Free fillable superbill template for therapists

Fill in your practice once, add the client and their sessions, and save a superbill as a PDF. The checker flags what gets out-of-network claims sent back: a bad NPI, a cut-short diagnosis code, a telehealth session coded as an office visit, codes that can’t be billed together.

FreeNo sign-upRuns in your browser, nothing you type is sent to us

Your practice

Saved in this browser

Client

Diagnoses

1.

Sessions

Session 1
Session 2
Session 3
Session 4

Payment and statement

Before you hand it over

Everything checks out
  • PassNPI looks valid
  • PassTax ID is in EIN format
  • NoteCode every diagnosis to its full lengthA code missing a required character is invalid. Check each one against the current ICD-10-CM list.

Bayside Counseling

200 Central Ave, Suite 410 St. Petersburg, FL 33701

(727) 555-0142 · billing@baysidecounseling.example

Superbill

No. 1042

Issued October 31, 2026

Provider
Name
Jordan Lee, LMHC
NPI
1234567893
Tax ID (EIN)
12-3456789
License
MH 12345, Florida
Client
Name
Alex Rivera
Date of birth
April 12, 1988
Address
55 Bay Street, Tampa, FL 33602

Diagnoses (ICD-10-CM)

  1. 1.F41.1Generalized anxiety disorder
DatePOSCPTModServiceDxUnitsFee
10/6/20261190791Psychiatric diagnostic evaluation (intake)11$200.00
10/13/20261190837Psychotherapy, 60 minutes (53 or more)11$165.00
10/20/2026109083795Psychotherapy, 60 minutes (53 or more)11$165.00
10/27/20261190834Psychotherapy, 45 minutes (38 to 52)11$140.00
Total charges$670.00Paid 10/27/2026$670.00Balance due$0.00
Provider signature
Date

The client paid for these services in full or in part. This statement is for the client to submit to their health plan for out-of-network reimbursement. It is not a claim and does not guarantee payment.

Made with the free superbill generator from dailybuilt · dailybuilt.co/tools/superbill-generator/

How to use it

  1. 1Enter your practice details. They stay saved in this browser for next time.
  2. 2Add the client's name, date of birth and diagnosis codes.
  3. 3Add one line per session with the date, place of service, CPT code and fee.
  4. 4Fix anything the checker marks, then save the superbill as a PDF and sign it.
  5. 5Give it to the client to file with their plan.

Questions

Is this superbill generator really free?

Yes. There is no sign-up and no limit. The superbill is built in your browser and saved as a PDF on your own computer.

Do you see my client's information?

No. Everything you type stays in your browser and is never sent to dailybuilt. Your practice details are saved in this browser so you don't retype them. Client details are not saved anywhere.

What has to be on a superbill?

Your name, credential, 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, CPT code and any modifier, ICD-10 diagnosis code, units and fee, plus the amount paid and your signature.

Which place of service code do I use for telehealth?

CMS uses 02 when the client is not at home and 10 when the client is at home. Many plans also want modifier 95 for a video session. Check the client's plan.

Can I bill 90837 for a 50-minute session?

No. 90837 needs 53 minutes or more. A session of 38 to 52 minutes is 90834.

Who files the superbill?

The client does. They attach it to their plan's member claim form or upload it in the plan's member portal, and the plan pays them back under their out-of-network benefits.

Why superbills get sent back

Most rejected superbills are missing something the plan’s claim form requires: the NPI, the tax ID, a diagnosis code with every character it needs, or a procedure code that matches the time documented. Telehealth sessions coded as place of service 11, and evaluation codes billed together on the same day, come back too.

Read the full guide, with the CPT codes for mental health, speech, occupational and physical therapy: How to make a superbill for therapy.

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