A superbill is an itemized, coded record of one patient encounter (provider identifiers, dates, place of service, CPT or HCPCS codes, ICD-10-CM diagnoses and charges) that a patient can submit to an insurer for out-of-network reimbursement, or that a practice uses internally as its encounter form.
The word is used in two ways. Inside many practices, the superbill is the encounter form: a checklist of the practice’s most common codes that the clinician marks during the visit and the billing team turns into a claim. Outside the practice, especially in therapy, psychology, chiropractic and direct-care settings, a superbill is a statement the provider gives to an out-of-network patient so the patient can claim benefits from their own plan.
Either way, the superbill is not itself a claim. It is the source data for one. If its codes are outdated or its identifiers are incomplete, the claim built from it fails, whether the practice files that claim or the patient does.
This guide explains what a superbill must contain, how it differs from a CMS-1500 claim, an itemized bill and a Good Faith Estimate, how out-of-network patients use it, how to keep a superbill template current, and a template checklist you can apply today.
Key Takeaways
- A superbill must identify the patient, the rendering provider (with NPI and tax ID), each date and place of service, each CPT or HCPCS code with modifiers and units, linked ICD-10-CM codes and the charge.
- A superbill is not a claim. The CMS-1500 (or 837P) is the claim; the superbill supplies the data for it.
- Medicare’s mandatory claim submission rule means providers who see Medicare patients generally must file the claim themselves, so superbills are mainly a commercial out-of-network tool.
- Uninsured and self-pay patients are entitled to a Good Faith Estimate before care. A superbill does not replace it.
- Update the template every year: CPT changes on 1 January and ICD-10-CM on 1 October. FY2027 ICD-10-CM codes have been in effect since 1 October 2026.
What a Superbill Must Contain
There is no single federal superbill format, but an insurer can only process a reimbursement request if it can identify the member, the provider and each service. The fields below mirror what the payer will need to build or check a professional claim.
| Section | Required fields | Why it matters |
|---|---|---|
| Patient | Full name, date of birth, address, insurance member ID and group number, subscriber name if different | The plan must match the request to a member |
| Provider | Rendering clinician name and credentials, individual NPI, practice name, address, phone, tax ID (EIN or SSN as used for billing), license number if the plan asks | Identifies who performed the service and who is paid |
| Referring provider | Name and NPI when the plan requires a referral or the service was ordered | Some services are paid only with a referring or ordering provider |
| Dates | Date of service for every line, not only the statement date | Sets which code set and benefit year apply |
| Place of service | Two-digit CMS POS code, for example 11 office or 10 telehealth in the patient’s home | Affects coverage and payment, especially for telehealth |
| Services | CPT or HCPCS code, plain-language description, modifiers, units | Defines what the plan is paying for |
| Diagnoses | ICD-10-CM codes to the highest specificity, linked to each service | Supports medical necessity |
| Money | Charge per line, total charges, amount paid by the patient and date paid, balance due | The plan reimburses against what was charged and paid |
| Signature | Provider signature or attestation and date | Many plans ask for it on member-submitted claims |
For the difference between the code sets on the form, see our guide to CPT, ICD-10 and HCPCS codes.
Worked Example: Out-of-Network Therapy Superbill
Hypothetical case: a licensed therapist who is out of network with the patient’s commercial plan sees an adult patient for a 60-minute psychotherapy session by video at the patient’s home. The patient pays the practice at the visit and asks for a superbill.
| Field | Entry | Check |
|---|---|---|
| Date of service | The session date | One line per session, never a monthly total with no dates |
| POS | 10 | Telehealth provided in the patient’s home; 11 if seen in the office |
| CPT | 90837 | Psychotherapy, 60 minutes with patient; time must be documented |
| Modifier | As the plan requires for telehealth (for example 95) | Commercial telehealth modifier rules vary by plan |
| Diagnosis | F41.1 Generalized anxiety disorder | Billable FY2027 ICD-10-CM code, linked to the 90837 line |
| Charge and payment | Practice fee, amount paid, payment date | Shows the patient’s out-of-pocket payment |
| Provider IDs | Individual NPI, tax ID, license | Needed for the plan to price the service |
For telehealth codes and modifiers in behavioral health, see our telehealth mental health CPT code guide.
Superbill vs CMS-1500 vs Itemized Bill vs Good Faith Estimate
These four documents contain overlapping information, which is why they are confused. Their purpose and legal weight are different.
| Document | What it is | Who uses it | When |
|---|---|---|---|
| Superbill | Coded, itemized record of an encounter | Practice (as an encounter form) or patient (to claim out-of-network benefits) | After the visit |
| CMS-1500 / 837P | The standard professional claim, paper or electronic | Provider or billing company submits it to the payer | After coding and charge entry |
| Itemized bill | Line-by-line statement of charges, often with revenue codes for facility services | Patient, to review or dispute charges; often from hospitals | After care, usually on request |
| Good Faith Estimate | Written estimate of expected charges required by the No Surprises Act | Uninsured or self-pay patient | Before scheduled care, or on request |
A superbill can be the starting point for a claim. In practices that file claims, the superbill or encounter form feeds charge entry, where each line becomes a CMS-1500 line item. Hospital and facility claims use the UB-04 instead; see how to get a UB-04 form from a hospital.
Good Faith Estimates and Superbills
CMS states that providers must give uninsured or self-pay patients a Good Faith Estimate of expected charges when care is scheduled or when the patient asks. The estimate must be delivered within 1 business day of scheduling when care is scheduled at least 3 business days ahead, within 3 business days when care is scheduled at least 10 business days ahead, and within 3 business days of a request. If the final bill is at least $400 more than the estimate, the patient can use the patient-provider dispute resolution process.
Out-of-network practices that collect payment at the visit and hand the patient a superbill often treat these patients as self-pay for Good Faith Estimate purposes. Confirm your obligations against current CMS No Surprises Act guidance rather than assuming the superbill covers them.
How Out-of-Network Patients Use a Superbill
- Check benefits. The patient confirms the plan has out-of-network benefits, the deductible, coinsurance and any pre-authorization rules. Practices can help by verifying eligibility before the first visit.
- Pay the practice. Payment is collected under the practice’s financial policy.
- Receive the superbill. The practice issues one per visit or a monthly statement that still lists each date of service on its own line.
- Submit to the plan. The patient sends the superbill with the plan’s member claim form, by portal, mail or app, before the plan’s filing deadline.
- Plan processes the claim. The plan prices each line at its out-of-network allowed amount, applies the deductible and coinsurance and sends an explanation of benefits.
- Patient is reimbursed. Payment usually goes to the member, because the provider has already been paid.
Expected reimbursement. Plan payment = the plan’s allowed amount minus any unmet deductible and the patient’s coinsurance. It is not a percentage of the practice’s charge, which is why patients are often reimbursed less than they paid.
Medicare Patients Are Different
Under Section 1848(g)(4) of the Social Security Act, physicians and suppliers who furnish covered services to Medicare beneficiaries must submit the claims, as Noridian explains on its mandatory claim submission page. A practice cannot simply hand a Medicare patient a superbill and ask them to file. Practitioners who have opted out of Medicare are different again: under their private contract the beneficiary agrees not to submit a claim to Medicare, and Medicare does not pay.
Do not give Medicare patients superbills to file themselves for covered services if you have not opted out. File the claim yourself, even when you are non-participating.
Keeping Superbills Current: Deleted and Changed Codes
A printed or EHR superbill is a list of codes frozen on the day it was built. Code sets keep moving: CPT updates take effect each 1 January, HCPCS Level II updates quarterly, and ICD-10-CM updates each 1 October. FY2027 ICD-10-CM has been in effect since 1 October 2026, so a template not reviewed since last year may already carry invalid codes.
| Example | What changed | Superbill risk |
|---|---|---|
| 99441-99443 | Telephone E/M codes deleted from CPT for 2025; new telemedicine codes 98000-98016 added, and Medicare does not recognize 98000-98015 | Old templates still list deleted telephone codes |
| K21.0 | Since FY2021 a non-billable category; use K21.00 Gastro-esophageal reflux disease with esophagitis, without bleeding, or K21.01 with bleeding | Four-character code rejects as invalid |
| Category headers | Many three- and four-character ICD-10-CM codes are not billable | Checkbox lists that stop at the category level |
The reflux example is covered in detail in our gastric reflux ICD-10 code guide. A code that was valid when the template was built but deleted before the date of service will be rejected; see denied vs rejected claims for how to correct each.
- Review the template every December (CPT) and September (ICD-10-CM).
- Compare each listed code with the new year’s code files and delete or replace retired codes.
- List billable ICD-10-CM codes only, with full titles.
- Add a write-in line for codes not on the form, rather than forcing the nearest checkbox.
- Keep a dated version history so you know which template applied to a past date of service.
Superbill Template Checklist
- Practice name, address, phone, tax ID and group NPI.
- Rendering provider name, credentials, individual NPI and license number.
- Patient name, date of birth, address, member ID, group number and subscriber.
- Referring provider name and NPI field.
- Line items with date of service, POS, CPT/HCPCS, modifiers, units, diagnosis pointer and charge.
- Diagnosis section with full ICD-10-CM codes and titles.
- Total charges, amount paid, payment date and balance.
- Provider signature and date.
- Template version date and the code-set years it reflects.
Do not change codes, dates or charges on a superbill to improve the patient’s reimbursement. The superbill must match the medical record. Correct real errors by issuing a dated, corrected superbill and keeping the original on file.
If the patient is later billed a balance after insurance, see how to handle patient balances legally after insurance adjustments.
Spending staff time on superbills, outdated encounter forms or claims patients cannot get paid? Steady Medical Billing’s small practice billing team keeps your templates current, verifies benefits and can file claims for you, in network or out.
Frequently Asked Questions
What is a superbill in medical billing?
A superbill is an itemized, coded record of a patient encounter that lists provider identifiers, dates and place of service, CPT or HCPCS codes, ICD-10-CM diagnoses and charges. Patients use it to claim out-of-network benefits, and practices use it as an encounter form.
Is a superbill the same as a CMS-1500?
No. The CMS-1500, or its electronic version the 837P, is the standard professional claim. A superbill is the source document that provides the data for a claim, but it is not a claim on its own.
What must a superbill include?
Patient name, date of birth and member ID; provider name, NPI and tax ID; date and place of service for each line; CPT or HCPCS codes with modifiers and units; linked ICD-10-CM codes; charges and payments; and a provider signature.
Can Medicare patients submit a superbill?
Generally no. Medicare’s mandatory claim submission rule requires physicians and suppliers to file claims for covered services. Practitioners who have opted out use private contracts, and under those contracts the beneficiary agrees not to submit a claim to Medicare.
How often should a superbill template be updated?
At least yearly: review CPT codes before 1 January and ICD-10-CM codes before 1 October, and check HCPCS Level II quarterly if you bill supplies or drugs. Remove deleted codes and list only billable diagnosis codes.
