What is a superbill? A template, a sample and how patients submit one

A superbill is an itemized record of a visit: who provided the care, what the service was, the diagnosis behind it, what it cost and what was paid, written in the codes insurers use. The word has two uses. Inside a practice's billing workflow, it is the form a visit is coded on before a claim goes out. In cash-pay care, it is the receipt a patient who paid out of pocket sends to their insurer to ask for out-of-network reimbursement.

Superbills are routine in private-pay therapy, psychiatry and other cash-pay specialties. This guide covers both meanings, what goes on one, a template you can copy, a filled-in sample, how patients submit one to insurance, and why it belongs in your marketing as much as your billing. The code formats were checked against CMS files on 8 October 2026.

What a superbill is, and what it isn't

In a cash-pay practice, a superbill documents a visit the patient has already paid for. The patient, not the practice, sends it to their insurer, usually with the insurer's own claim form, and asks to be reimbursed under their out-of-network benefits.

• It is not a claim. The practice isn't billing the insurer and isn't in its network.
• It is not a promise. Whether the patient gets anything back depends on their plan: whether it has out-of-network benefits, the deductible, and the share it pays. Never tell a patient they will be reimbursed.
• It is not a plain receipt. A receipt shows a payment. A superbill adds the provider identifiers and the service and diagnosis codes an insurer asks for.

What is a superbill in medical billing?

In a practice that bills insurance itself, the superbill never reaches the patient. It is the form, on paper or on screen, where the clinician records what was done at a visit and why, so the billing staff can build the claim. You'll also see it called an encounter form or a charge slip.

The American Academy of Family Physicians' journal described the superbill's main purpose as letting the doctor tell the office staff, and through them the payer, what services were provided and why they were necessary (Family Practice Management, 2006). That article's code lists use ICD-9, which CMS says was replaced by ICD-10 for services on or after 1 October 2015.

The codes on the form become the claim. CMS describes the CMS-1500 as the standard claim form a non-institutional provider or supplier uses to bill Medicare, and some state Medicaid agencies use it too. The National Uniform Claim Committee maintains the form, and CMS says the paper version is for providers who qualify for a waiver from the requirement to submit claims electronically (checked 8 October 2026).

The rest of this guide is about the second kind: the superbill a cash-pay or out-of-network practice hands to a patient.

What a superbill includes

Use the codes you actually billed and documented. A superbill has to match the record of the visit, so it is the clinician's or biller's document to complete, not the front desk's to improvise. Two details catch people out:

• Diagnosis codes have to be complete. ICD-10-CM codes have 3 to 7 characters, and the official coding guidelines say a code is invalid if it isn't coded to the full number of characters it requires. Use the code set in effect on the date of service: CMS's current ICD-10-CM files apply to encounters from 1 October 2026 to 30 September 2027.
• Place of service matches where the visit happened. In CMS's place of service code set, 11 is an office, 10 is telehealth provided in the patient's home, and 02 is telehealth provided somewhere other than the patient's home.

Superbill template

A free layout you can copy onto your letterhead or set up in your practice management system. It carries every field in the table above. It is a template to adapt, not a form any insurer requires: replace everything in brackets, check it against your patients' plan instructions, and have your biller or a healthcare attorney review your version.

Many practice management and EHR systems can generate this from the visit record, which is safer than typing it by hand each month.

Sample superbill

Here is the same template filled in for one month of therapy. The practice, clinician, client, identifiers and fee are fictional. The codes are real: CPT codes with the short descriptors CMS publishes in its October 2026 physician fee schedule file, and a diagnosis code from CMS's current ICD-10-CM code descriptions. It shows format only. It is not coding advice for any client.

The $200 fee is a placeholder, not a typical or recommended rate. For a longer session, CMS lists 90837 with the short descriptor "Psytx w pt 60 minutes". The clinician picks codes from what was documented, not from a sample. CPT codes and descriptions are copyright the American Medical Association, as CMS's fee schedule files note.

Superbills for therapy

Therapy practices issue more superbills than almost anyone, and one point deserves a conversation before the first one goes out: a superbill shares a diagnosis with the client's insurer. Insurers generally need a diagnosis code to consider reimbursement. Some clients pay privately precisely so that no diagnosis reaches their insurer, and they should know that submitting a superbill changes that.

Agree how often you'll issue them (per session or monthly both work), and deliver them the way you deliver any record with health information: through your portal or another channel your compliance adviser has approved, not an ordinary email.

How to submit a superbill to insurance

The patient submits it, not the practice. Every plan sets its own process, so give patients the general steps and point them to their plan's instructions for the rest. As a real example, the steps below quote Cigna Healthcare's behavioral health customer claim form (PDF, revision 03/2023), listed on Cigna's customer forms page and checked 8 October 2026. Other insurers' forms and rules differ.

1. Check out-of-network benefits first. Before the first session, not after the fifth. The questions to ask are below.
2. Get the insurer's own claim form. Insurers usually want their member claim form with the superbill attached. Cigna's says it only needs completing when the provider isn't submitting the claim for the member, and that each provider and each family member needs a separate form.
3. Attach the superbill as the itemized bill. Cigna's form says a claim can't be processed without an itemized bill, and that receipts, balance-due statements and canceled checks don't replace one. Its list of what the bill must show: the employee's and patient's names, the type of service or procedure code, the provider's name, credentials, address and tax ID, the date of service, the diagnosis code in ICD-10 format and the charge. A superbill built from the template above covers each of those; if the plan is in someone else's name, such as a spouse's or parent's, add the policyholder's name.
4. Send it the way the plan says, within its deadline. Filing deadlines vary by plan. Cigna's form says Cigna must receive the claim within 180 days of the date of service, unless the plan or state law allows more time.
5. Keep copies. Cigna suggests keeping a copy of the bills and the completed claim form.
6. Read the explanation of benefits. After processing, the insurer sends an explanation of benefits showing what went toward the deductible and what the patient owes. Nothing on a superbill changes what the plan covers.

Cigna's form also says an out-of-network provider can submit the claim if they are able and willing to file for the member. If your practice doesn't, say so on your fees page so nobody expects it.

Questions to ask the insurer first

Encourage patients to check their out-of-network benefits before the first session. The questions worth asking their insurer:

1. Does my plan have out-of-network benefits for this kind of care?
2. What is my out-of-network deductible, and how much of it have I met?
3. What share of the allowed amount does the plan reimburse, and how is the allowed amount set?
4. Do I need pre-authorization, or a referral?
5. How do I submit, and is there a deadline?

You can publish those five questions on your fees page. It saves your front desk the same conversation every week, and it makes the fee easier to say yes to.

If the patient has Medicare

A superbill is how patients claim under a private plan's out-of-network benefits. Original Medicare works differently. According to Medicare.gov (checked 8 October 2026):

• providers who accept assignment have to submit the claim to Medicare directly;
• non-participating providers should submit a claim for Medicare-covered services, and the patient can file their own claim if the provider refuses;
• Medicare won't pay for services from a provider who has opted out of Medicare, except in emergencies.

If you see Medicare patients, settle your Medicare status before you write your fees page. Our guide to concierge medicine and Medicare explains the routes.

Superbills and the good faith estimate

A patient who plans to submit a superbill still pays you directly, and you don't submit a claim for them. Under 45 CFR 149.610, someone with an employer, individual or federal employee health plan who doesn't have a claim submitted for a service counts as self-pay (checked 8 October 2026), and self-pay patients are generally entitled to a written good faith estimate of expected charges. Treat superbill patients as entitled to one unless your healthcare attorney tells you otherwise. Our guide to good faith estimates covers when one is due and what it has to include.

Why this is a marketing question too

"Do you take my insurance?" is the question a cash-pay practice hears most, and "no" ends the conversation. "We're out of network, and we provide a superbill each month that you can submit to your insurer; here are the questions to ask them" keeps it going, and it is true.

Put that answer where the question gets asked: on the fees section of your site, next to your cancellation policy, on the booking page, and in the script for the first call. Our guide to therapist website examples shows where a fees section works best, and booking pages covers how we build them.

If you're still opening the practice, our checklist on how to start a private practice puts the fee and insurance decisions in order. For staff who need the short version, the glossary defines a superbill in one line.

Sources

• eCFR — 45 CFR 149.610, Requirements for provision of good faith estimates of expected charges for uninsured (or self-pay) individuals, checked 8 October 2026
• CMS — Professional paper claim form (CMS-1500), checked 8 October 2026
• CMS — ICD-10 codes (2027 ICD-10-CM files), checked 8 October 2026
• CMS — 2027 ICD-10-CM code descriptions in tabular order (ZIP), checked 8 October 2026
• CMS and NCHS — ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (PDF), checked 8 October 2026
• CMS — Physician fee schedule relative value file RVU26D, October 2026 release (short descriptors for CPT 90791, 90834 and 90837), checked 8 October 2026
• CMS — Place of service code set, checked 8 October 2026
• Cigna Healthcare — Behavioral health customer claim form, revision 03/2023 (PDF), from Cigna's customer forms page, checked 8 October 2026
• Medicare.gov — Does your provider accept Medicare as full payment?, checked 8 October 2026
• AAFP, Family Practice Management — In search of a super superbill (2006), checked 8 October 2026