CMS 1500 claim form billing instruction Part 5

BLOCK 14 DATE OF CURRENT ILLNESS

CMS 1500 claim form billing instruction Part 4

CMS 1500 claim form billing instruction Part 2

CMS 1500 claim form billing instruction Part 3

CMS 1500 claim form billing instruction Part 1

the six - digit date (MMDDYY) of current illness, injury, or pregnancy. For chiropractic services, enter the six - digit date (MMDDYY) of the initiation of the course of treatment and enter the six - digit date (MMDDYY) x-ray date in block 19
.Note: Effective for dates of service January 1, 2000 and after, the x-ray date is no longer required for chiropractic services.Completion of this field is required for all chiropractic services; conditional for other services.

BLOCK 15 IF PATIENT HAS HAD SAME OR SIMILAR ILLNESS