MSP Payment Calculator

This MSP Calculator is a tool to assist in determining the line by line claim payment calculations for Medicare covered services when Medicare is the secondary payer. It is necessary to have the primary insurer's Explanation of Benefits (EOB) and Medicare's Remittance Advice (RA) available when using this calculator. For additional information, please refer to the CMS Internet Only Manual (IOM), Publication 100-05, Medicare Secondary Payer Manual, Chapter 5, Section 40.7.3

Note: This calculator is intended to provide an estimate only, and any special reductions are not included in the calculation.

The calculator will not provide accurate MSP calculations for the following situations:

  • Non-participating providers/suppliers
  • Sequestration
  • 100% Allowed payments (i.e. lab codes)
  • Psychiatric Reduction
  • Tertiary Payments




Last Updated Dec 10 , 2023