What Acupuncturists Need to Know About the CMS-1500

The CMS-1500 is the standard paper claim form used by all non-institutional medical providers (private practices, etc.) to bill Medicare, and is also, accepted by health insurance payers.

The forms are designed by both the Centers for Medicare and Medicaid Services (CMS) and the National Uniform Claim Committee (NUCC). The NUCC is part of the American Medical Association (AMA).

The forms are printed in special red ink so that they can be easily scanned and the data read by a computer.

The CMS-1500 is separated into a series of boxes to collect all the necessary information needed to submit an accurate claim.

The fields include payer information, insurance information, patient demographic information, ICD-10 codes, and dates of service.

Payer Info

The first box in the CMS-1500 is for identifying the payer. (ie. Medicare, Medicaid, insurance, etc.)

Insured Info

A grouping of boxes make up information about the insured, like the insured policy number, plan name, policy group and contact information.

Patient Info

Next, you have patient contact information and his/her relationship to the insured.

Diagnosis Codes

In box 21, is where you'll put the ICD-10 codes.

Treatment Codes

Next, you enter the dates of service, CPT codes and charges. As well as, associating the diagnosis code from above to each service.

Provider Info

In box 33, you have the provider information, including the provider NPI and the taxonomy code. The taxonomy code for an acupuncturist is 171100000X.

And, that's a quick run down of the CMS-1500.

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