2025 Printable Template
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Form last updated: 03/2024. Please verify this is the current version before use.
Easily complete & submit your CMS 1490S form
Follow these simple steps to fill, sign, and send your CMS 1490S form online.
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Sign the form
Add your electronic signature to the fillable CMS 1490S form to certify it came directly from you.
Send it to the requester
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What is a CMS 1490S used for?
Form CMS-1490S is used by Medicare beneficiaries to request reimbursement for medical services that were paid out-of-pocket. This form allows individuals to claim costs for healthcare services that may be covered by Medicare, ensuring they receive appropriate financial support for their medical expenses.
Who needs to fill out a CMS 1490S form
Medicare beneficiaries who have paid for medical services out-of-pocket and are seeking reimbursement.
How to fill out a CMS 1490S online?
Follow these steps to complete your CMS 1490S form online.
Frequently Asked Questions
Find quick answers to common questions about our PDF editor.
It is a form used by Medicare beneficiaries to request reimbursement for medical services they have paid for out-of-pocket.
The form must be submitted by mail to the appropriate Medicare contractor address.
If you make an error, it is best to start over with a new form to ensure accuracy.
Currently, the form must be submitted by mail.
The form should generally be submitted within one year from the date of service.
