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Are you ready for the new CMS 1500 claim form?



November 05, 2013
Area(s) of Interest: Payor Issues and Reimbursement Practice Management Public Payors 

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.


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


  • CMS is updating the Medicare Claims Processing Internet Only Manual (IOM, Pub. 100-04), Chapter 26, with instructions on how to complete the revised form. This information will be posted on the CMS website when it is available.


    Medicare anticipates implementing the revised CMS 1500 claim form (version 02/12) as follows:


  • January 6, 2014: Medicare begins accepting paper clams submitted on revised CMS 1500 claim form (version 02/12).

  • January 6 through March 31, 2014: Medicare continues to accept paper claims submitted on the old CMS 1500 claim form (version 08/05).

  • April 1, 2014: Medicare no longer accepts paper claims on the old form and will only receive and process claims submitted on the revised CMS 1500 claim form (version 02/12).

  • These dates are tentative and subject to change. CMS will provide more information as it is available.

  • 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.

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