Form CMS-1500 is the standard paper claim form used by many non-institutional health care providers and suppliers to report professional services to health plans.
What the form contains
- Patient and insured information
- Payer and other insurance information
- Diagnoses and claim-related dates
- Service dates, Place of Service, procedure codes, modifiers, charges, and units
- Rendering, service-facility, and billing provider information
Current form version
The current form version is 02/12. NUCC maintains the form and publishes a reference instruction manual, while CMS maintains information for Medicare claims.
Paper and electronic claims
The CMS-1500 is the paper form. The X12 837P is the corresponding standard electronic professional claim transaction. Whether paper is accepted depends on the payer and the filer’s circumstances.
Billing reminder: Payer and program requirements vary. Confirm the current instructions for the payer receiving the claim.