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January 15, 2019

Medicare Secondary Payer Explanation Codes

To assist in processing Medicare Secondary Payer (MSP) claims, CGS developed MSP Explanation Codes for providers to enter into the “Remarks” field on the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) Page 04 (UB-04 Form Locator 80) (Loop 2300).  Simply enter the 2 digit code to explain the situation that applies.  Reporting the MSP Explanation Codes in the Remarks field will help to expedite processing of your MSP claims.

The Medicare Secondary Payer Billing & AdjustmentsPDF quick resource tool includes the MSP Explanation Codes that apply to each specific MSP situation.  Below is the list of the MSP Explanation Codes and the MSP value codes to which they apply. 

MSP Explanation Codes (Remarks FL 80)

MSP Explanation Codes
(Remarks FL 80)

Description

Applicable Value Codes

BE

Benefits are exhausted.

12, 13, 14, 15, 41, 43, 47

CD

Charges applied to co-payment, coinsurance or deductible.

12, 13, 14, 43

DA

120 days have passed since the primary payer was billed.

14, 15, 47

DP

Delay in payment from liability insurer.

47

FG

Beneficiary did not follow guidelines of their primary health plan. Use only for out of network, untimely filing or no prior authorization. Note: Indicate which of these guidelines was not followed.

12, 13, 15, 43

LD

Response received from liability insurer stating they are not responsible for claim.

47

NB

Not a covered benefit.

12, 13, 14, 15, 41, 43,

PC

Pre-existing condition.

12, 13, 43

PE

No-Fault (also known as PIP) has been exhausted toward medical expenses.

14

PP

Beneficiary paid by liability insurer. Note: May not be used for medical payment insurance payments to the beneficiary (VC 14). Providers are required to pursue those dollars.

 

Please share this information with your billing staff.

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