Qualifier codes for Block's 14 and 15

Block 14 (Date of Current Illness, Injury, or Pregnancy) on the CMS-1500 requires a qualifier code to go along with the date entered into the block. Enter the qualifier to the right of the vertical, dotted line. Enter the applicable qualifier to identify which date is being reported:

• 431 Onset of Current Symptoms or Illness
• 484 Last Menstrual Period (LMP)

Block 15 (Other Date) The "Other Date" identifies additional date information about the patient's condition or treatment. Enter the applicable qualifier between the vertical, dotted lines 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
• 091 Report End
• 444 First Visit or Consultation