ContractCap Physician Election Agreement • February 4th, 2016
The CAP Physician Election Agreement is used annually by physicians to elect to participate in the CAP or to make changes to the previous year’s selections. The information collected by these documents is used by CMS, its Medicare contractor, and the approved CAP vendor to meet programmatic requirements pertaining to physician election as established by the MMA. Form Number: CMS–10167 (OMB# 0938–0955); Frequency: Yearly; Affected Public: Business or other for- profits; Number of Respondents: 3,800; Total Annual Responses: 3,800; Total Annual Hours: 7,600.
COMPETITIVE ACQUISITION PROGRAM (CAP) FOR MEDICARE PART B DRUGS CAP PHYSICIAN ELECTION AGREEMENTCap Physician Election Agreement • May 5th, 2020
City State ZIP Code Telephone Number (Include Area Code) Identification Number or NPI (when effective) Unique Provider ID or NPI (when effective)
