Click to enlargeCMS1500 Claim Forms (Version 02/12)

The National Uniform Claim Committee (NUCC) maintains the CMS-1500 paper claim form and makes updates according to health care industry requirements. NUCC recently announced that the health care industry will transition to a revised version of the CMS-1500 paper claim form in early 2014. Notable changes include:

  • Indicators added for differentiating between ICD-9-CM and ICD-10-CM diagnosis codes
  • The number of possible diagnosis codes expanded to 12
  • Qualifiers added to identify provider roles: Ordering, Referring, Supervising



  • CMS1500 1-part Pin Feed [02/12]
    CMS1500 1-part Pin Feed [02/12]

    CMS1500 Single Sheets [02/12]
    CMS1500 Single Sheets [02/12]

    CMS1500 2-part Pin Feed [02/12]
    CMS1500 2-part Pin Feed [02/12]

    CMS1500 2-part Snap Apart [02/12]
    CMS1500 2-part Snap Apart [02/12]

    CMS1500 3-part Pin Feed [02/12]
    CMS1500 3-part Pin Feed [02/12]

    CMS1500 1-part Pin Feed with Mailing Label [02/12]
    CMS1500 1-part Pin Feed with Mailing Label [02/12]

    CMS1500 2-part Pin Feed with Mailing Label [02/12]
    CMS1500 2-part Pin Feed with Mailing Label [02/12]

    Click to enlarge
    CMS 1500 Instructions [2012 version]


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