Form CMS-10052 Medicare Electronic Application Request Information Syst

Recognition of Pass-Through Payment for Additional (New) Categories of Devices Under the Outpatient Prospective Payment System and Supporting Regulations (CMS-10052)

Device Pass-through

Recognition of pass-through payment for additional (new) categories of devices under the Outpatient Prospective Payment System and Supporting Regulations (CMS-10052)

OMB: 0938-0857

Document [pdf]
Download: pdf | pdf
Clicking “Yes” will take you to this page:

Clicking “No” will take you to this page:

Clicking “Yes” takes you to this page:

Clicking “No” takes you to this page:

Clicking “Yes” takes you here:

Clicking “No” takes you here:

Clicking “Yes” to the above screen takes you here:

Clicking “No” takes you here:

Clicking on “Add/Edit File(s)” takes you to this screen:

Clicking “Save” takes you to this screen:

Clicking on “Add/Edit File(s)” takes you to this screen:

Clicking “Save” will take you to this screen:

Clicking “Add/Edit File(s)” will take you to this screen:

Clicking “Save” takes you to this screen:

Clicking on “Add/Edit File(s)” takes you to this screen:

Clicking on “Save” will take you to this screen:

Clicking on “Add Claim” takes you to this screen:

Clicking “Save” will take you to this screen:


File Typeapplication/pdf
AuthorSophia Iannacone
File Modified2021-05-11
File Created2021-05-11

© 2024 OMB.report | Privacy Policy