CAP Required Modifiers

100.2.1 - CAP Required Modifiers (Rev. 3721, Issued: 02-24-17, Effective: 05-25-17, Implementation: 05-25-17) The A/B MAC (B) shall identify physicians who have elected CAP and will no longer pay the physician for drugs under the ASP system that were obtained through CAP. A/B MACs (B) shall continue to pay physicians for the administration of CAP drugs. Unless claims for the CAP drugs include the no-pay (J1), furnish as written (J3) modifier, or MSP (M2) modifier the claim will be denied. When physicians submit a claim for a drug they have provided under the CAP without the J1, J3, or MSP modifiers, the contractor shall use the following remittance advice messages and associated codes when rejecting/denying claims under this policy. This CARC/RARC combination is compliant with CAQH CORE Business Scenario Three. Group Code: CO CARC: 96 RARC: N348 MSN: 7.7 A/B MACs (B) shall treat as unprocessable CAP claims with the following invalid modifier combinations on CAP claims: J1 + J3 - invalid J2 without a J1 - invalid J2 + J3 - invalid A/B MACs (B) shall treat as unprocessable claims received with invalid modifier combinations. The contractor shall use the following remittance advice messages and associated codes when rejecting/denying claims under this policy. This CARC/RARC combination is compliant with CAQH CORE Business Scenario Two. Group Code: CO CARC: 16 RARC: N519 MSN: N/A