OBJECTIVES: The objective of the study is to assess state level variation of Medicare beneficiaries with a recent diagnosis of chronic hepatitis C in 2016. We also estimated average claim payments for services with a hepatitis C diagnosis.

METHODS: The study used the 2016 restricted sample of Medicare claims to identify beneficiaries with a diagnosis of chronic hepatitis C. We used the ICD-10 code of B18.xx to indicate a diagnosis of chronic hepatitis C. We scanned the diagnosis codes for Medicare claims for inpatient hospitalizations, institutionalized outpatient services, and noninstitutionalized outpatient services. We restricted our sample to beneficiaries with both Parts A and B of Medicare, which represent approximately 50 million beneficiaries. Beneficiaries with a chronic hepatitis C diagnosis were compared to total number of beneficiaries within each state using the Medicare enrollment summary data file.

RESULTS: We estimated 232,000 beneficiaries had a chronic hepatitis C diagnosis in their Medical claims. These beneficiaries had a total number of 1.38 million claims with a chronic hepatitis C diagnosis. For inpatient claims, the average claim is $13,800. For institutionalized claims, the average claim is $362, while for the noninstitutionalized outpatient claims the average claim is $81. The top three states with the highest rates of beneficiaries with chronic hepatitis C were Washington DC, Alaska, and Maryland with prevalence rates of 2.0%, 1.0%, and 0.9% respectively. The bottom three states with the lowest rates of beneficiaries with chronic hepatitis C were South Dakota, Utah, and North Dakota, all with prevalence rates of about 0.2%. The mean prevalence rate was 0.46%.

CONCLUSIONS: Variation exists of Medicare beneficiaries with a hepatitis C diagnosis in their claims. This may reflect differences in screening rates of chronic hepatitis C, true prevalence rates, or both. Policymakers should ensure all providers adhere to uniform screening guidelines.