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CMS-1500 Claim Forms Laser Version (08/05)

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CMS-1500 (HCFA) Claim Forms (08/05) Laser 2500 Count



CMS-1500 (HCFA) Claim Forms (08/05) Laser 5000 Count



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Blank CMS 1500 (HCFA 1500) Paper Claim Forms - Laser Format

The Current CMS 1500 (HCFA 1500) Health Insurance Claim Form APPROVED OMB-0938-0999 CMS-1500 (08-05) 

A new CMS 1500 claim form was released by the U.S. Centers for Medicare and Medicaid Services (CMS). The new CMS-1500 (02/12) will replace this current form (08/05).

The updated CMS implementation timeline* for government payments, such as Medicare and Medicaid, is as follows:

January 6, 2014: Medicare begins receiving and processing paper claims submitted on the revised CMS-1500 claim form (02/12)

January 6 - March 31, 2014: Dual-use period during which Medicare continues to receive and process paper claims submitted on either version of the form

April 1, 2014: The current claim form (08/05) is discontinued; Medicare receives and processes paper claims submitted only on the revised CMS-1500 claim form (02/12)

*These dates are tentative and subject to change.

The 08/05 version of the CMS-1500 forms was revised by the NUCC effective June 29, 2007 and replaced the CMS-1500 12/90 version. The CMS1500 Form is the standard paper claim form used by a non-institutional provider or supplier to bill Medicare, durable medical equipment contractors, and private health insurance.

All CMS 1500 Claim Forms Ship via FREE Ground Shipping (delivery in 2-5 business days).


All Claim Forms Ship via FREE Ground Shipping (delivery in 2-5 business days).

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