Healthcare Common Procedure Coding System (HCPCS) - Level II Code Modification Request Process

Forms and Documents

Document Name	Status
Form CMS-10224 Healthcare Common Procedure Coding System (HCPCS) - Level II Code Modification Request Process Form and Instruction	Modified
CMS-10224 CMS Response to Comments.pdf Supplementary Document	2011-04-29
Crosswalk Document2010.docx Supplementary Document	2011-04-29
CMS-10224 2012 Supporting Statement 2010 [rev 04-29-11].doc Supporting Statement A	2011-04-29

IC Document Collections

IC ID	Document Title	Status
183056	Healthcare Common Procedure Coding System (HCPCS) - Level II Code Modification Request Process Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1042	ICR Reference No: 201104-0938-008
Status: Historical Active	Previous ICR Reference No: 200712-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Healthcare Common Procedure Coding System (HCPCS) - Level II Code Modification Request Process
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/24/2011
	Date Received in OIRA: 04/29/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2014	36 Months From Approved	07/31/2011
Responses	300	0	300
Time Burden (Hours)	3,300	0	3,300
Cost Burden (Dollars)	0	0	0

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Abstract: The information on this form is used to update the HCPCS code set. All information is received and distributed to CMS' HCPCS workgroup and is reviewed and discussed at monthly workgroup meetings. In turn, CMS' HCPCS workgroup reaches a decision as to whether a change should be made to codes in the HCPCS code set. The respondent who submits the application form can be anyone who has an interest in obtaining a code or modifying an exiting code. However, respondents are usually manufacturers of products, or consultants on behalf of the manufacturer.

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Authorizing Statute(s): PL: Pub.L. 104 - 191 261-264 Name of Law: HIPPA
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 76988	12/10/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 24034	04/29/2011
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Healthcare Common Procedure Coding System (HCPCS) - Level II Code Modification Request Process	CMS-10224, CMS-10224	Healthcare Common Procedure Coding System (HCPCS) Level II Code Set (2012) ,   Healthcare Common Procedure Coding System (HCPCS) Level II Code Set Form (2013)

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	300	300	0	0	0	0
Annual Time Burden (Hours)	3,300	3,300	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/29/2011

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