CMS Pub. 100-05, ch. 2, § 20.1

Medicare May Be Secondary Payer

(Rev. 11755, Issued:12-21-2022, Effective: 01-23-2023, Implementation: 01-23-23)

If Medicare was not the primary payer for an individual on the basis of age or disability

at the time the individual became eligible for or entitled to Medicare on the basis of

ESRD, Medicare is secondary payer to GHPs for items and services furnished during a

period of up to 30 consecutive months, which begins with the earlier of:

• The month in which a regular course of renal dialysis is initiated, or

• If the patient undergoes a course of self-dialysis training the first day of the month

in which the training occurred, or

• If an individual who received a kidney transplant, the first month in which the

individual became entitled.

NOTE: In the rare case of an untimely application by an individual who receives a

transplant, the 30-month period could begin with the first month in which the individual

would have been eligible for or entitled to Medicare benefits if a timely application had

been filed. It is not necessary to consider this possibility absent a specific indication,

e.g., information that the transplant occurred before the first month of eligibility or

entitlement. If further development is required, the contractor should contact the SSO.

When the 30-month period begins before the month the individual becomes eligible for or

entitled to Medicare, A/B MACs and DME MACs pay secondary benefits for the portion

of the period during which the individual is eligible or entitled. The latter is the

coordination period. Medicare entitlement usually begins with the third month after the

month in which the individual starts a regular course of dialysis.