CMS-1490S, Patient's Request for Medical Payment
Download CMS-1490S, complete the patient request for Medicare payment, and mail it to the Medicare Administrative Contractor shown in the current official guidance.
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Check the official form requirements
Download the current CMS-1490S, then complete and sign it outside IRIS. Use IRIS for the finished PDF only when the agency's required filing method and the acceptable-use policy permit a printed PDF.
IRIS is an independent printing and mailing service. It is not USPS or Centers for Medicare & Medicaid Services. Review the document, destination, mailing options, and total before checkout.
Read the current Centers for Medicare & Medicaid Services instructionsLoading the document tools…