Free template

Superbill template for therapy practices

By Albert Wong, PhD, Clinical Psychologist

A superbill is an itemized receipt with enough billing detail that your client can file it with their insurance for out-of-network reimbursement. You do not bill the insurer; the client pays you in full, submits the superbill, and the plan reimburses them according to their out-of-network benefits. For a cash-pay practice, a clean superbill is the highest-leverage document you produce: it costs you two minutes and can return a meaningful share of your fee to the client every month.

Two ways to use this page: copy the plain-text template below into your own document, or use our free superbill generator — the interactive version of this same document, which fills in the structure, does the math, and produces a one-page PDF entirely in your browser.

The template

Plain text — paste into any EHR or document

SUPERBILL — STATEMENT FOR INSURANCE REIMBURSEMENT

PROVIDER
Practice name: ______________________________
Practice address: ___________________________
Phone / email: ______________________________
Clinician name & credentials: _______________
License number / state: _____________________
Clinician NPI: ______________________________
Practice (group) NPI, if any: _______________
Tax ID (EIN or SSN): ________________________
Taxonomy code (optional): ___________________

CLIENT
Name: _______________________________________
Date of birth: ______________________________
Address: ____________________________________

DIAGNOSIS
ICD-10 code(s): _____________________________

SERVICES
Date of       CPT     Description           Place of   Fee      Paid
service       code                          service
__________    _____   ___________________   ________   ______   ______
__________    _____   ___________________   ________   ______   ______
__________    _____   ___________________   ________   ______   ______

Total charged: ______________
Total paid by client: ______________
Amount due from client: $0.00 (paid in full) / ______________

Payment received by: ________________________
Provider signature: _________________________   Date: ____________

Note to insurer: The client has paid for these services directly.
Please send reimbursement to the client (the subscriber), not to
the provider.

A filled example

"Jamie A.", the practice, and every identifier below are fictional (the NPI and license are placeholder zeros). Never copy identifying details from real charts into templates or samples.

Fictional example — for structure, not content

SUPERBILL — FILLED EXAMPLE (fictional client and practice)

PROVIDER
Practice name: Harborview Counseling (fictional)
Practice address: 100 Example Street, Suite 2, Springfield, ST 00000
Phone / email: (555) 555-0100 / billing@example.com
Clinician name & credentials: A. Beaumont, PsyD
License number / state: PSY-000000 / ST
Clinician NPI: 0000000000 (10-digit NPI goes here)
Practice (group) NPI, if any: n/a
Tax ID (EIN): 00-0000000

CLIENT
Name: Jamie A. (fictional)
Date of birth: 01/01/1990
Address: 200 Sample Avenue, Springfield, ST 00000

DIAGNOSIS
ICD-10 code(s): F41.1

SERVICES
Date of       CPT     Description           Place of   Fee      Paid
service       code                          service
03/05/2026    90791   Diagnostic eval       11         $200     $200
03/12/2026    90834   Psychotherapy, 45m    11         $150     $150
03/19/2026    90834   Psychotherapy, 45m    10         $150     $150
                      (telehealth, home)

Total charged: $500
Total paid by client: $500
Amount due from client: $0.00 (paid in full)

Payment received by: A. Beaumont, PsyD
Provider signature: A. Beaumont, PsyD        Date: 03/19/2026

Note to insurer: The client has paid for these services directly.
Please send reimbursement to the client (the subscriber), not to
the provider.

Getting the details right

NPI and diagnosis are the two fields that decide the claim. Missing either is the classic bounce. If you have both an individual and a group NPI, include both.
CPT code and session length must agree. 90834 is 45-minute psychotherapy, 90837 is 60 — the CPT code picker covers the codes and time thresholds a therapy practice actually uses.
Set the client's expectations before the first superbill. Reimbursement depends on out-of-network benefits and deductibles, and unfamiliar terms ("allowed amount," "coinsurance") do the confusing — the billing glossary translates them. For self-pay clients, remember a Good Faith Estimate is its own obligation — see the GFE checklist.
Monthly beats per-session. One superbill covering the month's paid sessions is less work for you and a simpler routine for the client.

Practice Harbor generates superbills automatically from your calendar and billing records — and its note templates with AI drafting keep the documentation behind each CPT code in order.

Common questions

What has to be on a superbill for a claim to process?

The fields insurers consistently need: practice name and address; clinician name, credentials, and license number; the clinician’s NPI; a tax ID; the client’s name and date of birth; an ICD-10 diagnosis code; and one line per session with date of service, CPT code, place of service, fee, and amount paid. The two most common reasons a superbill bounces are a missing NPI and a missing diagnosis code. Everything else on the template — taxonomy code, group NPI — is occasionally requested and cheap to include.

Does a superbill really need a diagnosis code?

Yes, if the client wants reimbursement — insurers pay for treatment of a diagnosed condition, and a claim without an ICD-10 code will be rejected or returned for more information. This is worth an explicit conversation at intake: a client who files superbills is placing their mental health diagnosis into their insurance record. Some clients will decide the reimbursement is not worth that, and that is a legitimate choice for them to make — but it is theirs to make, informed.

How do I fill out a superbill for telehealth sessions?

Use the place-of-service code that reflects where the client was: POS 10 for telehealth in the client’s home, POS 02 for telehealth elsewhere, versus POS 11 for your office. Many plans also expect a telehealth modifier (95 is the most commonly requested) appended to the CPT code. Telehealth reimbursement rules genuinely vary by plan, so when a client’s telehealth superbills bounce, the plan’s own out-of-network telehealth policy is the first thing to check.

Can I give a superbill for sessions the client hasn’t paid for yet?

A superbill asserts that the client paid you and asks the insurer to reimburse the client. Issuing one for unpaid sessions misstates that, and can result in the client being reimbursed for money they never spent. Wait until payment has been made — most practices generate superbills monthly, after the month’s sessions are paid — and show the amount paid on the document, as the template does.

Should I submit the superbill to the insurance company for my client?

The standard arrangement is that the client submits it — through their member portal, app, or by mail — and reimbursement goes to the client, since they already paid you. If you start filing with the insurer on the client’s behalf, you are effectively doing out-of-network billing, a different workflow with its own claim forms (the CMS-1500) and payer relationships. There is nothing wrong with that choice, but make it deliberately; handing the client a complete superbill and a two-line explanation of how to submit it serves most practices well.

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This template and guidance are general billing education, not legal or payer-specific advice. Reimbursement depends on each client's plan; nothing here guarantees payment. Requirements vary by state and payer contract — check yours.

Billing is the other half of the job. Practice Harbor is an EHR built by a psychologist — superbills, invoices, and claims generated from the calendar you already keep.

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