Ccms1500.app
CMS-1500 (02/12) · Free · No signup

Fill the CMS-1500 form online — free, validated, PDF export

The interactive CMS-1500 claim form for medical billers. Instant NPI, ICD-10, and POS validation. Drafts saved in your browser. Export an official PDF in one click.

Start filling form →

No account. No email. Your data never leaves your browser.

Features

Everything a biller needs, nothing they don't.

✓

Instant validation

NPI Luhn checksum, ICD-10-CM format, POS 01–99, modifier compatibility — checked as you type.

✓

Official PDF export

One-click export to a PDF that mirrors the CMS-1500 (02/12) paper form layout.

✓

Save drafts

Autosaved to your browser. Close the tab, come back tomorrow, pick up exactly where you left off.

✓

Batch entry

Tab through up to 5 claims in one session. Export each as its own PDF.

No signup. Your data never leaves your browser.

Local-only storage
Drafts live in your browser's localStorage. We have no server-side database for claim contents.
No accounts
No email, no password, no tracking pixels on the form. Open the page and start typing.
PDF generated client-side
The PDF is built in your browser. Nothing is uploaded.

How it works

Three steps. No surprises.

  1. 1

    Enter data

    Type into each of fields 1–33. Hover any field number for the NUCC definition.

  2. 2

    Fix errors

    Inline validators flag bad NPIs, ICD-10 codes, place-of-service, modifier conflicts.

  3. 3

    Export PDF

    Download a CMS-1500-formatted PDF ready to submit or print.

Frequently asked

Is it really free?
Yes. The CMS-1500 form, validation, drafts, and PDF export are free. No signup required for your first form.
Will the PDF be accepted by payers?
Our PDF mirrors the official CMS-1500 (02/12) layout used by clearinghouses and payers. Some payers require the red-ink scannable original — confirm with each payer before mailing.
Can I save and resume?
Yes. Every keystroke autosaves to your browser's local storage. Come back later in the same browser to continue exactly where you left off.
What CMS-1500 version?
The current 02/12 revision approved by the National Uniform Claim Committee (NUCC), with all 33 fields (1–33) and up to 6 service lines.
What if I have many claims?
Batch entry lets you tab between up to 5 claims in one session and export each as a separate PDF.
Where does my data go?
Nowhere. The form runs entirely in your browser. We do not have a server-side database, account system, or analytics on form contents.
Start filling form →