The Form CMS-1500 is the standard paper claim form used by health care professionals and suppliers to bill Medicare Carriers or Part A/B and Durable Medical Equipment Medicare Administrative Contractors (A/B MACs and DME MACs).
A claim is a request for payment of Medicare benefits for services furnished by a health care professional or supplier. Claims must be submitted within one year from the date of service and Medicare beneficiaries cannot be charged for completing or filing a claim.
The Administrative Simplification Compliance Act (ASCA) prohibits payment of services or supplies not submitted to Medicare electronically, with limited exceptions. Medicare will receive and process paper claims from health care professionals and suppliers who meet the exceptions to the requirements set forth in the ASCA.
The Form CMS-1500 is maintained by the National Uniform Claim Committee (NUCC). The NUCC updated the Form CMS-1500 to accommodate the National Provider Identifier (NPI), a unique provider number mandated by HIPAA. The revised form is designated as Form CMS-1500 (8/05) and was developed through a collaborative effort led by NUCC, in consultation with CMS. The Form CMS-1500 (08/05) is the only version now accepted by Medicare.
The timely filing period for both paper and electronic Medicare claims for services furnished on or after January 1, 2010, is 1 calendar year after the date of service. Claims for services furnished before January 1, 2010, must be filed no later than December 31, 2010. Claims with dates of service October 1, 2009, through December 31, 2009, must be submitted by December 31, 2010.
- Use current valid diagnosis codes and code them to the highest level of specificity (maximum number of digits) available. Also make sure that the diagnosis codes used are appropriate for the gender of the beneficiary.
- Use current valid procedure codes as described in the Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) manuals.
- Use only Level II HCPCS codes, not local codes.
- Use current valid modifiers when necessary.