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Information Collection

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

IC 8676 under ICR 202407-0938-015 · OMB 0938-0860.

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Information Collection (IC) Details

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Recognition of payment for new technology services for ambulatory payment classification (APC) groups under the Outpatient Prospective Payment System (CMS- 10054) CM-FFS
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 419

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

Health Health Care Services

 

28 17
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 28 0 18 0 0 10
Annual IC Time Burden (Hours) 400 0 240 0 0 160
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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