- Claim form (version 02/12) replaces the current form (version 08/05)
- Printed on OCR "dropout" red soy-based ink on 20# paper per government regulations
- Available in laser and continuous format
- The most significant changes were the addition of eight diagnosis codes in field 21
- NEW The addition of the QR code at the top left of the form
-
New CMS-1500 02/12 Claim Form (100 forms)
109.9510.75 -
NEW CMS 1500 Claim Forms - HCFA (Version 02/12) (250 Sheets)
11.000 -
NEW CMS 1500 Claim Forms - 25 Sheets (02/12 Version) for Laser or Inkjet Printers
10.996.14 -
NEW CMS 1500 Claim Forms - 500 Sheets (02/12 Version) for Laser or Inkjet Printers
11.650
