US · guidance
CMS Pub. 100-04, ch. 17, § 100.2.8
Claims Submitted for Only Drugs Listed on the Approved
CAP Vendor’s Drug List
(Rev. 3721, Issued: 02-24-17, Effective: 05-25-17, Implementation: 05-25-17)
The A/B MAC (B) shall edit to verify that the no-pay lines (lines with the CAP drug
HCPCS code and the J1modifier) that the participating CAP physician has billed is for a
drug included in the CAP and is from the particular CAP vendor they have chosen to
receive drugs from.
If the A/B MAC (B) determines that the physician has billed no-pay lines along with the
codes for the payment of the administration for drug HCPCS code(s) that are not
provided by the approved CAP vendor that the physician had selected, it shall return as
unprocessable those no-pay lines along with the lines for the codes for the payment of the
administration for these drugs.
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: 7.8
History
(Rev. 3721, Issued: 02-24-17, Effective: 05-25-17, Implementation: 05-25-17)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
ebbce7a5e1a92fa1af3a6761a115b898e3211cbbc2d54a33f6ad098ae70b0040
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.