CMS-10638 New Technology Tracking Form

PRA for the Add-On Payments for New Medical Services and Technologies Policy(CMS-10638)

FY_2018_New_Technology_Tracking_Form

Miscellaneous Tasks: Applicant Follows-Up, Applicant Gives Further Clarification of Data or Gives Further Application Information to CMS

OMB: 0938-1347

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Centers for Medicare & Medicaid Services

Center for Medicare Management

7500 Security Boulevard

Baltimore, Maryland 21244-1850

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Tracking Form for Applicants for New Technology Add-on Payments under the Acute Inpatient Prospective Payment System (IPPS) for Federal Fiscal Year (FY) 2018


Note: The information provided on this tracking form will be made publicly available.



  1. Technology Name:

  2. Manufacturer Name:

  3. Trade Brand of Technology:

  4. Brief Description of Service, Device or Drug:























For the complete application requirements, please see the instructions at http://www.cms.hhs.gov/AcuteInpatientPPS/08_newtech.asp#TopOfPage)--.

Note: The information provided on this tracking form will be made publicly available.



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorGeri M.
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File Created2021-01-14

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