Ask the Contractor Teleconference

May 30, 2006

Topic: Competitive Acquisition Program (CAP)

Questions & Answers

 

Question 1:   Modifier J1 & J2, how are they different? 

Answer 1:  Modifier J1 is used on the “no pay” line while the when J2 is used for an emergency re-supply. 

 

When billing Medicare Part B for the cost of the administration, the drug code  must still be billed to the Medicare Program with no dollar charge.  Since the CAP vendor will be handling the re-imbursement for the drug itself, the J1 modifier is added to the physician’s claim on the detail line for the drug code itself.  The detail line for the drug administration should NOT have a J1 modifier attached. 

 

If the provider is using their own supply of the drug if the drug is needed immediately, it is billed with the J2 modifier.  While the CAP vendor does have the capabilities to send drugs & biologicals in emergency situations, that will still take one business day and sometimes it is  medical necessary for the patient to receive the drug immediately and the provider has that drug on hand.  Both the J1 and J2 modifiers will be used when billed to Medicare Part B for emergency re-supply. 

 

NOTE:  There has been a change since the ACT.  There is now a second election period for providers to enroll in the CAP.  Originally, the CAP election period closed on June 2nd 2006 with their participation in the CAP beginning July 1st 2006.  Enrollment applications now received after June 3rd and before June 30th will be enrolled in the CAP with a start date for their CAP participation as of August 1st 2006.

 

For more information on the CAP, there are a number of websites for additional clarification. 

 

The CMS website has there own section dedicated to the CAP http://www.cms.hhs.gov/CompetitiveAcquisforBios/02_infophys.asp#TopOfPage

 

The application for enrolling in the CAP may be found here:

http://www.cms.hhs.gov/CompetitiveAcquisforBios/Downloads/CAP_election_form.pdf

 

Please return the enrollment application to your local Medicare Part B enrollment department

 

California                                             New England

P.O. Box 2812                                    P.O. Box 3434                                   

Chico, CA 95927-2812                       Hingham, MA 02044-3434

 

6/22/2006