New CMS-1500 Claim Form Now in Effect

Starting on April 1, 2014, you must use the revised CMS-1500 claim form (02/12) for submitting paper claims to government and private payers (regardless of date of service). Using the old form after March 31 will result in a rejected claim.

Among other changes, the new form accommodates indicators for differentiating between ICD-9-CM and ICD-10-CM diagnosis codes. Note that Congress' March 31 vote to delay ICD-10 to Oct. 1, 2015, does not delay use of the new CMS-1500 claim form.

The Centers for Medicare & Medicaid Services has no plans to delay implementation the new form. If your practice software vendor is combining the CMS-1500 update with its ICD-10 update, you should discuss with your vendor how to proceed with the ICD-10 update.

The revised form also allows for:

  • Expansion of the number of possible diagnosis codes to 12; and
  • Qualifiers to identify ordering, referring, and supervising providers (on item 17).

See all the changes in this presentation (PDF) from the National Uniform Claim Committee.

Instructions for completing the revised form for Medicare claims are in the Medicare Claims Processing Manual (Pub. 100-04).

If you experience any problems with payers accepting and paying for claims on the new form, submit your information to the TMA Hassle Factor Log for help toward a speedy resolution.

Revised April 1, 2014

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