US · guidance
CMS Pub. 100-05, ch. 6, § 40.3
Conditional Payment
To make a conditional payment, A/B MACs and DME MACs indicate conditional
payment on the CWF, Part B Claim by placing a "C" in the "MSP code" field (field 97 of
the CWF Part B Claim record.). Intermediaries indicate conditional payment on the CWF
Inpatient/SNF Bill by placing zeros (0) in the "value amount" field (position 77b)
along with the appropriate "value code." An MSP auxiliary record for the beneficiary
with a "Y" validity indicator must be present. The CWF will reject the claim with error
code 6805 when a claim for conditional payment is submitted and there is no matching
MSP auxiliary record present.
History
(Rev. 12078; Issued:06-14-23; Effective: 05-29-23; Implementation: 05-29-23)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
4af708300e08093819a627e1db6be6fe4ab550f411634a6b219b98dcac545e3d
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