A Field Guide to the CMS-1500 (Professional) Claim Form

Health Data Guru #016: plus a downloadable Cheat Sheet and reference table of all fields + descriptions

In this article, we’re diving into the CMS-1500 professional claim form’s fields and what those fields mean with descriptions.

I highly recommend you bookmark this for future reference. In a later article, we’ll also do a UB-04 (institutional) claim form.

The 1500 isn’t just any form.

It’s arguably the backbone of medical billing in the US, where every box is a trove of valuable information for analytics.

The CMS-1500 form is used for medical insurance billing and was born out of the necessity to streamline multiple claim forms and coding systems used by third-party payers in the 1960s. Thus, the American Medical Association (AMA) in collaboration with the Centers for Medicare & Medicaid Services (CMS), birthed a universal health claim form.

Today, it’s recognized nationwide and is maintained by the National Uniform Claim Committee (NUCC). All credit for the resources below go to the NUCC.

If you ever see a red version, it is because the CMS-1500 form was printed in a particular shade of red (Flint OCR Red J6983)…