How to Make a Superbill for Therapy

A superbill is a detailed invoice for therapy services, allowing clients to seek reimbursement from their insurance providers for out-of-network care. It itemizes the services received, dates of service, and associated costs. Creating and utilizing a superbill helps both therapists operating outside insurance networks and clients seeking to maximize their benefits. This document allows clients to potentially recover a portion of their therapy expenses, even when their therapist does not directly bill insurance.

Understanding the Superbill

A superbill is a comprehensive receipt outlining the healthcare services a client has received. Its purpose is to provide all necessary information for an insurance company to process an out-of-network claim. When a therapist operates outside insurance networks, clients typically pay for services directly. The superbill then allows clients to submit a claim to their insurer, potentially recouping a percentage of their out-of-pocket expenses.

The superbill connects cash-pay or out-of-network services with potential insurance reimbursement. It itemizes the services provided and includes the specific codes insurance companies require for claim processing. This document does not guarantee reimbursement, as coverage depends on the client’s individual insurance plan and out-of-network benefits. However, it is a necessary document for clients to initiate the reimbursement process with their insurer.

Essential Information for a Superbill

A superbill must contain specific details for insurance company acceptance and reimbursement. These include:

• The provider’s name, address, and phone number.
• The therapist’s National Provider Identifier (NPI), a unique 10-digit identification number assigned to healthcare providers by the Centers for Medicare & Medicaid Services (CMS) for billing purposes.
• The provider’s Tax ID, which can be an Employer Identification Number (EIN) or Social Security Number (SSN).
• The client’s full name, address, and date of birth.
• Each date of service, alongside the specific type of therapy service provided, such as individual therapy or family therapy.
• Current Procedural Terminology (CPT) codes for each service rendered. These are standardized five-character codes maintained by the American Medical Association (AMA) that describe medical services and treatments. Examples for therapy include 90837 for a 60-minute psychotherapy session or 90834 for a 45-minute session.
• The duration of each session and the fee charged per session.
• The International Classification of Diseases, 10th Revision (ICD-10) code. This global standard documents medical diagnoses and explains why a patient is receiving care. These codes identify the client’s diagnosis, such as a mood disorder or an anxiety disorder.
• A place of service code, indicating where the service was provided (e.g., outpatient office).

Creating Your Superbill

Several methods exist for creating a superbill.

Manual templates can be designed in a word processor or spreadsheet program. These templates should include dedicated fields for provider and client details, dates of service, CPT codes, and fees. Data is then manually entered into these fields for each session.

Electronic Health Record (EHR) systems and practice management software solutions often offer built-in superbill generation features. Within such software, therapists can select the client, specify the dates of service, and choose the appropriate CPT and ICD-10 codes from a dropdown menu. The system then automatically populates the superbill and can generate a printable or electronic document. This method often reduces manual entry errors and streamlines the process.

Specialized superbill software or third-party services can automate and simplify the creation process. These tools are designed to manage billing and claims, often integrating with existing practice workflows. They help ensure all necessary fields are completed accurately and may offer features like secure client portals for easy superbill access. Verify the accuracy of all entered data before providing the superbill to the client.

Client Submission and Follow-Up

After receiving a complete superbill, the client begins the process of submitting it to their insurance company for reimbursement. The initial step for the client is to contact their insurance provider to understand their specific out-of-network benefits for behavioral health services and the exact submission process. This inquiry helps clarify deductible amounts, reimbursement percentages, and whether claims can be submitted online, via mail, or by fax.

The insurance company may require the client to complete a specific claim form, which typically asks for basic policyholder information and details about the services received. The superbill is then attached to this completed claim form. Clients should make copies of all submitted documents for their own records, including the superbill and any forms.

Once the complete package is submitted, clients can generally expect to receive an Explanation of Benefits (EOB) from their insurer. This document details how the claim was processed, the amount covered, and the amount the client remains responsible for. Reimbursement timelines can vary, typically ranging from two weeks to three months, though some claims might take longer, especially if there are discrepancies. Tracking the submission date and following up with the insurance company if reimbursement is not received within a reasonable timeframe, such as 30 days, is advisable.