Which professionals use the CMS 1500 form?

• A. Hospitals
• B. Physicians or other professional providers
• C. Pharmacies
• D. Insurance companies

Answer: (B)

The CMS 1500 form is the standard claim form used to bill for professional services provided by individual clinicians. It’s the form physicians and other professional providers use to request payment from Medicare, Medicaid, and most private payers for office visits, consultations, and other non-facility services. Hospitals and other facility-based providers typically use the UB-04 for institutional claims, which cover facility charges. Pharmacies and other providers use different formats specific to their needs, and insurance companies are the payers rather than the claim-submitters in this context. So, the professionals who use the CMS 1500 form are physicians and other professional providers.