How it works
The form has numbered boxes for patient and insured information, diagnosis codes (up to twelve), and service lines with dates, place of service, procedure codes, modifiers, diagnosis pointers, charges, units and the rendering provider’s NPI. The current version is the 02/12 form, printed in red ink so it can be scanned.
Why it matters
Most claims are now electronic, but the CMS-1500 still defines the data a professional claim must carry, and some payers — certain workers’ compensation and auto insurers, for instance — still accept or require paper. Medicare ambulatory surgery centers also bill on this format rather than the institutional one.
Example
A workers’ compensation carrier requires a paper claim with notes attached. The practice prints the CMS-1500 from its system, attaches the documentation and keeps proof of mailing.