Understanding the CMS 1500 Claim Form

The CMS 1500 is a standardized health insurance billing document created by the Centers for Medicare & Medicaid Services (CMS). It facilitates claims submission for professional medical services by healthcare providers. Designed by the National Uniform Claim Committee (NUCC), this form is used not only for Medicare but also for billing through various government and private insurers.

While CMS does not send the form directly to providers, it can be purchased from the U.S. Government Printing Office, local print shops, or office supply stores for a fee.

Available in single or multi-part formats, including continuous feed and laser options, printed forms are essential for claim processing, as photocopies are not accepted. Proper form specifications, including OCR-compatible color and scale, are crucial to ensure accurate automated data reading, preventing delays or denials. Electronic submissions via scanned OCR forms are also permitted, streamlining claim processing across both paper and electronic formats.

The CMS 1500 form is the standard for billing Medicare Fee-For-Service claims when paper submissions are allowed. The claim submission window is typically 12 months from the service date, although exceptions may apply. This form is vital for billing services provided by physicians, nurses, therapists, ambulance providers, diagnostic labs, and social workers. It is essential to follow all instructions carefully when completing the form to ensure proper reimbursement.