The National Uniform Claim Committee (NUCC), an industry organization in
which CMS participates, maintains the CMS 1500 claim form and
periodically revises it according to industry needs. The NUCC recently
revised this form (version02/12).
The NUCC changed the form to adequately accommodate and implement
ICD-10-CM diagnosis codes, although the form does include other changes
as well. More information is available on the NUCC website.
On June 10, 2013, the White House Office of Management and Budget (OMB)
approved the revised CMS 1500 claim form, version02/12,
OMB control number, 0938-1197. The CMS 1500 claim form is the required
format for submitting claims to Medicare on paper.
Features of the Revised Form
The revised form, among other changes, notably adds the following
• Indicators for differentiating between ICD-9-CM and ICD-10-CM
• Expansion of the number of possible diagnosis codes to12.
(now only 4 codes are available)
• Qualifiers to identify the following provider roles (on item 17):
Instructions for Completing the Revised Form
CMS is updating the Medicare Claims Processing Internet Only Manual
(IOM, Pub. 100-04) Chapter 26 to instruct contractors and providers
regarding how to complete the revised form. CMS will post this
information on the CMS website when it is available.
Tentative Timeline for Implementing the Revised Form for Medicare Claims
Medicare anticipates implementing the revised CMS 1500 claim form
• January 6, 2014: Medicare begins receiving and processing paper claims
submitted on the revised CMS 1500 claim form (version02/12).
• January 6 through March 31, 2014: Dual use period during which
Medicare continues to receive and process paper claims submitted on the
old CMS 1500 claim form (version 08/05).
• April 1, 2014: Medicare receives and processes paper claims submitted
only on the revised CMS 1500 claim form (version02/12).
These dates are tentative and subject to change. CMS will provide more
information as it is available.
Note: The Administrative Simplification Compliance Act (ASCA)
requires that Medicare claims be sent electronically unless certain
exceptions are met. Some Medicare providers qualify for these exceptions
and send their claims to Medicare on paper. For more information about
ASCA exceptions, please contact the Medicare contractor who processes
your claims. Claims sent electronically must abide by the standards
adopted under the Health Insurance Portability and Accountability Act of
1996 (HIPAA). The current standard adopted under HIPAA for
electronically submitting professional health care claims is the 5010
version of the ASC X12 837 Professional Health Care Claim standard and
its implementation specification, Technical Report 3 (TR3). More
information about the ASC X12 and TR3 is available on the ASC X12