---
kind: "section"
citation: "42 C.F.R. § 412.120"
title: "42"
number: "412.120"
heading: "Reductions to total payments."
url: "https://uscodex.org/cfr/42/412.120"
---

# §412.120. Reductions to total payments.

- (a) **Deductible and coinsurance.** Subject to paragraph (a)(2) of this section, the total Medicare payments otherwise payable to a hospital are reduced by the applicable deductible and coinsurance amounts related to inpatient hospital services as determined in accordance with §§ [409.82](/cfr/42/409.82.md), [409.83](/cfr/42/409.83.md), and [409.87](/cfr/42/409.87.md) of this chapter.
- (b) **Payment by workers' compensation, automobile medical, no-fault or liability insurance or an employer group health plan primary to Medicare.** If workers' compensation, automobile medical, no-fault, or liability insurance or an employer group health plan which is primary to Medicare pays in full or in part, the Medicare payment is determined in accordance with the following guidelines:
  - (1) If workers' compensation pays, in accordance with the applicable provisions of [§§ 405.316 through 405.321](/cfr/42/405.316..405.321.md) of this chapter.
  - (2) If automobile medical, no-fault, or liability insurance pays, in accordance with the applicable provisions of [§§ 405.322 through 405.325](/cfr/42/405.322..405.325.md) of this chapter.
  - (3) If an employer group health plan which is primary to Medicare pays for services to ESRD beneficiaries, in accordance with the applicable provisions of [§§ 405.326 through 405.329](/cfr/42/405.326..405.329.md) of this chapter.
  - (4) If an employer group health plan which is primary to Medicare pays for services to employees age 65-69 and their spouses age 65-69, in accordance with the applicable provisions of [§§ 405.340 through 405.344](/cfr/42/405.340..405.344.md) of this chapter.

## Notes

### Amendments

[50 FR 12741, Mar. 29, 1985, as amended at 55 FR 36071, Sept. 4, 1990; 56 FR 573, Jan. 7, 1991; 57 FR 39825, Sept. 1, 1992]

### Authority

Authority: 42 U.S.C. 1302 and 1395hh.

### Source

Source: 50 FR 12741, Mar. 29, 1985, unless otherwise noted.

### Amendments

[50 FR 12741, Mar. 29, 1985, as amended at 55 FR 36071, Sept. 4, 1990; 56 FR 573, Jan. 7, 1991; 57 FR 39825, Sept. 1, 1992]