Fill Out Form CMS-1500 Online
Health Insurance Claim Form
Centers for Medicare & Medicaid Services
The standard paper claim form used by physicians and suppliers to bill Medicare and other payers; claims submitted by mail must use the official red-ink printed version.
Reviewed July 2026
How it works
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Open the form. The official PDF loads straight into the editor, no download needed first.
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Fill it out in the editor. Click anywhere to type, add checkmarks and place your signature.
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Download your PDF. Save the completed form, ready to print or submit.
Form CMS-1500 is the standard paper health insurance claim form used by physicians, other practitioners, and suppliers to bill Medicare and many other payers for professional services. The current version, 02/12, has been in use since it became effective on April 1, 2014, and its layout is maintained by the National Uniform Claim Committee (NUCC).
You can complete the CMS-1500 in the Universal PDF editor to prepare claim data cleanly and keep records. One critical caveat: claims mailed to Medicare must be submitted on the official red-ink printed version of the form, so the downloadable PDF is for reference and completion, not for mailing to Medicare.
What is Form CMS-1500 used for
The CMS-1500 is the paper claim form for non-institutional billing: physician services, other practitioner services, diagnostic tests, durable medical equipment, and similar professional claims. Institutional providers such as hospitals bill on a different form, the UB-04.
Most Medicare claims are required to be submitted electronically under the Administrative Simplification Compliance Act, so the paper CMS-1500 is generally reserved for providers and suppliers that qualify for an exception, and for billing certain other payers that still accept paper claims.
Who files Form CMS-1500
Providers and suppliers, or their billing staff, complete the CMS-1500. Patients normally do not file it; Medicare beneficiaries who need to submit a claim themselves in unusual situations use a different patient request form. If you are a patient with billing questions, contact your provider or your payer before attempting to file a CMS-1500 yourself.
How to fill out Form CMS-1500
The form has two broad regions, and payers publish detailed completion manuals for each field:
- Items 1 through 13 cover the patient and insured: payer type, patient identification, address, insurance policy details, other coverage, and the signature authorizations
- Items 14 through 33 cover the provider and services: dates of illness or injury, referring provider, diagnosis codes, service lines with procedure codes, charges, units, rendering provider identifiers, tax ID, and billing provider information
- Use current diagnosis and procedure code sets and follow the completion instructions published by the payer you are billing; NUCC publishes a general reference manual for the form
Where to send it
Paper claims go to the payer's claims address, which for Medicare means the Medicare Administrative Contractor for your jurisdiction. Claims mailed to Medicare must be on the official red-ink printed CMS-1500 (02/12), which is designed for scanning; photocopies and forms printed from a downloaded PDF are not accepted for Medicare mail-in claims.
Official printed forms are available from forms suppliers and the U.S. Government Publishing Office bookstore.
Frequently asked questions
No. Medicare requires mailed claims to be on the official red-ink printed version of the form, which is manufactured for scanning. Use the downloadable PDF to prepare and reference claim data, then transfer it to an official printed form or bill electronically.
The CMS-1500 is for non-institutional claims from physicians, practitioners, and suppliers. Institutional providers such as hospitals and skilled nursing facilities use the UB-04 (CMS-1450).
Version 02/12, which became effective April 1, 2014. The NUCC maintains the form's data set and physical layout.
No. Federal rules require most Medicare claims to be submitted electronically, and paper submission is limited to providers that qualify for an exception, such as certain small suppliers.
From commercial forms suppliers or the U.S. Government Publishing Office bookstore. The version downloadable from government sites is an image for reference and is not valid for claim submission to Medicare by mail.
Normally no. Providers file claims on your behalf. If you ever need to request Medicare payment yourself, there is a separate patient claim form, so contact Medicare or your provider first.
Related forms
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