US · guidance
CMS Pub. 100-02, ch. 16, § 50.1.2
Medicare Secondary Payment Where VA Authorizes Fewer
Days Than Total Number of Covered Days in the Stay
(Rev. 1, 10-01-03)
A3-3153.1.C, HO-260.3.B
The Medicare secondary payment is the lower of:
• The gross amount payable by Medicare for all covered days in the stay (without
regard to deductible or coinsurance) minus the amount paid by the VA for
Medicare covered services, or
• The gross amount payable by Medicare (without regard to deductible or
coinsurance) minus any applicable Medicare deductible or coinsurance.
EXAMPLE: The VA authorizes payment for 4 days of a 7-day stay. Charges for the 4
days total $2,350. The VA reimburses the hospital that amount. The gross amount
payable by Medicare (unreduced by deductible and coinsurance) for the 7-day stay is
$3,350. The beneficiary’s Part A deductible has not been met. The Medicare secondary
payment is determined by subtracting the VA payment from the gross amount payable by
Medicare: $3,350 - $2,350 = $1,000.
Medicare pays $1,000, which is less than the gross amount payable by Medicare minus
the Medicare deductible ($3,350 - $812 = $2,538). The beneficiary’s Part A deductible is
met by the VA payment.
History
(Rev. 1, 10-01-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
288c4352ff2fdd8c4ea8d51871e1e683751b218c0a46193cf5a03af1415b7506
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