decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
CMS 1500 Instructions / Instructions for revised CMS-1500
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Article Overview
This article explains the revised CMS-1500 claim form at a broad, practical level. It is aimed at billing staff, coders, and other revenue cycle professionals who need to understand what information belongs in each item on the form, along with general guidance on diagnosis reporting, provider identifiers, service line completion, and payer-specific fields.
Why This Topic Matters
Accurate completion of the CMS-1500 is essential for claim acceptance and clean processing. This reference helps users orient themselves to the form structure and the types of information expected in the revised instructions.
Article Sections
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Overview of the revised CMS-1500
Introduces the updated claim form and notes that most instructions remain consistent while some fields have changed. Provides context for the field-by-field instructions that follow.
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Items 1–13: Patient, insured, and coverage information
Covers the opening form fields for patient identity, insured details, coverage relationships, status, and signatures. Includes general instructions for other insurance and related coverage questions.
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Items 14–19: Clinical and payer-specific information
Addresses dates and circumstance-related fields such as current illness, employment status, referring source, hospitalization, and local-use items. Highlights that some entries depend on payer requirements.
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Items 20–24j: Claim line and supplemental service information
Describes the service-line area, including purchased services, diagnosis reporting, authorization data, place of service, procedure line details, and supplemental identifiers. Also notes how multiple line items and payer-specific supplemental data are handled.
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Items 25–33: Provider, payment, and billing information
Summarizes the remaining form fields for tax identification, account numbers, assignment, totals, facility location, and billing provider data. Includes the identifiers used for service facility and billing provider entries.
What You Will Learn
- How the revised CMS-1500 form is organized
- Which types of patient and insured information belong in the early item fields
- How service-line and supplemental information is structured
- What categories of provider and billing information are captured at the end of the form
- Which fields are noted as payer-specific or reserved for local use
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle teams
- Provider office staff
- Claims administrators
Codes Discussed
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