Health Insurance Claims Form, UB-04 CMS 1450

ICR 202401-0720-001CF

OMB: 0938-0997

Federal Form Document

Forms and Documents

Document Name	Status
Form CMS-1450 (UB04) Fr Medicare Uniform Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5 Form and Instruction	Modified

IC Document Collections

IC ID	Document Title	Status
243027	Medicare Uniform Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5 Form and Instruction	Modified