Superbill

A superbill is a detailed billing form used by healthcare providers that lists the services rendered during a patient visit along with the corresponding CPT codes, ICD-10 diagnosis codes, provider information, and patient details needed to submit an insurance claim or provide a receipt for out-of-network reimbursement. In behavioral health, superbills are commonly provided to patients who see out-of-network providers and need documentation to submit claims to their insurance for partial reimbursement.

Superbill Components

A compliant behavioral health superbill includes the provider's name, credentials, NPI number, and tax ID, the practice name, address, and contact information, the patient's name, date of birth, and insurance information, the date of service, the CPT code(s) for services rendered (such as 90834, 90837, 90853), the ICD-10 diagnosis code(s) supporting medical necessity, the fee charged for each service, the place of service code, and the provider's signature or electronic attestation.

Superbills for Out-of-Network Patients

Superbills are most commonly used when a patient sees an out-of-network behavioral health provider. The provider collects payment directly from the patient and provides a superbill. The patient then submits the superbill to their insurance company, which processes the claim against out-of-network benefits. Reimbursement depends on the plan's out-of-network allowed amount, deductible status, and coinsurance percentage. Patients typically receive 50-80% of the allowed amount (not the billed amount) after meeting their out-of-network deductible.

Superbills in EHR Systems

Modern EHR systems automate superbill generation by pulling service codes, diagnosis codes, and provider information directly from the session documentation. This eliminates manual form completion, reduces coding errors, and ensures that the superbill accurately reflects the documented services. Automated superbills can be generated as PDFs and made available to patients through the patient portal, emailed securely, or printed at checkout.

Common Superbill Errors

Frequent errors that delay patient reimbursement include mismatched CPT codes and session duration, missing or incorrect diagnosis codes, expired or incorrect provider NPI numbers, missing place of service codes, and diagnoses that do not support medical necessity for the billed service. EHR-generated superbills with built-in validation reduce these errors.

Superbills vs Claims

A superbill and an insurance claim contain similar information but serve different purposes. Providers use claim forms (CMS-1500 or electronic 837P) to bill insurance directly for in-network patients. Superbills are patient-facing documents that enable the patient to seek out-of-network reimbursement independently. Some practices provide superbills in addition to submitting claims when patients want documentation of services for their own records.

FAQs

When should a practice provide a superbill?

A superbill should be provided when the practice does not bill the patient's insurance directly — typically for out-of-network patients or those choosing to pay out of pocket and seek their own reimbursement.

Can patients get reimbursed from a superbill?

Yes, if their insurance plan includes out-of-network benefits. Reimbursement amounts depend on the plan's out-of-network allowed amount, deductible, and coinsurance structure. Not all plans have out-of-network benefits.

What is the difference between a superbill and a receipt?

A superbill includes specific CPT codes, diagnosis codes, and clinical information that insurance companies require to process a claim. A standard receipt only shows the amount paid. Insurance companies cannot process reimbursement from a receipt alone.

Should superbills include the diagnosis description or just the code?

Best practice is to include both the ICD-10 code and the written description to facilitate insurance processing and help patients understand what was documented. Some patients may have questions about their diagnosis, and the description provides context.

Learn More

• Superbills for Therapy: Complete Guide — How to create superbills and help clients get reimbursed
• Insurance Credentialing Guide — The in-network alternative to superbills
• Mental Health CPT Codes Guide — The codes that appear on superbills