Medicare AdvantageReimbursementMedium impact
TPL Code 920 For Medicare Advantage Plan Participants – Payment Methodology
Illinois Medicaid - HFS·IL · General Surgery, Nephrology·Provider Notice
Effective date
Apr 22, 2020
We identified it
Jun 20, 2026
Summary
For Medicare Advantage Plan participants using TPL code 920 on institutional claims, HFS now caps secondary payments at the MAP deductible/coinsurance/copayment amount reported on the claim, similar to traditional Medicare processing. This payment methodology change affects ambulatory surgical centers, hospitals, and renal dialysis facilities.
Action Required
Immediately: Billing team must ensure accurate reporting of MAP deductible/coinsurance/copayment amounts on 837I or UB-04 claim transactions when using TPL code 920. Verify billing system calculates secondary payments correctly with the new payment cap. Review and adjust expectations for secondary payments from HFS as they will not exceed the MAP patient responsibility amounts submitted.