C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 411—EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT › Subpart B—Insurance Coverage That Limits Medicare Payment: General Provisions

42 C.F.R. § 411.25

Primary payer's notice of primary payment responsibility

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(a) If it is demonstrated to a primary payer that CMS has made a Medicare primary payment for services for which the primary payer has made or should have made primary payment, it must provide notice about primary payment responsibility and information about the underlying MSP situation to the entity or entities designated by CMS to receive and process that information.

(b) The notice must describe the specific situation and the circumstances (including the particular type of insurance coverage as specified in § 411.20(a)) and, if appropriate, the time period during which the insurer is primary to Medicare.

(c) The primary payer must provide additional information to the designated entity or entities as the designated entity or entities may require this information to update CMS' system of records.

[54 FR 41734, Oct. 11, 1989, as amended at 55 FR 1820, Jan. 19, 1990; 73 FR 9684, Feb. 22, 2008]
Notes of Decisions
Cited in 11 cases (5 in the last 5 years), 1992–2025 · leading case: United States v. Baxter International, Incorporated
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United States v. Baxter International, Incorporated (2003) ca11 · cites it 3× “d payments to be made, or received such payments, from product liability insurers; (4) a subrogation claim under the MSP against disbursements from the MDL Settlement Fund and/or the Common Benefit Fund; (5) a claim for declaratory relief that the RSP Defendants are liable under…”
Health Insurance Ass'n of America, Inc. v. Shalala (1994) cadc · cites it 6× “25 (a), which declares that “[i]f a third party payer learns that HCFA has made a Medicare primary payment for services for which the third party payer has made or should have made primary payment, it must give notice to that effect to the Medicare intermediary or carrier that…”
In Re Silicone Gel Breast Implants Liab. Litig. (2001) alnd · cites it 3× “Although the regulations require a third party payer to give notice when it "learns" HCFA has made a payment for which the third party payer was responsible, 42 C.F.R. § 411.25 (a), the HCFA considers the regulation "to embrace a situation where a third-party payer `receives the…”
Frazer v. CNA Insurance (2005) alnd “42 C.F.R. 411.25 imposes a requirement upon insurers to notify CMS when it has been mistakenly compensated for expenses and 42 C.”
Blue Cross and Blue Shield Ass'n v. Sullivan (1992) dcd “42 C.F.R. § 411.25 HIAA challenges 42 C.F.”
United States v. Baxter International, Inc. (2001) alnd · cites it 3× “Although the regulations require a third party payer to give notice when it “learns” HCFA has made a payment for which the third party payer was responsible, 42 C.F.R. § 411.25 (a), the HCFA considers the regulation “to embrace a situation where a third-party payer ‘receives the…”
MSP Recovery Claims, Series LLC v. Massachusetts Bay Insurance Company (2024) mad · cites it 3× “Count 4 of the PAC does not assert a cause of action, but instead simply seeks three declarations: (1) “a declaration that when defendants receive notice that claims they are insuring involve plaintiff’s assignor as the secondary payer, 42 C.F.R. § 411.25 applies,” and that…”
MSP Recovery Claims Series 44, LLC v. Zurich American Insurance Company (2023) ilnd · cites it 2× “First, Zurich points to a federal regulation, 42 C.F.R. § 411.25 . But a close look at that regulation shows that it imposes notice obligations on Zurich, not Plaintiff.”
MSP Recovery Claims, Series LLC v. Massachusetts Bay Insurance Company (2025) mad · cites it 2× “According to plaintiff, Massachusetts Bay was required under 42 C.F.R. § 411.25 (a) to notify BCBSMA of the potential for coverage, at which point BCBSMA could have exercised its right to subrogation and pursued the claim in A.”
SERIES 15-09-321 v. UNITED SERVICES AUTOMOBILE ASSOCIATION (2025) flsd · cites it 2× “Under 42 C.F.R. § 411.25 , where “it is demonstrated to a primary payer that CMS has made a Medicare primary payment for services for which the primary payer has made or should have made primary payment, it must provide notice about primary payment responsibility and information…”
MSP Recovery Claims Series 44, LLC v. The Hanover Insurance Company, Inc. (2023) mad “The complaint alleges that plaintiff is entitled to a declaratory judgment under 42 C.F.R. § 411.25 (a) and Massachusetts law “establishing that [defendants] ha[ve] a historical, present, and continuing duty to reimburse BCBSMA for payments made on behalf of beneficiaries’…”
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