Is this CMS-1500 form free?
Yes. Fill and download claim forms without an account 3 times a day, or 5 times a day with a free account. Pro removes the daily limit.
Business Tools
CMS-1500 Claim Form
Fill out and print the CMS-1500 (HCFA) insurance claim form.
Filled in your browser: patient details are never uploadedFree: 3 uses a day, 5 with a free account. Unlimited on Pro
1Provider and practice
Remembered in this browser. Sign in to keep it in your account instead.
Logo (optional)
Signature
2Insurance company
The insurance company the claim is sent to, as printed at the top right of the form.
3Patient and insured
Never saved or uploaded. Use the name exactly as on the insurance card.
Another health plan? (11d)
Related to employment? (10a)
Auto accident? (10b)
Other accident? (10c)
4Diagnosis codes
Box 21. The first code is the primary diagnosis. ICD indicator 0 (ICD-10) is filled in for you.
5Services
Box 24. Six lines fit on one form; more lines create more forms automatically.
Line 1
Dx pointer
Add a diagnosis above
Charge $0.00
6Claim details
Leave anything you do not need blank.
Referring provider, dates, resubmission and service facility
Check before you send (9)
- Add the insurance company name and claims address (top right of the form).
- Add the insured ID number (box 1a), exactly as on the insurance card.
- Add the patient name, date of birth and sex (boxes 2 and 3).
- Add the patient address (box 5).
- Add at least one diagnosis code (box 21).
- Add at least one service line (box 24).
- Add your Tax ID (box 25) in the practice section.
- Add the billing NPI (box 33a) in the practice section.
- Add the practice address (boxes 32 and 33). Use a physical address, not a PO box.
Printing on red CMS-1500 forms
Payers that scan paper claims, including Medicare, need the official red-ink form. Use Data only and print at 100% (actual size, not "fit to page"). If the text lands a little off, move it here and print again. 72 points = 1 inch.
Service lines0
Claim forms1
Total charges$0.00
How it works
1
Add your practice once
Fill in from the NPI Registry and save to your account. Boxes 25, 31, 32 and 33 fill in every time.
2
Enter the claim
Add the insurance, patient and insured, diagnosis codes and service lines. Or load a superbill you saved from the Superbill Generator.
3
Download or print
Download a filled CMS-1500, or print data only onto official red forms, with an adjustable offset.
What is the CMS-1500 form?
The CMS-1500 (also called the HCFA 1500) is the standard paper claim form doctors, therapists and other non-institutional providers use to bill Medicare, Medicaid and private insurers. The current version is 02/12, maintained by the National Uniform Claim Committee (NUCC). Hospitals and facilities use the UB-04 instead.
Most claims are sent electronically today, but many small practices still need the paper form for certain payers, secondary claims, auto and workers compensation claims, or to give a patient a claim they can submit themselves.
The boxes that cause most rejections
| Box | What to enter |
|---|---|
| 1a | The insured ID number exactly as on the insurance card |
| 2, 3, 5 | Patient name (last, first, middle initial), date of birth, sex and address |
| 21 | ICD-10-CM codes A to L, with ICD indicator 0 |
| 24A to 24G | Dates, place of service, CPT or HCPCS code, modifiers, diagnosis pointer, charges and units |
| 24J | Rendering provider NPI, when billing under a group NPI |
| 25 | Federal Tax ID (EIN or SSN) |
| 31 | Provider signature, or "Signature on file", and the date |
| 32, 33 | Service facility and billing provider name, address (no PO box in 32) and NPI |
Printing on red CMS-1500 forms
Payers that scan paper claims, including Medicare, need the original red-ink form printed to NUCC specifications. Photocopies and black and white printouts are often returned. Buy red forms from an office supply store, choose "Data only, for red forms", and print at 100% size. If the text is a little off, use the Move right and Move up settings and print again on plain paper to check.
CMS-1500 Claim Form features
- Every box on the CMS-1500 (02/12), from the payer address to box 33, with plain-language labels and the box numbers.
- Six service lines per form. Add more lines and extra claim forms are created and totaled for you.
- Diagnosis pointers A to L, up to 4 modifiers, units, EMG, EPSDT, rendering NPI and the shaded supplemental line for NDC codes.
- Search all 2027 ICD-10-CM codes. The ICD indicator (0) is added for you.
- Data-only printing for red OCR forms, with left and up adjustments so the text lands in the boxes.
- Checks for missing NPI, Tax ID, insured ID, diagnosis pointers and other common rejection reasons.
- Load a superbill file to turn a superbill into a claim in seconds. Saved practices and services are shared with all Craftora medical tools.
- Patient and insurance details never leave your browser.
CMS-1500 Claim Form FAQ
Is my patient information uploaded?
No. The claim is filled in your browser. Only your practice details are saved, and only if you choose to save them to your account.
Can I print the data on a red form?
Yes. Choose Data only, for red forms, print at actual size, and adjust the position if needed. The adjustment is remembered on your computer.
What if I have more than 6 services?
Add them all. The tool creates as many forms as needed, 6 lines each, and totals each form on its own.
Can I turn a superbill into a CMS-1500?
Yes. In the Superbill Generator, choose Save to file. Then choose Load a superbill file here, and the patient, diagnosis codes and services fill in.
Does Medicare accept paper claims?
Medicare requires electronic claims for most providers. Paper claims are allowed only in limited cases, such as small providers that qualify for an exception. Other payers set their own rules.
Related Business Tools
Invoice GeneratorCreate and download professional PDF invoices for free.Superbill GeneratorCreate insurance-ready superbills with NPI lookup and ICD-10 codes.Good Faith EstimateCreate No Surprises Act cost estimates for self-pay patients.Letter of Medical NecessityWrite insurance, appeal and HSA/FSA medical necessity letters.
Recent from the blog
JPG vs PNG vs WebP: Which Image Format Should You Use? (2026 Guide)
JPG, PNG, and WebP all store images, but picking the wrong one gives you blurry photos, huge files, or lost transparency. Here is exactly when to use each, in plain English.
Read guide →How to Compress a PDF Without Losing Quality (2026 Guide)
A large PDF is a pain to email or upload, but most compressors either barely shrink it or turn your crisp text into a blurry mess. Here is how to reduce PDF file size while keeping it looking clean.
Read guide →How to Merge PDF Files for Free (2026 Guide)
Combining several PDFs into one file used to mean paid software or uploading private documents to a stranger server. Here is the faster, safer way to merge PDF files for free.
Read guide →