Busy. Please wait.

show password
Forgot Password?

Don't have an account?  Sign up 

Username is available taken
show password


Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account.
We do not share your email address with others. It is only used to allow you to reset your password. For details read our Privacy Policy and Terms of Service.

Already a StudyStack user? Log In

Reset Password
Enter the associated with your account, and we'll email you a link to reset your password.
Don't know
remaining cards
To flip the current card, click it or press the Spacebar key.  To move the current card to one of the three colored boxes, click on the box.  You may also press the UP ARROW key to move the card to the "Know" box, the DOWN ARROW key to move the card to the "Don't know" box, or the RIGHT ARROW key to move the card to the Remaining box.  You may also click on the card displayed in any of the three boxes to bring that card back to the center.

Pass complete!

"Know" box contains:
Time elapsed:
restart all cards
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

  Normal Size     Small Size show me how

CMS-1500 Form

Blocks (14-24) Physician Demographics Diagnosis Procedures

Block 14 Date of current illness, injury, or pregnancy ( LMP )
Block 15 Other Date ( identifies additional date information about the patients condition or treatment )
Block 16 Dates patient is unable to work in current occupation
Block 17 Name of referring provider or other source. ( Enter a qualifier to the left of the vertical, dotted line to identify which provider is being reported
Block 17 a Leave Blank
Block 17 b NPI ( National Provider Number )
Block 18 Hospitalization Dates Related to Current Services
Block 19 Additional Claim Information ( NUCC )
Block 20 Outside Lab $ Charges ( Yes or No question )
Block 21 Diagnosis or Nature of illness or injury
Block 22 Resubmission and/ or Original Reference Number
Block 23 Prior authorization number
Block 24 a Dates of service [ Line 1-6 ]
Block 24 b Place of Service [ Line 1-6 ]
Block 24 c EMG identifies if the service was an emergency
Block 24 d Procedures, Services or supplies ( CPT/HCPCS ) ( Modifiers)
Block 24 e Diagnosis Pointer
Block 24 f $ Charges
Block 24 g Days of units ( 1-6) it allows for up to 3 characters
Block 24 h EPSDT Family Plan [Lines 1-6 ]
Block 24 i ID Qualifier [ Lines 1-6 ]
Block 24 j Rendering Provider ID #
Created by: Leiannlg