CMS-1500 Claim Form boxes list
Two free downloads for the CMS-1500 (HCFA 1500) claim form — a full CSV list of every box and field with 837P mapping, and a blank CMS-1500 form with bounding boxes annotated for every box.
CMS-1500 form fields — CSV
Every box on the CMS-1500 (HCFA 1500) claim form — 60+ fields including all Box 24 sub-columns — with field name, section, plain-English description, and X12 837P loop / segment mapping. Ready to open in Excel, Google Sheets, or import into a database.
CSV · 60+ fields · ~10 KB
DownloadBlank CMS-1500 form — bounding boxes annotated
A blank CMS-1500 claim form with every box outlined and labeled — a visual reference showing exactly where each of the 33 fields sits on the form. Useful for training staff, building OCR datasets, or aligning UI mockups with paper claim intake.
PNG · Annotated
Download
Automate the whole form
These references are useful — but if you handle real CMS-1500 claim volume, Hewto.ai reads every one of these boxes automatically (scanned, faxed, handwritten, or red drop-out ink) and generates a validated X12 837 Professional file end-to-end.
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