Organization | Field Name | ID | Required |
|---|---|---|---|
KCR | Primary Payer (PrimaryPayor) | 30220 | yes |
NAACCR | Primary Payer at DX | yes |
Field Length: 2
Code the patient's primary payer or insurance carrier at the time of initial admission.
Coding Instructions
1. Code the type of insurance reported on the patient’s admission record
2. Code the first insurance mentioned when multiple insurance carriers are listed on one admission record
3. Code the type of insurance reported closest to the date of diagnosis when there are multiple insurance carriers reported for multiple admissions and/or multiple physician encounters
4. Code the patient’s insurance at the time of initial diagnosis and/or treatment. Do not change the insurance information based on subsequent information.
a. Code the first insurance mentioned when there is more than one type of insurance specified during the initial diagnosis and/or treatment
5. Use code 02 when the only information available is “self-pay”
6. Use code 10 for prisoners when no further information is available
7. Assign code 99 for death certificate only (DCO) cases when the primary payer at diagnosis is unknown
Code | Label | Description |
|---|---|---|
01 | Not insured | Patient has no insurance and is declared a charity write-off |
02 | Not insured, self pay | Patient has no insurance and is declared responsible for charges |
10 | Insurance, NOS | Type of insurance unknown or other than the types listed in codes 20, 31, 35, 60-68 |
20 | Managed Care, HMO, PPO | An organized system of prepaid care for a group of enrollees usually within a defined geographic area |
21 | Private Insurance: Fee-for-service | An insurance plan that does not have a negotiated fee structure with the participating hospital |
31 | Medicaid | State government administered insurance for persons who are uninsured, below the poverty level, or covered under entitlement programs |
35 | Medicaid administered through a Managed Care Plan | State government administered insurance which is administered through a commercial Managed Care plan |
60 | Medicare without supplement, Medicare, NOS | Federal government funded insurance for persons who are retired or disabled, or over 65 years old |
61 | Medicare with supplement | Patient has Medicare and another insurance to pay costs not covered by Medicare |
62 | Medicare administered through a Managed Care Plan | Patient enrolled in Medicare through a Managed Care Plan (e.g. HMO, PPO). The plan pays for all incurred costs |
63 | Medicare with private supplement | Patient has Medicare and private insurance to pay costs not covered by Medicare |
64 | Medicare with Medicaid eligibility | Federal government Medicare insurance with State Medicaid administered supplement |
65 | TRICARE (Formerly CHAMPUS) | Department of Defense program providing supplementary civilian-sector hospital and medical services to military dependents, retirees, and their dependents |
66 | Military | Military personnel or their dependents who are treated at a military facility |
67 | Veterans Affairs | Veterans who are treated in Veterans Affairs facilities |
68 | Indian/Public Health Service | Patient who receives care at an Indian Health Service facility and costs are reimbursed by the Indian Health Service. |
99 | Insurance status unknown | It is unknown from the patient’s medical record whether or not the patient is insured |
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