Features of the Revised Form
The revised form, among other changes, notably adds the following functionality:

• Indicators for differentiating between ICD-9-CM and ICD-10-CM diagnosis codes.
• Expansion of the number of possible diagnosis codes to 12.
• Qualifiers to identify the following provider roles (on item 17):
• Ordering
• Referring
• Supervising

Instructions for Completing the Revised Form
The CMS Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 26  (636 KB) will be updated to instruct contractors and providers how to complete the revised form. CMS will post this information on the CMS Web site when it is available.

Tentative Timeline for Implementing the Revised Form for Medicare Claims
Medicare anticipates implementing the revised CMS-1500 claim form (version 02/12) as follows:

January 6, 2014: Medicare begins receiving and processing paper claims submitted on the revised CMS-1500 claim form (version 02/12).

January 6 through March 31, 2014: Dual use period during which Medicare continues to receive and process paper claims submitted on the old CMS-1500 claim form (version 08/05).

April 1, 2014: Medicare receives and processes paper claims submitted only on the revised CMS-1500 claim form (version 02/12).

These dates are tentative and subject to change. CMS will provide more information as it is available.

Members who print paper claims should contact their software vendors to insure that they will be able to print on the new claim forms.

A list of the changes that have been made to the claim form can be viewed on the National Universal Claim Committee website at http://www.nucc.org/images/stories/PDF/understanding_the_changes_to_the_0212_1500_claim_form.pdf.