CMS announces implementation plan for new CMS 1500 claim form

August 30, 2013

On June 10, 2013, 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, among other changes, 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 - 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 for and will only receive and process claims submitted only 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.

The California Medical Association is in the process of surveying the major payors in California regarding their timelines for implementation of the revised CMS 1500 claim form.

Contact: CMA reimbursement help line, (888) 401-5911 or economicservices@cmadocs.org.


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