The CMS-1490S is the
Patient's Request for Medicare Payment. Medicare beneficiaries can use this form when billing for Medicare covered services. Providers and suppliers are required by law to submit claims on behalf of the beneficiary, but if the beneficiary wishes to file the claim, they must do so on the CMS-1490S claim form. The beneficiary must also attach to the CMS-1490S any bill(s) they receive from providers/suppliers.
Click here to be taken to CMS' website where this form and instructions for filling it out can be downloaded and printed. Completed CMS-1490S forms for Part B services should be sent to Railroad Medicare, PO Box 10066, Augusta Georgia, 30999 for consideration.