How to Complete a CMS-1500 Claim Form

1. Use the current official instructions

The NUCC publishes the 1500 Claim Form Reference Instruction Manual for the current 02/12 form. For Medicare paper claims, CMS also provides Medicare-specific completion guidance. Payers and programs can add their own requirements, so the applicable payer instructions should be checked before filing.

2. Work through the form in sections

• Coverage and patient information: Boxes 1–13.
• Claim and provider context: Boxes 14–23.
• Service lines: Box 24 and its subfields.
• Totals and provider identifiers: Boxes 25–33.

3. Reconcile diagnosis and service lines

Diagnosis information in Box 21 connects to service-line diagnosis pointers in Box 24E. Dates, procedures, modifiers, place of service, units and charges on the service lines should be reviewed together rather than as isolated fields.

4. Verify provider and facility information

Review billing provider information in Box 33, service facility information in Box 32 when applicable, and rendering/referring provider identifiers where required. NPI, taxonomy, payer and program rules can affect what belongs in these areas.

5. Review before printing

Before submitting a paper claim, check patient/insured data, provider identifiers, diagnosis pointers, service dates, procedure codes, units, charges, signatures and the payer address. Then verify that the printed data aligns correctly on the form.