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

Healthcare Common Procedure Coding System (HCPCS) - Level II Code Modification Request Process (CMS-10224)

⚠️ Notice: This information collection may be referencing outdated material.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
20190809 Qualtrics Screenshots.docx Other-Screenshot
CMS-10224 HCPCS Application CMS-10224_2020_HCPCS_Application_FINAL_112619.pdf Form and Instruction

Information Collection (IC) Details

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 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 %

	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

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.