Who Must Use the CMS/HCFA 1500

 If you are one of the following providers, you must use the CMS/HCFA 1500

form:
Advance Practice Registered Nursing Services
Ambulances
Ambulatory Care Clinics
Ambulatory Surgical Centers
Audiologists
Chiropractic Services
Community Support Services
Consumer Directed Attendant Services
Day Habilitation Services for Persons with Mental Retardation
Day Health Services
Day Treatment Services
Developmental and Behavioral Clinics
Medical Supplies and Durable Medical Equipment
Early Intervention Services
Family Planning Clinics
Federally Qualified Health Centers
Genetic Testing and Clinical Genetic Services
Hearing Aids and Services
Home and Community Based Benefits for the Elderly and
for Adults with Disabilities
Home and Community Based Benefits for Members
with Mental Retardation
Home and Community Based Benefits for the Physically Disabled
Home Based Mental Health Services
Independent Laboratories
Licensed Clinical Social Workers, Licensed Clinical Professional
Counselors, and Licensed Marriage and Family Therapist Services
Medical Imaging Services
Occupational Therapy Services
Optometrists
Outpatient Mental Health Providers
Physical Therapy Services
Physician Services
Psychological Services
Podiatrist Services
Rehabilitation Services
Rural Health Clinic Services
School Based Rehabilitation Services
Speech and Hearing Services
Substance Abuse Treatment Services
Targeted Case Management Providers
Transportation/Wheelchair Van Services
VD Clinics
Vision Services

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