If you run an out-of-network or private pay therapy practice, many of your clients still have insurance, and some of them will ask for a superbill so they can get part of their session fees back. A superbill that is missing one detail can mean a rejected reimbursement request and a frustrated client. Here is what a therapy superbill needs to include, how clients use it, and the rules that apply when clients pay you directly.
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What Is a Superbill?
A superbill is an itemized statement of the services you provided, written in the language insurance companies use: procedure codes, diagnosis codes, dates, and fees. Your client pays you directly, then submits the superbill to their insurance plan to request reimbursement under their out-of-network benefits. You are not filing a claim or dealing with the payer; the client is.
Superbills are common in therapy practices that are not in network with a client’s plan, and in practices that choose not to accept insurance at all.
What to Include on a Therapy Superbill
Practice and clinician information
- Clinician’s full name and credentials, such as LMHC, LPC, LMFT, LCSW, or PhD.
- License number and the state that issued it.
- NPI number. Use the clinician’s individual (Type 1) NPI, and include the group (Type 2) NPI if you bill under a group practice.
- Tax ID (EIN) or, for some solo clinicians, the identifier your practice uses for tax reporting.
- Practice name, address, and phone number.
Client information
- Client’s full name, date of birth, and address.
- Insurance member ID and the subscriber’s name if the client is a dependent. This is optional on many superbills, but it helps the plan match the request.
Session details
- Date of each session.
- CPT code for each service.
- Place of service code: 11 for an office visit, 10 for telehealth when the client is at home, and 02 for telehealth when the client is somewhere other than home.
- Any modifiers the client’s plan requires for telehealth, such as 95.
- ICD-10 diagnosis code or codes.
- Your fee for each session, the amount the client paid, and any balance.
Signature
The clinician’s signature and the date the superbill was issued. Many plans will not process a superbill without it.
Common CPT Codes on Therapy Superbills
- 90791: psychiatric diagnostic evaluation, usually the intake session.
- 90832, 90834, 90837: individual psychotherapy for 16 to 37 minutes, 38 to 52 minutes, and 53 minutes or more. The documented time has to support the code.
- 90846 and 90847: family psychotherapy without and with the client present.
- 90853: group psychotherapy.
- 90839 and 90840: psychotherapy for crisis, for the first 60 minutes and each additional 30 minutes.
Using the wrong time-based code is one of the most common reasons a reimbursement request is reduced or denied.
Diagnosis Codes and Client Privacy
Insurance plans reimburse treatment for a diagnosed condition, so a superbill must include an ICD-10 code. Some clients are surprised by this, and some choose to pay entirely out of pocket rather than share a diagnosis with their insurer. It is worth explaining before the first superbill that the plan will see the diagnosis, and that services without a covered diagnosis, such as some relationship counseling, may not be reimbursed at all.
How Clients Get Reimbursed
- Check out-of-network benefits first. HMO and EPO plans often have no out-of-network benefits. PPO and POS plans usually do, with a separate deductible and coinsurance.
- Understand the allowed amount. The plan reimburses based on its own allowed amount for the service, not on your fee. If your fee is $175 and the plan allows $120 at 70% after the deductible, the client receives $84, not $122.50.
- Submit the superbill. Clients usually upload it through the plan’s member portal or mail it with the plan’s claim form.
- Watch the deadline. Every plan has a time limit for submitting out-of-network claims. Encourage clients to submit monthly rather than waiting until the end of the year.
Superbills and the Good Faith Estimate
Under the No Surprises Act, since January 1, 2022, therapists must give a Good Faith Estimate of expected charges to clients who are uninsured or who are not using insurance, either when a session is scheduled or when the client asks for one. A client who has insurance but pays you directly and submits their own superbill counts as self-pay for this purpose, so they are entitled to an estimate. If a client’s final bill comes in at least $400 above the estimate, they can dispute it. The Good Faith Estimate comes before care; the superbill comes after.
Common Superbill Mistakes
- Leaving off the NPI or the license number.
- Using place of service 11 for a telehealth session.
- Listing a 60-minute fee with a 90834 code, or a 45-minute session with 90837.
- Omitting the diagnosis code.
- Listing the fee but not the amount paid, so the plan cannot tell what the client is owed.
- Issuing one superbill for many months of sessions, which can push older sessions past the plan’s deadline.
- Missing the clinician’s signature.
Superbills or Going In Network?
Superbills keep insurance paperwork off your desk, but they shift the work to your clients, and some clients will choose a therapist who is in network instead. If you are seeing more clients ask about insurance, it may be time to look at which plans make sense to join. Credentialing commonly takes months, so it helps to start before you need it. Our mental health credentialing services cover the applications, CAQH, and follow-up, and our therapy billing services handle the claims once you are in network.
If you run a small or solo practice and want to talk through whether accepting insurance is worth it, see our billing services for small practices or contact us.
Quick Superbill Checklist
- Clinician name, credentials, license number and state
- Individual NPI, and group NPI if applicable
- Tax ID and practice contact information
- Client name, date of birth, and address
- Date, CPT code, and place of service for every session
- Telehealth modifier if the plan requires one
- ICD-10 diagnosis code
- Fee, amount paid, and balance
- Clinician signature and date
If you would rather submit out-of-network claims for your clients than hand them superbills, our out-of-network billing services cover benefit checks, claim submission, and follow-up.