Patient's Request for Medicare Payment

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.

This form is on the
CMS website (PDF, 67 KB). Completed CMS-1490S forms for Part B services should be sent to:

Railroad Medicare
P.O. Box 10066
Augusta, Georgia 30999

Contact Railroad Medicare

Email Railroad Medicare

Contact a specific Railroad Beneficiaries department


800-833-4455 - How to use

TTY 877-566-3572

Spanish inquiries:


Railroad beneficiary info:

Gayle Patterson (706) 855-3198

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bidding Program

Jurisdiction J Part A MAC

Jurisdiction J Part B MAC

Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC


National Supplier Clearinghouse MAC


RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries