The CMS-1500 form is primarily used to submit which type of healthcare claims?

• A. Professional claims
• B. Facility/hospital inpatient claims
• C. Pharmacy claims
• D. Dental claims

Answer: (A)

The form is designed for professional claims, meaning non-institutional services billed by physicians and other individual clinicians in offices or outpatient settings. It collects data such as patient information, provider details, procedure codes (CPT/HCPCS), diagnosis codes (ICD-10-CM), and charges to support reimbursement for these outpatient, non-institutional services. It isn’t used for facility or hospital inpatient claims, which use a different form (UB-04) with data tailored to institutional settings. Pharmacy claims are processed through the NCPDP format, and dental claims typically use the ADA dental claim form. So the CMS-1500 is the standard for professional claims.