US · guidance
CMS Pub. 100-05, ch. 5, § 50.2.1
Payment Calculation Processes for MSP Claims
The following payment calculation processes are performed for a complete
Medicare secondary payer bill.
• Apportions the primary payer's paid amount and obligated to accept as
payment in full (if applicable), for outpatient services, based on the ratio
computed by the Total Medicare Covered Charges for each service line divided
by the Total Medicare Covered Charges;
• Computes the Medicare secondary payment amount, applicable
deductible, and coinsurance amounts;
• Reduces benefit utilization (if applicable); and
• Computes Medicare secondary savings.
MSPPAY is the "driver" module in the above processes.
History
(Rev. 11550; Issued: 08-12-22; Effective: 10-13-22; Implementation:10-13-22)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
01cc9267ede8ca6fdf3cfbee7410f8e5f85470c44e70f4517473eee1a9b348e8
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