A superbill is an itemized receipt a practice gives a patient after a visit. It lists diagnosis and procedure codes, the provider's NPI and tax ID, and the charges, so the patient can ask their insurer for out-of-network reimbursement.

What should be included on a superbill?

Include the patient's name, date of birth, and insurance ID; the provider's name, NPI, and tax ID; the practice address; dates and place of service; CPT or HCPCS codes with modifiers; ICD-10-CM diagnosis codes; the charges and payments; and the provider's signature.

How do I submit a superbill to insurance?

Attach the superbill to your insurance plan's member claim form and send both by mail, fax, or the member portal. The insurer then applies your out-of-network benefits, deductible, and coinsurance before deciding on reimbursement.

Can I give a Medicare patient a superbill?

Generally, no. CMS requires physicians and practitioners to submit claims on behalf of Medicare beneficiaries for covered services. Providers who have formally opted out of Medicare are the exception and use private contracts instead.

What is the difference between a superbill and a claim?

A claim is filed by the practice directly with the insurer, and payment can go to the practice. A superbill goes to the patient, who files it with their insurer and receives any reimbursement themselves.

Does a superbill guarantee reimbursement?

No. Reimbursement depends on the patient's out-of-network benefits, deductible, and coinsurance, and on whether the codes support the service. Plans with no out-of-network coverage usually pay nothing.

What is a superbill? A guide for practices that see out-of-network patients