Bill Instructions: CMS-1500 (HCFA)

The CMS-1500 (HCFA) Form is used by healthcare providers and professionals to file original workers' compensation medical bills in Kentucky.

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CMS-1500 (HCFA)

Applicable Services

Filling out the Form


Reporting Requirements

Forms & Attachments

Timely Filing

45 from DOS

CMS-1500 (HCFA) Services

The following table provides a link to the Kentucky regulations which require a provider to complete the CMS-1500 (HCFA) Form for all non-pharmaceutical, non-hospital billing purposes.



Physician Services

803 KAR 25:096. Selection of physicians, treatment plans and statements for medical services. 

Laboratory / Pathology

Facility – Outpatient


CMS-1500 Form Instructions

The state of Kentucky requires providers to compliantly complete the CMS-1500 Form but provides no further specifications.

To make things easier for you, DaisyBill created this NUCC CMS-1500 Instructions Table showing the requirements of the National Uniform Claim Committee (NUCC), the entity which created and maintains the form. This information is provided for educational purposes only and is not intended to represent state-specific requirements.

For additional information, review the complete NUCC Manual:
1500 Health Insurance Claim Form Reference Instruction Manual for Form Version 02/12

CMS-1500 Required Billing Documentation

For a complete bill, Kentucky requires the provider to submit the following supporting documentation with the CMS-1500 Form, when applicable.

CMS-1500 Medical Bill

Required Documents


For a non-pharmaceutical bill, a completed Form HCFA 1500, or for a hospital, a completed Form UB-92, with an attached copy of legible treatment notes, hospital admission and discharge summary, or other supporting documentation for the billed medical treatment, procedure, or hospitalization;


For a pharmaceutical bill, a bill containing the identity of the prescribed medication, the number of units prescribed, the date of the prescription, and the name of the prescribing physician

For additional information related to reporting please refer to DaisyBill’s Kentucky Billing Guide.

Timely Filing

Medical bills must be filed within 45 days of the date of service for all services rendered in Kentucky.


Timely Filing

Kentucky Revised Statutes


Medical Bills

45 days

Kentucky Revised Statutes KRS Chapter 342


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