CMS 1500 (08/05) / UB-04 (CMS 1450) Claim Forms
(formerly HCFA 1500 and UB-92)
CMS 1500 (08/05) (formerly HCFA 1500)
laser printer claim forms and the latest UB-04 claim forms (CMS 1450 forms and formerly
the UB-92 form) for your medical billing
needs are available below. We have the correct
CMS-1500 forms, Approved OMB-0938-0999. To purchase from the website, click the checkbox to right of the product
and then click Add to Cart. You can adjust the quantity in the cart
page. You can
also print our order
form to pay by mail or fax.
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CMS-1500 (08-05) Approved OMB-0938-0999
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CMS issued a statement that some forms were
incorrectly printed, however, our forms are
correct, Approved
OMB-0938-0999.
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The (12/90) version of the 1500 Claim Form has been
discontinued; only the revised (08/05) form is to be used.
All rebilling of claims should use the revised (08/05)
form. You can examine the
changes to claim form here.
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UB 04 Form
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The UB-04 is a difficult form to complete given the host rules concerning
insurance coverage. The
Universal Billing Editor is the industry standard reference manual to make
certain your forms meet requirements. Check it out!
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Providers must be using the
UB 04 form after May 23rd, 2007.
The UB-04 data set accommodates the National Provider
Identifier and incorporates a number of other important changes
and improvements.
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If you have other forms needs or prefer other formats,
please email us at
and let us know!
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