What is a Superbill for Therapy?
A superbill is essentially an itemized receipt for services that an out-of-network provider provides to clients after a therapy session. These contain a few elements and the main use of a superbill is for clients to potentially get reimbursed at some amount from their insurance provider.
What is included in a Superbill?
Superbills have the following information:
Diagnosis with an ICD code: A therapist must provide an insurance company with a diagnosis in the form of an ICD (international classification of diseases) code. This informs the insurance company about what the client is being treated for. Diagnoses can be discussed between a client and their therapist if a client decides they want superbills.
CPT Code: A CPT (Current Procedural Terminology) code is used to tell the insurance company what kind of service is provided. For example, CPT code 90834 designates up to a 50 minute psychotherapy session and code 90837 designates over 53 minutes of psychotherapy. If you see the code 90834-95, the 95 indicates that the session was conducted via telehealth.
Client information: Client name, DOB, address, phone number and email will be included on the superbill.
Therapist information: Therapist name, business name, business address, phone number, email, NPI code and Tax ID (EIN). An NPI code is a unique healthcare provider code that every health care provider is required to have by HIPAA and basically just identifies them in the healthcare world.
Date of service: Date the session was conducted.
Cost of service: How much the client paid for the session.
When do I pay for my therapy session?
Depending on the therapist’s payment policies and electronic healthcare record system, you may be charged before session or right after session. either way, you are paying for the session “out-of-pocket”, meaning you are not using insurance to pay the fee. Most therapists take credit cards, debit cards or even HSA (health savings account) debit cards. Specifically when you work with me (Blaire) you will be charged automatically after session with the card you provide online.
Can I expect to be reimbursed after I submit my superbill?
This completely depends on your insurance company and your insurance policy. Here are a few things that could impact if you get reimbursed and for how much:
Whether or not you have met your out-of-network provider deductible for the year
Your out of network benefit level
Your coinsurance rate for out of network providers (the percentage of charges your insurance company expects you to pay)
These are things you can look at on your policy or questions to ask when asking about insurance reimbursement.
What do I do with my superbill after my therapist sends it to me?
These superbills are what the insurance companies need in order to reimburse you. Your insurance provider will tell you how to submit it (ideally). Typically there will be a place through your insurance company portal to submit a claim online or you might have to mail them in but I think this is less typical.
Is there a time limit on submitting my superbill?
Yes and this is something to check with your insurance provider. From my research it can generally range from 90-180 days from the date of service listed on the superbill but depends on the insurance provider agreement.
Do you provide superbills for couples therapy?
I do provide superbills for couples therapy but please note that the diagnosis code that I will always designate is Z63.0 (relational distress). This is the most ethical way I have found to provide superbills under one person’s name when treating a couple for couples therapy. Please keep in mind that in the medical field it is far less common to get reimbursed for couples therapy by insurance but it is not unheard of.
