Form CMS-10834 EPCS Waiver Application

EPCS Waiver
Application
CMS

Opening Screen to Apply for a Waiver
EPCS Dashboard
From the main page of the CMS EPCS Prescriber Portal, you can view your NPI compliance status.

•

One or Multiple NPIs separated by commas can be entered in the Search NPI box below. OR

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A CSV file with multiple NPIs can be uploaded in the Upload Data box below.

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Go to the Check NPI
Compliance
Status / Submit Waiver
Application section. Enter
the prescriber’s NPI into the
box. Click Check Status.

Next, you will see one of the following boxes that indicates your status. For prescribers who are part of the CMS EPCS Program, the boxes contain the
prescriber’s name, taxonomy (specialty), prescribing data, and exceptions.

•

Example 1:
Green Box –
No Further
Action
Required:
NPI meets
the CMS
EPCS
Program
requirement.

•

Internal Medicine

A Green Box indicates the NPI met at least one of the following compliance criteria:

o At least 70% of Medicare Part D Schedule II-V controlled substances were prescribed electronically,
o has been provided a Declared Disaster Exception, and/or o has been provided a Small Prescriber
Exception.

•

Example 2:
Red Box –
Consider
Submitting a
Waiver.

Family Medicine

•

A Red Box indicates the NPI does not meet the EPCS requirement in measurement year 2024.The prescriber may use the waiver application to
report circumstances beyond control.

Note: See the Submitting a Waiver section of this user guide for more information.

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Example 3:
Blue Box –
No further
action
required for
the checked
NPI.
General Practice

•

The Example 3 Blue Box indicates the NPI orginally had a Red Box but has submitted a waiver application.

•

Example 4:
Blue Box –
No Further
Action
Required:
NPI is not part of the
CMS EPCS
Program….

•

The Example 4 Blue Box indicates the NPI is not part of the CMS EPCS Program for the measurement year.

PRA Disclosure Statement

The CMS Electronic Prescribing for Controlled Substances (EPCS) Program collects information from Medicare prescribers as part of the EPCS
Application hardship waiver request and review process. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a
collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1455
(Expires 11/30/2025). This is a voluntary information collection, however, failure to submit necessary information may affect CMS efforts to review
your hardship waiver request and could negatively impact your EPCS status.
The time required to complete this information collection is estimated to average 0.1667 hours per response, including the time to review instructions,
search existing data resources, gather the data needed, and complete and review the information collection. In addition to the OMB control number,
authority for the collection of this information is covered under section 1860D-4(7) of the Social Security Act (the Act), as added by Section 2003 of the
SUPPORT for Patients and Communities Act of 2018 which mandates EPCS. CMS may use and disclose the prescriber’s responses as specified in the
System of Records Notice (SORN) “Quality Payment Program (QPP)”, System No. 09-70-0539, 83 Federal Register 6587, February 14, 2018, and as
permitted by the Privacy Act of 1974. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form,
please write to CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
****CMS Disclosure**** Please do not send applications, claims, payments, medical records, or any documents containing sensitive information to the
PRA Reports Clearance Office. Please note that any correspondence not pertaining to the information collection burden approved under the associated
OMB control number listed on this form will not be reviewed, forwarded, or retained. If you have any questions or concerns regarding where to submit
your documents, please contact EPCS-EPrescribe@cms.hhs.gov.

Enter Waiver Application Information
Submitter Details
• Name
• Email Address
• Additional Email
•
•

Address
Phone Number
Relationship to
Prescriber

Single NPI entry

Waiver Details

• Reasons for Submitting a
•

Waiver Application
Documentation Upload
to provide existence of a
circumstance beyond
control that prevented the
prescriber from
conducting EPCS

Attestation Statement

Multiple (Bulk) NPI

Software limitations are not within the control of the prescriber. (No system for conducting electronic
prescribing or no electronic health record system installed.)
Technological limitations are not within the control of the prescriber. (The service area lacks broadband
access or pharmacies in the area do not have the technology to accept electronic prescriptions.)
Local disaster or emergency that prevented the use of electronic prescribing. (Dates and documentation
of the event or reason.)
Other

Multiple (Bulk) NPI

General Notice Text
The image on this slide captures the complete text included in the general
notice box.

EPCS Waiver Application
Submitted
Upon completion of these steps, the site confirms the successful submission of
the EPCS waiver application

Single NPI

EPCS Waiver Application
SubmittedMultiple (Bulk) NPI