Superbill Template: CPT, ICD-10 and Out-of-Network Claims

Quick answer: A superbill template is an itemised receipt for self-pay patients that lists the provider's name, NPI and tax ID, the patient's details, each date of service, place of service, CPT procedure codes, ICD-10-CM diagnosis codes, fees, amount paid and a signature. The patient sends it to their insurer to claim out-of-network reimbursement.

Therapists, psychiatrists, dietitians, physical therapists and other private-pay clinicians use superbills every month. Patients pay you directly, then ask their insurer to pay some of it back. The superbill is the document that makes that possible, and a missing code or identifier is enough to get the claim returned. Like any medical invoice template, it needs to be accurate, consistent and easy to read.

This guide covers every field a superbill needs, the codes most often used, how out-of-network reimbursement works, the No Surprises Act rules for self-pay patients, a worked example with real arithmetic, and how to produce a clean superbill PDF in our free invoice generator.

What is a superbill and who uses one?

A superbill is a detailed receipt, not a claim. When a provider is in network, they bill the insurer directly on a CMS-1500 or electronic claim. When a provider is out of network or does not accept insurance, the patient pays in full and then claims from their own plan. The insurer needs proof of what was done, why, by whom and what was paid. That is the superbill.

Superbills are most common in:

• Mental health: psychotherapists, counsellors, psychologists and psychiatrists in private practice.
• Allied health: physical, occupational and speech therapists, dietitians.
• Specialist care: some chiropractors, acupuncturists and direct primary care practices.

Patients with PPO or POS plans are the most likely to have out-of-network benefits. HMO and EPO plans often have none outside emergencies, so it helps to tell patients to check their benefits before they rely on reimbursement.

What a superbill template must include

Insurers process superbills by matching them to claim data, so completeness matters more than design. A complete superbill template has four blocks.

Provider information

• Provider name and credentials, such as Maria Ortiz, LCSW.
• Practice name, address and phone number.
• Individual NPI, and the group NPI if you bill as a group.
• Tax ID (EIN or SSN). Many solo clinicians get an EIN to avoid printing their SSN; our guide on how to get an EIN explains the process, and tax IDs on invoices covers where to place it.
• State licence number, and taxonomy code if payers ask for it.

Patient information

• Patient's full name, date of birth and address.
• Insurance member ID, if the patient gives it to you.
• The policy holder's name if different from the patient.

Service lines

• Date of service, one line per session.
• Place of service code.
• CPT code and any modifier.
• ICD-10-CM diagnosis code or codes, linked to each line.
• Units and fee for each line.

Payment and signature

• Total charges, amount paid, payment dates and balance due.
• Provider signature and date, typed or handwritten according to payer preference.

An itemized invoice already follows most of this structure. The superbill simply adds the clinical codes and identifiers insurers require.

CPT, ICD-10 and place of service codes explained

Three code sets do most of the work on a superbill. Getting them right is the difference between a quick reimbursement and a returned claim.

Code type	What it describes	Example	Who maintains it
CPT	The procedure or service	90837, psychotherapy, 53 minutes or more	American Medical Association, updated each January
ICD-10-CM	The diagnosis that makes the service medically necessary	F41.1, generalised anxiety disorder	CMS and CDC, updated each October
Place of service	Where the service happened	11 office, 10 telehealth at home, 02 telehealth elsewhere	CMS
Modifier	Extra detail about the service	95, synchronous telehealth	AMA and payers

The ICD-10-CM code set changes every 1 October. CMS publishes the FY 2027 code files, which apply to patient encounters from 1 October 2026 to 30 September 2027, on its CMS ICD-10 code set page. Use the most specific code your documentation supports.

Common therapy CPT codes

• 90791: psychiatric diagnostic evaluation, usually the intake session.
• 90832: psychotherapy, about 30 minutes (16 to 37 minutes).
• 90834: psychotherapy, about 45 minutes (38 to 52 minutes).
• 90837: psychotherapy, 53 minutes or more.
• 90847: family psychotherapy with the patient present.

Bill the code your documented time supports, not the scheduled length. If a 60-minute appointment ran 50 minutes of therapy, 90834 is usually the correct code. Check payer policies and the current CPT book, because codes and guidance change.

How out-of-network reimbursement works

Patients are often surprised by how little or how much comes back. Walking them through the process up front saves you from being asked later. The usual steps are:

1. The patient checks their plan's out-of-network benefits: deductible, coinsurance and any session limits.
2. The patient pays you at each session.
3. You issue a superbill, usually monthly.
4. The patient submits it with the insurer's member claim form, online or by post.
5. The insurer works out its allowed amount for each CPT code, which may be lower than your fee.
6. The insurer applies the out-of-network deductible, then pays its coinsurance share of the allowed amount.
7. The insurer sends the patient an explanation of benefits and a payment.

Helping patients submit their superbill

A little guidance up front saves a lot of email later. Many practices give new self-pay patients a one-page handout explaining how to find their plan's out-of-network claim form, where to upload or post it, and roughly how long processing takes. Suggest that patients call the number on their insurance card and ask three questions: whether they have out-of-network mental health or therapy benefits, how much of the out-of-network deductible remains, and what percentage the plan reimburses after that. Some insurers also cap the number of sessions per year or require pre-authorisation. Encourage patients to submit monthly rather than saving a year of superbills, because many plans have claim filing deadlines.

You are not part of the claim, so you cannot chase it. What you can do is make sure the superbill is complete and matches your records, so that any problem is on the plan's side, not yours.

Sample superbill with reimbursement arithmetic

Here is an illustrative example. A licensed clinical social worker charges $180 for a 53-minute or longer psychotherapy session. In October 2026 the patient attended four in-office sessions and paid in full each time. The patient's plan has met its out-of-network deductible, allows $150 for 90837 and pays 70% of the allowed amount.

Date	POS	CPT	ICD-10-CM	Fee	Paid
6 Oct 2026	11	90837	F41.1	$180.00	$180.00
13 Oct 2026	11	90837	F41.1	$180.00	$180.00
20 Oct 2026	11	90837	F41.1	$180.00	$180.00
27 Oct 2026	11	90837	F41.1	$180.00	$180.00
Totals				$720.00	$720.00

Balance due: $720.00 - $720.00 = $0.00. The plan's allowed amount is 4 x $150 = $600, and 70% of $600 is $420, so the patient should expect about $420 back. Their out-of-pocket cost is $720 - $420 = $300, or $75 a session. The numbers are illustrative; real allowed amounts and coinsurance vary by plan.

How to build a superbill in the generator

Our generator is a general invoice tool rather than medical billing software, but it produces a clean, professional superbill PDF if you set it up like this:

1. Open the USA invoice generator.
2. In your business details, add your name, credentials, practice address, NPI, tax ID and licence number.
3. In the client section, add the patient's name, date of birth and address.
4. Add one line per session, with a description such as 06 Oct 2026, POS 11, CPT 90837, ICD-10 F41.1. Quantity 1, rate $180.
5. Leave tax at zero, since medical services are generally not subject to sales tax.
6. Enter the amount paid so the balance due shows $0.00.
7. In the notes, add Superbill for out-of-network reimbursement, and a signature line with the date.
8. Download the PDF and send it to the patient through a secure channel.

A restrained layout reads best for clinical documents. The corporate invoice template and the classic invoice template both work well.

No Surprises Act: good faith estimates for self-pay patients

Since 2022, the federal No Surprises Act has required healthcare providers to give uninsured or self-pay patients a good faith estimate of expected charges when they schedule care or ask for one. Patients who pay you directly and claim out-of-network themselves are generally treated as self-pay for this purpose.

According to CMS, if the final bill from a provider is at least $400 more than the expected charges on that provider's good faith estimate, the patient can use the federal patient-provider dispute resolution process. For ongoing therapy, many practices issue an estimate covering a set period, such as twelve months of weekly sessions, and update it if the fee or frequency changes. Keep the estimate, the superbills and your receipts consistent with each other. This is general information, not legal advice; check current CMS guidance or a healthcare attorney for your situation.

Privacy and secure delivery

A superbill contains protected health information: diagnosis codes, dates of treatment and identifiers. If you are a HIPAA-covered entity, treat it accordingly. Practical steps:

• Send superbills through a secure client portal or encrypted email, not ordinary unencrypted email.
• Only include the diagnosis codes needed to support the services billed.
• Confirm the patient's address and policy holder details before sending, especially for dependants.
• Keep copies with your billing records for as long as your state and licensing board require. Our guide on how long to keep invoices covers general retention.

Superbill vs invoice vs receipt

These three documents overlap, but they do different jobs.

Document	Purpose	Clinical codes?	Typical user
Invoice	Requests payment that is owed	No	Any business
Receipt	Confirms payment was received	No	Any business, and HSA or FSA claims
Superbill	Proves paid medical services for insurance reimbursement	Yes: CPT, ICD-10, POS	Out-of-network providers and their patients

Read our explainer on invoice vs receipt for the general difference. If a client only needs proof of payment for an HSA, a simple payment receipt may be enough. For bodywork clinics, our sibling guide to the massage therapy invoice template explains HSA receipts and letters of medical necessity.

Common superbill mistakes

• Missing NPI or tax ID. The most common reason superbills are returned.
• Codes that do not match the notes. The CPT code must reflect the documented time and service.
• Outdated ICD-10 codes. Codes change every October; use the current set.
• Wrong place of service for telehealth. Use the code for where the patient was.
• Totals that do not reconcile. Fees, payments and balance must add up exactly.
• No signature. Many insurers require one.
• Sending it insecurely. Diagnosis codes are sensitive health information.

Create your superbill

A superbill template turns a self-pay session into money back for your patient, and it costs you only a few minutes a month. Include your NPI and tax ID, one line per date of service with POS, CPT and ICD-10-CM codes, the fee and the amount paid, then sign it and send it securely. Build a clean superbill PDF in the free invoice generator and keep a copy with your records.