Line Primary Payer Code (if not Medicare)

SAS Name
LINE_BENE_PRMRY_PYR_CD

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.

Comments

Values C, M, N and Null/missing indicate Medicare is primary payer.

Source: NCH, VA, DOL, SSA

Values C, M, N and Null/missing indicate Medicare is primary payer.
Code Code value
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 (eff. 4/97; Prior to 3/94, also included any liability insurance)
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 (eff. 4/97) (eff. 12/90 for carrier claims and 10/93 for FI claims; obsoleted for all claim types 7/1/96)
M Override code: EGHP services involved (eff. 12/90 for carrier claims and 10/93 for FI claims; obsoleted for all claim types 7/1/96)
N Override code: non-EGHP services involved (eff. 12/90 for carrier claims and 10/93 for FI claims; obsoleted for all claim types 7/1/96)
W Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA)
Null/Missing Medicare is primary payer