Blue Button 2.0 Implementation Guide
| Defining URL: | https://bluebutton.cms.gov/assets/ig/ValueSet-line-bene-prmry-pyr-cd |
| Name: | Line Primary Payer Code (if not Medicare) |
| Definition: | The code specifying a federal non-Medicare program or other source that has primary responsibility for the payment of the Medicare beneficiary's medical bills relating to the line item service on the non-institutional claim. The presence of a primary payer code indicates that some other payer besides Medicare covered at least some portion of the charges. Source: https://bluebutton.cms.gov/resources/variables/linebeneprmrypyrcd |
| Source Resource | XML / JSON / Turtle |
The code specifying a federal non-Medicare program or other source that has primary responsibility for the payment of the Medicare beneficiary's medical bills relating to the line item service on the non-institutional claim. The presence of a primary payer code indicates that some other payer besides Medicare covered at least some portion of the charges. Source: https://bluebutton.cms.gov/resources/variables/linebeneprmrypyrcd
This value set includes codes from the following code systems:
https://bluebutton.cms.gov/assets/ig/CodeSystem-line-bene-prmry-pyr-cdThis value set contains 13 concepts
Expansion based on https://bluebutton.cms.gov/assets/ig/CodeSystem-line-bene-prmry-pyr-cd version 1.1.1
All codes from system https://bluebutton.cms.gov/assets/ig/CodeSystem-line-bene-prmry-pyr-cd
| Code | Display | Definition |
| A | Working aged bene/spouse with employer group health plan (EGHP) | Working aged bene/spouse with employer group health plan (EGHP) |
| B | End stage renal disease (ESRD) beneficiary in the 18 month coordination period with an employer group health plan | End stage renal disease (ESRD) beneficiary in the 18 month coordination period with an employer group health plan |
| C | Conditional payment by Medicare; future reimbursement expected | Conditional payment by Medicare; future reimbursement expected |
| D | Automobile no-fault | Automobile no-fault |
| E | Workers' compensation | Workers' compensation |
| F | Public Health Service or other federal agency (other than Dept. of Veterans Affairs) | Public Health Service or other federal agency (other than Dept. of Veterans Affairs) |
| G | Working disabled bene (under age 65 with LGHP) | Working disabled bene (under age 65 with LGHP) |
| H | Black Lung | Black Lung |
| I | Dept. of Veterans Affairs | Dept. of Veterans Affairs |
| L | Any liability insurance | Any liability insurance |
| M | Override code: EGHP services involved | Override code: EGHP services involved |
| N | Override code: non-EGHP services involved | Override code: non-EGHP services involved |
| W | Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Null/missing= Medicare is primary payer | Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Null/missing= Medicare is primary payer |
Blue Button 2.0 Version: 1.1.1 ®© FHIR Version: 3.0.1 (IG Publisher v3.0.1-11916) generated on Tue, Nov 27, 2018 15:56+0000. |
