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This variable is contained in the following files: Carrier (Fee-for-Service), Durable Medical Equipment (Fee-for-Service)
Short SAS Name
LPRPAYCD
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.
CodeCode 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