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CMS 1500 (HCFA 1500) AND UB-04 (UB92) FORMS

According to CMS, a CMS 1500 (HCFA 1500) form is used by non-institutional providers to bill Medicare Part B covered services and some Medicaid services. UB-04 (UB92) forms are generally used for Medicare Part A services. Some private insurance carriers may also accept claims filed on CMS 1500 (HCFA 1500) forms.

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•	CMS 1500 ONE PART CONTINUOUS FORMS FOR DOT MATRIX OR PINFEED PRINTERS

•	UB-O4 ONE PART CONTINUOUS FORMS FOR DOT MATRIX OR PINFEED PRINTERS

•	CM21 CM23 CMS 1500 TWO PART CONTINUOUS FORMS FOR DOT MATRIX OR PINFEED PRINTERS

•	UB-04 TWO PART CONTINUOUS FORMS FOR DOT MATRIX OR PINFEED PRINTERS

•	CMS 1500 LASER FORMS

•	UB-O4 LASER FORMS

•	2 PART SNAP/OUT SETS (NCR)

•	MEDICAL CLAIM FORM ENVELOPES

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CMS 1500 (HCFA 1500) AND UB-04 (UB92) FORMS