How to make a superbill for therapy

A superbill is an itemized receipt with the codes an insurance plan needs to pay a client back for out-of-network therapy. To make one, list your name, credentials, NPI, tax ID, license and practice address, the client's name and date of birth, and one line per visit with the date, place of service code, CPT code and any modifier, ICD-10 diagnosis code, units, fee and amount paid. Sign it and give it to the client, who files it with their plan.

You file nothing. The client does, and in therapy that is common. In an April 2024 report built on claims for more than 22 million people, RTI International found that patients went out-of-network 3.5 times more often to see a behavioral health clinician than a medical or surgical clinician, and 10.6 times more often to see a psychologist. Many of those clients pay in full, then ask their plan for money back.

What is a superbill, and who can use one?

A superbill is not a claim. You hand it to the client, who attaches it to the plan's own claim form.

It only pays if the plan covers out-of-network care. HealthCare.gov says a PPO lets members use providers outside the network "for an additional cost". An HMO "generally won't cover out-of-network care except in an emergency", and an EPO covers services only inside its network, except in an emergency. Ask clients to check their benefits before the first session, not after the fifth.

What goes on a superbill?

There is no single federal superbill form, so test yours against the plan's claim form. Florida Blue's current form requires an itemized bill showing the provider's name, address, tax ID and NPI, the member's name, the patient's full name, the type of service and procedure code, the date of service, the diagnosis and diagnosis code, the condition treated and the charge for each service.

Use this checklist on every superbill.

Field	What to write	Watch for
Practice	Legal name and street address	Match what the plan has on file
Provider	Name and credential (LMHC, CCC-SLP, OTR/L, DPT)	The clinician who saw the client
NPI	10 digits	Your Type 1; add the group's Type 2 if you bill as a group
Tax ID	Your EIN	Keeps your SSN off client paperwork
License	Number and issuing state	Exactly as the state lists it
Client	Full name, date of birth, address	Add the policyholder if it is someone else
Date of service	One line per visit	Never one line for a whole month
Place of service	11, 02 or 10	Telehealth needs its own code
CPT code	Code plus any modifier, such as 90837 with 95	Must match the time you documented
Diagnosis	ICD-10-CM code or codes	Every character the code requires
Diagnosis pointer	Which diagnosis each line treats	1 for primary, 2 for secondary
Units	1 for most session codes	Timed 15-minute codes count differently
Fee	Your full charge per line	Not what you expect the plan to pay
Amount paid	Total paid and the date	Shows the client already paid you
Signature	Provider signature and date	Sign every one

NPI and tax ID

CMS issues the NPI as a 10-digit number: Type 1 for individual providers, including sole proprietors, and Type 2 for organizations. An incorporated clinician can hold both.

For the tax ID, use an Employer Identification Number. The IRS issues one online and says "You never have to pay a fee for an EIN."

Diagnosis codes

Use the code set in force on the date of service. The FY 2027 ICD-10-CM guidelines cover October 1, 2026 to September 30, 2027. They say codes have 3 to 7 characters, and a code "is invalid if it has not been coded to the full number of characters required for that code". A three-character code is only valid when the category has no subdivisions.

Place of service and telehealth modifiers

The CMS place of service codes for most therapy visits are 11 (office), 02 (telehealth, client not at home), 10 (telehealth, client at home) and 12 (in person at the client's home).

Modifier 95 marks a session over real-time audio and video. Modifier 93 marks audio only. Plans differ on whether they want the modifier, the telehealth code or both, so check. Medicare requires GN, GO or GP on speech, occupational and physical therapy lines. Add them if the client's plan asks.

Which CPT codes go on a therapy superbill?

CPT codes belong to the American Medical Association. The tables below summarize descriptors from CMS, a Medicare contractor and the professional associations. Check the current CPT book before you build a template.

Mental health

Code	Service	Time
90791	Psychiatric diagnostic evaluation	Intake
90832	Psychotherapy, 30 minutes	16 to 37 minutes
90834	Psychotherapy, 45 minutes	38 to 52 minutes
90837	Psychotherapy, 60 minutes	53 minutes or longer
90846	Family psychotherapy, client not present
90847	Family psychotherapy, client present
90853	Group psychotherapy

A 50-minute session is 90834, not 90837.

Speech-language pathology

Code	Service
92507	Treatment of speech, language, voice, communication or auditory processing disorder, individual
92508	The same, group of 2 or more
92521	Evaluation of speech fluency
92522	Evaluation of speech sound production
92523	Speech sound production plus language evaluation
92524	Behavioral and qualitative analysis of voice and resonance
92526	Treatment of swallowing dysfunction or oral function for feeding
92610	Evaluation of oral and pharyngeal swallowing function

ASHA notes that most SLP codes are untimed. Medicare's claims manual bills an untimed code as 1 unit, however long the session ran. ASHA's list also says not to bill 92522 with 92523.

Occupational and physical therapy

Evaluations are 97161, 97162 and 97163 for physical therapy and 97165, 97166 and 97167 for occupational therapy, at low, moderate and high complexity. Re-evaluations are 97164 and 97168.

Code	Service, each 15 minutes
97110	Therapeutic exercise for strength, endurance, range of motion and flexibility
97112	Neuromuscular reeducation of movement, balance, coordination and posture
97140	Manual therapy techniques
97530	Therapeutic activities, one-on-one, to improve functional performance
97535	Self-care and home management training

Medicare counts 15-minute units by total timed minutes in the day: 8 to 22 minutes is 1 unit, 23 to 37 is 2, 38 to 52 is 3, and 53 to 67 is 4. A plan may count differently, so check before you set up a template.

How do clients submit a superbill?

Check benefits. The client asks the plan about out-of-network coverage, the deductible, coinsurance and the filing deadline.
Get the form. The client downloads the plan's member claim form, or finds the claim upload page in the member portal.
One form per person and per provider. Florida Blue requires a separate form for each family member and each provider.
Attach the superbill. Keep a copy. Florida Blue does not return originals.
File on time. Florida Blue gives members one year from the date of service.
Read the explanation of benefits. If the charge went toward the deductible, nothing is paid yet.

Florida and Medicare

Medicare works differently. Medicare.gov says a non-participating provider should submit the claim to Medicare, and if you opted out, "Medicare won't pay for any service you get from this doctor, even if it's a Medicare-covered service." In Florida, Medicare claims go to First Coast Service Options.

Why do superbill claims get rejected?

No NPI or tax ID. Florida Blue lists both as required.
A diagnosis code that is missing or cut short. A code without its required characters is invalid.
Time that does not support the code. A 50-minute session billed as 90837.
A telehealth session coded as an office visit. Place of service 11 with no modifier.
Codes that cannot be billed together, such as 92522 and 92523 on the same day.
A late claim. Past the plan's deadline, nothing pays.
No out-of-network benefits. HMO and EPO plans generally pay nothing outside the network.
A receipt with no codes. Florida Blue requires procedure and diagnosis codes, and a plain payment receipt has neither.

Do self-pay clients need a Good Faith Estimate?

Under the No Surprises Act, providers must give a Good Faith Estimate to uninsured and self-pay clients. CMS defines a self-pay client as one who has coverage but is not seeking to have a claim submitted to it. That splits private-pay clients into groups.

Client	Good Faith Estimate
No health coverage	Required
Has coverage, will not file a claim	Required
Has coverage, will file your superbill	Enforcement deferred by HHS since 2021, pending further rules
Medicare, Medicaid or TRICARE	Not eligible

Timing, from the CMS decision tree:

Scheduled 3 to 9 business days ahead: give it within 1 business day of scheduling.
Scheduled 10 or more business days ahead: within 3 business days.
Requested without scheduling: within 3 business days of the request.
Scheduled fewer than 3 business days ahead: not required.

For recurring care, such as counseling or physical therapy, one estimate can cover the series. It lists the expected services, diagnosis codes, service codes and charges, and tells the client they can dispute a bill that comes in $400 or more above it. It must be in writing, on paper or electronically, in the form the client prefers.

Ask every new client at intake whether they plan to file a claim, and write the answer down. Giving an estimate to the third group anyway costs little. This post is not legal advice.

Where dailybuilt fits

dailybuilt builds superbills from your invoices in its Healthcare Edition. From a sent invoice, it generates a superbill PDF with the provider's NPI, the client's ICD-10 diagnoses and the CPT code on each line. The client gets an email with a link to their client page, where they download it. The email itself carries no codes or diagnoses. dailybuilt does not file claims with insurers. The client files.

We switch on Healthcare Edition when a practice asks, free on any plan. The owner accepts a Business Associate Agreement in the product, and online booking stays closed until they do. Texts are off in that edition, so reminders go by email. If an agency put your practice on GoHighLevel, see what its HIPAA add-on costs and the alternatives.

For private-pay practices in Florida, our team sets up the website, booking, consent forms, invoices and superbills for you. See our practice setup.