Information Collection

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

IC 183056 under ICR 201104-0938-008 · OMB 0938-1042.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1042 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10224 Healthcare Common Procedure Coding System (HCPCS) - Level II Code Modification Request Process	Form and Instruction
CMS-10224 Healthcare Common Procedure Coding System (HCPCS) Level CMS-10224 2012 HCPCS Update Application-8-17-10.doc	Form and Instruction
CMS-10224 Healthcare Common Procedure Coding System (HCPCS) Level 2013 HCPCS Application.doc	Form and Instruction
Crosswalk Document2010.docx CMS-10224 Crosswalk	IC Document

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 414.40 45 CFR 162.10002

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10224	Healthcare Common Procedure Coding System (HCPCS) Level II Code Set (2012)	CMS-10224 2012 HCPCS Update Application-8-17-10.doc		Yes	No	Fillable Printable
Form and Instruction	CMS-10224	Healthcare Common Procedure Coding System (HCPCS) Level II Code Set Form (2013)	2013 HCPCS Application.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	3,300	3,300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10224 Crosswalk	Crosswalk Document2010.docx	04/29/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.