CMS-1450
When you qualify to submit paper claims, you must use the CMS-1450 to bill a MAC. The form is also known as the Uniform Billing (UB)-04, which is the current version of this uniform institutional hardcopy claim form.
The terms CMS-1450 and UB-04 are interchangeable throughout the provider community. The National Uniform Billing Committee (NUBC) handles the design and the award of the contract for printing the form. Visit the NUBC website for more information.
CMS doesn’t supply the CMS-1450 form for claim submission. You can download a copy from the Paperwork Reduction Act (PRA) Listing webpage, but you can’t use this copy to submit claims. It doesn’t replicate colors that enable automated form reading. Blank copies may be available from local office supply stores.
When filing a CMS-1450, keep the copy labeled Institution Copy and submit the remaining copies to your MAC, managed care plan, or other insurer.
The CMS-1450 has 22 lines for charges, but you can submit up to 9 pages to list charges. The electronic version, 837I, allows up to 450 charge lines.
You can find Medicare CMS-1450 UB-04 completion and coding instructions in the Medicare Claims Processing Manual, Chapter 25.