Competitive Acquisition Program (CAP) and MSP
In CR 5332 (Transmittal 1088) "Instructions for the Coordination of Medicare Secondary Payer (MSP) claims for the Competitive Acquisition Program (CAP)", issued October 27, 2006, it was indicated that under certain circumstances, a participating CAP physician may procure a CAP drug from a source other than the CAP vendor because of a mistake in identifying the patient's primary insurer. Under these unusual circumstances, we instructed CAP physicians to use the J3 modifier to receive payment for the drug at the non-CAP rate.
The M2 "Medicare secondary payer" modifier was created for the purpose described in the CR identified above and was included in the 2007 Alpha-Numeric HCPCS File posted to the CMS website in November 2006. Effective January 1, 2007, the M2 modifier will be the dedicated modifier for the unusual circumstances identified above, and the J3 modifier will no longer be accepted for this purpose.
Page Last Updated: Tuesday, 04-Dec-2007 13:19:10 CST
