Form cms701 form 2026

1. Click ‘Get Form’ to open the CMS-701 form in the editor.
2. Begin by entering the patient’s last name, first name, and middle initial in the designated fields.
3. Input the provider number issued by Medicare and the patient's health insurance claim number (HICN).
4. Fill in the provider's name and, if applicable, the medical record number.
5. Specify the onset date of the primary diagnosis and the start of care (SOC) date for services.
6. Select the type of therapy being billed (e.g., PT, OT, SLP) and provide both primary and treatment diagnoses.
7. Indicate total visits from SOC and current frequency/duration of treatment sessions.
8. Detail any updates to the current plan, including functional goals and recertification details if necessary.
9. Ensure that all required signatures are completed before finalizing your document.

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