Free CMS-1500 form filler
Fill in the boxes of the 1500 Health Insurance Claim Form, version 02/12, and download it as a PDF. Search ICD-10-CM codes as you type, add up to six services a page, and the totals add themselves up.
It's free and needs no account. The PDF is made in your browser: nothing you type about your patient is sent to CloudMedico.
Fill in the claim
What you type here stays in this browser. The PDF is made on your device, and the ICD-10 search runs on a copy of the code list downloaded to your browser.
Check before you send it
- Add the payer's name and the type of insurance (1).
- Add the insured's ID number (1a), as on the insurance card.
- Add the patient's name and date of birth (2, 3).
- Add at least one diagnosis (21).
- Add at least one service with a code and a charge (24).
- Add your NPI and federal tax ID (25, 33a).
- Answer “Accept assignment?” (27): the NUCC asks for it on every claim.
Data only: print it at actual size (100%), not “Fit to page”, and try it on plain paper held against a red form before you print onto one.
CloudMedico for US practices
CloudMedico is practice software for small practices: appointments with online requests and reminders, visit notes with ICD-10-CM diagnoses, invoices with your own codes and fees, and a patient portal.
If your practice is in the United States, it makes the superbill from the invoice, with your NPI and EIN, the visit's diagnoses and your codes already on it, and your patients can download it from the portal once the invoice is paid.
Try CloudMedico free for 30 daysWhat the CMS-1500 is
The CMS-1500, or 1500 Health Insurance Claim Form, is the paper claim form for professional services: what physicians, therapists, chiropractors and other practitioners bill. The National Uniform Claim Committee (NUCC) maintains it. Version 02/12 has been in use since April 1, 2014.
Payers that take paper claims read them by machine, so each piece of data has its place: names in capitals, dates as MM DD YY or MM DD YYYY, amounts without dollar signs or commas, diagnosis codes without their dot. This filler prints them that way.
How to fill in the main boxes
- Top of the form: the payer's name and address, and in box 1 the type of insurance.
- Boxes 1a to 13: the patient and the insured, as on the insurance card. When the patient holds the policy, the relationship (6) is Self.
- Box 21: up to twelve ICD-10-CM diagnoses, A to L, the primary one first.
- Box 24: each service with its date, place of service, CPT or HCPCS code and modifiers, the letters of its diagnoses (up to four, the main one first), the charge and the units.
- Boxes 25 to 33: your tax ID, whether you accept assignment, the totals, your signature, where the services were given and the billing provider with its NPI.
Place of service codes
The place of service code in 24B says where the service happened. These come from the CMS Place of Service code set:
- 11: Office.
- 02: Telehealth provided other than in patient's home.
- 10: Telehealth provided in patient's home.
- 12: Home.
Why this page lists no CPT codes
CPT codes and their descriptions are copyrighted by the American Medical Association, so this page doesn't list them. Type the codes you bill.
Questions
Is this CMS-1500 filler free?
Yes. There is no account and no limit: fill in and download as many claims as you need.
Do you see my patients' information?
No. The form is filled in and made into a PDF in your browser. Nothing you type about a patient, their insurance, diagnoses or services is sent to CloudMedico.
Can I mail a printout of the form to Medicare?
No. CMS takes only claim forms printed in Flint OCR Red ink, and says copies can't be used to submit claims. Download the data only and print it onto red forms. Many other payers work the same way, so check with the payer first.
What's the difference between the two downloads?
The CMS-1500 PDF is the whole form, red lines and labels included, with your data in its boxes. The data-only PDF has your data alone, in the same places, to print onto red forms you already have.
How many services fit on one form?
Six. With more lines the claim continues on more pages: each page carries “Page 1 of 2” at the top, the same diagnoses and the total of its own lines.
Which ICD-10 codes can I use?
The search uses the CDC's ICD-10-CM list for fiscal year 2027, the one in force since October 1. Payers want billable codes, the most specific that fits. You can also type any code yourself.
What's the difference between a CMS-1500 and a superbill?
Providers send the CMS-1500 to the payer as the claim itself. A superbill is a detailed receipt that patients send with their own claim. Use the free superbill generator for that.