CMS-1500 Form Revisions

Please see notification below regarding a new CMS-1500 form (version 02/12) to be use defective April 1, 2014.  The new form can be used starting January 1, 2014, but must be implemented April 1, 2014.  The new form allows providers to use the ICD-9 or ICD-10 diagnosis codes.  

For questions contact Ronda Buhrmester at 888-665-6518 or Peggy Walker at 800-401-3643.

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The CMS-1500 Claim Form has been recently revised withchanges including those to more adequately support the use of the ICD-10 diagnosis code set. The revised CMS-1500 form (version 02/12) will replace version 08/05. The revised form will give providers the ability to indicate whether they are using ICD-9 or ICD-10 diagnosis codes,which is important as the October 1, 2014, transition approaches.

ICD-9 codes must be used for services provided before October 1, 2014, while ICD-10 codes should be used for services provided on or after October 1, 2014. The revised form also allows for additional diagnosis codes, expanding from 4 possible codes to 12.

Only providers who qualify for exemptions from electronic submission may submit the CMS-1500 Claim Form to Medicare. For those providers who use service vendors, CMS encourages them to check with their service vendors to determine when theywill switch to the new form.

Medicare will begin accepting the revised form on January 6, 2014. Starting April 1, 2014, Medicare will accept only the revised version of the form.

Keep Up to Date on ICD-10

Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, deadline. Sign up for CMS ICD-10 Industry Email Updates and follow us on Twitter.