Which entity primarily uses the CMS-1500 form?

The CMS-1500 form is primarily utilized by outpatient services for billing purposes. This form is designed for healthcare providers to submit claims for services rendered to patients in an outpatient setting, such as physician offices, clinics, or other non-institutional environments. It captures essential information about the services provided, including the patient's diagnosis, treatment, and insurance details, allowing for the reimbursement process to begin.

In contrast, inpatient care providers typically use alternative forms, such as the UB-04 (CMS-1450), which is specifically tailored for institutional services rendered during a patient's stay in a hospital or other inpatient facility. Long-term care facilities and research agencies also have their respective forms and billing processes, distinct from those applicable to outpatient services. As a result, the CMS-1500 form's design and functionality align closely with the needs and operations of outpatient providers.