US · guidance
CMS Pub. 100-05, ch. 1, § 20.8
When Medicare Secondary Benefits Are Payable and Not Payable
A/B MACs and DME MACs may pay Medicare secondary benefits when a provider,
physician or other supplier, or beneficiary submits a claim that is payable under
Medicare’s coverage requirements and the primary plan does not pay the entire charge.
Medicare will not make a secondary payment if the provider/physician/supplier accepts, or
is obligated to accept, the primary plan payment as full payment or full satisfaction of the
patient’s responsibility.
When a primary plan’s payment for Medicare covered services is less than the provider's,
physician’s, or other supplier’s charges for those services and less than the gross amount
payable by Medicare, and the provider, physician, or other supplier does not accept and is not
obligated to accept the primary plan’s payment as full payment, then A/B MACs and DME
MACs can process Medicare secondary payment as appropriate. See 42 CFR § 411.32,
411.33, 411.162, 411.172 and 411.204.
History
(Rev. 11755, Issued:12-21-22, Effective: 01-23-23, Implementation: 01-23-23)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
eb4ef6829facf60bbbf3acb9e78da405f0defecbf1176032c535433fb54a11c4
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