HCPCS Modification to Code Set Form (CMS-10224)

Forms and Documents

Document Name	Status
Form CMS-10224 Healthcare Common Procedure Coding System (HCPCS) - Level II Code Modification Request Process Form and Instruction	Modified
Nonsubstantive Change Request to CMS-10224.docx Justification for No Material/Nonsubstantive Change	2021-03-05
HCPCS+Crosswalk+Document Final.docx Supplementary Document	2021-03-05
CMS-10224_Supporting_Statement_Part_A.docx Supporting Statement A	2021-03-05

IC Document Collections

IC ID	Document Title	Status
183056	Healthcare Common Procedure Coding System (HCPCS) - Level II Code Modification Request Process Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1042	ICR Reference No: 202103-0938-009
Status: Received in OIRA	Previous ICR Reference No: 201912-0938-012
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-FFS
Title: HCPCS Modification to Code Set Form (CMS-10224)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 03/08/2021

	Requested	Previously Approved
Expiration Date	07/31/2023	07/31/2023
Responses	150	150
Time Burden (Hours)	1,500	1,500
Cost Burden (Dollars)	0	0

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Abstract: Healthcare Common Procedure Coding System (HCPCS) Level II Code Modification Application Form (CMS-10224) to allow CMS to collect HCPCS Level II Code Modification requests in an electronic application intake system on the CMS-10224 form. All information is received and distributed to CMS' HCPCS workgroup and is reviewed and discussed at monthly workgroup meetings. In turn, CMS' HCPCS workgroup reaches a decision as to whether a change should be made to codes in the HCPCS code set. The respondent who submits the application form can be anyone who has an interest in obtaining a code or modifying an exiting code. However, respondents are usually manufacturers of products, or consultants on behalf of the manufacturer. Applicants will be able to access the HCPCS Level II application, via the Medicare Electronic Application Request Information SystemTM (MEARISTM), on a designated website through CMS.gov. The electronic version of the HCPCS Level II application will be the same as the paper version except for a few minor non-substantive changes as described in question one above and in our crosswalk document. This secure online application maintained by CMS enables applicants to submit their responses to our application questions directly to CMS as opposed to downloading the application from CMS.gov, completing the application, and attaching the completed application and sending via email.

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Authorizing Statute(s): PL: Pub.L. 104 - 191 261-264 Name of Law: HIPPA
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 48145	09/12/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 64898	11/25/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Healthcare Common Procedure Coding System (HCPCS) - Level II Code Modification Request Process	CMS-10224	MEARIS HCPCS Level II Application Screenshots.

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ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	150	150	0	0	0	0
Annual Time Burden (Hours)	1,500	1,500	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/08/2021

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