Medicare Uniform Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5

Health Insurance Claims Form, UB-04 CMS 1450

OMB: 0938-0997

IC ID: 243027

Documents and Forms

Document Name Document Type
Form CMS-1450 (UB04) Fr Medicare Uniform Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5 Form and Instruction
CMS-1450 (UB04) Front Uniform Institutional Providers Form CMS-1450 UB04-front.pdf Form and Instruction
CMS-1450 (UB04) Back Uniform Institutional Providers Form CMS-1450 UB04 - Back.pdf Form and Instruction