HCPCS Level II modifier
Modifier J3
Modifier J3 is a HCPCS Level II modifier. CMS describes it as: Competitive acquisition program (CAP), drug not available through cap as written, reimbursed under average sales price methodology.
Source: CMS HCPCS Level II, October 2026 file dated September 23, 2026. Publisher page
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- Modifier
- J3
- Type
- HCPCS Level II modifier, maintained by CMS
- CMS description
- Competitive acquisition program (CAP), drug not available through cap as written, reimbursed under average sales price methodology
- Claim form
- CMS-1500 item 24D, up to four modifiers per line. 837P SV101-3 to SV101-6.
- Guidance
- CMS HCPCS quarterly update
Related modifiers
- J4DMEPOS item subject to DMEPOS competitive bidding program that is furnished by a hospital upon discharge
- J2Competitive acquisition program, restocking of emergency drugs after emergency administration
- J5Off-the-shelf orthotic subject to DMEPOS competitive bidding program that is furnished as part of a physical therapist or occupational therapist professional service
- J1Competitive acquisition program no-pay submission for a prescription number
- JAAdministered intravenously
- HZFunded by criminal justice agency
- JBAdministered subcutaneously
- HYFunded by juvenile justice agency
Related pages
Questions
What does modifier J3 mean?
Modifier J3 is a HCPCS Level II modifier. CMS describes it as: Competitive acquisition program (CAP), drug not available through cap as written, reimbursed under average sales price methodology.
Is modifier J3 a CPT or a HCPCS modifier?
J3 is a HCPCS Level II modifier from the CMS quarterly HCPCS file. Two-digit numeric modifiers, such as 25 or 59, are CPT modifiers.
Where does modifier J3 go on a claim?
On the CMS-1500 it goes in item 24D next to the procedure code. Each line holds up to four modifiers. On an 837P it goes in SV101-3 to SV101-6.
What denial comes back when a modifier is wrong?
A missing or mismatched modifier often comes back as CARC 4. A modifier that was not valid on the date of service comes back as CARC 182. A bundling edit the modifier should have bypassed comes back as CARC 97 or 236.