FFS-1-007-29

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Measure Name	Average # of procedures
File Type	CIP
Measure ID	FFS-1-007-29
Measure Type	Average # Occurrences
Content area	FFS

Validation Type	Longitudinal and Inferential

Measure Priority	Medium
Focus Area	N/A
Category	Utilization

Claim Type	Medicaid,FFS
Adjustment Type	Original
Crossover Type	Non-Crossover

Minimum	1.1
Maximum	2.9
TA Minimun	1.1
TA Maximum	2.9
Longitudinal Threshold	0.15
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

DD Data Element	PROCEDURE-CODE-6 • PROCEDURE-CODE-1
DD Data Element Number	CIP090 • CIP070

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	FFS-1-007-29	UPDATE	Annotation	Average number of procedures codes for Medicaid FFS: original, non-crossover, paid IP claims	N/A
11/20/2025	4.0.22	FFS-1-007-29	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Non-missing procedure codesOf the claims that meet the criteria from STEP 2, set Count_Elements equal to the total number of non-missing data elements IN PROCEDURE-CODE-1, PROCEDURE-CODE-2 ... PROCEDURE-CODE-6STEP 4: Total number of diagnosesSum Count_Elements for all claims in STEP 3 STEP 5: Calculate the average for measureDivide the sum from STEP 4 by the count of claims from STEP 2	N/A
04/24/2025	4.0.7	FFS-1-007-29	ADD	N/A		Created

FFS-1-007-29

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements