Form CMS-1500
Health Insurance Claim Form
The standard paper claim form non-institutional providers and suppliers use to bill Medicare, Medicaid, and most commercial health insurers.
What is Form CMS-1500?
The CMS-1500 (maintained by the National Uniform Claim Committee) is the paper claim for physicians, therapists, labs, and suppliers. It captures the patient, the insured, the diagnosis codes (ICD-10), the services (CPT/HCPCS codes), charges, and the rendering and billing provider.
Most payers now require electronic claims (the 837P transaction); the paper CMS-1500 is used by small providers with an approved waiver and for secondary or specialty claims.
The 33 numbered items map to specific data elements. Payers reject claims for missing or inconsistent fields, so the NUCC instruction manual is the authority on exactly what goes where.
- Who needs it
- Non-institutional healthcare providers and suppliers billing Medicare, Medicaid, TRICARE, or commercial insurers on paper. Hospitals and facilities use the UB-04 (CMS-1450) instead.
- Deadline
- Set by each payer. Medicare requires claims within one calendar year of the date of service; commercial payers commonly allow 90–180 days.
- How to submit
- Mail the completed form to the claims address for the patient's plan, or submit electronically as an 837P if you are set up for it. Medicare paper claims go to your Medicare Administrative Contractor.
Form CMS-1500 — line-by-line
Items 1–13 — Patient and insured
Insurance type, insured's ID, patient name and address, relationship to the insured, other insurance, and the patient's authorization signatures.
Items 14–23 — Condition and prior authorization
Dates of illness/injury, referring provider and NPI, prior authorization number, and the diagnosis codes in Item 21.
Item 24 — Service lines
For each service: date(s), place of service, CPT/HCPCS code and modifiers, the diagnosis pointer, charges, units, and the rendering provider NPI.
Items 25–33 — Provider and billing
Federal Tax ID, patient account number, total charge and amount paid, the service facility location, and the billing provider's name, address, and NPI (Item 33).
Form CMS-1500 — frequently asked questions
Can I print and mail this CMS-1500 PDF?+
The downloadable PDF is for reference. Payers only accept the original form printed in OCR (dropout) red ink, sold by approved vendors, or an electronic 837P claim.
CMS-1500 vs UB-04?+
CMS-1500 (professional claims) is for individual providers and suppliers. UB-04 / CMS-1450 (institutional claims) is for hospitals and facilities.
Where do the diagnosis codes go?+
ICD-10 diagnosis codes go in Item 21 (up to 12), and each service line in Item 24E points to the ones that apply.
Who maintains the form?+
The National Uniform Claim Committee (NUCC) designs it; CMS adopts it for Medicare and Medicaid.
Form CMS-1500 is published by the Centers for Medicare & Medicaid Services (CMS) / NUCC. Official page and instructions .
PDFCure is not a government agency and does not provide tax, legal, or immigration advice. This page is general information — for your specific situation, follow the official instructions or consult a qualified professional. Always download the current edition from the agency before filing. Revision referenced: Version 02/12.