OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

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

IC 183056 under ICR 202604-0938-022 · OMB 0938-1042.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Healthcare Common Procedure Coding System (HCPCS) - Level II Code Modification Request Process CM-FFS
 
No Modified
 
Voluntary
 
45 CFR 162.10002 42 CFR 414.40

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10224 HCPCS Level II Application Screenshots HCPCS Level II Application Screenshots.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

250 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested 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 250 0 0 0 0 250
Annual IC Time Burden (Hours) 2,500 0 0 0 0 2,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) LEVEL II CODING PROCEDURES HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) LEVEL II CODING PROCEDURES .pdf 04/24/2026
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].