Submitting a Prior Authorization Request and Mailing Medical Records

Medicare Program: Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) (CMS-10524)

OMB: 0938-1293

IC ID: 212039

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Submitting a Prior Authorization Request and Mailing Medical Records
 
No Modified
 
Mandatory
 
42 CFR 414.234(c)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability

Health Health Care Services

 

321,551 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 321,551 0 0 164,051 0 157,500
Annual IC Time Burden (Hours) 160,776 0 0 82,026 0 78,750
Annual IC Cost Burden (Dollars) 5,160,897 0 0 3,623,397 0 1,537,500

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