Health Insurance Common Claims Form and Supporting Regulations at 42 CFR Part 424, Subpart C (CMS-1500 and CMS-1490S)
Extension without change of a currently approved collection
No
Regular
07/22/2024
Requested
Previously Approved
36 Months From Approved
12/31/2024
998,032,912
975,664,249
17,329,912
17,163,310
0
0
Medicare Administrative Contractors use the data collected on the CMS-1500 and the CMS-1490S to determine the proper amount of reimbursement for Part B medical and other health services (as listed in section 1861(s) of the Social Security Act) provided by physicians and suppliers to beneficiaries. The CMS-1500 is submitted by physicians/suppliers for all Part B Medicare. Serving as a common claim form, the CMS-1500 can be used by other third-party payers (commercial and nonprofit health insurers) and other Federal programs (e.g., TRICARE, RRB, and Medicaid).
US Code:
42 USC 1395k
Name of Law: SCOPE OF BENEFITS
US Code:
42 USC 1395x
Name of Law: DEFINITIONS OF SERVICES, INSTITUTIONS, ETC
US Code:
42 USC 1395u
Name of Law: PROVISIONS RELATING TO THE ADMINISTRATION OF PART B
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Form CMS-1490S CMS-1500 (02-12)/CMS-1490S
CMS-1500 and CMS-1490S-Supporting-Statement-Part-A_2024.docx
CMS-1500 (02-12)/CMS-1490S