Therapy Superbill Template: An Easy, Essential Field Guide
A therapy superbill template is a reusable form that turns each paid session into an itemized receipt a client can send to their health plan for out-of-network reimbursement. The finished document is a superbill: it lists the provider, the client, the diagnosis, the service codes and what the client paid. This guide gives you the fields, the codes and the checks, from the practice’s side.
What goes on a therapy superbill template
A therapy superbill template needs the same facts a plan would look for on a claim: who provided the service, who received it, what was done, and what was paid. Missing or mismatched fields are the usual reason a plan sends the document back. Build every field into the template so staff fill it in from the note, not from memory.
| Field | What to enter | Check |
|---|---|---|
| Provider | Name, credentials, address and National Provider Identifier (NPI); tax ID if the plan asks | NPI is the unique ID for covered providers |
| Client | Name and date of birth as on the plan card | Spelling must match the card |
| Member ID and group number | Exactly as printed on the card | The NUCC claim form manual uses the card for both |
| Date of service | One line per session | Matches the note |
| Diagnosis | ICD-10-CM code you documented | Use the most specific code the note supports |
| Service | CPT code for the documented time | See the next section |
| Place of service | Where the session happened | Video: 10 if the client is at home, 02 if not |
| Fee and payment | Fee charged and amount paid, per session | No payment, no superbill |
| Signature and date | Provider’s | Never pre-signed |
For the telehealth place of service codes, CMS defines 10 as telehealth with the patient at home and 02 as telehealth with the patient elsewhere. Private plans can add modifier rules, so confirm what the plan wants.
Which CPT code goes on the therapy superbill template?
The code follows the documented time with the client, not the length of the appointment slot. The American Psychiatric Association’s CPT overview gives the time ranges for the stand-alone psychotherapy codes. We paraphrase the descriptors because CPT belongs to the AMA.
| Code | Psychotherapy time |
|---|---|
| 90832 | 16 to 37 minutes |
| 90834 | 38 to 52 minutes |
| 90837 | 53 minutes or more |
So a 50-minute session belongs under 90834. Psychiatrists: when psychotherapy happens in the same visit as medication management, the same overview says to report an evaluation and management (E/M) code plus the add-on that matches the time (90833, 90836 or 90838). Code what you documented. Changing a code to raise reimbursement is a compliance problem, so ask your counsel if a payer’s rules seem to push you that way.
Build your therapy superbill template in six steps
- Make one master file with every field above and lock the fixed ones, such as provider details.
- Add a line for each session date, code, diagnosis and fee.
- Add the amount paid and the payment date.
- Test it on one recent session and compare it with the note.
- Save it as a PDF so formatting does not shift.
- Add a short line stating that reimbursement is the plan’s decision.
Superbill, invoice and claim form: what is different?
A superbill documents paid services for the client’s plan, an invoice asks the client to pay, and a claim goes from the practice to the payer. Mixing them up causes errors, so keep three templates.
| Document | Purpose | Who sends it |
|---|---|---|
| Invoice | Requests payment and shows a balance | Practice to client |
| Superbill | Shows paid services, codes and diagnosis | Practice to client, then client to plan |
| CMS-1500 claim | Professional claim to the payer | Practice or biller to payer |
The money side belongs to a different guide. Read how a plan calculates its payment in our out-of-network billing guide, and use our insurance verification steps before the first session.
What to tell clients before you hand over a superbill
Tell clients that the plan decides whether and how much to reimburse, and that you cannot promise an amount. Say it once at intake and again on the document. For a client who pays without using insurance, remember the estimate rules for self-pay clients, and ask your counsel how they apply.
- Ask the client to confirm their out-of-network benefits and the plan’s filing deadline.
- Explain that a superbill shows what was paid, not what the plan will pay.
- Keep a copy and note the date you sent it.
Private payers
Each plan sets its own form requirements, filing deadline and rules for member-filed claims. We give no universal deadline because there is none. Check each plan’s instructions, and see the credentialing guide on in-network vs out-of-network status for why network status changes the paperwork.
Medicare and Medicaid
A superbill is a private-plan tool. CMS says providers who opt out of Medicare sign a private contract with each Medicare patient, the patient pays directly, and no one bills Medicare. Medicaid is administered by each state, so check your state agency before issuing superbills to Medicaid clients.
Can a client send a superbill to their insurance?
Yes, if the plan has out-of-network benefits and accepts member-filed claims. The plan then decides what it reimburses and how fast. Some plans have no out-of-network benefit at all, which is why verification comes first.
Which document does this client need?
Plans set their own out-of-network rules. Tell clients to check their benefits. This is operational guidance, not legal advice.
Therapy superbill field checklist
Tick each field before you hand a superbill to a client.
What to do Monday morning
- Open your current therapy superbill template and check it against the field table.
- Confirm the CPT code on a recent superbill matches the documented time.
- Add the reimbursement disclaimer line.
- Spot-check three recent superbills against their notes.
The short version: therapy superbill template
A good therapy superbill template has every provider, client, code and payment field filled from the note. Match the CPT code to documented time, add a no-promise line, and send it only for paid sessions.
How MCM South helps
MCM South Medical Billing Service, LLC bills out-of-network claims for psychotherapists and psychiatrists in solo and medium-size practices. You keep control of your fee and your payment policy, and we handle the claim work.
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FAQ
How many sessions can go on one superbill?
Many practices list several dates on one superbill, one line per session. Some plans want a different layout, so ask the client to check their plan.
Does a superbill guarantee reimbursement?
No. The plan decides what it reimburses based on the client’s out-of-network benefits and its own rules.
What if the plan sends the superbill back?
Find the reason. If a field was wrong or missing, correct it and reissue. Never change the documented service to match what the plan will pay.
Should I put a tax ID on the template?
Add it if the plan asks for it. Check each plan’s instructions.
Where MCM South works
MCM South Medical Billing Service, LLC works with psychotherapists and psychiatrists in our ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. We serve solo and medium-size practices that bill mental and behavioral health. Founder Michael Williams has worked with insurance payers in all 50 states. Browse the state and regional billing guides for rules that vary by state, or see our billing services.
This post is operational guidance for billing, not legal advice. Rules change, so confirm with the payer or your counsel.
