CMS-1490S

PATIENT'S REQUEST FOR MEDICAL PAYMENT (English/Spanish)

Agency
CMS
Revision
2021-06-01
Fillable fields
49
Fill CMS-1490S online
CMS-1490S

Form CMS-1490S: PATIENT'S REQUEST FOR MEDICAL PAYMENT (English/Spanish)

Effective April 1, 2019, only the revised 01-18 version will be accepted for the Form CMS-1490S. The provided link below includes the form and all the applicable instructions. Please read all instructions prior to submitting a claim to Medicare.(1) The Form CMS-1490S is fillable, can be completed online, printed then mailed. (2) Mail the completed form and itemized bills to the correct Medicare Administrative Contractor as indicated on pages 7 through 18 of the instructions.

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