TMPPM 2010 > Volume 1, General Information > Section 6: Claims Filing > CMS-1500 Claim Filing Instructions


6.5 CMS-1500 Claim Filing Instructions

The following providers bill for services using the ANSI ASC X12 837P 4010A electronic specifications or the CMS-1500 claim form:



ASC (freestanding)

Case Management: blind and visually impaired children (BVIC), Early Childhood Intervention (ECI), and Children and Pregnant Women (CPW)

Certified nurse-midwife (CNM)

Certified registered nurse anesthetist (CRNA)

Certified respiratory care practitioner (CRCP)

Chemical dependency treatment facilities


Clinical nurse specialist (CNS)

Dentist (doctor of dentistry practicing as a limited physician)

DME or durable medical equipment-home health services (DMEH) supplier (CCP and home health services)

Family planning agency that does not also receive funds from Title V, X, or XX


Genetic service agency

Hearing aid

In-home total parenteral nutrition (TPN) supplier


Licensed dietitian (CCP only)

Licensed clinical social worker (LCSW)

Licensed professional counselor (LPC)

Maternity service clinic (MSC)

Mental health (MH) rehabilitative services

Nurse practitioner (NP)

Occupational therapist (CCP only)


Orthotic and prosthetic supplier (CCP only)

Physical therapist

Physician (group and individual)

Physician assistant (PA)

Tuberculosis clinic


Private duty nurse (PDN) (CCP only)



School Health and Related Services (SHARS)

Speech language pathologist (CCP only)

THSteps medical

Providers obtain copies of the CMS-1500 claim form from a vendor of their choice; TMHP does not supply them.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2009 American Medical Association. All rights reserved.