Reminder: Practices required to use new CMS 1500 claim form beginning April 1

March 27, 2014
Area(s) of Interest: Payor Issues and Reimbursement Practice Management 

Earlier this year, the White House Office of Management and Budget (OMB) approved the revised Centers for Medicare & Medicaid Services (CMS) 1500 claim form (version 02/12 OMB control number 0938-1197). The CMS 1500 claim form is the required format for submitting paper claims to Medicare. As of April 1, 2014, CMS will no longer accept paper claims on the old form. Until then, CMS is accepting both the old and new forms.

The revised form adds the following functionality:

  • Indicators for differentiating between ICD-9 and ICD-10 diagnosis codes.

  • Expansion of the number of possible diagnosis codes to 12.

  • Qualifiers to identify the following provider roles (on item 17):
  • Ordering

  • Referring

  • Supervising

  • Physicians should note that while the new claim form includes fields for ICD-10 codes in preparation for the transition in October 2014, practices should continue to submit only ICD-9 codes until notified otherwise by payors.

    Contact: CMA's reimbursement helpline (888) 401-5911 or economicservices@cmadocs.org.


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