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    • CMS 1500 Form
    for Filing Medicare Claims

    Form CMS-1500 is the basic form required by CMS (Centers for Medicare & Medicaid Services) for filing physician and supplier Medicare claims. Micro Format CMS 1500 forms are printed to Government Printing Office (GPO) Standards in OCR Red Ink.
    Approved by the AMA's Council on Medical Services and HCFA/CMS
    especially for use with laser printers.

    CMS 1500 Claim Forms

    CMS1500-Click to Enlarge

    CMS 1500 Claim Forms - Mini Carton
    1,000 sheets per carton
    $50.00 per carton plus shipping by UPS

    CMS 1500 Claim Forms - Standard Carton
    2,500 sheets per carton
    $95.00 per carton plus shipping by UPS

    CMS 1500 Large Envelopes
    SELF SEAL Flap

    1,000 Envelopes (2 cartons of 500)
    $250.00 plus shipping by UPS

    HCFA | CMS 1500 #10.5 (4-1/2" x 9-1/2") Envelopes
    SELF SEAL Flap

    1500 self-seal env

    1,000 Envelopes (2 cartons of 500)
    $80.00 plus shipping by UPS

    UB-04 Health Care Forms

    UB-04 Claim Form - Click to Enlarge

    UB-04 Mini Carton
    1,000 sheets per carton
    $50.00 per carton plus shipping by UPS

    UB-04 Standard Carton
    2,500 sheets per carton
    $95.00 per carton plus shipping by UPS

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    All Rights Reserved 
    Micro Format, Inc. 
    830-3 Seton Court ~ Wheeling, IL 60090 
    847/520-4699 FAX 847/520-0197
    800-333-0549