Line Primary Payer Code (if not Medicare)
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.
Values C, M, N and Null/missing indicate Medicare is primary payer.
This variable is coded, and will contain one of the following values.
| Value | Description |
|---|---|
A |
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 |
C |
Conditional payment by Medicare; future reimbursement expected |
D |
Automobile no-fault |
E |
Workers' compensation |
F |
Public Health Service or other federal agency (other than Dept. of Veterans Affairs) |
G |
Working disabled bene (under age 65 with LGHP) |
H |
Black Lung |
I |
Dept. of Veterans Affairs |
L |
Any liability insurance |
M |
Override code: EGHP services involved |
N |
Override code: non-EGHP services involved |
W |
Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Null/missing= Medicare is primary payer |
Some additional information on this variable: