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Acupuncture Today – December, 2006, Vol. 07, Issue 12

The New CMS1500 Form

By Samuel A. Collins

Q: I heard there is going to be a new CMS1500 (formerly HCFA1500). Will this mean I have to get a new billing program and when will I have to start using the new form?

A: What you heard is correct; there are some changes occurring to the CMS1500.

The revised form could be used as of Oct. 1, 2006, but there is dual acceptability with the current version. This dual acceptability will remain until Jan. 31, 2007. Beginning Feb. 1, 2007, usage of the revised version will be mandatory. These dates currently are the federal guides, but there have been reports stating that the mandated-use date may be extended to April 1, 2007.

The revision does not markedly change the appearance of the form, but it does make changes. One of the driving factors of the change is to rename certain blocks, but also to accommodate the use of the National Provider Identifier (NPI) numbers. The upper half of the form essentially is unchanged except to extend the region for the year of birth to accommodate a four-digit year.

The bottom section of the form has an added line in 17A to allow the placement of the NPI. Also, in block 24D, the region to place modifiers has been expanded to allow up to four modifiers per code. Block 24E also has been renamed as "Diagnosis Pointer" to clarify that the section is used to "point" or reference the particular diagnosis in block 21 that is being treated with the specific service billed on that line. There is a change for block 24J, which now is titled "Rendering Provider I.D.," and has space for the rendering provider's NPI.

Block 32 is now titled "Service Facility Location Information" and block 33 is "Billing Provider Information and Phone Number." Therefore, on the new updated form, you will be required to fill out both block 32 and block 33.

These are the basic changes, and considering that overall, it's not a marked change, when you see the new form it will look virtually the same at a glance. But, of course, the software used to fill out the forms will have to change. It appears so far that most companies who produce billing software are supplying the update at no charge; this makes sense since it's such a small change. Be sure to check with your software manufacturer as to how it will be accommodating the update.

I recommend that if you have a lot of the old forms, use them; as there is no reason to waste them. But around the beginning of 2007, offices should begin using the new form. Note that the cost of the CMS1500 forms is not exorbitantly expensive, so even if some of the old ones will have to be disposed, it should not be a major cost.

If you need a billing program for the new form, there are many software versions solely designed to fill out the CMS1500 form. They are simple on-screen versions that the user completes and then prints to a blank form. The cost of the programs varies from $30-$50 and can be found online as well as in computer/software stores.

Click here for more information about Samuel A. Collins.

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