What Is a Superbill for Therapy?

As a therapist, you may have heard a colleague talk about a “superbill” or may have had a client ask you for a superbill, and, perhaps, you wondered: “What is a superbill for therapy?”

This article answers the questions “What is a superbill?” and “Why are they so important?” 

For therapy clients, one of the biggest factors that can lead to treatment dropout is the cost of therapy.  

When clients are able to receive reimbursement from their health insurance plan for therapy, it can help them afford treatment.  

Unfortunately, both therapists and clients are often confused about how to seek reimbursement from insurance companies when the therapist is not credentialed or paneled with the client’s health insurance network.   

Developing an understanding of the billing form used in these cases—the superbill for therapy and mental health services—is a great place to start.

First, what is a superbill for insurance?

A superbill for insurance is an invoice or statement that is specifically designed for out-of-network clients or patients who are seeking insurance reimbursement for mental health services, such as therapy sessions.  

Essentially, the superbill for therapy is an itemized list of all services provided to a client, showing the charges and payments for those services.  

However, unlike a standard invoice, an ICD-10 superbill will have additional, more detailed information that an insurance plan needs to know about the session to determine if they will cover it, like ICD diagnosis codes and CPT codes. 

When you might provide a superbill for therapy

According to the superbill definition, they are only used for out-of-network billing.  

Therefore, you would NOT provide a superbill to a client if you were an in-network provider with your client’s insurance plan.  

Usually, out-of-network clients pay you directly as private pay therapy clients for your services. 

And, for those private pay clients who have out-of-network insurance coverage and who wish to seek insurance reimbursement, you would provide them with a superbill detailing those services and the costs.  

Then, the client would submit this superbill directly to their health insurance company. Or, another option is that you can submit the superbill to insurance on behalf of the client (more about this later). 

In some cases, clients may need to obtain a special claim form from their employer or their health plan to submit along with the superbill. This form would contain additional details, like the client’s address and their health plan name and ID numbers.

Can all therapy clients receive insurance reimbursement for therapy?

Clients should call their health plan before starting treatment to check their out-of-network mental health coverage.  

Typically, only clients with PPO (Preferred Provider Organization) or POS (Point of Service) insurance plans have the possibility of coverage for out-of-network therapists. 

In fact, even clients with PPO and POS insurance plans might not receive reimbursement if they have a large out-of-network deductible. In these cases, there may be a large amount of money the client would have to pay out-of-pocket before the insurance plan would reimburse them. 

Additionally, some plans have separate deductibles for in-network and out-of-network services.  Also, a few insurance plans won’t cover specific services, such as telehealth, when provided by out-of-network therapists, though this is less common.

What does a superbill look like?

Here is a sample image showing a superbill template:

What should be included on a superbill?

Like any statement or invoice, a superbill for mental health should contain basic information about you, your license, your degree, your tax ID, your office address, the client’s name and date of birth, and the specific mental health services you provided.  

Additionally, because it’s being provided to an insurance company, a superbill must also include ICD diagnosis codes and CPT codes.  

Here’s the information you need to include on a superbill:

Therapist info:

• Your name, degree, license, and license #
  
• Your Tax ID (Social Security Number or Employer ID Number) and your National Provider ID (NPI)
  
• Your address and phone number, and email address
  

o   Don’t use a PO Box – these may be rejected

o   For telehealth, use your official office address, even if you were at home for the session

Client info:

• Client’s full name and date of birth
  
• Diagnosis: Just the code(s)—the name of the diagnosis is optional

Session info:

• Session date of each session, listed separately
  
• Place of Service codes
  
• CPT codes and telehealth modifiers, if needed (most health plans require modifiers for video or phone sessions but not in-person sessions)
  
• Your charge for the service
  
• Amount paid by the client
• Your signature, which can be digital (may be optional, but recommended)

Tip:  Be sure to put each session—with their individual dates, codes, charges, and amount paid—on a separate line.

Now, if someone asks you “What is a superbill?” you will have a thorough understanding to respond with confidence.

After submitting the superbill

After you or the client has submitted the superbill to the insurance plan, the payer will review it. 

Then, the insurance company will decide to reimburse all, some, or none of the services, depending on the client’s coverage. This process can take a few weeks to a few months, depending on the insurance company. 

The client will then receive an Explanation of Benefits, or EOB, which outlines what was paid, what wasn’t paid, and why. The insurance company may also send the therapist a copy of the EOB for their records.

Tips for creating superbills for mental health

Provide clients superbills in PDF format

Providing the client a superbill in a PDF document format reduces the risk of potential fraud if a client were to alter it or add anything in order to get a higher reimbursement.

Encourage clients to submit superbills frequently throughout the year

When a client submits a year’s worth of superbills at one time, they may be more likely to get audited by the health plan. Also, it helps to find out early if there is a problem with their reimbursement, so it can be fixed.

If a client doesn’t ask for a superbill, inquire and educate

Clients may not be aware that they can get reimbursement for therapy with an out-of-network provider. They may appreciate you informing them about superbills, which may help make therapy more affordable for them.

Frequently asked questions (FAQs) about superbills

Q: If I have offered my client a reduced fee, should I put the reduced fee the client paid on the superbill, or put my full fee? 

A: If you have negotiated a lower fee with a client, that reduced fee should be reflected on the superbill. Making it seem like the client paid more would be fraud.

Q: On the superbill, can I put a higher fee than my regular full fee, to help my client get reimbursed more? 

A: While you may have a kind intent (to help the client get a higher reimbursement), that would be fraud.

Q: The health plan told my client that they needed me to sign a W-9 form before they could process her superbill.  Should I sign it? 

A: Yes. Some health plans require the provider to sign an IRS W-9 form to attest to their tax ID before they can put the provider in their database and pay the client.  Don’t worry—by providing this form, you are not joining the provider network or making any other commitment.

Can a therapist provide the client a superbill before they have paid for the session? 

Q: Can I give the client a superbill before they pay me for the session?

A: No. A client might ask you to do this, as getting insurance reimbursement first could help them pay you for the session. However, the superbill is a receipt for payment. The client can’t seek reimbursement for an amount they have yet to pay.   

Can the insurance company request to see a therapist’s client notes?

Q: Since I’m an out-of-network clinician, the health plan can’t ask for a clinical review, or to see my notes, right?

A: Unfortunately, this isn’t the case. As soon as your client submits a superbill and asks the health plan to pay for services, they are opening the door for the plan to review your care or ask to see your therapy notes to determine whether they want to reimburse the client for the sessions. Although this doesn’t happen frequently, it can happen. You will need to release the records if the client wishes you to do so and gives you a release form. 

This is why—even as an out-of-network clinician—it is essential to take and retain excellent therapy notes defending your care and supporting the diagnosis.

Should a therapist submit claims to out-of-network health insurance for clients?

Q: Even though I’m an out-of-network clinician, can I submit claims for clients?

A: If the client has paid you in full for a session, you can offer to submit the superbill (via mail or electronically) for them. This is a nice client benefit with little risk and little additional administrative effort for you. However, I do not recommend that you submit an out-of-network claim to the insurance, billing the insurance company on the client’s behalf, before the client has paid in full.

What I’m referring to here is when therapists submit insurance claims for out-of-network clients, requesting that the insurance plan pay the therapist whatever reimbursement amount they would have normally paid the client, and then, collecting the rest of your fee from the client. 

In recent years, therapists who submit out-of-network insurance claims are reporting difficulty with getting paid accurately—or receiving payment at all from the insurance plan. 

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