Templates
Superbill template for therapists: every field, explained
A superbill template is only as good as its fields. Here is what each block should contain, why a plan asks for it, and a filled-in example line you can compare your own against.
Quick answer
A therapy superbill template needs five blocks: the provider (name, credentials, individual NPI, tax ID, address, phone), the client (legal name, date of birth, address, member ID), the diagnoses (ICD-10-CM codes, each with a letter), one line per session (date of service, CPT code, modifier, place of service, diagnosis pointer, units, fee) and the totals (charged, paid, balance) with the provider’s signature and date.
Updated · Sources are listed at the end of the page.
Last reviewed October 2026. General information for out-of-network therapists, not legal or billing advice. Payer rules change — confirm with the payer before you bill.
Try the free check first. It runs entirely in your browser, takes about three minutes, and never uploads client data.
Fill the template freeBlock 1: the provider
The plan has to identify who delivered the service and who is being paid. Use the individual (Type 1) NPI of the clinician who saw the client; you can confirm it in the NPPES registry. If a group practice is the billing entity, add the group (Type 2) NPI and the group’s tax ID.
| Field | What to enter |
|---|---|
| Name and credentials | As licensed, e.g. “Jane Doe, LCSW” |
| Individual NPI | Ten digits, no spaces |
| Tax ID | The practice EIN, or the number your plan instructions ask for |
| Address and phone | The practice address where records are kept |
| License number and state | Optional, but some plans ask for it |
Block 2: the client and the plan
Plans match a claim to a member by name, date of birth and member ID. Spell the name exactly as it appears on the insurance card. For a dependent, add the policyholder’s name and relationship, because the member ID often belongs to the policyholder.
Block 3: the diagnoses
List each ICD-10-CM code once, with a letter. On the CMS-1500 claim form, item 21 has room for twelve codes, A to L, and each service line points back to them by letter. Superbill keeps four diagnosis slots, A to D, per client, which covers typical outpatient therapy.
Code to the highest specificity your documentation supports, using the code set in effect on the date of service. ICD-10-CM updates take effect each October 1.
Block 4: one line per session
Every session gets its own line, even when several sessions share a code and fee. These are the columns a plan reads:
| Column | Example | Notes |
|---|---|---|
| Date of service | 10/06/2026 | One date per line |
| CPT code | 90837 | Must match the documented time |
| Modifier | 95 | For synchronous video, when the payer asks for it |
| Place of service | 10 | Where the client was: 02, 10 or 11 |
| Diagnosis pointer | A | Must point at a filled diagnosis slot |
| Units | 1 | Psychotherapy codes are one unit per session |
| Fee | $180.00 | Your full charge, not the expected reimbursement |
Block 5: totals, payment and signature
Show the total charged, the amount the client paid with the date and method, and any balance. Plans reimburse members for services they have paid for, so the payment line matters. Finish with the provider’s signature and the date signed.
An example line, filled in
An illustrative video session, with a fictional client, as it would appear on the superbill: diagnosis A is F41.1 (generalized anxiety disorder); the session on October 6, 2026 lasted 55 minutes, was held by video while the client was at home, and was paid in full that day.
That gives the line 10/06/2026 · 90837 · modifier 95 · POS 10 · pointer A · 1 unit · $180.00, paid $180.00. Each value can be checked against something in the record: the time against the code, the client’s location against the POS, the modality against the modifier.
Why a template alone is not enough
A blank template cannot tell you that 90837 does not fit a 45-minute session, that POS 11 is not a telehealth place of service for many payers, or that pointer C is empty. Those are the mistakes that send a superbill back.
Superbill fills the same fields and checks them as you type: CPT against session length, telehealth POS and modifier pairing, diagnosis pointers, NPI check digit, and the age of each date of service. Payer rules differ, so confirm with the payer when a warning concerns a plan-specific rule.
The app only sends your license key and a device id to our license check (which asks Creem) — no patient or practice data ever leaves your browser.
What the free check catches
- CPT vs. session length (90832 = 16–37 min, 90834 = 38–52, 90837 = 53+; these codes require at least 16 minutes)
- Telehealth POS 02 / 10 vs. POS 11, and modifier 95 pairing
- Diagnosis pointers A–D that don’t resolve to a code on the client
- NPI format and check digit, TIN, member ID, units, signatures
- DOS age against the 60 / 90 day timely-filing warnings