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

OMB 0938-0857

Information is necessary to determine eligibility of medical devices for establishment of additional device categories for payment under transitional pass-through payment provisions as required by section 1833(t)(6) of the Social Security Act.

The latest form for Recognition of Pass-Through Payment for Additional (New) Categories of Devices Under the Outpatient Prospective Payment System and Supporting Regulations (CMS-10052) expires 2022-11-30 and can be found here.

Latest Forms, Documents, and Supporting Material
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Name
Form and Instruction
Supporting Statement A
Supplementary Document
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Approved with change
 Extension without change of a currently approved collection 2022-07-18
Approved without change
 No material or nonsubstantive change to a currently approved collection 2021-06-22
Approved without change
 Reinstatement with change of a previously approved collection 2019-08-13
Approved without change
 Revision of a currently approved collection 2013-12-23
Approved without change
 Extension without change of a currently approved collection 2011-01-25
Approved without change
 Extension without change of a currently approved collection 2007-11-19
Approved without change
 Extension without change of a currently approved collection 2004-11-23
Approved without change
 New collection (Request for a new OMB Control Number) 2001-11-21
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