License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA website.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

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The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

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POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

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March 4, 2013 - Revised: 08.06.13

Billing MSP Claims With Value Code 44

Value code 44 is defined as the amount a provider agreed to accept from a primary insurer as payment in full. You may also see this referred to as "Obligated to Accept as Payment in Full," or OTAF.

Value code 44 should be submitted on MSP claims when the amount the provider agreed to accept is:

Less than the charges; and
Higher than the payment received from the primary insurer.

Value code 44 should not be submitted when:

The provider did not agree to accept a lesser amount than their charges from the primary payer as payment in full; or
Charges are equal to the amount the provider agreed to accept; or
Payment from the primary insurance is more than the amount they agreed to accept.

In addition, when the primary insurer has applied the charges to the patient's deductible or a coinsurance amount is due, value code 44 can be used to capture this information.

Example: A beneficiary has a working aged insurance (value code 12) that is primary to Medicare. Covered charges for the claim are $5,000.00. An allowed amount of $3,500.00 is expected from the primary payer and the provider agrees to accept this as payment in full (value code 44). The primary payer paid $3,000.00 and applied $500.00 toward the patient's deductible.

MSP value code 12 should be reported with dollar amount of $3,000.00, and value code 44 with $3,500.00 as the amount.

When submitting the claim to Medicare, report the following information, in addition to the other data as required by the type of bill (TOB).

UB-04 Form Locator (FL)	Code Entered	Date/Dollar Amount
Value Code (FL 39-41)	12	$3,000.00
Value Code (FL 39-41)	44	$3,500.00

Reference:

CMS Medicare Secondary Payer Manual (Pub. 100-05), chapter 3, section 40.2.1