New CMS-1500 02/12 Claim Form (25 forms)

Description

New CMS-1500 02/12 Claim Form (25 forms)
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