Complete this form for a Feasibility Request for pricing/coding from Clinical Billing Review (CBR).

This request form should be used to obtain pricing or coding from CBR as part of a feasibility review. This form is NOT the official submission required to start the study. If you are ready to begin the submission process, please complete the official CBR-CCTS-OCS Submission here.

If you have any questions, please contact:

Note - if you do not have some of the information as of yet, please type “Pending”.

REMINDER - NO PHI should be entered in this form.

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