CMS claim form field reference lookup
Search high-level CMS-1500 professional claim field groups and their operational sources before consulting the official form and instructions.
Updated
This quick reference groups common CMS-1500 information areas by operational purpose and likely source. It is not a substitute for the official form, CMS instructions, 837P implementation guidance, or payer requirements.
10 field groups shown
| Field group | CMS-1500 area | Operational purpose | Typical controlled source |
|---|---|---|---|
Insurance and insured | Items 1–11 | Identify coverage, insured or subscriber, relationship, and related plan information. | Eligibility response, patient registration, and verified insurance record. |
Patient and authorization | Items 2–13 | Identify the patient and applicable signature or release indicators. | Approved registration, consent, and assignment records. |
Clinical dates and referring role | Items 14–18 | Report applicable illness, injury, similar dates, and referring or other provider information. | Encounter, referral, order, and clinical documentation. |
Additional claim information | Items 19–23 | Carry situational claim references such as additional narrative, diagnosis data, resubmission, or authorization information. | Documentation, coding, payer authorization, and prior claim records. |
Service lines | Item 24 | Describe each billed service through dates, setting, procedure, modifiers, diagnosis linkage, charges, units, and provider details. | Encounter, coded charge, provider master, and service-location records. |
Federal tax and account references | Items 25–26 | Identify applicable tax and internal patient-account references. | Controlled billing entity and secured patient-account master data. |
Assignment and claim totals | Items 27–30 | Report assignment indicator, total charges, amount paid, and reserved information as applicable. | Consent or assignment record and claim financial calculation. |
Rendering certification | Item 31 | Represent provider certification or signature information under applicable instructions. | Approved provider, signature, and claim-attestation workflow. |
Service facility | Item 32 | Identify the service facility location when applicable. | Documented encounter location and governed facility master. |
Billing provider | Item 33 | Identify the billing provider and billing location requesting payment. | Effective-dated billing-provider, NPI, taxonomy, enrollment, and address master. |
Check the controlling source
Field requirements are situational and can change. Use the official CMS material and current payer instructions as controlling sources; never insert unsupported values merely to complete a field.
Source and currency
CMS-1500 professional claim field-group quick reference · Updated June 2024 · Reviewed July 18, 2026
CMS Medicare Billing: CMS-1500 and 837P (opens in a new tab)