Form CMS-1490S (2026): File Your Own Medicare Claim

Updated October 19, 2026. Quick answer: Form CMS-1490S is the Patient’s Request for Medical Payment. You use it to file your own Medicare claim when a provider or supplier will not or cannot file one. Send the completed form and an itemized bill to your Medicare Administrative Contractor, keep a copy, and allow at least 60 days. Medicare will not process requests for diabetic test strips, Part B drugs or competitive-bidding items.

Quick reference

When you file your own claim

Normally a doctor or supplier files for you. The instructions say “In most situations, your physician, other practitioner or supplier will submit your claim to Medicare, if they do not, you can submit a claim.” The form asks you to pick one reason: the provider or supplier refused to file a claim, is unable to file one, or is not enrolled with Medicare.

The form also states the provider’s obligation: “Physicians and other suppliers, such as clinical laboratories, imaging service suppliers, and durable medical equipment suppliers are required by law to submit a claim for Medicare covered services furnished to you, the Medicare beneficiary, within one year of the date of service.” If a provider refuses, the form says to call 1-800-MEDICARE (1-800-633-4227) to file a complaint with the Medicare contractor.

What to attach

The cover page is direct: “Include a copy of the itemized bill and any supporting documents.” Section 2 lists what the itemized bill must show: date of service, place of service, a description of the illness or injury, a description of each service or supply, the charge for each service, the doctor’s or supplier’s name and address, and the National Provider Identifier if known. If the bill comes from a laboratory, an imaging center or a medical equipment supplier, the ordering or referring provider’s legal name must appear on it.

Section 2 also asks whether the condition was related to employment, an auto accident, chronic dialysis or kidney transplant treatment, or another accident. Section 3 covers other health insurance for people age 65 or older whose own or spouse’s current work gives them coverage, and asks you to attach the primary insurer’s Explanation of Benefits if Medicare is secondary. For the work-coverage rules see working past 65 and Medicare.

What Medicare will and will not pay

Social Security’s Medicare booklet describes what Part B covers: “Medicare Part B (medical insurance) helps cover medically necessary doctors’ services, outpatient care, home health services, durable medical equipment, mental health services, limited outpatient prescription drugs, and other medical services.”

Two limits are printed on the first page. “Medicare will not process a beneficiary request for payment for diabetic test strips, Part B drugs, or for items paid for under the DMEPOS Competitive Bidding program.” For vaccines the instructions say “Annual Part B deductible and coinsurance amounts do not apply.” and add “Medicare does not pay for the hepatitis B vaccines.”

Foreign travel is the other common use. The form says “Medicare law prohibits payment for health care services furnished outside the United States (U.S.) except in certain limited circumstances.” It lists three situations for a foreign hospital: a medical emergency in the U.S. when the foreign hospital is closer, a medical emergency while traveling directly between Alaska and another state through Canada, and living in the U.S. when the foreign hospital is closer to home than the nearest U.S. hospital that can treat you. On ships, “Services furnished on a ship in a U.S. port or within 6 hours of when the ship arrived at or departed from a U.S. port are furnished inside the U.S.” Our page on Medicare and travel medical coverage covers the money side.

Signing, sending and the deceased patient

The signature block is made under penalty of perjury and authorizes any holder of medical information to release it to CMS or its contractor. If the patient cannot sign, the form describes marking an X with a witness, or signing on the patient’s behalf with a brief explanation. It also says “If the Patient is deceased, please contact your Social Security office for instructions on how to file a claim.”

Send only the completed form, not the instruction pages. The cover page says “allow at least 60 days for Medicare to receive and process your request”. If the claim is incomplete, the contractor returns it with a letter listing what is missing, so complete every section that applies.

The edition read for this page is Form CMS-1490S (version 01/18) as the agency served it on 2026-10-19. Check the edition printed on the copy you use, because a later edition can change the questions, the mailing instructions and the evidence asked for.

Common mistakes

• Filing your own claim when the provider is simply slow. The form’s three reasons are refused, unable to file, or not enrolled with Medicare.
• Sending the claim without an itemized bill. The form says to include one with every supporting document.
• Mailing the form to the CMS paperwork address. The claim goes to your Medicare Administrative Contractor.
• Expecting Medicare to pay for diabetic test strips, Part B drugs or competitive-bidding items through this form. It will not process them.

Related: Medicare travel medical coverage, Social Security and Medicare abroad, and Medicare billing appeals.

Sources

• Form CMS-1490S (version 01/18), Patient’s Request for Medical Payment: https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms1490s-english.pdf
• SSA Publication 05-10043 (2026), Medicare: https://www.ssa.gov/pubs/EN-05-10043.pdf

Read from the Social Security Administration and Centers for Medicare and Medicaid Services documents linked above on October 19, 2026. General information, not legal or benefits advice. Your own facts decide the outcome, and Social Security at 1-800-772-1213 is the right place to confirm anything consequential.