Fill out CMS-1500 (Health Insurance Claim Form) online
The CMS-1500 is the standard paper claim form used by healthcare professionals and suppliers to bill Medicare, Medicaid, and other health insurance payers for professional (non-institutional) services. Developed by the National Uniform Claim Committee (NUCC), it is the most widely used healthcare claim form in the United States.
How to fill out CMS-1500 (Health Insurance Claim Form)
Complete the patient and insured information
Fill in the patient's name, address, date of birth, sex, and insurance ID number. Indicate the type of insurance (Medicare, Medicaid, CHAMPVA, Group Health Plan, FECA, or Other).
Enter the diagnosis codes
Enter up to 12 ICD-10-CM diagnosis codes in Box 21. List the primary diagnosis first. Each service line in Box 24 will reference these diagnoses using pointer letters A through L.
Record the services and procedures
For each service line in Box 24, enter the date of service, place of service code, CPT/HCPCS procedure code, modifier(s) if applicable, diagnosis pointer, charges, and units of service.
Complete provider and billing information
Enter the referring provider's name and NPI (if applicable), the service facility name, address, and NPI, and the billing provider's name, address, NPI, and tax ID number. Sign the form.
About CMS-1500 (Health Insurance Claim Form)
Who needs this form
Healthcare providers, physicians, therapists, suppliers, and medical billing staff who need to submit claims for outpatient or professional services to Medicare or other health insurance payers.
Where to submit
Submit to the appropriate Medicare Administrative Contractor (MAC) or the patient's health insurance payer. Most claims are now submitted electronically via the 837P electronic equivalent, but paper CMS-1500 forms are still accepted.
Source and content freshness
- Filing deadlines may shift for weekends and holidays. Verify due dates with official instructions.
Common mistakes to avoid
- Using incorrect or outdated ICD-10 diagnosis codes
- Mismatching the diagnosis pointer with the procedure code
- Not entering the provider NPI number correctly
- Leaving required fields blank (patient signature, insured information)
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What is the difference between CMS-1500 and UB-04?
The CMS-1500 is used for professional and outpatient services billed by individual providers (physicians, therapists, suppliers). The UB-04 (CMS-1450) is used for institutional claims from hospitals, skilled nursing facilities, and other facility-based providers. If the service was performed in a facility setting by an institutional provider, the UB-04 is used instead.
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