The CMS-1500 and UB-04 forms are used for medical billing but differ in purpose and use:
- CMS-1500: For outpatient and non-institutional services. Used by individual providers (e.g., physicians, therapists, labs) to bill for professional services like office visits, diagnostic tests, and outpatient procedures.
- UB-04: For inpatient and institutional services. Used by facilities (e.g., hospitals, nursing homes) to bill for services like hospital stays, surgeries, and long-term care.
The CMS-1500 focuses on professional services, while the UB-04 handles facility-based billing.
When to Use CMS-1500 vs. UB-04
- Use the CMS-1500 form if:
- You’re billing for professional services provided by individual practitioners.
- Services are rendered in an outpatient or office-based setting.
- Use the UB-04 form if:
- You’re billing for institutional services provided by a facility.
- Services are rendered in an inpatient or hospital-based setting.