Crosswalk#1

Supporting Statement for Updated
CMS HCPCS Level II Code Modification Application
(CMS-10224, OMB 0938-1042)
Below are the changes beginning on page 5 of the application document, and the reasons for them. Please
submit for 30-day comment period.
1) The CMS agency logo was changed (not the Center for Medicare logo) on the form. Explanation
– the application process is an agency one, and is not specific to any particular component of the
agency.
2) Application form title revised to read:
Healthcare Common Procedure Coding System (HCPCS) Level II Code Modification Application
Attachment to Healthcare Common Procedure Coding System (HCPCS) Level II Code Modification
Application Instructions
It previously read: 2020 Alpha-Numeric HCPCS Coding Recommendation Format
3) Re-sequenced Question numbers 4, 5 and 6: Reason – to group like questions.
Move current Item # 4 (and all sub-questions) to below current Item #6, and renumber.
 Item 5 becomes Item 4;
 Item 6 becomes Item 5; and
 Item 4 becomes Item 6
4) Changes to Item #9: Reason – Clarify responses for existing item 9


Add new item 9C: Specify what types of health care professionals may or may not prescribe or
administer the product, in accordance with FDA label.

5) Changes to Item #12: Reason – Eliminate information no longer required and clarify responses
for existing item 12A.


Omit 2nd sentence in current item 12A



Omit entire current item 12B



Omit entire current item 12C



Add new item 12B: Date of first sale (required information for drug and biological products
only).

Note that we do not anticipate a changes in time or resources to complete the application based on
these changes.