Who can file a paper Medicare claim?

A provider of services, such as a hospital, with fewer than 25 full-time equivalent employees, and a physician, practitioner, facility or supplier with fewer than 10. Any filer that averages fewer than 10 Medicare claims a month also qualifies. Medicare's manual has these filers self-assess and mail paper without asking CMS for a waiver, though one contractor, Wellpoint Federal (formerly National Government Services), requires an approved waiver form first.

How many employees can a practice have and still file paper Medicare claims?

Fewer than 10 full-time equivalent employees for a physician practice, and fewer than 25 for a provider of services such as a hospital. Everyone the practice withholds taxes for counts, owner-physicians who treat patients included, and part-timers count by hours against the employer's full-time week. Volunteers, contract workers and a billing company's staff do not count.

Can I fax documents for a Medicare claim?

Yes, for a claim already filed electronically with a PWK segment. Medicare's manual gives 7 calendar days to fax the documents and 10 to mail them, on the contractor's cover sheet, and late documents are not considered. Each contractor publishes its own fax lines, and First Coast counts both windows from the day the electronic claim is submitted.

Does Medicare accept faxed reopening requests?

It depends on the contractor. Noridian's Part B general fax line takes written reopenings. CGS stopped taking faxed Part B clerical reopenings on October 21, 2019. Its durable medical equipment Jurisdiction B stopped taking faxed reopening requests on August 1, 2026. A reopening corrects a claim already on file, so it is not an initial claim.

What happens if you mail a paper Medicare claim and are not exempt?

Medicare does not pay a paper claim from a filer that must file electronically. Noridian's Part B page lists remark code M117, 'Not covered unless submitted via electronic claim', for a paper CMS-1500 from such a provider, and tells the filer to resubmit electronically. Medicare's manual treats every paper claim as the filer's statement that an exception applies.

October 14, 2026

Can you fax a Medicare claim?

No. Medicare pays an initial claim only if it is filed electronically, unless the filer has under 10 FTE employees (25 for hospitals) or files under 10 claims a month. Fax carries paperwork.

An old desktop fax machine with a handset and a coiled cord on a white desk

No. Medicare pays an initial claim only if it is filed electronically (42 CFR 424.32(d)). Paper is allowed for a physician practice with fewer than 10 full-time equivalent (FTE) employees, a hospital or other provider of services with fewer than 25, and any filer that averages fewer than 10 claims a month. Paper goes by mail. Fax carries the paperwork for a claim already on file.

What counts as an initial claim?

A claim with paper attachments is initial. So is a rejected claim sent again, a demand bill, a claim where Medicare pays second and a non-payment claim. Adjustments, corrections and appeals are not. The definition is in section 90 of chapter 24 of the Medicare Claims Processing Manual, Pub. 100-04, which this page calls the manual.

The requirement comes from the Administrative Simplification Compliance Act (ASCA) and its rule at 42 CFR 424.32(d), in force since October 16, 2003. It covers claims under Part A and Part B. A Medicare Advantage claim is a Part C claim, which the rule excludes (42 CFR 424.32(d)(1)(v)), and a claim a patient files for themselves is waived (42 CFR 424.32(d)(3)(i)).

Who may still file on paper?

Filer	Paper allowed when	Rule
Provider of services, such as a hospital	Fewer than 25 FTE employees	42 CFR 424.32(d)(1)(viii)(A) and (d)(3)(ii)
Physician, practitioner, facility or supplier that is not a provider of services	Fewer than 10 FTE employees	42 CFR 424.32(d)(1)(viii)(B) and (d)(3)(ii)
Any filer	Fewer than 10 Medicare claims a month on average, which the manual puts at no more than 120 a year	42 CFR 424.32(d)(4)(iii); manual section 90.3.1

Roster-billed vaccinations, claims under a demonstration project that calls for paper, and some secondary-payer claims with more than one primary payer are exceptions too (section 90.2).

These filers do not ask CMS for a waiver. The manual has them self-assess, and a paper claim counts as the filer's statement that an exception applies (sections 90.1, 90.3.1 and 90.4). CMS's self-assessment page, last modified September 10, 2024, tells a filer that meets an exception to skip the waiver request. A small filer may send some claims electronically and others on paper (section 90.1).

Contractor pages differ. CGS tells Kentucky and Ohio Part B filers to self-assess before they mail paper (page updated December 7, 2022). Wellpoint Federal, the name National Government Services adopted on April 1, 2026, processes Part A and Part B claims for Illinois, Minnesota, Wisconsin, New York and New England. Its page says a filer that meets an exception still needs an approved ASCA waiver form before it mails paper claims, and approval takes 30 business days (page revised June 11, 2026).

The manual bars payment of a paper claim from a filer that does not qualify (section 90). Noridian's Part B page, updated April 2, 2025, lists remark code M117, "Not covered unless submitted via electronic claim", as the message on a paper claim from a provider that must file electronically.

How do you count FTE employees?

Payroll decides. Everyone the practice withholds taxes for is on the count, including an owner-physician who treats patients and the staff who bill and keep records. Volunteers are off it. So is anyone working under contract with no tax withheld, a billing agency's employees included. Part-timers add up by hours against the full-time week the employer has set. On a 35-hour week, five full-timers plus seven people working 25 hours come to 10 FTEs (section 90.1). For a physician practice, 10 is not fewer than 10.

Can a paper claim go by fax?

No. The manual bars Medicare contractors from accepting claims through fax-imaging (section 50.1.2). Noridian's Part B fax page for Jurisdiction F, updated March 4, 2026, says it cannot accept initial or new claim forms by fax. CGS's page for durable medical equipment Jurisdiction B says "We cannot accept faxed claims" (notice of January 23, 2024) and tells exempt suppliers to mail paper. CGS's Kentucky and Ohio Part B phone and fax page, updated March 3, 2026, lists no claims fax line.

What can go by fax, and how fast?

Paperwork for a claim already on file. A practice that files electronically can mark the claim with a PWK (paperwork) segment, which tells the contractor that documents are on the way, and a contractor may not refuse the electronic claim because of the attachment (section 90.3.2). Without PWK, the practice waits for the contractor's development letter before it sends records (section 50.10.1).

The manual gives 7 calendar days to fax the documents and 10 to mail them, and late documents are not considered (section 50.10.2.1). First Coast counts both windows from the day the electronic claim goes in (page dated August 6, 2025). Each contractor supplies the cover sheet, returns an incomplete one and runs its own fax lines (sections 50.10.2.1 and 50.10.2.2).

Fax use	Noridian, Jurisdiction F Part B	CGS, Jurisdiction 15 Part B (Kentucky, Ohio)
New or initial claim	No	No claims fax line; paper goes to a mailing address
PWK documents for an electronic claim	Yes	Yes
Written reopening	Yes	No, since October 21, 2019

Noridian takes PWK, redeterminations, written reopenings and general written inquiries on one line, with medical review documentation on separate lines. It cannot match a second transmission to the first, so a claim's records belong in one fax.

How do you show a fax arrived in time?

Late paperwork is not considered, so the time of delivery matters. Fax Pigeon issues a delivery certificate for every delivered fax. It shows the date and time of delivery and the pages transmitted.

Does a billing company change the count?

No. The manual counts the provider's own staff, not the staff of a billing agent or clearinghouse (section 90.1). HIPAA's business associate definition names billing and claims processing (45 CFR 160.103), and 45 CFR 164.502(e) calls for written assurances at each link; HIPAA fax for medical billing companies covers that side. Every Fax Pigeon plan includes a signed BAA, executed at signup.

What does faxing Medicare paperwork cost?

Basic is $4.99 a month billed annually, or $5.99 month to month, for 200 pages sent and received combined. Extra pages cost 10 cents each on a separate invoice. The other plans are on the pricing page.

* Fax Pigeon prices and plan terms as of October 14, 2026. Medicare rules and contractor pages read at source on October 11, 2026. Fax Pigeon is not affiliated with CMS or any Medicare contractor named here.

Frequently asked questions

Can you fax a Medicare claim?: No. Medicare pays an initial claim only if it is filed electronically, and Medicare's claims processing manual bars its contractors from accepting claims by fax-imaging. Small filers may mail paper instead. Fax carries paperwork for a claim already on file, such as PWK documents, and at some contractors redeterminations and written reopenings.
Who can file a paper Medicare claim?: A provider of services, such as a hospital, with fewer than 25 full-time equivalent employees, and a physician, practitioner, facility or supplier with fewer than 10. Any filer that averages fewer than 10 Medicare claims a month also qualifies. Medicare's manual has these filers self-assess and mail paper without asking CMS for a waiver, though one contractor, Wellpoint Federal (formerly National Government Services), requires an approved waiver form first.
How many employees can a practice have and still file paper Medicare claims?: Fewer than 10 full-time equivalent employees for a physician practice, and fewer than 25 for a provider of services such as a hospital. Everyone the practice withholds taxes for counts, owner-physicians who treat patients included, and part-timers count by hours against the employer's full-time week. Volunteers, contract workers and a billing company's staff do not count.
Can I fax documents for a Medicare claim?: Yes, for a claim already filed electronically with a PWK segment. Medicare's manual gives 7 calendar days to fax the documents and 10 to mail them, on the contractor's cover sheet, and late documents are not considered. Each contractor publishes its own fax lines, and First Coast counts both windows from the day the electronic claim is submitted.
Does Medicare accept faxed reopening requests?: It depends on the contractor. Noridian's Part B general fax line takes written reopenings. CGS stopped taking faxed Part B clerical reopenings on October 21, 2019. Its durable medical equipment Jurisdiction B stopped taking faxed reopening requests on August 1, 2026. A reopening corrects a claim already on file, so it is not an initial claim.
What happens if you mail a paper Medicare claim and are not exempt?: Medicare does not pay a paper claim from a filer that must file electronically. Noridian's Part B page lists remark code M117, 'Not covered unless submitted via electronic claim', for a paper CMS-1500 from such a provider, and tells the filer to resubmit electronically. Medicare's manual treats every paper claim as the filer's statement that an exception applies.

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