Revised CMS 1500 Paper Claim Form: version 02/12

The National Uniform Claim Committee (NUCC), maintains the CMS 1500 claim form and periodically revises it according to industry needs. On June 10, 2013, the White House Office of Management and Budget (OMB) approved the revised CMS 1500 claim form (version 02/12). The NUCC changed the form to adequately accommodate and implement ICD-10-CM diagnosis codes, although the form does include other changes as well; Indicators for differentiating between ICD-9-CM and ICD-10-CM diagnosis codes, expansion of the number of diagnosis codes to 12, qualifiers to identify the Ordering, Referring and Supervising physician, etc..

Tentative Timeline for Implementing the Revised Form for Medicare Claims

Medicare anticipates implementing the revised CMS 1500 claim form (version 02/12) as follows:

• January 6, 2014: Medicare begins receiving and processing paper claims submitted on the revised CMS 1500 claim form (version 02/12).
• January 6 through March 31, 2014: Dual use period during which Medicare continues to receive and process paper claims submitted on the old CMS 1500 claim form (version 08/05).
• April 1, 2014: Medicare receives and processes paper claims submitted only on the revised CMS 1500 claim form (version 02/12).

These dates are tentative and subject to change. CMS will provide more information as it is available.