Fill Out Form CMS-1500 in 2026
Itemize office visits, labs, and equipment charges, note other coverage for coordinating benefits, sign where allowed, and download your completed copy.
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How to fill out a CMS-1500 Form
Follow the steps below and you'll finish with no guesswork.
Open the form
Access the pre-loaded claim form in the editor—no upload needed to start.
Fill in your details
Complete every required field, including the insured's ID and diagnosis codes.
Download as PDF
Save your completed claim form as a PDF file, ready to print or submit.
What is a CMS-1500 Form?
The CMS-1500 Form is the standard paper claim form that doctors, therapists, and other non-institutional providers use to bill Medicare, Medicaid, and private insurers for services you received. It lists patient details, provider information, diagnosis codes, and procedures performed. This standard format lets insurers review each claim the same way, so they can process payment without confusion or delay caused by mismatched paperwork.
Key Takeaways
- CMS-1500 bills Medicare and Medicaid claims
- Non-institutional providers file this form
- Form lists diagnoses, procedures, and details
What is a CMS-1500 Form used for?
Providers use this form to bill for professional and outpatient services rather than hospital stays. Here's what it typically covers:
- Billing Medicare carriers and durable medical equipment regional carriers when a paper-filing waiver applies
- Submitting claims to some Medicaid state agencies
- Reporting office visits, lab work, and durable medical equipment charges
- Listing other health insurance coverage so payers can coordinate benefits correctly
What information is required on a CMS-1500 Form?
Item 1 – Type of Health Insurance Coverage
Mark an X in the single box showing which health insurance plan applies to the claim.
Item 1a – Insured's ID Number
Enter the insured's ID number exactly as shown on the member's insurance card.
Item 2 – Patient's Name
Enter the patient's last name, first name, and middle initial as shown on the insurance card.
Item 3 – Patient's Birth Date and Sex
Enter the patient's 8-digit birth date and mark the appropriate sex box.
Item 4 – Insured's Name
Enter the subscriber's name in Last, First, MI order if the patient is a dependent.
Item 5 – Patient's Address
Enter the patient's street address, city, state, ZIP code, and telephone number.
Item 21 – Diagnosis or Nature of Illness/Injury
Enter the ICD diagnosis codes describing the patient's condition, linked to each service line.
Item 24 – Date(s) of Service, Procedures/Services/Supplies, and Charges
Enter each service's HCPCS code, date, and charge, then total all charges in Item 28.
When is a CMS-1500 Form due?
There is no fixed calendar date. Medicare requires claims within 12 months of the date of service, or they get denied. Medicaid and commercial payers set their own limits, often between 90 days and one year, so timing depends on the payer's contract and state rules rather than a single deadline.
Get your CMS-1500 Form done right
Open the CMS-1500 Form here, fill in every field, and download your completed copy ready to use.
When is a CMS-1500 Form not required?
Electronic submission through the 837P transaction removes the need for a paper CMS-1500 Form, since ASCA requires most providers to file claims electronically. Paper filing applies only when a provider self-assesses and qualifies for an ASCA exception, such as fewer than 10 FTE employees or a staff disability preventing electronic submission. Institutional providers instead use the CMS-1450/UB-04.
What does a CMS-1500 form look like
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