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MED-PASS:  The Fine Art of Document Design

CMS 1500 (02/12) Claim form, Laser, 1 part, White paper, Red (OCR) ink - 500/pack


Availability: In stock

Price: $14.95
  • Buy 2-4 for $12.50 each and save 17%
  • Buy 5-39 for $8.25 each and save 45%
  • Buy 40 or more for $7.75 each and save 49%

This CMS1500 claim form matches the revised version 02/12 which became mandatory for submitting Medicare claims April 1, 2014.


MED-PASS CMS claim forms are produced on high quality paper and printed in OCR red "drop out" ink to ensure efficient processing of claims. These claim forms are in strict compliance with government printing specifications.


A QR code is included in the top corner of the form that can be scanned to quickly link to the NUCC website where instructions and other resources related to the new claim form are available.

  • The CMS1500 (02/12) version can be used for billing Medicare June 1, 2013 and is mandatory for billing Medicare October 1, 2013.
  • The CMS1500 (08/05) version will be available to order until October 1, 2013 – see ST11786N.
Size 8-1/2" x 11"
Unit Package of 500
Other Info Laser Printer Compatible

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