decisionhealth Newsletters, Coder Pink Sheets - 2005 Issue 8 (August)
CMS releases CAP rules; alternative to ASP
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Article Overview
This premium article discusses CMS final rules for the competitive acquisition program (CAP) as an alternative to the average sales price (ASP) payment system for physician-administered drugs. It is relevant to urologists, practice managers, and medical coders who need to understand how the program affects drug acquisition, reimbursement, and participation choices, as well as which urology-related drugs were slated for inclusion in the program’s first year. The article also touches on carrier least costly alternative (LCA) policies and how they intersect with CAP.
Why This Topic Matters
Drug payment policy changes can affect office purchasing, billing workflow, and Medicare reimbursement for physician-administered medications. Knowing which drug categories are involved helps practices prepare for operational and coding impacts.
Article Sections
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CMS releases CAP rules; alternative to ASP
Introduces CMS’s competitive acquisition program and compares it with the existing physician drug payment environment. It also frames the operational concerns raised by specialty stakeholders.
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Urology drugs (with HCPCS codes) to be in CAP
Lists the urology-related drug products identified for inclusion in the program’s initial year. The section presents the associated HCPCS identifiers in a reference format.
What You Will Learn
- How CMS positioned the competitive acquisition program relative to the existing drug payment system
- What categories of policy and administrative concerns the article raises for office-based practices
- Which urology drug products were identified for inclusion in the program’s first year
- How the article situates carrier policy concepts within the broader CAP discussion
Who Should Read This
- Urologists
- Medical coders
- Practice administrators
- Billing staff
- Revenue cycle teams
- Healthcare compliance staff
Codes Discussed
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