PROVIDER PROVIDE_ID UNIQSAMPID ELIG_DSCHG FIRSTNAME MIDDLEINIT LASTNAME GENDER
AGE_CODE STREET CITY STATE ZIP PHONE ADM_DATE DISDATE
ADM_SOURCE DIS_STATUS DOS PRA
Fields Research field names
are in column 1 and should PROVIDER PROVIDE_ID UNIQSAMPID ELIG_DSCHG
not be altered.
HCAHPS XML FIELD
provider-
NAMES (HCAHPS XML FILE provider-id number-eligible-discharge
name
LAYOUT VERSION 3.3)
Unique number
ROW 3 AND DOWN IN EACH Valid 6 digit
assigned by the
COLUMN ARE THE Name of the Medicare # OF ELIGIBLE DISCHARGE
hospital to
DESCRIPTION Hospital Provider (TOTAL POSSIBLE SAMPLE)
identify the
/CODE CHOICES Number.
sample/patient
*changes are Bold, Italicized and Underlined
FIRSTNAME MIDDLEINIT LASTNAME GENDER AGE_CODE STREET CITY STATE ZIP
5 digit
codes 1-15 zip:
99999
1 - Male 0 - Under 18
2 - Female 1 - 18 to 24
M - Missing 2 - 25 to 29
3 - 30 to 34
4 - 35 to 39
5 - 40 to 44
6 - 45 to 49
7 - 50 to 54
8 - 55 to 59
9 - 60 to 64
10 - 65 to 69
11 - 70 to 74
12 - 75 to 79
13 - 80 to 84
14 - 85 to 89
15 - 90 or older
M - Missing/Unknown
PHONE ADM_DATE DISDATE ADM_SOURCE
admitted date discharge-date *admission-source
include area
code:
MM/DD/YYYY MM/DD/YYYY 1 - The patient was admitted to this facility
999-999-9999
2 - The patient was admitted to this facility
4 - Transfer from a hospital (Different Facility)
5 - Transfer from a SNF or ICF
6 - Transfer from another Health Care Facility
8 - Court/law Enforcement
9 - Information not available
D - Transfer from one distinct unit of the hospital to
another distinct unit of the same hospital resulting in a
separate claim to the payer
E - Transfer from Ambulatory Surgery Center
Note: Valid values 1 and 2 have the same definition
CMS has removed "7 - Emergency room"
DIS_STATUS DOS
*discharge-status *Determination of Service Line
1 = V.28, V.27, V.26 or V.25 MS-
1 = Home care or self care
DRG codes
2 = Another short-term general hospital 2 = CMS V.24 DRG codes
3 = Mix of V.28, V.27, V.26, V.25,
3 = Skilled nursing facility or V.24 codes based on payer
source
4 = Intermediate care facility 4 = ICD-9 codes
5 = Discharge/transfer to a designated cancer
5 = Hospital unit
center or children’s hospital
6 = Home with home health services 6 = New York State DRGs
7 = Other – Approved Exceptions
7 = Left against medical advice
Request only
20 = Expired
21 - Discharged/transferred to court/law
enforcement
41 = Expired in medical facility
43 = Federal healthcare facility
50 = Hospice – home
51 = Hospice – medical facility
61 = SNF swing bed within hospital
62 = Inpatient rehabilitation facility
63 = Long-term care hospital
64 = Certified Medicaid nursing facility
65 = Psychiatric hospital or psychiatric unit
66 = Critical Access Hospital
70 = Discharge/transfer to health care institution
not defined elsewhere in the code list
PRA
*service line
principal-reason-admission
Assigned by utilizing
information contained in the
V.28 MS-DRG Codes. While
V.28 Medicare Severity
Diagnosis Related Group (MS-
DRG) codes are the preferred
method for determining the
patient’s service line, CMS also
allows the following
methodologies to be used: V.26
MS-DRG codes; V.25 MS-DRG
codes; V.24 CMS-DRG codes;
Mix of V.28, V.27, V.26, V.25,
V.24 codes based on payer
source; ICD-9 codes; hospital
unit; and New York State
1 – Maternity Care
2 – Medical
3 – Surgical
M – Missing