CMS-1500 PDF - Fillable Form Template
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Single User License: Purchase of the CMS-1500 PDF entitles the user to perpetual use of the form, for an unlimited amount of time. A licensed user may open, use, access, display and copy the CMS-1500 PDF on up to two (2) computers. This license and PDF file may not be shared, transferred or used by others.
The revised CMS-1500 (version 02/12) is the universal claim form for all payers (not just Medicare) to receive and process claims. The newly revised form now allows for ICD-10 reporting, and brings uniformity with current electronic health care claims requirements.