Instructions for the Coordination of Medicare Secondary Payer (MSP) Claims In Change Request (CR) 5332 (Transmittal 1088) “Instructions for the Coordination of Medicare Secondary Payer (MSP) claims for the Competitive Acquisition Program (CAP),” issued October 27, 2006, the Centers for Medicare & Medicaid Services (CMS) 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, CR 5332 instructed CAP physicians to use the J3 modifier to receive payment for the drug at the non-CAP rate. However, CR 5332 further indicated that a new modifier would be created in the near future for the situation described above. Please take note that the new modifier M2 has been created and effective January 1, 2007, participating CAP physicians must use the M2 modifier when billing for the unusual circumstances identified above. Medicare will no longer accept the J3 modifier for this purpose. For more information, please see the related MLN Matters article at http://www.cms.hhs.gov/MLNMattersArticles/Downloads/SE0703.pdf CMS Learn Resource 200701-09 |
