Even if you have decided not to deal with insurance companies, you may have a client ask you for a “Super Bill” so they can submit on their behalf for reimbursement.
A Super Bill is much more than just a receipt or a standard invoice you might see or use on a regular basis. Insurance companies require specific information in order to consider requests for reimbursement or requests that your charges be counted toward your client’s deductible.
Super Bills should include:
- Your (the provider’s) Name & Credentials
- Your office address
- Your federal tax ID number (if you don’t have one of these you’ll have to give them your social security number)
- The date(s) of service
- The CPT code(s) (of the type of service you provide — for example, 90801 for Initial Assessment or 90806 for 50-minute follow up therapy visit)
- The ICD-9 or DSM codes for the diagnosis
- The fee for service
You might want to set up a template on your computer so they are at your fingertips and you can fill them out quickly for your client.
Clearly there is sensitive information on the Super Bill (You really want to get a tax ID number now don’t you?), but it is a must for any client who has to submit these bills to their insurance company for any reason.
There you have it…
Deb Legge
Thanks for the great post Dr. Legge. One question, if I am listing the FEE per session, am I required to list what the patient actually paid for that session, or can I list a number of sessions on the SuperBill with the associated fees and then have a total paid at the bottom?
@Wilson: Usually companies will accept a Super Bill with more than one date of service as long as you note the CPT code and fee for each session. You can then note the total paid at the bottom.
Hi Deb,
I just started going through your Boot Camp material and I’m finding it very helpful. I saw this post and have a question about the Super Bill. If my client pays me my fee and I give them a Super Bill to turn into their insurance company (Insurance Company A) — do I have to be on panel with Insurance Company A for the client to be reimbursed? Or, is there typically a different level of reimbursement to the client if I’m on panel with them versus not being on panel? That’s one thing about the Super Bill that I’m unclear on — thanks and hope you had a great Labor Day Weekend!
Hi Elizabeth. The super bill is for any client to turn into their insurance company. Whether or not they get reimbursed is based on their insurance coverage. You do not have to be on panel with that insurance company (if you were, you would be billing them direct and not giving your client a super bill). If insurance companies provide out of network benefits, the reimbursement rates are often different (higher) than they pay paneled providers. That being said, you give your client the super bill for the amount you collected from them. It is just the paperwork they need to apply for reimbursement from their insurance. Hope that helps!
Crystal clear and very helpful -as always….thanks!
Hi Deb,
Hope you can assist in answering the below question for me. I recently became a LMHC and am working independently. A client would like a “superbill” so they may be reimbursed by their insurance carrier. However, a “superbill” requires a diagnosis code. As a LMHC in the state of NY am i allowed to provide this? This is the individuals first time in counseling and has not be ddiagnosed previously. If i cannot diagnosis clients, what is the procedure for working with client’s who would like a “superbill” for insurance reimbursement that do not have a diagnosis when they come to see me?
@Keith – You can provide a diagnosis code for the superbill and for any insurance billing as well. The word “diagnosis” was left out, but we are able to utilize the DSM multi axial system to assess our clients. Hopefully this will soon be a moot point in NYS.
Thank you for the quick response!
Hi Deborah, I work in an acupuncture office, so I’m not sure if this is the right place to ask my question, but I’d appreciate your input. We package our services into a flat rate fee. Treatment usually consists of a combination of consultation and acupuncture services. However, the actual procedures differ slightly from patient to patient. Given that we charge a flat rate (as opposed to having an assigned price for each specific procedure), what would you suggest is the best way to present this on the superbill so that the patient gets the appropriate reimbursement? Thanks!
@Neelie – Insurance companies usually require the procedure code as well as the fee for that service. You may have to divide it up on the super bill as I’m guessing your combined services don’t have a CPT code. You can always call the specific insurance company as well.
Hi, thanks for all your help; however, I would like to see a sample form to use for me to set up my own form. Can you provide that?
@Adrienne – You can find lots of examples of superbills in a Google search however you’ll find that most of them are for physical health issues. In Behavioral Health, you’ll find that most clinicians put the items listed in this post on their letterhead and give them to the client for submission.
Hi Deb,
So I just wanted to know, is Super bill one whole word or is it two separate words? I’ve been seeing it both ways and I would like to know which is the correct way???
@ Brittney – I’ve seen it both ways. Whichever gets you paid, I guess LOL
Dr. Legge,
Thank you for this helpful information. To clarify: If I am on an insurance panel, does that mean that I cannot opt for my clients to submit their own insurance claims via Superbill for reimbursement?
Are there any restrictions on which patients you can ask to submit their own claims ? Or can you do it for any and all patients, regardless of whether you are an In-Network or Out of Network provider on insurance panels?
Thank you so genuinely for your helpful and incredibly *useful* information.
Warmly, Christina
@Christina – I’ve never encountered an insurance company that does not require the participating provider to bill for the clients. You can check your contracts, but I’ve never seen otherwise. When it comes to providing “out of network” benefits, you’ll have to check with the specific insurance company for their requirements. As the rules can be very different for out-of-network providers vs. in-network providers.
For example, there are insurance companies that will allow electronic billing ONLY for participating providers. Out-of-network providers must send in paper claims. If you are accepting assignment for the out-of-network benefit (you are getting the checks directly), then you must follow their rules.
If, on the other hand, you do not wish to participate with insurance, you can simply provide your clients with a Super Bill, which they can submit for their own reimbursement.
I hope that helps
Hi Dr. Legge,
My colleague told me that it is illegal to charge a client more than it is stated or amt the insurance agreed to pay. For example, if I charged $90 and my client actually paid $90 and I gave the client the superbill for $90 but the insurance only allowed $60. Is that illegal?
Thanks,
Rachel
@Rachel – This is a good question. You will want to check with the laws in your specific state, but for the most part, when you are out of the insurance company’s network and you provide a Super Bill to your client, you are simply providing them with a RECEIPT for what they paid you. They can submit that to the insurance company for consideration according to their plan.
Thanks a lot for the grt stuff. I have two questions.
1.Is Superbill only applicable for consumers to get their money reimbursed from the Payers or Providers also can use it ?
2. What is the difference between a Superbill and a Claim?
Super bills are usually given to clients who are seeing reimbursement from their insurance carriers. Essentially, the super bill is a receipt that has all of the elements that are required by most insurance companies in order to reimburse the insured.
A claim is an invoice the provider sends to the insurance company. It can be submitted electronically or on paper (CMS1500 form).
Thank you for providing this forum for us to get our questions answered…it is much appreciated.
My question is in regards to how much to charge.
I am not asking for an actual amount, but am curious to whether or not we use the same fee schedule for both types of payment options…
1) the In-Network patients that we are submitting the claims for, and 2) for the Out-of-Network patients that are paying at the time service, and are then receiving a Superbill in order for them to process and get reimbursed with.
For example : If I am in-network with A, do I charge them $100 for a service because I am submitting the claim and charge, out-of-network B $80 for the same service and give them a superbill to get reimbursed.
I am under the assumption that there needs to be one set fee schedule, regardless of who is doing the submitting.
I hope that made sense 🙂
Thank you in advance for your time and commitment to helping us!
@Dustin – You set a fee that you use whenever you bill insurance companies (your posted fee). If you collect from client and they want to submit to their insurance for reimbursement, you give the clients a Super Bill for the amount they paid you (essentially it is a receipt). You are always billing insurance the same amount. I think you might find my Money Matters in Private Practice program helpful — it answers lots of questions about money issues including insurance, out of network, and talking with clients about private pay.
Thank you for the valuable information. Have you found or do you have a good superbill template to work from? If so, are you willing to share?
@Joseph – So glad you find the info helpful Joseph. You can find the requirements for the super bill in the post. If you’d like some good templates, forms, worksheets, and training videos, check out the Money Matters in Private Practice program!
I have been getting the question lately, as a new practitioner in the cash for service world, of how easy is it to get reimbursed (providing I give them the proper superbill)?
In other words, is it a pain in the butt which will deter patients from coming in because they don’t want to deal with it as it is a hassle, or is it simply a matter of getting the right address and sending it in and the reimbursement comes in a month or so.
Thanks so much!!
Health, Sean
@ Sean One big thing to remember Sean, is you can’t speak for the insurance companies. If and how they reimburse for out of network services is up to them. I encourage clients to check on that benefit (and often I make the call for them and relay the information), and let them know that I will provide them with a comprehensive receipt (“super bill”) for them to access the benefit. You can’t really tell them how it is going to go — that is between them and their insurance company. Empower the client to get the facts up front so there are no surprises. Give them a great reason to choose you despite the insurance situation and they will do what they need to do in order to work with you!
hello,
great post. thank you.
my question – as an LMHC in New York, do I need to include an NPI # on the super bill?
if yes, can I provide a bill after my number is assigned (currently in process) that includes dates of service prior to having the NPI number?
For example: Assume I get my NPI number on 2/1/15. Can I give my client a bill on 2/2/15 with my NPI number attached, itemizing sessions from January ’15?
also, are we allowed to bill clients immediately after getting licensure using our social, and then update the paperwork to utilize our tax ID when that is finalized?
thanks!
You need to include your tax ID (or your social security number if you don’t have a tax ID). You can get a Tax ID number by going online to the IRS site It does not take long. You probably don’t want to give your clients access to your social security number. You don’t need your license to get a tax ID number.
Hi Legge, thanks for this awesome post! I am a mental health therapist, got my Masters in Clinical Social Work on the eastcoast, but currently live/work in California. I am not licensed in California yet, but I do have my masters degree (so can provide counseling) and I am also CAADAC certified as a dual diagnosis mental health therapist ( to do counseling). My q’s is- I normally collaborate with another private practice when my clients want super bills, and also give the practice 40% for just that. I am looking into doing superbilling on my own- and my q’s is….do you know if I can get an NPI # if I am not “licensed” in California? Can I use my CAADAC certification in lue of that? as I am an accredited by them to do mental health counseling? I have been dying to get this answer-fingers crossed, and thank you!
@ Joanna – You can find out about getting an NPI here: https://nppes.cms.hhs.gov/NPPES/Welcome.do With regard to what you are doing — It seems you may want to consult with California licensing body to find out if you are, in fact, allowed to do counseling without a license in a private practice setting. Your question about the super bill coming from another private practice even though you are providing the services is something you will want to ask them as well. Because your intent is to one day be licensed, you don’t want to preclude yourself from that option by not knowing and abiding by the state laws around that profession. Good luck to you Joanna.
Thank you so much for all the very useful information!
I would like to know if it is mandatory to put your address on the superbill. I am a speech language pathologist and go in the home to provide services. The only address I have is my home address and I am reluctant to put it on the superbill…
Thanks for your help!
@ Andrea – It’s really up to the insurance company I believe. If you try it without and they are rejected you will know. You can always get a P.O. Box if necessary.
Hello Dr. Legge,
Thank you for this helpful blog. I am a psychologist and specialize in assessment, and have a four-fold question.
1) I charge per assessment, not per CPT code (since I only accept out-of-pocket). So, when I provide the superbill, do I need to make a rate that matches each CPT code? Or do I just list all CPT codes used and then the entire fee for the assessment?
2) For assessment, can clients get reimbursed for my writing time and interpretation time? Or just administration?
3) I am not a neuropsychologist, but I have a neuropsychology certificate and frequently administer neuropsychological assessments (i.e., NEPSY-II). Can I use the neuropsychology codes? Or is that just for board certified neuropsychologists?
4) Is there a limit to the number of Mental Health CPT codes that patients can get reimbursed for, or does that differ per client’s health insurance?
Any information would be greatly appreciated!
Thank You!
Mishone
@Susan – These are all questions for each insurance company. They are the ones who ultimately determine what they will pay for and whom they will pay. It can not only differ by insurance company, but it can also differ by insurance plan. It’s always good practice to contact the insurance company of any new client to verify coverage, verify you are an acceptable provider, and verify which codes/services they will cover. Good luck to you Susan.
Thanks for writing this post. I have been using superbills for quite a few years. I just got a question that I did not know the answer to. Can clients submit the superbill to the insurance company without any further information? My superbills do have all the info you mentioned. I am assuming all a client needs is a complete superbill and the correct claims address. Thanks for your help.
@Uriah – That would be up to their insurance company. Some may have out of network benefit forms. They would have to call member services to find out how to submit for reimbursement. I hope that helps…
Hello Dr Legge,
I’m an lmft that’s licensed in CA. am I able to practice without having an office or address and see clients in their homes instead? Is it okay to provide them with a superbill and can I have a PO box as my address or nothing at all on the superbill? Is it ethical to see a client from the past that has returned to therapy with you even if you saw them in a different setting before ?Thank.you so much for your help.
@Joseph – I would encourage you to ask these questions of your State, Joseph. As long as there are no legal or ethical barriers, you should be able to structure your business as you like. With regard to the superbill, the insurance company will let you know if the P.O. Box is not sufficient. I would be surprised if it is a problem, however. Read the ACA code of ethics and as long as you are not in violation of those guidelines, you should be okay.
Hi, thanks for all this helpful info.
I am a patient starting to see a new therapist, she offers a Superbill in which I pay $70 out of my pocket each time and then she spoke to my insurance which will give me about $40 back but I need to be diagnosed which will be on my record and insurance. I just don’t know if I’m doing the right thing in staying with this out of network therapist and have been reading online that the Superbill is not always guaranteed, come the end of the month. Is there a catch?
@lilroxyange – Even if you go to an in-network therapist, there will need to be a diagnosis. For the most part, mental health benefits are paid based on medical necessity — that means you need to have a psychiatric diagnosis. The only way around this that I’m aware of is for you to pay privately. I hope that helps.
Hi Deborah,
I’m an acupuncturist that supplies Superbills quite frequently (and its all been great!) but recently I have a patient asking me for my NPI number. I’ve never needed one before, and haven’t heard back from her insurance company yet. From my understanding its a number that providers need to bill directly for insurance. Is this necessary for a superbill? Are they, or she, just not understanding things? Thanks for your help!
@Patricia = Some insurance companies require NPI numbers in addition to tax ID numbers on Superbills. You can call her insurance company and find out exactly what they need. I know I put my NPI on my superbills as well as my tax ID.
Hi Dr. Legge!
I run a fee for service practice, but will provide Superbills to those wishing to seek reimbursement from their insurance companies. I have chosen not to work directly with managed care, for several reasons, but primarily to protect confidentiality. Lately, however, I have received requests directly from a couple insurance companies asking that I provide them with the entire medical records of my clients in order for them to be reimbursed for services (this, in addition to the Superbills). This is not something I feel comfortable with, and is also something that doesn’t seem typical for OON services. Are you familiar with companies requiring this information outside of the Superbill? Thanks!!
@Chris – I have never had this experience. Since you are not a contracted provider you don’t have to provide them with anything. If you want to comply, ask your client if s/he wants you to do this and then have them sign a release.
Hi Deb!
Thanks for all the inspiration! I had been in discussion with a client about using a superbill, but after the first session she informed me that her deductible is too high. She really wanted to stay with me, so I offered her a sliding scale fee. Now, about 2 months later, she is asking for superbill receipts for all the sessions she has attended–stating that she “plans to submit them anyway”. My understanding is that superbills are provided to those clients paying full fee for services…not for those on a sliding scale. Because if she’s gonna get reimbursed, the sliding scale wouldn’t have existed to begin with–and now she really comes out on top. Does that make sense? What are your thoughts?
Thanks, Sarah
@Sarah — A superbill is just a special receipt. Your super bill should reflect the amount she paid. She can submit that. She will be reimbursed based on what she paid you. I hope that helps
Can you clarify on this? My understanding is it is insurance fraud if we provide a Superbill for insurance reimbursement while the client is on a sliding scale. To me it feels unethical to charge one person my full rate to get reimbursement, but offer a sliding scale to another client and they still get reimbursed from insurance.
The Super Bill is simply a receipt of what the client has paid you. What they are, or are not reimbursed is between them and their insurance company. If you’re uncomfortable with the sliding scale folks being reimbursed, then perhaps you can find a way to make peace with that in terms of your fees. That’s the only leverage you have there.
Hi Dr Leggie,
You have been a wealth of information so far, thanks for the information. My question is I am currently a Registered Clinical Social Work Intern in private practice under supervision in Florida, can I use a superbill for clients who have insurance? I have an Npi number but do I need my supervisor to sign off on diagnosis or can I sign off in order for the client to get reimbursed? Thanks for your response.
@Claudia – Check with the insurance company to see if you are an approved provider for out of network benefits. This will likely vary and they can tell you what they need if, in fact, you are.
Hi Deb!
Are you aware of any new CPT codes recently put in place? I have been using 90806 for individual therapy on my superbills, but was just informed by a client that her insurance company is asking me to redo them all because “my codes are outdated”, and the new CPT for individual therapy should be 90843?
Thanks, Christine
@Christine – The CPT codes changed in 2013. The new code for 90806 is 90834. You can find a summary of the changes here: http://www.apapracticecentral.org/reimbursement/billing/crosswalk-codes.aspx. I hope that helps!
If I have a client on a sliding scale fee, and later they ask for a Superbill, is that insurance fraud as they received a discount AND are submitting to insurance?
As long as you are not a provider for that insurance company, and you give her a super bill for the amount she actually paid you, you are fine. They will pay or deny her claim and that’s between them. Hope that helps!
Your statement in your article almost directly addresses my situation:
“Clearly there is sensitive information on the Super Bill (You really want to get a tax ID number now don’t you?), but it is a must for any client who has to submit these bills to their insurance company for any reason.”
I do NOT have a tax ID number/EIN. I only take 2 insurances (Medicare and Empire) and they use my ss # . I work part-time as a NY State LCSW private psychotherapist.
I looked at the IRS.gov site about EIN’s
(https://www.irs.gov/businesses/small-businesses-self-employed/do-you-need-an-ein)
and all the answers to their list, in my case, are “No.”
Should I get the EIN anyway? Will it change my tax status and will I be required to do anything different when I file my taxes? I don’t think a NY State tax ID number will accomplish what I need, the only thing I can find is a sales tax number and I clearly don’t want that.
Thanks for any info on this. I could not log in to participate in the discussion and your article was written a while ago so I don’t know if I can reach you or if this topic is still open.
Kathy R., LCSW
Sorry for the delay Kathy. Yes, get the EIN – otherwise you’ll have to give out your social security number. You likely file a schedule C, so it won’t matter if you use and EIN, but check with your tax accountant.
Hello!
My question has to do with insurance companies waiving fees during the pandemic.
Do I need to include telehealth codes (location – 02; modifier – 95) on my superbill for my client’s fees to be waived?
Thank you!
Hi Jen. You should always use accurate CPT codes and modifiers on your super bills. So the location and modifier should be accurate. That being said, I’ve found that during the pandemic different insurance companies are requiring different coding. For example, I’m using 90834 GT for most, but I’ve got one that requires 90834 95 (and rather than using 02 for “telehealth” it requires “11” because, they say, it would be in the office if possible. So… i’d just be as accurate as possible and if the client tells you their insurance needs different coding you’ll know how to edit and resubmit.
That’s good to know that the bill will include a lot of things. That sounds hard to keep track of. I should take a look into someone to help me.
Hi! Thanks for the advice on your site. It’s so helpful. I am wondering if I apply for an EIN number and used my home address, would my clients find my home address that way? I am providing virtual psychotherapy at this time. Thank you!
I can only say that I wouldn’t put my home address on anything that is public record. I’m not sure how difficult/easy it would be, but probably not worth taking the chance.
My daughter’s new therapist is out-of-network and has provided a superbill which did not include the EIN. The therapist is refusing to give her EIN to my insurance company, even verbally over the phone, for “security reasons”. My insurance company is denying my claim and says that they have to have the EIN to process claims and that this typically isn’t an issue. Do I have any recourse other than to find a new therapist?
It is my understanding the EIN is public information – they are used so people don’t have to divulge their social security numbers. Without it you likely won’t be able to submit to your out of network benefit.