Information Collection

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

IC 183056 under ICR 201912-0938-012 · 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⚠️ Notice: This information collection may be referencing outdated material.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
20190809 Qualtrics Screenshots.docx	Other-Screenshot
CMS-10224 HCPCS Application CMS-10224_2020_HCPCS_Application_FINAL_112619.pdf	Form and Instruction

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	HCPCS Application	CMS-10224_2020_HCPCS_Application_FINAL_112619.pdf		Yes	No	Fillable Fileable
Other-Screenshot			20190809 Qualtrics Screenshots.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

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	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	150	0	50	100
Annual IC Time Burden (Hours)	1,500	-150	550	1,100
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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