What's The Difference Between CMS-1500 and UB-04 or CMS-1450

by Debbie
(Logan WV)

This site sure has helped me out alot to answering my questions. I am just getting into medical billing and coding, this is a life saver. Just wanted to say "THANK YOU".


Response:
Thanks for visiting the site - glad it's helped you.

Although these forms look similar, they can't be used interchangeably. I understand the CMS-1450 is based on the CMS-1500. The UB-04 replaced the UB-92 back in 2007. Because of the complexities of hospital billing, the UB-04 has over twice as many field or blocks for all the different codes and services.

The CMS-1500 form is the health insurance claim form used for submitting physician and professional claims for providers.

When a physician has a private practice but performs services at an institutional facility such as a hospital or outpatient facility, the CMS-1500 form would be used to bill for their services.

The CMS-1450 (UB-04) form is the claim form for institutional facilities such as hospitals or outpatient facilities. This would include things like surgery, radiology, laboratory, or other facility services. Durable Medical Equipment (DME) would typically be submitted using the CMS-1500.

The CMS-1500 is used to submit charges covered under Medicare Part B. The UB-04 or CMS-1450 to submit charges under Medicare Part A.

The Centers for Medicare and Medicaid Services is the government entity which mandates use of these forms.

Please comment below if you have a different understanding or interpretation of CMS-1500 and CMS-1450 differences and application. I understand form requirements may vary some by payer and provider agreements.

Thanks!

Comments for What's The Difference Between CMS-1500 and UB-04 or CMS-1450

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Aug 22, 2017
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by: Gina

Assuming the physician is not employed by the facility, the physicians services would be billed on the CMS-1500 form for seeing the patient in the facility setting.

Aug 21, 2017
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What form for physician billing in a facility setting
by: Anonymous

What if a physician is billing for seeing a patient in a facility setting (like if an OB is rendering services during an inpatient stay)... is that billed on a UB or CMS Form?

Aug 01, 2017
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Telehealth/telemonitoring
by: Anonymous

What claim form would a Home Health Agency use to file claims on telemonitoring?

Jun 16, 2017
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Confusion
by: Anonymous

Can we use UB-04 and CMS form for paper claims only? Or we can use this electronically as well?

Kindly reply on this.

Response:
The UB-04 (CMS-1450) or the CMS-1500 can be submitted electronically. Usually you can print a claim in an electronic file format (sometimes called a print image file) which can be uploaded to a clearinghouse.

Hope this answers your question.

Mar 24, 2017
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Still confused
by: Anonymous

Thanks so much for all of your input. Where I am confused is when a hospital based outpatient clinic performs a service (say podiatry), then do I bill a UB-04 for this (inclusive of the doctor's services) or do I bill a UB-04 for the technical costs of the clinic PLUS a 1500 for the podiatrist, or just a 1500 for the podiatrist services? How do I know (depending on the service provided)? Thank you all.

Mar 21, 2017
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Um... some of you are very confused
by: Anonymous

It does not matter if services are inpatient or out patient. The CMS 1450 (UB-04) form is used by facility based billing for use of the clinic or hospital room, supplies and medication.

A CMS 1500 is used for professional services like the doctors bill or anesthesiologist etc.

Hope this helps.

Aug 11, 2016
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Difference between 1500 & UB-04
by: Anonymous

The comment made by the billing consultant is incorrect. Just glad he/she is not my consultant. The 1500 is for physicians/professional claims and the UB-04 is for IP / OP. I would look for a new line of work if I were that consultant.

Jul 26, 2016
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medical term
by: Anonymous

Thanks for all your help. This web site has helped me a lot - thanks a whole bunch.

Jul 11, 2016
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Different use of claims forms
by: Anonymous

1500 is a professional form used by physicians and specialist not facilities (hospitals). UB04 is for Facility hospitals whether it is IP or OP. Facilities can not file Hospital charges on 1500 only professional fees can be filed.

May 24, 2016
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UB04 FACILITY CLAIM
by: Anonymous

UB04= FACILITY BILING FOR IP/OP.
CMS/1500 CLAIM IS FOR PHYSICIAN BILLING.

Feb 25, 2016
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Billing Consultant
by: Anonymous

This is wrong; it is the opposite. Please check your resources. 1500 is for inpatient/professionals; UB04 is for outpatient/facilities i.e. outpatient therapy or home health, etc. There is nothing more frustrating as a biller than insurance companies and individuals getting the two confused.

Jan 12, 2016
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The difference between CMS-1500 and UB-04
by: Patricia

Thank you for the information.

Mar 11, 2015
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going further
by: Anonymous

UB-04 claim for is for inpatient stay greater than 24 hours in a medical facility. And CMS-1500 is for outpatient visits that are same day discharge or less than 24 hours. CMS-1450 is sometimes another term for UB-04 claim form.

Feb 12, 2015
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This information is wrong.
by: Nikki

CMS prefers that you submit all claims to Medicare electronically.

(http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE0729.pdf)

Jan 14, 2015
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CSM-1500 and UB-04
by: Anonymous

Thank you for your information, it was great help.

May 24, 2014
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Thanks
by: Anonymous

Thanks for all your information an all but it would have helped more if you could have gave some more on the differences between the two (CMS-1500, and UB-1450) but thanks anyway I use this site a lot and usually it helps a lot I try to use it in all of my medical billing and coding questions so thank you very much.

Feb 27, 2014
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Claim form UB-04
by: Jacob Marcus

Claim form UB-04 is one of the very important claim forms required to be filled up by medical service providers for reimbursement of medical expenses.

Jun 12, 2012
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for the info
by: Anonymous

Thank U

Mar 02, 2012
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Claim form Difference
by: Robin

Thank you! Your information was great.

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