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P M A S PLEASE PRINT OR TYPE E L APPROVED OMB-0938-1197 FORM 1500 (02-12)
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The CMS-1500 form is a standard claim form used by health care providers to bill Medicare.
Health care providers who provide services covered by Medicare are required to file a CMS-1500 form.
To fill out a CMS-1500 form, you must provide information such as patient demographics, diagnosis codes, procedure codes, and provider information.
The purpose of the CMS-1500 form is to submit claims for reimbursement for services provided to Medicare patients.
Information such as patient name, address, date of birth, insurance information, diagnosis codes, procedure codes, and provider information must be reported on the CMS-1500 form.
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