Recognition of payment for new technology services for ambulatory payment classification (APC) groups under the Outpatient Prospective Payment System (CMS- 10054)

New Technology Services for Ambulatory Payment Classifications under the Outpatient Prospective Payment System (CMS-10054)

Documents and Forms

Document Name Document Type
Form CMS-10054 Recognition of payment for new technology services for ambulatory payment classification (APC) groups under the Outpatient Prospective Payment System (CMS- 10054) Form
CMS-10054 Process and Information Required for a New Technology Am CMS 10054 Form.pdf Form

Information Collection (IC) Details

IC Title:	Recognition of payment for new technology services for ambulatory payment classification (APC) groups under the Outpatient Prospective Payment System (CMS- 10054)	Agency IC Tracking Number:	CM-FFS

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 419

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10054	Process and Information Required for a New Technology Ambulatory Payment Classification (APC) Assignment Under the Hospital Outpatient Prospective Payment System (OPPS)	CMS 10054 Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 28	Number of Respondents for Small Entity: 17

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	28	18	10
Annual IC Time Burden (Hours)	400	240	160
Annual IC Cost Burden (Dollars)	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.