The CMS-1500 is the uniform claim form for professional services, capturing patient and insured information, diagnosis codes, procedure codes with modifiers, dates and places of service, and charges.
It is the professional counterpart to the institutional UB-04.
Alternative Names:
CMS-1500, HCFA-1500, Professional Claim Form
Why it Matters?
Place of service codes on this form identify where treatment occurred, which sometimes contradicts the clinical narrative. The diagnosis pointer linking each procedure to a specific diagnosis is also useful, since it shows what condition the provider was treating with each service. Charges for conditions unrelated to the incident become visible through those pointers.
Frequently Confused with
Related terms
Frequently asked questions
What is the diagnosis pointer?
Why does place of service matter?
