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This variable is contained in the following files:
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.
Source: NCH, VA, DOL, SSA
| 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 |
| 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 |
Values C, M, N and null/missing indicate Medicare is primary payer.