On June 17, 2013 the Centers for Medicare & Medicaid Services (CMS) released the revised CMS-1500 Claim Form (version 02/12). The new CMS-1500 (02/12) will replace the current form (08/05). One of the reasons for this change is to support the use of the ICD-10 diagnosis code set. The revised form will give providers the ability to indicate whether they are using ICD-9 or ICD-10 diagnosis codes, which is important as the October 1, 2014, transition approaches.  The revised form also allows for additional diagnosis codes, expanding from 4 possible codes to 12.

ICD-9 codes must be used for services provided before October 1, 2014, while ICD-10 codes should be used for services provided on or after October 1, 2014.

Only providers who qualify for exemptions from electronic submission may submit the CMS-1500 claim form to Medicare. For those providers who use service vendors, CMS encourages them to check with their service vendors to determine when they will switch to the new form.

Timeline for Transition to the New Form

The National Uniform Claim Committee (NUCC) approved the following transition timeline at its in-person meeting in Chicago on August 1, 2013.

January 6, 2014

Private insurance carriers and Medicare begin receiving and processing paper claims submitted on the revised CMS-1500 claim form (02/12).

January 6 – March 31, 2014

Dual-use period during which private insurance carriers and Medicare continue to receive and process paper claims submitted on either version of the form.

April 1, 2014

The current claim form (08/05) is discontinued; all private insurance carriers and Medicare receive and processes paper claims submitted only on the revised CMS-1500 claim form (02/12).

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