What Is a Superbill (and When Therapists Use It)

If you run a private pay (out-of-network) practice, you will inevitably hear the question: “Do you take my insurance?”

When you say “No, but I can provide a superbill,” the client often nods while secretly wondering, “What is a superbill?” And sometimes, let’s be honest, the therapist is wondering the same thing—specifically, what exactly needs to be on it to ensure the client actually gets paid back and doesn't send you ten angry emails later.

A superbill is essentially a detailed receipt designed for insurance reimbursement. It bridges the gap between your cash-pay practice and the client’s insurance benefits. It allows you to maintain your rates and autonomy while still helping clients access their out-of-network (OON) benefits.

Educational note: Requirements vary by payer and plan. This article is for educational purposes and is not billing or legal advice.

Who this is for

This guide is for private practice therapists who are not paneled with insurance (or who have a hybrid practice) and want to provide professional, accurate documentation to clients seeking reimbursement.

What you’ll walk away with

You’ll learn exactly what data points are required on a superbill, how to handle the tricky "Place of Service" codes for telehealth (02 vs 10), how to explain the process to clients using a simple script, and how to avoid the common errors that cause claims to be rejected.

When therapists use superbills

You generally provide a superbill when three specific conditions are met. First, you are out-of-network, meaning you do not hold a contract with the client's insurance company (or you have opted out of Medicare). Second, the client has out-of-network benefits. Not all insurance plans cover out-of-network providers. PPO plans usually do, while HMO plans usually don't. It is the client's responsibility to verify this, but you can help them by providing a "Cheat Sheet" of questions to ask their insurer. Third, the client has already paid you. A superbill is a receipt. It serves as proof that the service happened and that it was paid for. If you submit a claim for an unpaid session, that’s a different process called "courtesy billing."

What typically belongs on a superbill

To an insurance company, a "receipt" from a credit card terminal (like Square or Stripe) is useless. It proves money changed hands, but it doesn't prove why. They need clinical and provider data to verify that the service was medically necessary and performed by a licensed professional. Most superbills must include three categories of data: Provider Information, Client Information, and Service Details.

1. Provider Information (Who you are)

You need to list your full name and credentials, for example, "Sarah Miller, PsyD" rather than just "Sarah Miller." Your NPI Number is critical; this is your Type 1 (Individual) National Provider Identifier and is the single most important number on the form. You must also include your Tax ID (EIN or SSN) because even if you are out-of-network, the insurer needs to know who got paid for tax purposes. Finally, include your license number with the state of licensure, your physical practice address and phone number, and a physical or digital signature to validate the document.

2. Client Information (Who they are)

The form must list the client's full legal name, not a nickname. It must match what is on their insurance card exactly. You also need their Date of Birth, which is essential for matching the member in the payer's system, and often their current address and phone number. Crucially, you must include a Diagnosis (ICD-10 Code), which acts as the medical justification for the service.

3. Service Details (What happened)

For each session, you must list the Date of Service and the CPT Code (procedure code), such as 90837 for 60-minute psychotherapy or 90791 for an intake. You also need a Diagnosis Pointer linking the procedure to the diagnosis, a Place of Service (POS) code indicating where the session happened, the fee charged, and the amount paid, confirming the client has a zero balance for that session.

Place of service codes and telehealth: The Confusion

One of the most common sources of confusion—and claim rejections—is the Place of Service (POS) code, especially since the explosion of telehealth. For years, "11" (Office) was the standard. Then came telehealth, and the codes have evolved.

CMS (Centers for Medicare & Medicaid Services) updated these codes to distinguish where the client is located. You should use POS 10 when the client is in their home, which is the case for most telehealth sessions. You should use POS 02 when the client is not in their home, such as if they are joining the session from a library or their workplace office. While many commercial payers now follow CMS guidance and prefer POS 10 for standard home-based telehealth, some legacy systems still look for POS 02, or even POS 11 with a "95" modifier. If a claim is rejected, checking the payer’s specific telehealth policy is the first troubleshooting step.

The diagnosis code conversation: How to explain it

This is the biggest friction point in private pay. To get reimbursed, the insurance company requires a "medical necessity" justification. In the language of billing, that justification is a diagnosis code (ICD-10). You cannot bill insurance (or provide a superbill) for "personal growth" or "couples conflict" without a medical diagnosis.

This has privacy implications. Once you submit a diagnosis (e.g., F41.1 Generalized Anxiety Disorder), it becomes part of the client’s permanent medical record. You should explain this to your clients. A simple script might be: "If you want to use your insurance benefits, I am required to give you a mental health diagnosis, such as Anxiety or Depression. This becomes part of your permanent medical record. Some clients prefer to keep their therapy completely private and pay out of pocket without a diagnosis. Which would you prefer?"

How clients use a superbill

The workflow is simple but puts the burden on the client. First, you generate the superbill (usually monthly) and email it or upload it to the portal for the client. Next, the client logs into their insurance portal or prints a claim form. They attach the superbill and submit it. The insurer then reviews the claim. If approved, the insurer sends a check to the client (not you) for their out-of-network rate, which might be something like 60% of the allowable amount after their deductible is met.

Common superbill mistakes (and how to avoid them)

We see claims rejected for simple administrative errors. A missing NPI or Tax ID is a frequent culprit; ensure these are on every document template. A diagnosis mismatch, where the code doesn't match the description or is no longer valid, will also cause rejection. Incorrect dates, especially typos in the year during January, are common. Using the wrong POS code, like "11" for a Zoom session, is another frequent error. Finally, illegible information on hand-written forms is a guarantee for rejection. It is always better to use software like Soli that generates these forms automatically and legibly.

Practical Next Steps

First, check your template. Does your current invoice or superbill have all the fields listed above? If not, update it today. Second, update your intake forms. Ensure you are collecting the client’s full legal name, DOB, and address—you’ll need them for the superbill later. Third, have the "Diagnosis Talk." Practice your script for explaining why a diagnosis is required for reimbursement so you don't feel awkward bringing it up.

The bottom line

Superbills are a powerful tool for access. They allow you to run a sustainable private practice without managing insurance contracts, while still helping your clients afford the care they need.

Sources

• CMS Place of Service Codes: Code Set Maintenance
• CMS Telehealth POS Guidance: New/Modifications to the Place of Service (POS) Codes for Telehealth
• HHS Telehealth Billing: Billing and Coding Medicare Fee-for-Service Claims
• SimplePractice: Superbills for Therapy: A Guide