License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

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This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third party beneficiary to this license.

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

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August 21, 2025

Medicare Secondary Payer (MSP) Claims – Billing Reminders

The term Medicare Secondary Payer (MSP) is used when Medicare considers payment after a primary insurance company makes their payment determination. This happens when the beneficiary has other insurance primary to Medicare such as Employer Group Health Plans, Accident/Injury Insurance, Other Government Sponsored Health Plans, etc.

If Medicare is the secondary payer, you must include information on the claim about what the primary insurance paid.

For electronic MSP claims, use the correct MSP type code in the 2000B (Loop), SBR05 (segment) of the claim. Here are the type codes:

Type Code	Description
12	Working Aged Beneficiary/Spouse Group Health Plan Working Aged
13	ESRD Beneficiary in a Medicare Coordination Period with an Employer Health Plan ESRD
14	No-fault, including auto/other
15	Workers' Compensation
16	PHS, Other Federal Agency
41	Black Lung
43	Disabled Beneficiary Under Age 65 with GHP Disability
47	Any Liability Insurance Liability Provision

If you submit a claim with the wrong MSP type codes, we’ll reject the claim for incomplete/invalid information. These claims don’t have appeal rights. You must correct and resubmit the claim.

Note: These instructions only apply where Medicare is the secondary payer. Don’t submit Explanation of benefits (EOBs) for Medigap plans or supplemental insurance as an MSP claim. This will cause a claim rejection.

myCGS DME Web Portal Users:

You can locate the beneficiary’s MSP information under Beneficiary Information menu. Keep in mind that the myCGS® Portal can only display what CMS HIPAA Eligibility Transaction System (HETS) provides. HETS is updated once daily on Tuesdays through Saturdays, between 9 pm – 6 am, CT.

Resources:

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

AMA Disclaimer of Warranties and Liabilities.

CMS Disclaimer

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

Medicare Secondary Payer (MSP) Claims – Billing Reminders

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