CMS 1500 FORM Field 15 - Other Date

Field 15 - Other Date


The “Other Date” identifies additional date information about the patient’s condition or treatment.

NUCC INSTRUCTIONS: Enter another date related to the patient’s condition or treatment. Enter the date in the 6-digit (MM│DD│YY) or 8-digit (MM│DD│YYYY) format.

Enter the applicable qualifier to identify which date is being reported.

454 Initial Treatment

304 Latest Visit or Consultation

453 Acute Manifestation of a Chronic Condition

439 Accident

455 Last X-ray

471 Prescription

090 Report Start (Assumed Care Date)

091 Report End (Relinquished Care Date)

444 First Visit or Consultation

Enter the qualifier between the left-hand set of vertical, dotted lines.

MEDICARE INSTRUCTIONS - Leave blank.