CMS 1500 Claim Form Instructions: Revised for Form Version 02/12
This change request (CR) 8509 revises the current CMS 1500 claim form instructions to reflect the
revised CMS 1500 claim form, version 02/12. Form Version 02/12 will replace the current CMS 1500 claim form, 08/05, effective with claims
received on and after April 1, 2014:
• Medicare will begin accepting claims on the revised form, 02/12, on January 6, 2014;
• Medicare will continue to accept claims on the old form, 08/05, through March 31, 2014;
• On April 1, 2014, Medicare will accept paper claims on only the revised CMS 1500 claim form,
02/12; and
• On and after April 1, 2014, Medicare will no longer accept claims on the old CMS 1500 claim
form, 08/05.
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: December 27, 2013
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.