C34.2, C34.30, C34.31, C34.32, C34.80, C34.81, C34.82, C34.90, C34.91, C34.92, D02.20, D02.21, D02.22, Z85.110, Z85.118 (any DX on the claim) | At least 1 inpatient/SNF claim OR 2 HOP/carrier claims with DX codes |
| Cancer, Prostate | 2 years | C61, D07.5, Z85.46 (any DX on the claim) | At least 1 inpatient/SNF claim OR 2 HOP/carrier claims with DX codes |
| Cancer, Urologic (Kidney, Renal Pelvis, and Ureter) | 2 years | C64.1, C64.2, C64.9, C65.1, C65.2, C65.9, C66.1, C66.2, C66.9, C68.8, C68.9, D09.10, D09.19, Z85.520, Z85.528, Z85.53, Z85.54, Z85.59 (any DX on the claim) | At least 1 inpatient/SNF claim OR 2 HOP/carrier claims with DX codes |
| Cataract | 1 year | E08.36, E09.36, E10.36, E11.36, E13.36, H25.011, H25.012, H25.013, H25.019, H25.031, H25.032, H25.033, H25.039, H25.041, H25.042, H25.043, H25.049, H25.091, H25.092, H25.093, H25.099, H25.10, H25.11, H25.12, H25.13, H25.20, H25.21, H25.22, H25.23, H25.811, H25.812, H25.813, H25.819, H25.89, H25.9, H26.001, H26.002, H26.003, H26.009, H26.011, H26.012, H26.013, H26.019, H26.031, H26.032, H26.033, H26.039, H26.041, H26.042, H26.043, H26.049, H26.051, H26.052, H26.053, H26.059, H26.061, H26.062, H26.063, H26.069, H26.09, H26.101, H26.102, H26.103, H26.109, H26.111, H26.112, H26.113, H26.119, H26.121, H26.122, H26.123, H26.129, H26.131, H26.132, H26.133, H26.139, H26.20, H26.211, H26.212, H26.213, H26.219, H26.221, H26.222, H26.223, H26.229, H26.30, H26.31, H26.32, H26.33, H26.40, H26.411, H26.412, H26.413, H26.419, H26.491, H26.492, H26.493, H26.499, H26.8, H26.9, Q12.0 (any DX on the claim) | At least 1 HOP or carrier claim with DX codes |
| Chronic Kidney Disease | 2 years | A18.11, A52.75, B52.0, E08.21, E08.22, E08.29, E09.21, E09.22, E09.29, E10.21, E10.22, E10.29, E11.21, E11.22, E11.29, E13.21, E13.22, E13.29, I12.0, I12.9, I13.0, I13.10, I13.11, I13.2, K76.7, M10.30, M10.311, M10.312, M10.319, M10.321, M10.322, M10.329, M10.331, M10.332, M10.339, M10.341, M10.342, M10.349, M10.351, M10.352, M10.359, M10.361, M10.362, M10.369, M10.371, M10.372, M10.379, M10.38, M10.39, M32.14, M32.15, M35.04, M35.0A, N01.0, N01.1, N01.2, N01.3, N01.4, N01.5, N01.6, N01.7, N01.8, N01.9, N01.A, N02.0, N02.1, N02.2, N02.3, N02.4, N02.5, N02.6, N02.7, N02.8, N02.9, N02.A, N02.B1, N02.B2, N02.B3, N02.B4, N02.B5, N02.B6, N02.B9, N03.0, N03.1, N03.2, N03.3, N03.4, N03.5, N03.6, N03.7, N03.8, N03.9, N03.A, N04.0, N04.1, N04.2, N04.20, N04.21, N04.22, N04.29, N04.3, N04.4, N04.5, N04.6, N04.7, N04.8, N04.9, N04.A, N05.0, N05.1, N05.2, N05.3, N05.4, N05.5, N05.6, N05.7, N05.8, N05.9, N05.A, N06.0, N06.1, N06.2, N06.20, N06.21, N06.22, N06.29, N06.3, N06.4, N06.5, N06.6, N06.7, N06.8, N06.9, N06.A, N07.0, N07.1, N07.2, N07.3, N07.4, N07.5, N07.6, N07.7, N07.8, N07.9, N07.A, N08, N14.0, N14.1, N14.11, N14.19, N14.2, N14.3, N14.4, N15.0, N15.8, N15.9, N16, N18.1, N18.2, N18.3, N18.30, N18.31, N18.32, N18.4, N18.5, N18.6, N18.9, N25.1, N25.89, N25.9, N26.1, N26.9, N99.0, Q61.02, Q61.11, Q61.19, Q61.2, Q61.3, Q61.4, Q61.5, Q61.8 (any DX on the claim) | At least 1 inpatient/SNF/HHA claim OR 2 HOP/carrier claims with DX codes |
| Chronic Obstructive Pulmonary Disease | 2 years | J40, J41.0, J41.1, J41.8, J42, J43.0, J43.1, J43.2, J43.9, J44.0, J44.1, J44.81, J44.89, J44.9, J47.0, J47.1, J47.9, J98.2, J98.3 (any DX on the claim) | At least 1 inpatient/SNF/HHA claim OR 2 HOP/carrier claims with DX codes |
| Depression, Bipolar, or Other Depressive Mood Disorders | 2 years | F06.31, F06.32, F31.0, F31.10, F31.11, F31.12, F31.13, F31.2, F31.30, F31.31, F31.32, F31.4, F31.5, F31.60, F31.61, F31.62, F31.63, F31.64, F31.71, F31.73, F31.75, F31.76, F31.77, F31.78, F31.81, F31.89, F31.9, F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.8, F32.89, F32.9, F32.A, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, F33.42, F33.8, F33.9, F34.0, F34.1, F43.21, F43.23 (any DX on the claim) | At least 1 inpatient/SNF/HHA claim OR 2 HOP/carrier claims with DX codes |
| Diabetes | 2 years | E08.00, E08.01, E08.10, E08.11, E08.21, E08.22, E08.29, E08.311, E08.319, E08.321, E08.3211, E08.3212, E08.3213, E08.3219, E08.329, E08.3291, E08.3292, E08.3293, E08.3299, E08.331, E08.3311, E08.3312, E08.3313, E08.3319, E08.339, E08.3391, E08.3392, E08.3393, E08.3399, E08.341, E08.3411, E08.3412, E08.3413, E08.3419, E08.349, E08.3491, E08.3492, E08.3493, E08.3499, E08.351, E08.3511, E08.3512, E08.3513, E08.3519, E08.3521, E08.3522, E08.3523, E08.3529, E08.3531, E08.3532, E08.3533, E08.3539, E08.3541, E08.3542, E08.3543, E08.3549, E08.3551, E08.3552, E08.3553, E08.3559, E08.359, E08.3591, E08.3592, E08.3593, E08.3599, E08.36, E08.37X1, E08.37X2, E08.37X3, E08.37X9, E08.39, E08.40, E08.41, E08.42, E08.43, E08.44, E08.49, E08.51, E08.52, E08.59, E08.610, E08.618, E08.620, E08.621, E08.622, E08.628, E08.630, E08.638, E08.641, E08.649, E08.65, E08.69, E08.8, E08.9, E09.00, E09.01, E09.10, E09.11, E09.21, E09.22, E09.29, E09.311, E09.319, E09.321, E09.3211, E09.3212, E09.3213, E09.3219, E09.329, E09.3291, E09.3292, E09.3293, E09.3299, E09.331, E09.3311, E09.3312, E09.3313, E09.3319, E09.339, E09.3391, E09.3392, E09.3393, E09.3399, E09.341, E09.3411, E09.3412, E09.3413, E09.3419, E09.349, E09.3491, E09.3492, E09.3493, E09.3499, E09.351, E09.3511, E09.3512, E09.3513, E09.3519, E09.3521, E09.3522, E09.3523, E09.3529, E09.3531, E09.3532, E09.3533, E09.3539, E09.3541, E09.3542, E09.3543, E09.3549, E09.3551, E09.3552, E09.3553, E09.3559, E09.359, E09.3591, E09.3592, E09.3593, E09.3599, E09.36, E09.37X1, E09.37X2, E09.37X3, E09.37X9, E09.39, E09.40, E09.41, E09.42, E09.43, E09.44, E09.49, E09.51, E09.52, E09.59, E09.610, E09.618, E09.620, E09.621, E09.622, E09.628, E09.630, E09.638, E09.641, E09.649, E09.65, E09.69, E09.8, E09.9, E10.10, E10.11, E10.21, E10.22, E10.29, E10.311, E10.319, E10.321, E10.3211, E10.3212, E10.3213, E10.3219, E10.329, E10.3291, E10.3292, E10.3293, E10.3299, E10.331, E10.3311, E10.3312, E10.3313, E10.3319, E10.339, E10.3391, E10.3392, E10.3393, E10.3399, E10.341, E10.3411, E10.3412, E10.3413, E10.3419, E10.349, E10.3491, E10.3492, E10.3493, E10.3499, E10.351, E10.3511, E10.3512, E10.3513, E10.3519, E10.3521, E10.3522, E10.3523, E10.3529, E10.3531, E10.3532, E10.3533, E10.3539, E10.3541, E10.3542, E10.3543, E10.3549, E10.3551, E10.3552, E10.3553, E10.3559, E10.359, E10.3591, E10.3592, E10.3593, E10.3599, E10.36, E10.37X1, E10.37X2, E10.37X3, E10.37X9, E10.39, E10.40, E10.41, E10.42, E10.43, E10.44, E10.49, E10.51, E10.52, E10.59, E10.610, E10.618, E10.620, E10.621, E10.622, E10.628, E10.630, E10.638, E10.641, E10.649, E10.65, E10.69, E10.8, E10.9, E11.00, E11.01, E11.10, E11.11, E11.21, E11.22, E11.29, E11.311, E11.319, E11.321, E11.3211, E11.3212, E11.3213, E11.3219, E11.329, E11.3291, E11.3292, E11.3293, E11.3299, E11.331, E11.3311, E11.3312, E11.3313, E11.3319, E11.339, E11.3391, E11.3392, E11.3393, E11.3399, E11.341, E11.3411, E11.3412, E11.3413, E11.3419, E11.349, E11.3491, E11.3492, E11.3493, E11.3499, E11.351, E11.3511, E11.3512, E11.3513, E11.3519, E11.3521, E11.3522, E11.3523, E11.3529, E11.3531, E11.3532, E11.3533, E11.3539, E11.3541, E11.3542, E11.3543, E11.3549, E11.3551, E11.3552, E11.3553, E11.3559, E11.359, E11.3591, E11.3592, E11.3593, E11.3599, E11.36, E11.37X1, E11.37X2, E11.37X3, E11.37X9, E11.39, E11.40, E11.41, E11.42, E11.43, E11.44, E11.49, E11.51, E11.52, E11.59, E11.610, E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.641, E11.649, E11.65, E11.69, E11.8, E11.9, E13.00, E13.01, E13.10, E13.11, E13.21, E13.22, E13.29, E13.311, E13.319, E13.321, E13.3211, E13.3212, E13.3213, E13.3219, E13.329, E13.3291, E13.3292, E13.3293, E13.3299, E13.331, E13.3311, E13.3312, E13.3313, E13.3319, E13.339, E13.3391, E13.3392, E13.3393, E13.3399, E13.341, E13.3411, E13.3412, E13.3413, E13.3419, E13.349, E13.3491, E13.3492, E13.3493, E13.3499, E13.351, E13.3511, E13.3512, E13.3513, E13.3519, E13.3521, E13.3522, E13.3523, E13.3529, E13.3531, E13.3532, E13.3533, E13.3539, E13.3541, E13.3542, E13.3543, E13.3549, E13.3551, E13.3552, E13.3553, E13.3559, E13.359, E13.3591, E13.3592, E13.3593, E13.3599, E13.36, E13.39, E13.40, E13.41, E13.42, E13.43, E13.44, E13.49, E13.51, E13.52, E13.59, E13.610, E13.618, E13.620, E13.621, E13.622, E13.628, E13.630, E13.638, E13.641, E13.649, E13.65, E13.69, E13.8, E13.9 (any DX on the claim) | At least 1 inpatient/SNF/HHA claim OR 2 HOP/carrier claims with DX codes |
| Glaucoma | 2 years | H40.011, H40.012, H40.013, H40.019, H40.021, H40.022, H40.023, H40.029, H40.041, H40.042, H40.043, H40.049, H40.051, H40.052, H40.053, H40.059, H40.10X0, H40.10X1, H40.10X2, H40.10X3, H40.10X4, H40.1110, H40.1111, H40.1112, H40.1113, H40.1114, H40.1120, H40.1121, H40.1122, H40.1123, H40.1124, H40.1130, H40.1131, H40.1132, H40.1133, H40.1134, H40.1190, H40.1191, H40.1192, H40.1193, H40.1194, H40.11X0, H40.11X1, H40.11X2, H40.11X3, H40.11X4, H40.1210, H40.1211, H40.1212, H40.1213, H40.1214, H40.1220, H40.1221, H40.1222, H40.1223, H40.1224, H40.1230, H40.1231, H40.1232, H40.1233, H40.1234, H40.1290, H40.1291, H40.1292, H40.1293, H40.1294, H40.1310, H40.1311, H40.1312, H40.1313, H40.1314, H40.1320, H40.1321, H40.1322, H40.1323, H40.1324, H40.1330, H40.1331, H40.1332, H40.1333, H40.1334, H40.1390, H40.1391, H40.1392, H40.1393, H40.1394, H40.1410, H40.1411, H40.1412, H40.1413, H40.1414, H40.1420, H40.1421, H40.1422, H40.1423, H40.1424, H40.1430, H40.1431, H40.1432, H40.1433, H40.1434, H40.1490, H40.1491, H40.1492, H40.1493, H40.1494, H40.151, H40.152, H40.153, H40.159, H40.20X0, H40.20X1, H40.20X2, H40.20X3, H40.20X4, H40.211, H40.212, H40.213, H40.219, H40.2210, H40.2211, H40.2212, H40.2213, H40.2214, H40.2220, H40.2221, H40.2222, H40.2223, H40.2224, H40.2230, H40.2231, H40.2232, H40.2233, H40.2234, H40.2290, H40.2291, H40.2292, H40.2293, H40.2294, H40.231, H40.232, H40.233, H40.239, H40.241, H40.242, H40.243, H40.249, H40.30X0, H40.30X1, H40.30X2, H40.30X3, H40.30X4, H40.31X0, H40.31X1, H40.31X2, H40.31X3, H40.31X4, H40.32X0, H40.32X1, H40.32X2, H40.32X3, H40.32X4, H40.33X0, H40.33X1, H40.33X2, H40.33X3, H40.33X4, H40.40X0, H40.40X1, H40.40X2, H40.40X3, H40.40X4, H40.41X0, H40.41X1, H40.41X2, H40.41X3, H40.41X4, H40.42X0, H40.42X1, H40.42X2, H40.42X3, H40.42X4, H40.43X0, H40.43X1, H40.43X2, H40.43X3, H40.43X4, H40.50X0, H40.50X1, H40.50X2, H40.50X3, H40.50X4, H40.51X0, H40.51X1, H40.51X2, H40.51X3, H40.51X4, H40.52X0, H40.52X1, H40.52X2, H40.52X3, H40.52X4, H40.53X0, H40.53X1, H40.53X2, H40.53X3, H40.53X4, H40.60X0, H40.60X1, H40.60X2, H40.60X3, H40.60X4, H40.61X0, H40.61X1, H40.61X2, H40.61X3, H40.61X4, H40.62X0, H40.62X1, H40.62X2, H40.62X3, H40.62X4, H40.63X0, H40.63X1, H40.63X2, H40.63X3, H40.63X4, H40.811, H40.812, H40.813, H40.819, H40.821, H40.822, H40.823, H40.829, H40.831, H40.832, H40.833, H40.839, H40.89, H40.9, H42, H44.511, H44.512, H44.513, H44.519, H47.231, H47.232, H47.233, H47.239, Q15.0 (any DX on the claim) | At least 1 HOP or carrier claim with DX codes |
| Heart Failure and Non-Ischemic Heart Disease | 2 years | I09.81, I11.0, I13.0, I13.2, I42.0, I42.5, I42.6, I42.7, I42.8, I43, I50.1, I50.20, I50.21, I50.22, I50.23, I50.30, I50.31, I50.32, I50.33, I50.40, I50.41, I50.42, I50.43, I50.810, I50.811, I50.812, I50.813, I50.814, I50.82, I50.83, I50.84, I50.89, I50.9, P29.0 (any DX on the claim) | At least 1 inpatient/SNF/HHA claim OR 2 HOP/carrier claims with DX codes |
| Hip/Pelvic Fracture | 1 year | M80.051A, M80.052A, M80.059A, M80.0B1A, M80.0B2A, M80.0B9A, M80.851A, M80.852A, M80.859A, M80.8B1A, M80.8B2A, M80.8B9A, M84.350A, M84.351A, M84.352A, M84.353A, M84.359A, M84.451A, M84.452A, M84.453A, M84.459A, M84.550A, M84.551A, M84.552A, M84.553A, M84.559A, M84.650A, M84.651A, M84.652A, M84.653A, M84.659A, M97.01XA, M97.02XA, S32.301A, S32.301B, S32.302A, S32.302B, S32.309A, S32.309B, S32.311A, S32.311B, S32.312A, S32.312B, S32.313A, S32.313B, S32.314A, S32.314B, S32.315A, S32.315B, S32.316A, S32.316B, S32.391A, S32.391B, S32.392A, S32.392B, S32.399A, S32.399B, S32.401A, S32.401B, S32.402A, S32.402B, S32.409A, S32.409B, S32.411A, S32.411B, S32.412A, S32.412B, S32.413A, S32.413B, S32.414A, S32.414B, S32.415A, S32.415B, S32.416A, S32.416B, S32.421A, S32.421B, S32.422A, S32.422B, S32.423A, S32.423B, S32.424A, S32.424B, S32.425A, S32.425B, S32.426A, S32.426B, S32.431A, S32.431B, S32.432A, S32.432B, S32.433A, S32.433B, S32.434A, S32.434B, S32.435A, S32.435B, S32.436A, S32.436B, S32.441A, S32.441B, S32.442A, S32.442B, S32.443A, S32.443B, S32.444A, S32.444B, S32.445A, S32.445B, S32.446A, S32.446B, S32.451A, S32.451B, S32.452A, S32.452B, S32.453A, S32.453B, S32.454A, S32.454B, S32.455A, S32.455B, S32.456A, S32.456B, S32.461A, S32.461B, S32.462A, S32.462B, S32.463A, S32.463B, S32.464A, S32.464B, S32.465A, S32.465B, S32.466A, S32.466B, S32.471A, S32.471B, S32.472A, S32.472B, S32.473A, S32.473B, S32.474A, S32.474B, S32.475A, S32.475B, S32.476A, S32.476B, S32.481A, S32.481B, S32.482A, S32.482B, S32.483A, S32.483B, S32.484A, S32.484B, S32.485A, S32.485B, S32.486A, S32.486B, S32.491A, S32.491B, S32.492A, S32.492B, S32.499A, S32.499B, S32.501A, S32.501B, S32.502A, S32.502B, S32.509A, S32.509B, S32.511A, S32.511B, S32.512A, S32.512B, S32.519A, S32.519B, S32.591A, S32.591B, S32.592A, S32.592B, S32.599A, S32.599B, S32.601A, S32.601B, S32.602A, S32.602B, S32.609A, S32.609B, S32.611A, S32.611B, S32.612A, S32.612B, S32.613A, S32.613B, S32.614A, S32.614B, S32.615A, S32.615B, S32.616A, S32.616B, S32.691A, S32.691B, S32.692A, S32.692B, S32.699A, S32.699B, S32.810A, S32.810B, S32.811A, S32.811B, S32.82XA, S32.82XB, S32.89XA, S32.89XB, S32.9XXA, S32.9XXB, S72.001A, S72.001B, S72.001C, S72.002A, S72.002B, S72.002C, S72.009A, S72.009B, S72.009C, S72.011A, S72.011B, S72.011C, S72.012A, S72.012B, S72.012C, S72.019A, S72.019B, S72.019C, S72.021A, S72.021B, S72.021C, S72.022A, S72.022B, S72.022C, S72.023A, S72.023B, S72.023C, S72.024A, S72.024B, S72.024C, S72.025A, S72.025B, S72.025C, S72.026A, S72.026B, S72.026C, S72.031A, S72.031B, S72.031C, S72.032A, S72.032B, S72.032C, S72.033A, S72.033B, S72.033C, S72.034A, S72.034B, S72.034C, S72.035A, S72.035B, S72.035C, S72.036A, S72.036B, S72.036C, S72.041A, S72.041B, S72.041C, S72.042A, S72.042B, S72.042C, S72.043A, S72.043B, S72.043C, S72.044A, S72.044B, S72.044C, S72.045A, S72.045B, S72.045C, S72.046A, S72.046B, S72.046C, S72.051A, S72.051B, S72.051C, S72.052A, S72.052B, S72.052C, S72.059A, S72.059B, S72.059C, S72.061A, S72.061B, S72.061C, S72.062A, S72.062B, S72.062C, S72.063A, S72.063B, S72.063C, S72.064A, S72.064B, S72.064C, S72.065A, S72.065B, S72.065C, S72.066A, S72.066B, S72.066C, S72.091A, S72.091B, S72.091C, S72.092A, S72.092B, S72.092C, S72.099A, S72.099B, S72.099C, S72.101A, S72.101B, S72.101C, S72.102A, S72.102B, S72.102C, S72.109A, S72.109B, S72.109C, S72.111A, S72.111B, S72.111C, S72.112A, S72.112B, S72.112C, S72.113A, S72.113B, S72.113C, S72.114A, S72.114B, S72.114C, S72.115A, S72.115B, S72.115C, S72.116A, S72.116B, S72.116C, S72.121A, S72.121B, S72.121C, S72.122A, S72.122B, S72.122C, S72.123A, S72.123B, S72.123C, S72.124A, S72.124B, S72.124C, S72.125A, S72.125B, S72.125C, S72.126A, S72.126B, S72.126C, S72.131A, S72.131B, S72.131C, S72.132A, S72.132B, S72.132C, S72.133A, S72.133B, S72.133C, S72.134A, S72.134B, S72.134C, S72.135A, S72.135B, S72.135C, S72.136A, S72.136B, S72.136C, S72.141A, S72.141B, S72.141C, S72.142A, S72.142B, S72.142C, S72.143A, S72.143B, S72.143C, S72.144A, S72.144B, S72.144C, S72.145A, S72.145B, S72.145C, S72.146A, S72.146B, S72.146C, S72.21XA, S72.21XB, S72.21XC, S72.22XA, S72.22XB, S72.22XC, S72.23XA, S72.23XB, S72.23XC, S72.24XA, S72.24XB, S72.24XC, S72.25XA, S72.25XB, S72.25XC, S72.26XA, S72.26XB, S72.26XC, S79.001A, S79.002A, S79.009A, S79.011A, S79.012A, S79.019A, S79.091A, S79.092A, S79.099A (any DX on the claim) | At least 1 inpatient, SNF, HOP or carrier claim with DX codes |
| Hyperlipidemia | 2 years | E78.0, E78.00, E78.01, E78.1, E78.2, E78.3, E78.4, E78.41, E78.49, E78.5 (any DX on the claim) | At least 1 inpatient/SNF/HHA claim OR 2 HOP/carrier claims with DX codes |
| Hypertension | 2 years | H35.031, H35.032, H35.033, H35.039, I10, I11.0, I11.9, I12.0, I12.9, I13.0, I13.10, I13.11, I13.2, I15.0, I15.1, I15.2, I15.8, I15.9, I1A.0, I67.4, N26.2 (any DX on the claim) | At least 1 inpatient/SNF/HHA claim OR 2 HOP/carrier claims with DX codes |
| Hypothyroidism | 2 years | E00.0, E00.1, E00.2, E00.9, E01.8, E02, E03.0, E03.1, E03.2, E03.3, E03.4, E03.8, E03.9, E89.0 (any DX on the claim) | At least 1 inpatient/SNF/HHA claim OR 2 HOP/carrier claims with DX codes |
| Ischemic Heart Disease | 2 years | I20.0, I20.1, I20.2, I20.8, I20.81, I20.89, I24.0, I24.1, I24.8, I24.81, I24.89, I25.10, I25.110, I25.111, I25.112, I25.118, I25.119, I25.3, I25.41, I25.42, I25.5, I25.6, I25.700, I25.701, I25.702, I25.708, I25.710, I25.711, I25.712, I25.718, I25.719, I25.720, I25.721, I25.722, I25.728, I25.729, I25.730, I25.731, I25.732, I25.738, I25.739, I25.750, I25.751, I25.752, I25.758, I25.759, I25.760, I25.761, I25.762, I25.768, I25.769, I25.790, I25.791, I25.792, I25.798, I25.799, I25.810, I25.811, I25.812, I25.82, I25.83, I25.84, I25.85, I25.89, I25.9 (any DX on the claim) | At least 1 inpatient/SNF/HHA claim OR 2 HOP/carrier claims with DX codes |
| Non-Alzheimer's Dementia | 2 years | F01.50, F01.51, F01.511, F01.518, F01.52, F01.53, F01.54, F01.A0, F01.A11, F01.A18, F01.A2, F01.A3, F01.A4, F01.B0, F01.B11, F01.B18, F01.B2, F01.B3, F01.B4, F01.C0, F01.C11, F01.C18, F01.C2, F01.C3, F01.C4, F02.80, F02.81, F02.811, F02.818, F02.82, F02.83, F02.84, F02.A0, F02.A11, F02.A18, F02.A2, F02.A3, F02.A4, F02.B0, F02.B11, F02.B18, F02.B2, F02.B3, F02.B4, F02.C0, F02.C11, F02.C18, F02.C2, F02.C3, F02.C4, F03.90, F03.91, F03.911, F03.918, F03.92, F03.93, F03.94, F03.A0, F03.A11, F03.A18, F03.A2, F03.A3, F03.A4, F03.B0, F03.B11, F03.B18, F03.B2, F03.B3, F03.B4, F03.C0, F03.C11, F03.C18, F03.C2, F03.C3, F03.C4, F05, G13.8, G31.01, G31.09, G31.1, G31.2, G31.83, G94, R41.81 (any DX on the claim) | At least 1 inpatient/SNF/HHA claim OR 2 HOP/carrier claims with DX codes |
| Osteoporosis With or Without Pathological Fracture | 2 years | M80.00XA, M80.011A, M80.012A, M80.019A, M80.021A, M80.022A, M80.029A, M80.031A, M80.032A, M80.039A, M80.041A, M80.042A, M80.049A, M80.051A, M80.052A, M80.059A, M80.061A, M80.062A, M80.069A, M80.071A, M80.072A, M80.079A, M80.08XA, M80.0AXA, M80.0B1A, M80.0B2A, M80.0B9A, M80.80XA, M80.811A, M80.812A, M80.819A, M80.821A, M80.822A, M80.829A, M80.831A, M80.832A, M80.839A, M80.841A, M80.842A, M80.849A, M80.851A, M80.852A, M80.859A, M80.861A, M80.862A, M80.869A, M80.871A, M80.872A, M80.879A, M80.88XA, M80.8AXA, M80.8B1A, M80.8B2A, M80.8B9A, M81.0, M81.6, M81.8 (any DX on the claim) | At least 1 inpatient/SNF/HHA claim OR 2 HOP/carrier claims with DX codes |
| Parkinson's Disease and Secondary Parkinsonism | 2 years | G20, G20.A1, G20.A2, G20.B1, G20.B2, G20.C, G21.11, G21.19, G21.3, G21.4, G21.8, G21.9, G31.83 (any DX on the claim) | At least 1 inpatient/SNF/HHA claim OR 2 HOP/Carrier claims with DX codes |
| Pneumonia, All-cause | 1 year | A01.03, A02.22, A06.5, A20.2, A21.2, A22.1, A31.0, A37.01, A37.11, A37.81, A37.91, A40.3, A42.0, A43.0, A48.1, A50.04, A54.84, B01.2, B05.2, B06.81, B37.1, B38.0, B38.2, B39.0, B39.2, B40.0, B40.2, B41.0, B58.3, B59, B66.4, B67.1, B77.81, B95.3, B96.0, B96.1, J09.X1, J10.00, J10.01, J10.08, J11.00, J11.08, J12.0, J12.1, J12.2, J12.3, J12.81, J12.82, J12.89, J12.9, J13, J14, J15.0, J15.1, J15.20, J15.211, J15.212, J15.29, J15.3, J15.4, J15.5, J15.6, J15.61, J15.69, J15.7, J15.8, J15.9, J16.0, J16.8, J17, J18.0, J18.1, J18.2, J18.8, J18.9, J20.0, J84.111, J84.116, J84.117, J84.178, J84.2, J85.1, J95.851, P23.0, P23.1, P23.2, P23.3, P23.4, P23.5, P23.6, P23.8, P23.9, Z87.01 (any DX on the claim) | At least 1 inpatient/SNF/HHA claim OR 2 HOP/carrier claims with DX codes |
| Rheumatoid Arthritis/Osteoarthritis | 2 years | L40.50, L40.51, L40.54, L40.59, M05.00, M05.011, M05.012, M05.019, M05.021, M05.022, M05.029, M05.031, M05.032, M05.039, M05.041, M05.042, M05.049, M05.051, M05.052, M05.059, M05.061, M05.062, M05.069, M05.071, M05.072, M05.079, M05.09, M05.10, M05.111, M05.112, M05.119, M05.121, M05.122, M05.129, M05.131, M05.132, M05.139, M05.141, M05.142, M05.149, M05.151, M05.152, M05.159, M05.161, M05.162, M05.169, M05.171, M05.172, M05.179, M05.19, M05.20, M05.211, M05.212, M05.219, M05.221, M05.222, M05.229, M05.231, M05.232, M05.239, M05.241, M05.242, M05.249, M05.251, M05.252, M05.259, M05.261, M05.262, M05.269, M05.271, M05.272, M05.279, M05.29, M05.30, M05.311, M05.312, M05.319, M05.321, M05.322, M05.329, M05.331, M05.332, M05.339, M05.341, M05.342, M05.349, M05.351, M05.352, M05.359, M05.361, M05.362, M05.369, M05.371, M05.372, M05.379, M05.39, M05.40, M05.411, M05.412, M05.419, M05.421, M05.422, M05.429, M05.431, M05.432, M05.439, M05.441, M05.442, M05.449, M05.451, M05.452, M05.459, M05.461, M05.462, M05.469, M05.471, M05.472, M05.479, M05.49, M05.50, M05.511, M05.512, M05.519, M05.521, M05.522, M05.529, M05.531, M05.532, M05.539, M05.541, M05.542, M05.549, M05.551, M05.552, M05.559, M05.561, M05.562, M05.569, M05.571, M05.572, M05.579, M05.59, M05.60, M05.611, M05.612, M05.619, M05.621, M05.622, M05.629, M05.631, M05.632, M05.639, M05.641, M05.642, M05.649, M05.651, M05.652, M05.659, M05.661, M05.662, M05.669, M05.671, M05.672, M05.679, M05.69, M05.70, M05.711, M05.712, M05.719, M05.721, M05.722, M05.729, M05.731, M05.732, M05.739, M05.741, M05.742, M05.749, M05.751, M05.752, M05.759, M05.761, M05.762, M05.769, M05.771, M05.772, M05.779, M05.79, M05.7A, M05.80, M05.811, M05.812, M05.819, M05.821, M05.822, M05.829, M05.831, M05.832, M05.839, M05.841, M05.842, M05.849, M05.851, M05.852, M05.859, M05.861, M05.862, M05.869, M05.871, M05.872, M05.879, M05.89, M05.8A, M05.9, M06.00, M06.011, M06.012, M06.019, M06.021, M06.022, M06.029, M06.031, M06.032, M06.039, M06.041, M06.042, M06.049, M06.051, M06.052, M06.059, M06.061, M06.062, M06.069, M06.071, M06.072, M06.079, M06.08, M06.09, M06.0A, M06.1, M06.20, M06.211, M06.212, M06.219, M06.221, M06.222, M06.229, M06.231, M06.232, M06.239, M06.241, M06.242, M06.249, M06.251, M06.252, M06.259, M06.261, M06.262, M06.269, M06.271, M06.272, M06.279, M06.28, M06.29, M06.30, M06.311, M06.312, M06.319, M06.321, M06.322, M06.329, M06.331, M06.332, M06.339, M06.341, M06.342, M06.349, M06.351, M06.352, M06.359, M06.361, M06.362, M06.369, M06.371, M06.372, M06.379, M06.38, M06.39, M06.80, M06.811, M06.812, M06.819, M06.821, M06.822, M06.829, M06.831, M06.832, M06.839, M06.841, M06.842, M06.849, M06.851, M06.852, M06.859, M06.861, M06.862, M06.869, M06.871, M06.872, M06.879, M06.88, M06.89, M06.8A, M06.9, M08.00, M08.011, M08.012, M08.019, M08.021, M08.022, M08.029, M08.031, M08.032, M08.039, M08.041, M08.042, M08.049, M08.051, M08.052, M08.059, M08.061, M08.062, M08.069, M08.071, M08.072, M08.079, M08.08, M08.09, M08.0A, M08.1, M08.20, M08.211, M08.212, M08.219, M08.221, M08.222, M08.229, M08.231, M08.232, M08.239, M08.241, M08.242, M08.249, M08.251, M08.252, M08.259, M08.261, M08.262, M08.269, M08.271, M08.272, M08.279, M08.28, M08.29, M08.2A, M08.3, M08.40, M08.411, M08.412, M08.419, M08.421, M08.422, M08.429, M08.431, M08.432, M08.439, M08.441, M08.442, M08.449, M08.451, M08.452, M08.459, M08.461, M08.462, M08.469, M08.471, M08.472, M08.479, M08.48, M08.4A, M08.80, M08.811, M08.812, M08.819, M08.821, M08.822, M08.829, M08.831, M08.832, M08.839, M08.841, M08.842, M08.849, M08.851, M08.852, M08.859, M08.861, M08.862, M08.869, M08.871, M08.872, M08.879, M08.88, M08.89, M08.90, M08.911, M08.912, M08.919, M08.921, M08.922, M08.929, M08.931, M08.932, M08.939, M08.941, M08.942, M08.949, M08.951, M08.952, M08.959, M08.961, M08.962, M08.969, M08.971, M08.972, M08.979, M08.98, M08.99, M08.9A, M15.0, M15.1, M15.2, M15.3, M15.4, M15.8, M15.9, M16.0, M16.10, M16.11, M16.12, M16.2, M16.30, M16.31, M16.32, M16.4, M16.50, M16.51, M16.52, M16.6, M16.7, M16.9, M17.0, M17.10, M17.11, M17.12, M17.2, M17.30, M17.31, M17.32, M17.4, M17.5, M17.9, M18.0, M18.10, M18.11, M18.12, M18.2, M18.30, M18.31, M18.32, M18.4, M18.50, M18.51, M18.52, M18.9, M19.011, M19.012, M19.019, M19.021, M19.022, M19.029, M19.031, M19.032, M19.039, M19.041, M19.042, M19.049, M19.071, M19.072, M19.079, M19.09, M19.111, M19.112, M19.119, M19.121, M19.122, M19.129, M19.131, M19.132, M19.139, M19.141, M19.142, M19.149, M19.171, M19.172, M19.179, M19.19, M19.211, M19.212, M19.219, M19.221, M19.222, M19.229, M19.231, M19.232, M19.239, M19.241, M19.242, M19.249, M19.271, M19.272, M19.279, M19.29, M19.90, M19.91, M19.92, M19.93, M45.0, M45.1, M45.2, M45.3, M45.4, M45.5, M45.6, M45.7, M45.8, M45.9, M45.A0, M45.A1, M45.A2, M45.A3, M45.A4, M45.A5, M45.A6, M45.A7, M45.A8, M45.AB, M46.80, M46.81, M46.82, M46.83, M46.84, M46.85, M46.86, M46.87, M46.88, M46.89, M46.90, M46.91, M46.92, M46.93, M46.94, M46.95, M46.96, M46.97, M46.98, M46.99, M47.011, M47.012, M47.013, M47.014, M47.015, M47.016, M47.019, M47.021, M47.022, M47.029, M47.10, M47.11, M47.12, M47.13, M47.14, M47.15, M47.16, M47.20, M47.21, M47.22, M47.23, M47.24, M47.25, M47.26, M47.27, M47.28, M47.811, M47.812, M47.813, M47.814, M47.815, M47.816, M47.817, M47.818, M47.819, M47.891, M47.892, M47.893, M47.894, M47.895, M47.896, M47.897, M47.898, M47.899, M47.9, M48.8X1, M48.8X2, M48.8X3, M48.8X4, M48.8X5, M48.8X6, M48.8X7, M48.8X8, M48.8X9 (any DX on the claim) | At least 1 inpatient/SNF/HHA claim OR 2 HOP/carrier claims with DX codes |
| Stroke/Transient Ischemic Attack | 1 year | G45.0, G45.1, G45.2, G45.3, G45.8, G45.9, G46.0, G46.1, G46.2, G46.3, G46.4, G46.5, G46.6, G46.7, G46.8, G97.31, G97.32, I60.00, I60.01, I60.02, I60.10, I60.11, I60.12, I60.2, I60.20, I60.21, I60.22, I60.30, I60.31, I60.32, I60.4, I60.50, I60.51, I60.52, I60.6, I60.7, I60.8, I60.9, I61.0, I61.1, I61.2, I61.3, I61.4, I61.5, I61.6, I61.8, I61.9, I62.00, I62.01, I62.02, I62.9, I63.00, I63.011, I63.012, I63.013, I63.019, I63.02, I63.031, I63.032, I63.033, I63.039, I63.09, I63.10, I63.111, I63.112, I63.113, I63.119, I63.12, I63.131, I63.132, I63.133, I63.139, I63.19, I63.20, I63.211, I63.212, I63.213, I63.219, I63.22, I63.231, I63.232, I63.233, I63.239, I63.29, I63.30, I63.311, I63.312, I63.313, I63.319, I63.321, I63.322, I63.323, I63.329, I63.331, I63.332, I63.333, I63.339, I63.341, I63.342, I63.343, I63.349, I63.39, I63.40, I63.411, I63.412, I63.413, I63.419, I63.421, I63.422, I63.423, I63.429, I63.431, I63.432, I63.433, I63.439, I63.441, I63.442, I63.443, I63.449, I63.49, I63.50, I63.511, I63.512, I63.513, I63.519, I63.521, I63.522, I63.523, I63.529, I63.531, I63.532, I63.533, I63.539, I63.541, I63.542, I63.543, I63.549, I63.59, I63.6, I63.8, I63.81, I63.89, I63.9, I67.841, I67.848, I67.89, I97.810, I97.811, I97.820, I97.821 (any DX on the claim) EXCLUSION: If any of the qualifying claims have any of the following codes in any DX position then EXCLUDE: S06.340A, S06.341A, S06.342A, S06.343A, S06.344A, S06.345A, S06.346A, S06.347A, S06.348A, S06.34AA, S06.349A, S06.350A, S06.351A, S06.352A, S06.353A, S06.354A, S06.355A, S06.356A, S06.357A, S06.358A, S06.35AA, S06.359A, S06.360A, S06.361A, S06.362A, S06.363A, S06.364A, S06.365A, S06.366A, S06.367A, S06.368A, S06.36AA, S06.369A, S06.370A, S06.371A, S06.372A, S06.373A, S06.374A, S06.375A, S06.376A, S06.377A, S06.378A, S06.37AA, S06.379A, S06.380A, S06.381A, S06.382A, S06.383A, S06.384A, S06.385A, S06.386A, S06.387A, S06.388A, S06.38AA, S06.389A, S06.5X0A, S06.5X1A, S06.5X2A, S06.5X3A, S06.5X4A, S06.5X5A, S06.5X6A, S06.5X7A, S06.5X8A, S06.5XAA, S06.5X9A, S06.6X0A, S06.6X1A, S06.6X2A, S06.6X3A, S06.6X4A, S06.6X5A, S06.6X6A, S06.6X7A, S06.6X8A, S06.6XAA, S06.6X9A, S06.810A, S06.811A, S06.812A, S06.813A, S06.814A, S06.815A, S06.816A, S06.817A, S06.818A, S06.81AA, S06.819A, S06.820A, S06.821A, S06.822A, S06.823A, S06.824A, S06.825A, S06.826A, S06.827A, S06.828A, S06.82AA, S06.829A, S06.890A, S06.891A, S06.892A, S06.893A, S06.894A, S06.895A, S06.896A, S06.897A, S06.898A, S06.89AA, S06.899A, S06.9X0A, S06.9X1A, S06.9X2A, S06.9X3A, S06.9X4A, S06.9X5A, S06.9X6A, S06.9X7A, S06.9X8A, S06.9XAA, S06.9X9A, S06.A0XA, S06.A1XA |
At least 1 inpatient, HOP or carrier claim with DX codes |
- ICD-10 codes are effective 10/2015. Researchers may be interested in confirming the code(s) of interest in the accompanying claims data files.
- SNF refers to skilled nursing facility; HHA refers to home health agency; HOP refers to hospital outpatient. Carrier claims refer to claim types 71 and 72 (not durable medical equipment [DME] claim types 81 or 82), and excludes any claims where all service lines contain a Berenson-Eggers Type of Service (BETOS) code equal to D1A, D1B, D1C, D1D, D1E, D1F, D1G (which is DME), or O1A (which is ambulance services). The intent of the algorithm is to exclude claims where the services do not require a licensed health care professional. When two claims are required, they must occur at least one day apart (i.e., different claim through dates [CLM_THRU_DT]).
27 CCW Chronic Conditions (1999–2021)
There are 27 CCW Chronic Condition categories, available for file years 1999–2021. These reference both ICD-9 and ICD-10 diagnosis codes.
All variables listed here are currently available in the Master Beneficiary Summary File (MBSF) in the MBSF_CC_YYYY file. The last data year for this file is 2021.
They are also available in Medicare-Medicaid Linked Enrollee Analytic Data Source (MMLEADS) (2006–2012) and Medicaid Enrollee Supplemental File (MESF) (1999–2013).
The Applying Chronic Conditions to Medicaid Data (MAX) document provides guidance when applying Chronic Conditions or Other Chronic Health, Mental Health, and Potentially Disabling Conditions algorithms to Medicaid data.
27 CCW Chronic Conditions Algorithms and Change History
27 CCW Chronic Conditions Algorithms Reference List
Original 21 CCW Chronic Conditions for file years 1999–2010
This original version is no longer available but listed here for reference purposes. These conditions were in the previously available Beneficiary Annual Summary File (BASF).
Original 21 CCW Chronic Conditions Algorithms
Original 21 CCW Chronic Conditions Algorithms Reference List