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CMS 1500 (08/05) Approved OMB-0938-0999 / UB 04 (CMS 1450) Claim Forms (formerly HCFA 1500 and UB 92)

All forms ship FREE Priority Mail so you if you order by 2pm Central Time, you should receive them in 2-4 days! 2nd day and overnight as also available.

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. 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

CMS issued a statement that some forms were incorrectly printed, however, our forms are correct, Approved OMB-0938-0999.
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.
Get EZCLAIM Medical Billing Software for $375!

UB04 (new UB92) Form

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!
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.
Read about the Medicare implementation of the form at the CMS Site.

If you have other forms needs or prefer other formats, please email us at and let us know!

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CMS 1500 (08/05) Approved OMB-0938-0999 / UB 04 (CMS 1450) Claim Forms (formerly HCFA 1500 and UB 92)

All forms ship FREE Priority Mail so you if you order by 2pm Central Time, you should receive them in 2-4 days! 2nd day and overnight as also available.

Q-15

CMS1500 (08/05) (HCFA) Claim Forms 100 count

$15.95

H-15

CMS1500 (08/05) (HCFA) Claim Forms 250 count

$24.95

CN-15

CMS1500 (08/05) (HCFA) Claim Forms 500 count

$29.95

CN2-15

CMS1500 (08/05) (HCFA) Claim Forms 1000 count

$37.95

CN5-15

CMS1500 (08/05) (HCFA) Claim Forms 2500 count (ships in two boxes)

$74.95

Q-04

UB04 Claim Forms 100 count

$15.95

H-04

UB04 Claim Forms 250 count

$24.95

U-04

UB04 Claim Forms 500 count

$29.95

U2-04

UB04 Claim Forms 1000 count

$37.95

U5-04

UB04 Claim Forms 2500 count (ships in two boxes)

$74.95

CMS-1500 (08-05) Approved OMB-0938-0999

CMS issued a statement that some forms were incorrectly printed, however, our forms are correct, Approved OMB-0938-0999.

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.

Get EZCLAIM Medical Billing Software for $375!

UB04 (new UB92) Form

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!

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.

Read about the Medicare implementation of the form at the CMS Site.

CMS1500 (08/05) (HCFA) Claim Forms 2500 count
(ships in two boxes)

UB04 Claim Forms 2500 count
(ships in two boxes)