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Instructions for Completing the CMS 1500 Claim Form
medical services. The form is used by Physicians and Allied Health Professionals to submit ... pharmaceuticals or durable medical equipment. 17a If Applicable ID Number of Referring Physician - Enter State Medical License number. ... justification or an Emergency Certification Statement. • This section may be used for an unlisted procedure
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Instructions for Completing the CMS 1500 Claim …
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