NCH Primary Payer Code (if not Medicare)

SAS Name

The code, on an institutional claim, specifying a federal non-Medicare program or other source that has primary responsibility for the payment of the Medicare beneficiary's health insurance bills.

The presence of a primary payer code indicates that some other payer besides Medicare covered at least some portion of the charges.


Source: NCH

Code Code value
A Employer group health plan (EGHP) insurance for an aged beneficiary
B EGHP insurance for an end-stage renal disease (ESRD) beneficiary
C Conditional payment by Medicare; future reimbursement from the Public Health Service (PHS) expected
D No fault automobile insurance
E Workers' compensation (WC)
F Public Health Service (PHS) or other Federal agency (other than VA)
G Working disabled beneficiary under age 65 with a local government health plan (LGHP)
H Black Lung (BL) program
I Department of Veteran's Affairs
L Any liability insurance
M Override EGHP - Medicare is primary payer
N Override non-EGHP - Medicare is primary payer
Blank/missing No other primary payer