CMS-1500 Entry Field Locations

There are two different 1500 forms in current use and the data locations in The THERAPIST are slightly different for each form. Click on one of the links below to open an Adobe Acrobat document with the respective field locations. In most browsers, you can right-click the link and select "Save As" or "Save Link As" to download and save the document to your computer.

In order to fit everything on the page width, the document is printed in landscape (sideways) mode. The Adobe Acrobat Reader add-in to most web browsers doesn't let have a menu option to rotate the image but you can press Ctrl+Shitf+Plus to rotate clockwise and Ctrl+Shirt+Minus to rotate counterclockwise. If you view a document in the stand-alone Acrobat Reader program, you can choose View > Rotate View or use the same key combinations to rotate the images.

  Form Date Notes
Updated
  HCFA-1500 12-90 Old form, valid for some payers until 5/23/2007
4/4/2007
  CMS-1500 08-05 Old form valid until 4/1/2014
5/23/2007
  CMS-1500 02-12 New form valid after 2/1/2012
8/11/2015