Project Title Short Title/OnCore Title Do you have an IRB Number? Yes No IRB Number Primary Investigator Contact Information Primary Investigator Primary Investigator E-Mail PI Department PI Research Division Enter if different from department. Primary Coordinator Contact Information Primary Coordinator Contact Name Primary Coordinator Contact Title Research Division/Department Primary Coordinator Contact Phone Primary Coordinator Contact E-Mail Service Descriptions and CPT Code Instructions For most efficient service, research staff should identify CPT codes for the services needing to be priced. If there is no CPT code, research staff should identify a CPT code for a comparable procedure, making note of this detail on the request form. If the correct CPT code or comparable CPT code/procedure is not known, research staff should ask the sponsor or PI. If the sponsor cannot provide, or PI does not know, the research team should contact their MCW Department resource that manages professional billing/coding. Research staff can expect that, if they provide CPT codes for each service when requesting pricing, OCRICC will be able to complete these requests within 5 business days. Researchers submitting pricing requests without corresponding CPT codes may experience a delayed turnaround. services Service Description CPT Code Department Providing Service Operations Service Description CPT Code Department Providing Service Add Add more items more items To add more lines, click the plus sign on the far right or enter the number of items in the box above and click the word "Add" to the left of it. CAPTCHA Save Draft Submit Leave this field blank Contact Us 414-805-4082 Contact Us MCW Office of Research MCW Human Research Operations Committee Office Location Froedtert Hospital Campus 9200 W Wisconsin Ave Milwaukee, WI 53226 Pavilion Building, 3rd floor Research For Researchers (OCRICC) Clinical Research Billing Compliance Requesting Froedtert Health Pricing Research Pricing Request Application Research Chargemaster Requesting OCRICC Administrative Approval Administrative Approval Request Application Operational Feasibility Planning Tool Research Consent Post-Approval Activities Use of Froedtert Health PHI PHI Accounting Log Contact Us Issue Escalation
