Free Fillable CMS 1500 Template and Information

When it comes to healthcare, the forms are abundant and confusing – and can be expensive. Mitigate these expenses by downloading our free fillable CMS 1500 template below.

But what is a CMS 1500 claim form? If you’re not sure whether or not the CMS 1500 claim form is the one you need, read on for more information.

What is a CMS 1500 form used for?

According to Very Well Health, “The CMS 1500 is the red ink on white paper standard claim form used by physicians and suppliers for claim billing. Although it was developed by The Centers for Medicare and Medicaid (CMS), it has become the standard form used by all insurance carriers.” In short, it is a health insurance claim form, CMS 1500.

To look at it a little more closely (and put it in layman’s terms), Therabill tells us the CMS HCFA 1500 form is the “standard paper claim form used to bill an insurance for rendered services and supplies. It provides information about the client, their corresponding insurance policy, and their diagnosis and treatment. Additionally, most insurances allow you to send an electronic version, called an 837 file.”

Medicare only accepts the revised version, 2/12, of the CMS 1500 form. The older version, 08/05, is outdated. Make sure you have the correct version before submission.

How do I fill out CMS 1500 form fields?

The CMS form, like most government-mandated forms, has many different fields all requiring unique information. Don’t get overwhelmed; instead, consult these resources, including a CMS 1500 form example.

The first is a helpful field-by-field guide by FreePT, which explains each box on the CMS 1500 form. They have each field individually numbered and a corresponding key below for ease of understanding.

FreePT’s Field-by-Field Explanation Of The CMS-1500 Form

Another resource for filling out your CMS 1500 form fields is this guide provided by San Francisco Health Plan, which breaks the form down in layman’s terms and makes each box easy to understand.

SFHP’s Instructions for Completing the CMS 1500 Claim Form

For a sample CMS 1500 form (filled out), check out this example. Please note: This is for visual sample purposes only and should not be used as a guide.

How do I fold a CMS form?

Folding your CMS form can be frustrating, but it doesn’t have to be. Here are the steps for an easy fold.

1. To correctly fold your CMS form, find the designated fold lines at the sides of your form.

2. At the ‘first fold’ guideline, fold your form with the sensitive information inside the fold.

3. At the ‘second fold’ guideline, fold your form with the relevant information – the pre-printed address – visible on the outside.

Your form should fit perfectly in its envelope with the address visible through the window. Tip: If you can see any extra information in the window, fold your form the same way, but roughly 5 mm above the designated fold lines.

Still unsure? Check out our video!

Where Do I Find a CMS 1500 Form, Fillable?

Right here:

Click here to download our free fillable CMS 1500 Form!

Quality free fillable CMS 1500 claim forms are hard to come by, so we made our own. Our government-approved, free fillable CMS 1500 template makes your lives a little bit easier. This CMS 1500 form, fillable and simple to use, is available to anyone who needs it.

Our CMS 1500 form PDF downloadable is simple to use and comes as a blank CMS 1500 claim form PDF. It’s easy to download and you can fill in the fields using the suggested resources above.

Our free fillable CMS 1500 form PDF is a resource you can keep on hand for repeated use.

To print CMS 1500 claim form, you will need a copy of Adobe Acrobat Reader, which you can download for free right here. Download the form below and open the PDF using the Acrobat Reader software, then simply enter your information into the form fields and print onto your pre-printed CMS-1500 claim forms using an inkjet or laser printer.

Template usage notes: 

The fillable CMS form we have created has been designed to only print the information you have entered into the form fields. You must load your printer with a pre-printed CMS-1500 claim form, as these forms are prepared with special red "drop out" ink that can be scanned using an OCR (Optical Character Recognition) scanner. This special scanning equipment will “drop out” the specific color of red ink that is on the paper, so that the information printed in black appears when scanned.

Alignment issues: If you have alignment issues when printing, please make sure you are printing at "100%" and not "fit to page," as this is the best way to ensure the fields align properly. If you have continued alignment issues, please note that the form fields can be moved around or edited into the best location for your specific alignment needs using Adobe Acrobat Pro software by clicking Toos > Prepare Form. Note that this can only be done with Acrobat Pro; the free version of Acrobat Reader will not allow for form editing.