CMS-1500 and UB-04 are both health insurance claim forms, but they represent different claim types.
CMS-1500
The CMS-1500 is generally used for professional and supplier claims. Typical users include physicians, therapists, independent practitioners, and other non-institutional providers.
UB-04
The UB-04, also called CMS-1450, is generally used for institutional or facility claims. Hospitals and other facilities use it to report information such as revenue codes, bill types, and facility services.
Which form should you use?
The correct form depends on the provider enrollment, services, billing arrangement, and payer rules. A service performed at a hospital is not automatically a UB-04 claim; professional and facility components may be billed separately.
Billing reminder: Payer and program requirements vary. Confirm the current instructions for the payer receiving the claim.