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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form CMS-10224 Healthcare Common Procedure Coding System (HCPCS) - Level II Code Modification Request Process Form and Instruction
CMS-10224 HCPCS LEVEL II CODE MODIFICATION REQUEST PROCESS 2013_HCPCS_Application (PRA).pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10224	HCPCS LEVEL II CODE MODIFICATION REQUEST PROCESS	2013_HCPCS_Application (PRA).pdf		Yes	No	Fillable Fileable

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 %

	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

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