Skip to content 
You can get a superbill from a provider who is not in your insurance network. It has a list of your diagnosis codes, treatment codes, times of service, and how much you paid. Patients send it to their insurance company to request payment for services they received that were not in their network.
Key Takeaways
- A superbill (also written as super bill) is not a claim form. It is documentation that patients use to self-file for out-of-network reimbursement after paying at the time of service.
- The three required field types are provider details, patient details, and service lines. It only takes one missing field, such as an NPI or ICD-10 code, for the submission to be rejected.
- Most PPO and POS plans will pay for submitted superbills. In most cases, HMO and EPO plans do not cover care outside their network unless it is an emergency.
- Medicare is one of the few exceptions. By federal law, doctors must directly send Medicare bills to their customers. Superbills are not a replacement for that duty.
- The No Surprises Act says that patients who are self-paying (even if they have insurance but aren’t filing through their plan) should get a Good Faith Estimate before they start care.
Introduction to Superbill
Whether you are a therapist, doctor, chef, or small business owner that doesn’t work with insurance companies, you must use superbills every day to bill your clients. This guide is also for people who paid for their care out of pocket and now want their insurance company to reimburse them.
Everything you need to know about a superbill (sometimes written as “super bill”) is on this page, along with a free downloadable template, how to submit it, and the rules that most guides skip over, like what happens with Medicare and when a Good Faith Estimate is needed. Use the link in the template area below to get the free superbill form.
What Is a Superbill?
A superbill is a detailed receipt a healthcare provider issues after a paid visit. It tracks exactly what services were provided, the diagnosis they were based on, how much they cost, and how much the patient paid. Instead of having their provider make a claim, the patient takes that paper and sends it straight to their insurance company.
It sounds official, and it is, but the paper itself goes by more than one name, depending on where it is used. The same thing is meant by “encounter form,” “charge slip,” and “itemized receipt.” In the past, superbills were pre-printed paper lists that front-desk staff would cross off as patients checked out. Modern EHR systems generate them online, but the format hasn’t changed much.
Usually, practices give out superbills when they are not in-network with a patient’s insurance plan or when a patient chooses to pay out of pocket and then wants to get reimbursed. The main difference is important. In-network providers send bills directly to the insurance company, so patients don’t need to be billed. The purpose of the superbill is to give the patient the paperwork they need to file their own claims.
Superbill vs Invoice vs CMS-1500 vs EOB
These four documents show up in almost every billing conversation, and confusing them is easy. Here is how they actually differ:
| Document | Who Creates It | Who Sends It | Codes Included | Purpose |
| Superbill | Provider | Patient submits to insurer | CPT, ICD-10, POS | Out-of-network reimbursement request |
| Invoice | Provider | Provider sends to patient | Itemized charges (no codes required) | Requests payment for services |
| CMS-1500 claim form | Provider or biller | Provider/biller sends to insurer | CPT, ICD-10, NPI, all claim fields | In-network or non-par claim submission |
| EOB | Insurer | Insurer sends to patient | Codes, amounts, adjustments | Explains what the plan paid or denied |
People often mix up the superbill and the CMS-1500 claim form, but they are not the same and go to different people. The claim form that providers and billers actually send is a CMS-1500. A superbill is what the customer fills out when the provider doesn’t file for them. The CMS-1500 will be discussed in a different post.
What to Include in a Superbill?
This is the section where most guides go wrong, or at least are incomplete. Miss one field, and the insurer has grounds to deny the submission outright. Organize the required fields into three sections.
Provider Details
Your license number, certificates, and name must match exactly what is on file with the state board. Remember to use your real address instead of a PO box. PO boxes are not a legal place to do business for most insurance.
Your National Provider Identifier (NPI) and your Employer Identification Number or Tax ID (EIN/TIN) are the two numbers that need to be on every bill. TIN is your Social Security number if you are a sole proprietor and file under that number. Your NPI is a 10-digit number that CMS gives you and that all payers use. Most plans will automatically reject the submission if it doesn’t have it.
Add your phone number and, if applicable, the name and NPI of the provider who sent you the request. For out-of-network payment, some plans require a referral, especially for trips to specialists.
Every superbill should have your name on it. For some payers, they need it and won’t pay the claim without it.
Patient Details
Write down the patient’s full legal name, date of birth, and mailing address. If you know their insurance member ID, put it in. This isn’t always needed, but because it links the entry to the right account, it makes the process go much faster.
The user’s name and ID should also be included if the patient is on someone else’s plan. One of the main reasons superbills are late is that they are often prepared incorrectly.
Service Lines
Each service line records one procedure that can be billed. Include the date of service, the CPT or HCPCS code, any modifiers, the ICD-10-CM illness code, the Place of Service (POS) code, the number of units, the fee charged, and the amount the customer actually paid on each line.
To let the insurance company know what was done, CPT and HCPCS numbers are used. The insurer can determine where the service took place using place of service (POS) codes. For telehealth, POS 02 is used when the patient is at a hospital or clinic, and POS 10 is used when the patient is at home. A very common, easy-to-fix mistake is using the wrong POS code on a telehealth bill. Also, make sure that modifier 95 applies if you use telehealth.
For honesty’s sake, the amount paid matters. Write down how much the patient really paid. If your fee ranges from low to high, list the lower amount. Never make the fee higher than it is. This is discussed in more detail below in the section on honesty rules.
Free Superbill Template
A superbill only works if every required field is on it. The filled-in sample below shows exactly how a completed superbill looks for a standard therapy session. Download the blank version in the format that works for your practice.
Download PDF (Fillable) | Download Word Document | Download Google Doc
A mental health version with common therapy CPT codes pre-filled (90837, 90834, 90847) is also available for therapists and counselors.
Sample Superbill
PROVIDER INFORMATION
| Field | Example |
| Provider Name | Sarah L. Mitchell, LCSW |
| Credentials / License | Licensed Clinical Social Worker — License No. SW-104822 |
| NPI (National Provider Identifier) | 1234567890 |
| EIN / Tax ID | 98-7654321 |
| Practice Name | Clearview Counseling, LLC |
| Practice Address | 412 Elm Street, Suite 3, Denver, CO 80203 |
| Phone | (720) 555-0184 |
| Referring Provider (if applicable) | N/A |
| Provider Signature | ___________________________ |
PATIENT INFORMATION
| Field | Example |
| Patient Name | James R. Thornton |
| Date of Birth | 03/14/1988 |
| Patient Address | 88 Mapleton Ave, Boulder, CO 80301 |
| Insurance Member ID | BCB-00291847 |
| Insurance Plan Name | BlueCross BlueShield PPO |
| Subscriber Name (if different) | N/A (self) |
| Subscriber ID | N/A |
SERVICE LINES
| Date of Service | CPT Code | Modifier | Diagnosis (ICD-10) | POS Code | Units | Fee Charged | Amount Paid |
| 11/05/2026 | 90837 | None | F41.1 (Generalized Anxiety Disorder) | 11 (Office) | 1 | $150.00 | $150.00 |
BILLING NOTES
| Field | Detail |
| Total Charged | $150.00 |
| Total Collected | $150.00 |
| Balance Due | $0.00 |
| Payment Method | Credit card |
| Superbill Issue Date | 11/05/2026 |
How To Use This Template
Replace every example field with your own practice and patient information. The only fields you adjust per session are the date of service, CPT code, modifier (if applicable), diagnosis code, POS code, units, fee charged, and amount paid. Provider and practice details stay the same across all superbills from your practice.
If you offer telehealth sessions, change the POS code to 10 (patient in their home) or 02 (patient at a healthcare facility), and add modifier 95 to the modifier field. Getting the POS code wrong on a telehealth superbill is one of the most common reasons those submissions get denied.
For the mental health version, the template pre-fills the most common therapy CPT codes: 90837 (60-minute individual psychotherapy), 90834 (45-minute individual psychotherapy), and 90847 (family psychotherapy with patient present). Swap in whichever code matches the actual session length and type.
A mental health version with common therapy CPT codes pre-filled (90837, 90834, 90847) is also available for therapists and counselors.
Both templates include every field required by commercial insurers, with guidance notes on what goes in each box. Use fictional data only when testing the form. Never use real patient information in a sample.
Superbill Examples by Specialty
Different specialties use different codes, but the superbill structure stays consistent. Here is how five common specialties would fill in the service lines section:
| Specialty | CPT Code(s) | Diagnosis (ICD-10) | Modifier / Notes |
| Therapy (psychotherapy) | 90837 (60 min) | F41.1 (GAD) | None typical; use modifier 95 for telehealth |
| Physical therapy | 97110 x 2 units, 97140 x 1 unit | M54.5 (low back pain) | Count timed units using the 8 minute rule; physical therapy billing has specific documentation requirements |
| Chiropractic | 98941 (3-4 regions) | M99.01 (subluxation, cervical) | POS 11 (office) |
| Acupuncture | 97810 + 97811 | M54.2 (cervicalgia) | See acupuncture CPT codes for unit limits |
| Dietitian | 97802 (initial, 15 min) | E11.65 (T2DM with hyperglycemia) | POS 11 |
Therapists seeking more detail on mental health billing services, specific coding, and documentation can find additional guidance in Credex Healthcare’s mental health billing section. For physical therapy, the 8-minute rule governs how timed units are counted across the entire session, not just per code.
How Superbills Work with Insurance
A superbill may not be covered by all insurance plans. First, look at the type of plan.
Out-of-network benefits are often part of PPO (Preferred Provider Organization) and POS (Point of Service) plans. That means they will fill out a superbill once the customer has paid their out-of-network fee. HMO and EPO plans usually don’t pay for care outside their network unless it’s an emergency. Because of this, people with these plans usually can’t use superbills to get reimbursed.
The reimbursement amount is based on the plan’s allowed amount for a specific CPT code, the patient’s coinsurance rate, and any remaining out-of-network deductible. For example, let’s say a person pays $150 for therapy. The most that the plan will pay for that code is $110. The penalty for not being in-network has already been met. The plan pays for 70% of what is allowed. The person would get $77 back ($110 x 0.70).
The patient gets an Explanation of Benefits (EOB) after the insurance company processes the submitted superbill. It shows what the plan paid, what changed, and what, if anything, was denied. For tax reasons, keep copies of both the bill and the EOB. This is especially important if you use an HSA or FSA account.
How to Submit a Superbill to Insurance (Steps for Patients)
If you are a patient who received a superbill from your provider, here is how to get reimbursed.
Step 1: Check your out-of-network benefits. Call the member services number on your insurance card and confirm that your plan has out-of-network coverage, what your out-of-network deductible is, and what percentage the plan reimburses after the deductible.
Step 2: Get the superbill from your provider. Ask for it right away after you pay. Make sure it has all the required fields, especially the NPI, diagnosis code, CPT code, POS code, and the amount you paid.
Step 3: Fill out your plan’s claim form. The out-of-network claim form differs by insurance company. You can get it from the insurance company’s website or call and ask for one. Put the superbill on.
Step 4: Submit by the method your plan accepts. The member portal, mail, or fax are the main ways that most plans accept documents. Keep a copy of everything you send, even the confirmation that it was received.
Step 5: Track the filing deadline. Different dates apply for out-of-network claims. For some plans, you must submit it within 90 days of the service date. Some people give you up to a year. Check the paperwork for your plan. If you miss the deadline, there is no way to appeal.
Step 6: Wait for the EOB. It usually takes 2 to 8 weeks to process. If the claim is turned down, the EOB will explain why. Common reasons for rejection include missing or incorrect codes, an out-of-network fee that hasn’t been met yet, or the service not being covered by your plan. Most denials are good enough to be appealed.
Superbills and Medicare
It’s clear that this part of the law applies to all providers who take care of Medicare patients.
Section 1848(g)(4) of the Social Security Act says that all Medicare Part B providers must submit claims. This includes providers who do not accept Medicare assignment, who are called “non-participating providers.” They can’t use a superbill instead of the claim that was sent by the source.
Two small things are different. First, providers who have officially chosen not to participate in Medicare make a private agreement with the patient. Because these doctors chose not to bill Medicare, neither party files a claim. Finally, if a patient’s provider forgot to file a claim, they can send form CMS-1490S directly to Medicare. This is the rare case, not the norm, and it only works when the provider didn’t meet their obligation, not as an alternative way to file.
In real life, this means that if you treat Medicare patients who haven’t officially opted out, you can’t just file a superbill and leave. Patients who have chosen not to be covered by Medicare and have signed private contracts cannot get reimbursed by Medicare.
Good Faith Estimates, HSAs, and Other Rules
Good Faith Estimates
As of January 2022, the No Surprises Act required providers to give uninsured and self-pay patients a Good Faith Estimate (GFE) before they were scheduled for services. A patient with insurance who does not file a claim through their plan is considered to be self-pay for GFE purposes. This is something that many practices forget. This includes most patients who receive superbills. According to 45 CFR 149.610, these people should get a GFE before they start getting care.
We will write a separate post that goes over all of the CMS Good Faith Estimate rules in more depth. But if you send out a lot of superbills, you should check your GFE compliance right now. There is a gap there.
HSA and FSA Reimbursement
IRS Publication 502 says that a superbill can be used as proof for HSA or FSA repayment of approved medical costs. Patients can send the bill to their plan administrator and get reimbursed from their tax-advantaged account. As long as the service is considered a medical cost by the IRS, this is still true even if the insurance company doesn’t pay for the visit.
Honesty Rules
Make a list of the fees that were actually charged and received. The bill should show $80 if a client paid $80 on a sliding scale for a session that you normally charge $150 for. Misrepresenting by saying you got $150 when you only got $80 is wrong. Inflating fees to get the insurance company to pay out more is, without a doubt, federal insurance fraud. For services, the same rule applies: never list a code for something that wasn’t given.
Should You Offer Superbills or Get In-Network?
This is a real business choice, not just a taste for bills. If you offer superbills, you can keep your private pay, set your own hours, and skip the licensing process. However, you will be competing for patients with PPO plans and the money to pay up front and wait for reimbursement.
If you get insurance credentialing, you can see a wider range of patients, get steady claim volume, and connect with other doctors in your network. As a trade-off, you have to deal with a 90–180-day credentialing process, payer fee schedules you can’t change, and the billing infrastructure needed to track it all.
Keep some payers secret while getting approved by the top one or two plans in your area. This is the best answer for many small practices. Mental health credentialing in particular has expanded significantly as payers have added behavioral health to their panels under parity laws.
If you’re ready to look into in-network billing, Credex Healthcare can help you make the switch. They can handle billing for small practices and specialty credentialing.
Common Superbill Mistakes and Denials
Most of the time, the first pass is turned down because the NPI or EIN is missing. Both numbers must match exactly what the provider has on file.
The second most common problem is incorrect or missing diagnosis codes. There must be a valid ICD-10-CM code for each service line. Most of the time, a denial will happen if the code is too broad or too short (using a category code when a more specific code exists).
Most commercial payers will flag your practice if you use a PO box as the address. Make use of the actual location.
Since 2020, it’s become more common for telehealth POS numbers to be wrong. POS 02 and POS 10 can’t be switched around. Using the wrong one is an error you can fix, but you have to resubmit.
Another problem is putting an unpaid amount on the bill. The “amount paid” field should only show what was paid at the time of service, not what may still be owed.
The denial codes guide provides detailed information on the most common denials and explains why claims are denied and what payers really look for.
Frequently Asked Questions
Do insurance companies pay superbills?
Yes, if the patient meets the deductible and their plan covers care from providers outside of their network. Plan types like PPO and POS usually pay. Most HMO and EPO plans don’t.
Is a superbill the same as an invoice?
No. An invoice asks for payment that hasn’t been received yet. A superbill lists the care that was paid for and includes treatment and illness numbers so the insurance company can process a reimbursement claim.
How does a superbill work for therapy?
After you pay, the therapist gives you the bill. You send it to your insurance company along with their claim form. The insurance company reviews it, applies your out-of-network benefits, and sends you an EOB.
How do I submit a superbill to Medicare?
Most of the time, you can’t. Medicare users must have their providers file their bills directly. CMS-1490S isn’t used only when a provider forgets to file a required claim.
What is another name for a superbill?
A form to fill out, a charge slip, or an itemized receipt.
How do I create a superbill?
Check off the items on the list above: provider information, patient information, and service lines with CPT, ICD-10, POS codes, units, fee, and amount paid. Get started right away by downloading the free Credex Healthcare template.
Is a super bill the same as a superbill?
Yes. The same thing is called a “super bill” or “superbill,” which is two words. This post always spells things with the standard industry spelling, superbill.
Can I use a superbill for my HSA or FSA?
Usually, yes. Send it to your plan administrator as proof of a qualified medical expense, and they will reimburse you. Check IRS Publication 502 or ask your boss to be sure.
How long does reimbursement take?
Two to eight weeks is the norm. When it happens depends on the insurance company and what information they need.
Can a provider charge more on a superbill to increase reimbursement?
Not at all. Write down exact charged and received fee. It is false to say it is bigger than it really is; that is insurance fraud under federal law.
Conclusion
The idea behind a superbill is simple, but it’s hard to do. There are Medicare and Good Faith Estimate rules that many practices don’t know about. Make sure to correct every field and code.
If you have an out-of-network practice and spend too much time on billing, or if you want to get credentialed to attract more patients, Credex Healthcare can help. We handle mental health billing, physical therapy billing, chiropractic billing services, and billing for small practices throughout the revenue cycle. We not only handle mental health credentialing, but we also help companies get insurance credentialing when they want to add more types of payers.
