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Billing Forms

Last update
October 16, 2025

Below are the required forms for submitting compliant medical, pharmacy, and dental bills under Texas workers’ compensation regulations.

Billing Forms

The table below lists the required forms for Texas-compliant workers’ comp billing.

Form

Services

CMS-1500 (HCFA)

Professional

Non-Institutional

UB-04

Institutional

DWC-066

Pharmacy

ADA

Dental

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