HCFA-1500 Box 14 - Date of Current Illness, Injury, Pregnancy (LMP)

On the HCFA-1500 form, Box 14 is used to indicate the date of the current illness, injury, or pregnancy (LMP). This date helps establish the beginning of the patient’s condition and is important for determining medical necessity, claim timeliness, and treatment context.

Tip: Enter the date in MMDDYYYY format. You may also include a qualifier that describes the type of date being reported—such as the onset of illness or the last menstrual period (LMP).

In our example below, we populated Box 14 with the date '01/07/2025' and used the qualifier '431', which indicates the onset of current symptoms or illness.

So far, we've discussed how the date of onset or related event is captured on the HCFA-1500 form. Now let’s look at how this information is represented in the X12 837 electronic format.

In the X12 837 transaction, Box 14 maps to the DTP segment in the 2300 Claim Information Loop. The DTP01 element indicates the type of date, and DTP03 contains the actual date value.

Key X12 837 Details:
  • DTP01: Date Qualifier (e.g., 431 for onset of current symptoms or illness, 484 for last menstrual period)
  • DTP02: Date Format Qualifier (typically D8 for CCYYMMDD)
  • DTP03: Date Value (e.g., 20250107)

Sample 837P (5010/4010) – 2300 Claim Information

Note: Box 14 maps to the DTP segment in Loop 2300 of the 837 transaction. The most common qualifier used is 431 (onset of current illness), but 484 (last menstrual period) may also be used depending on the type of service or patient condition.

For additional information on the X12 837 standard, please refer to the official implementation guides published by X12.

HCFA-1500 Form Box Locations

• HCFA-1500 Box 0 - Carrier Block
• HCFA-1500 Box 1 - Insurance Type
• HCFA-1500 Box 1a - Insured's ID Number
• HCFA-1500 Box 2 - Patient's Name
• HCFA-1500 Box 3 - Patient's Birth Date and Sex
• HCFA-1500 Box 4 - Insured's Name
• HCFA-1500 Box 5 - Patient's Address
• HCFA-1500 Box 6 - Patient Relationship to Insured
• HCFA-1500 Box 7 - Insured's Address
• HCFA-1500 Box 8 - Reserved For NUCC Use
• HCFA-1500 Box 9 - Other Insured's Name
• HCFA-1500 Box 9a - Other Insured's Policy or Group Number
• HCFA-1500 Box 9b - Reserved For NUCC Use
• HCFA-1500 Box 9c - Reserved For NUCC Use
• HCFA-1500 Box 9d - Insurance Plan Name or Program Name
• HCFA-1500 Box 10 - Is Patient's Condition Related To
• HCFA-1500 Box 10d - Claim Codes
• HCFA-1500 Box 11 - Insured's Policy Group or FECA Number
• HCFA-1500 Box 11a - Insured's Date of Birth and Sex
• HCFA-1500 Box 11b - Other Claim ID
• HCFA-1500 Box 11c - Insurance Plan Name or Program Name
• HCFA-1500 Box 11d - Is There Another Health Plan
• HCFA-1500 Box 12 - Patient's or Authorized Person's Signature
• HCFA-1500 Box 13 - Insured's or Authorized Person's Signature
• HCFA-1500 Box 14 - Date of Current Illness, Injury, Pregnancy (LMP) [You are Here]
• HCFA-1500 Box 15 - Other Date
• HCFA-1500 Box 16 - Dates Patient Unable to Work in Current Occupation
• HCFA-1500 Box 17 - Name of Referring Provider or Other Source
• HCFA-1500 Box 17a - Other ID
• HCFA-1500 Box 17b - NPI
• HCFA-1500 Box 18 - Hospitalization Dates Related to Current Services
• HCFA-1500 Box 19 - Additional Claim Information
• HCFA-1500 Box 20 - Outside Lab Charges

Grab a sample of the HCFA-1500 claim form here - HCFA 02/12 Claim Form