Certification page
Provider name and 6-digit number, the calendar quarter ended, the officer's or administrator's signature, name, title and date, a check one choice, and a contact person with phone number.
CMS-838
Medicare Credit Balance Reporting Requirements
- Agency
- CMS
- Revision
- 10/03
- Fillable fields
- 214
- Pages
- 6
- Official source
- CMS form page
- Checked
- October 20, 2026
Form CMS-838: Medicare Credit Balance Report
Form CMS-838 is the Medicare Credit Balance Report from the Centers for Medicare & Medicaid Services. The CMS page lists it as Medicare Credit Balance Reporting Requirements. Its instructions say all providers participating in the Medicare program are to complete it to help ensure that monies owed to Medicare are repaid in a timely manner.
The instructions define a credit balance as an improper or excess payment made to a provider as the result of patient billing or claims processing errors. The form has a certification page signed by an officer or administrator of the provider, a detail page with 15 columns for each credit balance, and four pages of provider instructions. The instructions say to submit it to the fiscal intermediary (FI) within 30 days after the close of each calendar quarter.
The form shows OMB No. 0938-0600. You can fill it out free in your browser on this page and download the result without an account.
What's on Form CMS-838
Detail page heading
Provider name and number, quarter ending, Medicare Part (A or B), page number and total pages, and a contact person with phone number.
Columns 1 to 8: Claim details
Beneficiary name (last name, first initial), Medicare Beneficiary Identifier (MBI), ICN, 3-digit type of bill, admission and discharge (or From and Through) dates, paid date, and an O or C for an open or closed cost report.
Columns 9 to 12: Amounts
The credit balance amount, the amount repaid with the report, the method of payment (C, A, Z or X) and the amount still outstanding, which is column 9 minus column 10.
Columns 13 to 15: Reason and primary payer
Reason code 1 (duplicate Medicare payments), 2 (primary payment by another insurer) or 3 (other reasons, with an explanation), the two-digit value code when Medicare was not primary, and the primary payer's name and billing address.
Provider instructions
Four pages on what a credit balance is, when and how to submit, each column, payment of amounts owed, supporting records, low utilization providers and Medicare Secondary Payer (MSP) rules.
The detail page has space for 17 claims. The instructions say more lines can be added or the page reproduced as needed.
How to complete Form CMS-838
- 1
Gather the quarter's credit balances
The instructions say to include all Medicare credit balances in the accounting records, including transfer, holding or other general accounts, as of the last day of the quarter, regardless of when they occurred.
- 2
Fill in the detail page heading
Enter the facility name, provider number, quarter end date, page count and contact. Part A and Part B credit balances go on separate detail pages.
- 3
Complete one line per credit balance
Fill in columns 1 to 15 for each claim. For a duplicate Medicare primary payment, the instructions say to report the most recently paid claim.
- 4
Prepare the repayment
The instructions say amounts owed are paid when the report is submitted, by check or adjustment bill, and that the detail page itself is not accepted as an adjustment bill.
- 5
Sign the certification page
Check one box, add the contact person, and have an officer or the Administrator sign and date it. With no credit balances, the instructions say only the signed certification page is submitted.
- 6
Send it to the FI
Submit the report to the fiscal intermediary within 30 days after the close of each calendar quarter. Detail pages can also go on a diskette from the contractor or by an acceptable secure electronic transmission.
Why fill Form CMS-838 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
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- The official blank straight from the CMS, not a copy someone retyped
- Works on a phone, tablet or computer
Due dates, payment and records
Due date
The instructions say to submit the report to the FI within 30 days after the close of each calendar quarter. A credit balance reported once is not reported on a later report.
Paying amounts owed
The instructions say amounts owed are paid at the time the report is submitted. If immediate repayment would cause financial hardship, they say the provider may contact the FI about an extended repayment schedule.
MSP credit balances
The instructions cite 42 CFR 489.20(h): Medicare is repaid within 60 days of receiving payment from a primary payer. An MSP credit balance still unpaid at quarter end is reported, and if the report is due before the 60 days run out, payment can follow within those 60 days.
Supporting records
The instructions describe documentation showing each patient record with a credit balance was reviewed, and say the FI reviews it during audits or reviews for cost report settlement.
Consequences the form states
The certification page says failure to submit this report may result in a suspension of payments under the Medicare program and may affect eligibility to participate.
Burden and OMB number
The form shows OMB No. 0938-0600 and estimates an average of 6 hours per response. It does not print an expiration date; the CMS page lists 2021-12-31.
Related forms
Who uses Form CMS-838?
The form is for providers participating in Medicare, not for beneficiaries.
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Questions about Form CMS-838
What is a Medicare credit balance?
The instructions define it as an improper or excess payment made to a provider as the result of patient billing or claims processing errors. Proper payments in excess of a provider's charges, such as DRG payments, are not included.
When is Form CMS-838 due?
The instructions say to submit it to the fiscal intermediary within 30 days after the close of each calendar quarter.
What if there are no credit balances this quarter?
The instructions say the form is still signed and submitted, and only a signed certification page is needed when there are no Medicare credit balances as of the last day of the quarter.
Who does not have to submit Form CMS-838?
The instructions exempt low utilization providers: a facility that files a low utilization Medicare cost report under PRM-I, section 2414.4.B, or files less than 25 Medicare claims per year.
Who signs the certification page?
An officer, meaning the Chief Financial Officer or Chief Executive Officer, or the Administrator of the facility, according to the instructions.
What do the reason codes in column 13 mean?
1 is duplicate Medicare payments, 2 is a primary payment by another insurer and 3 is other reasons. The instructions ask for an explanation on the detail page for each 3.
Can the same credit balance appear on two reports?
No. The instructions say that once a credit balance is reported on Form CMS-838, it is not reported on a later report.