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MED-PASS:  The Fine Art of Document Design

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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 $13.25 each and save 12%
  • Buy 5-39 for $8.85 each and save 41%
  • Buy 40 or more for $8.25 each and save 45%

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.


Size 8-1/2" x 11"
Unit Package of 500
Other Info Laser Printer Compatible

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