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”.

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.