What Is CMS-1500 form?
The CMS-1500 is the paper claim form Medicare prescribes for non-institutional providers (physicians, NPPs, suppliers); its electronic equivalent is the 837P (Professional) HIPAA EDI transaction, and many other payers accept the same form and transaction on their own terms.
- Knowledge of CMS-1500 box numbers remains relevant because EHR/PM systems often label data fields by box number (Box 19 = additional claim information, Box 24G = days/units, Box 32 = service facility location).
- Mismapped data between EHR/PM and the 837P transaction is a common source of front-end rejections.
CMS-1500 form
Also known as: 1500 Claim Form; Health Insurance Claim Form; HCFA-1500 (former name)
The CMS-1500 is the paper claim form Medicare prescribes for non-institutional providers (physicians, NPPs, suppliers); its electronic equivalent is the 837P (Professional) HIPAA EDI transaction, and many other payers accept the same form and transaction on their own terms.
Definition
Maintained by the National Uniform Claim Committee (NUCC), the current form version is 02/12, and the NUCC's reference instruction manual for it is version 13.0, released July 2025 (NUCC 1500 Claim Form pages, checked 17 September 2026). Item numbers 1 through 33 cover patient demographics, insurance information, diagnosis codes (Item 21, no more than 12 ICD-10-CM codes, related to service lines by the letters A through L), service lines (Item 24, six lines per form), the referring or ordering provider, and provider identification. Note where the provider data actually sits: the rendering provider is Item 24J, the service facility is Item 32 and the billing provider is Item 33, while Item 31 is the signature of the physician or supplier rather than a provider identifier. The 837P electronic transaction uses ASC X12 standards and carries the same information in EDI format. Medicare prescribes the CMS-1500 as the paper claim form for physicians and other suppliers at 42 CFR 424.32. Other payers set their own requirements, so which form or transaction a given payer accepts for a given claim type has to be confirmed against that payer's own instructions.
Example
A primary care visit with CPT 99213 and diagnosis E11.9 (type 2 diabetes mellitus without complications), billed by the physician practice to a commercial payer, goes out on the CMS-1500 or its 837P equivalent. The same visit billed by a hospital outpatient department for the facility component would use the UB-04 (CMS-1450) or 837I instead.
Common Misconceptions
Paper is not the usual route, but calling the form obsolete overstates it, and we have no sourceable figure for the share of professional claims still filed on paper, so we do not publish one. The rule that actually governs Medicare is 42 CFR 424.32(d): an initial Medicare claim may be paid only if it is submitted electronically, subject to stated exceptions. Those exceptions include a small provider of services (fewer than 25 full-time equivalent employees) or a small supplier (a physician, practitioner, facility or supplier with fewer than 10 full-time equivalent employees), and situations CMS treats as unusual — dental claims, a service interruption outside the submitter's control, an entity submitting fewer than 10 Medicare claims a month on average, and entities furnishing services only outside U.S. territory. Other payers set their own paper-claim policies, which is a separate question from the Medicare rule.
Practical Application
Knowledge of CMS-1500 box numbers remains relevant because EHR/PM systems often label data fields by box number (Box 19 = additional claim information, Box 24G = days/units, Box 32 = service facility location). Mismapped data between EHR/PM and the 837P transaction is a common source of front-end rejections.
Related Terms
UB-04 form
The UB-04 (also known as CMS-1450) is the standard paper claim form used by institutional providers (hospitals, SNFs, home health, hospice) to bill Medicare and other payers; its electronic equivalent is the 837I (Institutional) HIPAA EDI transaction.
Read definitionX12 (HIPAA EDI)
ASC X12 is the standards body whose X12N subcommittee develops the HIPAA-named electronic data interchange transactions for healthcare administrative data: 837 (claims), 835 (remittance), 270/271 (eligibility), 276/277 (claim status), 278 (prior auth), and 834 (enrollment).
Read definitionCPT (Current Procedural Terminology)
CPT is the five-digit procedural code set developed and maintained by the American Medical Association that describes medical, surgical, and diagnostic services performed by physicians and qualified health professionals; it is HIPAA-named for use in claims.
Read definitionICD-10-CM
ICD-10-CM is the U.S. clinical modification of the WHO's ICD-10 diagnosis code set, maintained by the CDC's National Center for Health Statistics, used to report diagnoses on all HIPAA-covered claims.
Read definitionClearinghouse
A clearinghouse is a HIPAA-defined entity that processes health information from one format into a standard electronic format and transmits 837 claims, 835 remittances, 270/271 eligibility, and 276/277 claim status transactions between providers and payers.
Read definitionWhere This Applies on MedPrecision
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