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The therapy superbill, field by field: what to put on one and what it will not do

The CPT codes therapists actually bill, how ICD-10 F-codes work, two complete worked superbills, telehealth place of service rules, and the honest math on what an out-of-network client really gets back.

October 10, 2026 · 13 min read

If you run a private practice and do not take insurance, you know the monthly ritual. A client pays your full fee, asks for "the paperwork for my insurance," and you spend an evening assembling something official enough to survive a claims department. Some months it works. Some months the client comes back with a denial letter and a question you cannot answer.

Below: every field that belongs on a therapy superbill, the CPT codes therapists use with their official time rules, how the ICD-10 F-codes work, two worked examples, the telehealth place of service rules, and the parts most guides skip. We make software for cash-pay practices and do not submit insurance claims, so this is the document your client submits themselves.

What is a superbill for therapy?

A superbill is an itemized statement of services you have delivered and the client has paid for, with enough coding detail that their plan can process it as an out-of-network claim. The client sends it in. You do not.

Three things it is not:

Not a claim. A claim is a transaction you send to a payer, usually on a CMS-1500, with a clearinghouse in the middle. A superbill goes to your client, who attaches it to their plan's member reimbursement form (longer comparison).

Not a receipt. A receipt proves money changed hands. A superbill carries your NPI, tax ID, CPT codes, an ICD-10 diagnosis, a place of service code and a zero balance. A payer that gets a receipt rejects it, and the client blames you.

Not a Good Faith Estimate. An estimate projects future cost; a superbill documents what already happened (field list).

Every field that belongs on one

Section	Fields
Provider	Legal name and credentials, license type, number and state, individual NPI (Type 1), group NPI (Type 2) if you bill under a group, tax ID (EIN rather than your SSN), practice name, physical street address, phone
Client	Full legal name exactly as printed on the insurance card, date of birth, mailing address, member ID and group number if the plan asks
Service line, one per session	Date of service, place of service code, CPT code and units, modifier if any, charge, amount paid, payment date
Diagnosis	At least one ICD-10 code, pointed at the service lines
Totals	Total charged, total paid, balance due, which must read zero

Two fields fail more often than the rest: a physical street address rather than a PO box, and a balance of zero, because a plan that sees an open balance can decide the client has not really paid. The rest of the same source's rejection list: missing NPI or tax ID, no diagnosis, a Z code alone, and a place of service that does not match how the session was delivered.

The CPT codes therapists actually use

Six codes cover most of a talk therapy practice. Time rules from the APA's psychotherapy coding page.

Code	What it is	Official time rule
90791	Psychiatric diagnostic evaluation, no medical services	Not time based
90832	Individual psychotherapy, 30 minutes	16 to 37 minutes
90834	Individual psychotherapy, 45 minutes	38 to 52 minutes
90837	Individual psychotherapy, 60 minutes	53 minutes or more
90847	Family psychotherapy with the patient present, 50 minutes	26 minutes or more
90853	Group psychotherapy, other than multiple-family	No time figure given

Add-ons, same source: 90785 interactive complexity, reported with 90791, 90832, 90834, 90837 or 90853 when at least one of four complicating factors is present; 90839 crisis psychotherapy, first 60 minutes; 90840 each further 30 minutes of crisis work. CPT also has 90792 for evaluations with medical services, which is for prescribers, and 90846 for family therapy without the patient present: check its current time rule in your CPT book.

90837 is the honest code for a 53-minute session, but it draws more scrutiny than 90834, so the note has to document the real length. Headway's reference on 90791 adds that most payers allow it roughly once every six months per client and that it generally cannot be reported the same day as psychotherapy or an E/M service. And since the AMA licenses CPT, nobody ships a free built-in code database: in our system the clinic enters its codes once.

How the ICD-10 F-codes work

Mental health diagnoses live in Chapter 5 of ICD-10-CM, F01 through F99:

Block	Title
F01-F09	Mental disorders due to known physiological conditions
F10-F19	Mental and behavioral disorders due to psychoactive substance use
F20-F29	Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders
F30-F39	Mood [affective] disorders
F40-F48	Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders
F50-F59	Behavioral syndromes associated with physiological disturbances and physical factors
F60-F69	Disorders of adult personality and behavior
F70-F79	Intellectual disabilities
F80-F89	Pervasive and specific developmental disorders
F90-F98	Behavioral and emotional disorders with onset usually in childhood and adolescence
F99	Unspecified mental disorder

Blocks from the ICD-10-CM F01-F99 chapter index. Within a category you add characters until it runs out. Under F41: F41.0 panic disorder, F41.1 generalized anxiety disorder, F41.3 other mixed, F41.8 other specified, F41.9 unspecified (F41.1 detail).

Two rules from the FY 2026 ICD-10-CM Official Guidelines settle most arguments. Codes "are to be used and reported at their highest number of characters available," and "a code is invalid if it has not been coded to the full number of characters required." But the same guidelines defend unspecified codes: they "should be reported when they are the codes that most accurately reflect what is known." F41.9 is legitimate when F41.9 is what you know.

Z codes are the trap. Relationship distress and life circumstance Z codes describe something real, but a superbill carrying only a Z code is on the published rejection list.

Why the diagnosis is mandatory, and the client who does not want one

There is no insurance reimbursement without a diagnosis. The plan pays for treatment of a covered condition, the ICD-10 code identifies it, and the code enters the client's claims history at that plan. That history can surface in underwriting for products that still ask health questions, and in any records release they sign later.

Say it at intake, not after. Some clients want the money and accept the record. Others would rather pay in full with nothing on file anywhere but your chart, and for them the superbill is the wrong tool. The client makes that call.

What you do not do is pick a milder code to make the client comfortable or a heavier one to improve the odds of payment. The guidelines cut both ways: the code matches the documentation, and the documentation matches the session.

A superbill template for mental health: a worked weekly 90837 client

A therapy superbill template for a weekly client, filled in. Fictional names, real structure.

Provider

Field	Value
Provider	Dana Whitfield, LCSW
License	LCSW #SW-104882, State of Florida
Individual NPI (Type 1)	1467392015
Tax ID (EIN)	85-4471920
Practice	Whitfield Counseling PLLC, 2150 NW 2nd Ave, Suite 310, Boca Raton, FL 33431
Phone	(561) 555-0184

Client

Field	Value
Client	Marissa J. Delgado
Date of birth	03/14/1991
Address	814 SE 9th St, Apt 2B, Delray Beach, FL 33483
Insurance	Member ID XQJ884210377, Group 0094512

Diagnosis

Pointer	Code	Description
A	F41.1	Generalized anxiety disorder

Service lines, September 2026

Date	POS	CPT	Mod	Units	Dx	Charge	Paid	Pay date
09/02/2026	11	90837		1	A	$185.00	$185.00	09/02/2026
09/09/2026	11	90837		1	A	$185.00	$185.00	09/09/2026
09/16/2026	10	90837	95	1	A	$185.00	$185.00	09/16/2026
09/23/2026	11	90837		1	A	$185.00	$185.00	09/23/2026
09/30/2026	11	90837		1	A	$185.00	$185.00	09/30/2026

Totals

Field	Value
Total charged	$925.00
Total paid by client	$925.00
Balance due	$0.00
Statement date	10/01/2026
Signature	Dana Whitfield, LCSW

Note the third line. That session was by video with the client at home, so the place of service changes to 10 and modifier 95 goes on that line only. Getting it wrong is a published rejection reason. Monthly is also the right cadence: one document for the claims department instead of five.

The second worked example: the intake

Intakes get their own statement, because 90791 generally cannot share a date with psychotherapy and the diagnosis is established during that session.

Field	Value
Provider	Dana Whitfield, LCSW, NPI 1467392015, EIN 85-4471920
Client	Marissa J. Delgado, DOB 03/14/1991, Member ID XQJ884210377
Diagnosis A	F41.1 Generalized anxiety disorder, established at this evaluation

Date	POS	CPT	Mod	Units	Dx	Charge	Paid	Pay date
08/26/2026	11	90791		1	A	$250.00	$250.00	08/26/2026

Field	Value
Total charged	$250.00
Total paid	$250.00
Balance due	$0.00

If the evaluation ends without a codable condition, tell the client that day, not in a statement four weeks later.

Telehealth: place of service and modifiers

The place of service code describes where the client was, not where you were (CMS place of service code set):

POS	Official description, abbreviated
11	Office. Location, other than a hospital or similar facility, where the professional routinely provides diagnosis and treatment on an ambulatory basis
10	Telehealth Provided in Patient's Home. Patient is located in their home when receiving services through telecommunication technology
02	Telehealth Provided Other than in Patient's Home. Patient is not located in their home when receiving services through telecommunication technology

Codes 10 and 02 took effect January 1, 2022 per that page. A Medicare contractor's telehealth modifier list gives modifier 95 as "synchronous telemedicine service rendered via real-time Interactive audio and video telecommunications system" and modifier 93 as "synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system." Modifier FQ is listed there as used only by RHCs and FQHCs, which does not include you.

Commercial payers are inconsistent about this. Industry guidance reports that some plans want modifier 95 on every telehealth line, others reject it as redundant once the place of service already says telehealth, and a few want POS 11 with 95 instead. Your client can settle it in one call to their plan.

On Medicare, CMS states in its Medicare and Mental Health Coverage booklet that "we cover telehealth for behavioral and mental health on a permanent basis," and that practitioners must be able to provide audio-video but "may use audio-only technology given an individual patient's technological limitations, abilities, or preferences."

What the client actually gets back

Mental health is one of the ten essential health benefit categories, so HealthCare.gov states that "all Marketplace plans cover mental health and substance abuse services as essential health benefits," with no yearly or lifetime dollar limits on them.

Parity does not create an out-of-network benefit, though. CMS is blunt: "MHPAEA does NOT require group health plans or health insurance issuers to cover MH/SUD benefits" (CMS on MHPAEA). The test runs classification by classification, and outpatient out-of-network is its own classification. A plan that pays something out of network for a knee has to treat therapy comparably, which is not the same as paying out of network at all.

Then the arithmetic, which is where clients get angry. Reimbursement is a percentage of the plan's allowed amount, never of your fee:

Step	Amount
Your fee for 90837	$185.00
Plan's allowed amount for 90837	$130.00
Coinsurance after the out-of-network deductible	Plan pays 60%
Plan pays	$78.00
Client's net cost per session	$107.00
Effective reimbursement against what the client paid	42%

That shape comes from TherapyAppointment's worked case, where a client expecting $108 receives $78. Thrizer puts out-of-network reimbursement at 50 to 80 percent of the allowed amount once the deductible is met, and notes the out-of-network deductible is separate from the in-network one.

The deductible comes first. A client with a $3,000 out-of-network deductible at $185 a week reimburses nothing until roughly mid-April, and still has to file monthly to get there. Say that in session one.

Timelines: statements monthly, an explanation of benefits typically two to six weeks later, and filing deadlines from 90 days to a year, so a client who hoards eight months of superbills may have missed the window on the first four.

When the client has no out-of-network benefits

Sometimes the answer is just no. HMO and EPO products commonly have no out-of-network benefit outside emergencies, and most Medicaid managed care plans do not either. Three things help instead.

1. Find out before session one. Ask the client to call the number on their card and get three answers: is there an out-of-network outpatient mental health benefit, what is the deductible, and what percentage of the allowed amount comes back.
2. Price for the real cost, not the hoped-for net cost. A client who cannot be reimbursed pays your full fee forever, and a sliding scale rate you set deliberately beats a standard fee quietly discounted under pressure (longer version).
3. Point them at HSA and FSA dollars. Not reimbursement, but pre-tax money changes the effective price whatever the network status.

And stop promising a result you do not control. Handing over a superbill promises that the document is accurate and complete, not that anyone will pay. Put that sentence, in your own words, on the statement.

Medicare: what it does and does not allow

Medicare Part B covers outpatient individual and group psychotherapy, family counseling when its main purpose is to support the beneficiary's treatment, psychiatric evaluation and medication management. After the Part B deductible the beneficiary pays 20% of the Medicare-approved amount, and the provider types listed include clinical psychologists, clinical social workers, nurse practitioners, physician assistants, marriage and family therapists and mental health counselors (Medicare.gov). CMS adds that since January 1, 2024, MFTs and mental health counselors "may enroll in Medicare and bill Medicare independently" (MLN booklet, linked above).

So a superbill does not function for a Medicare beneficiary the way it does for a PPO member: Medicare pays enrolled providers through claims, not members through receipts.

To see them privately, the formal path is opting out. A Medicare contractor's list of who may opt out includes clinical psychologists, clinical social workers, mental health counselors and marriage and family therapists, and excludes clinics and groups. Opting out means a written private contract with each beneficiary, signed before services are furnished, in which the beneficiary agrees "not to submit a claim to Medicare." The practitioner "may receive no direct or indirect Medicare payment for services" under those contracts, an affidavit goes to every MAC with jurisdiction over your claims, and contracts run for each two-year opt-out period (CGS). Do not improvise this one.

What to look for in the best EHR for a mental health private practice

If you do not bill insurance, most of what mental health EHR vendors charge for is machinery you will never switch on: claim scrubbing, clearinghouses, eligibility checks, denial queues, ERA posting. You are paying for a billing department you do not have. The cash-pay shortlist is shorter:

• Superbills as a one-click PDF carrying NPI, EIN, CPT, ICD-10, place of service, modifier and a zero balance, built from sessions already in the chart and batched monthly.
• Notes that produce the billing facts. Session start and stop time, so the code matches the note. A 90837 with a note showing 44 minutes is a problem for both of you.
• Payment capture at the time of service and telehealth tied to the service line, so the zero balance, POS 10 and modifier 95 are facts rather than something you reconstruct.
• Full export and a signed BAA. Your notes and billing history are yours.

Two things to reject deliberately. ONC certification, which matters for Medicare and MIPS reporting rather than cash-pay practice (the longer argument). And a claims engine: if you ever go in network, a system with a real clearinghouse beats ours, and we would tell you so.

The bottom line

A therapy superbill is a boring document that has to be exactly right: provider and client identifiers as printed on the card, one line per session with the correct place of service and modifier, an ICD-10 code that matches the chart, a balance of zero, monthly, and a line saying it is not a guarantee of payment.

The three honest conversations are the ones that save you. A diagnosis is mandatory and it goes on record. The client verifies their out-of-network benefit before session one. And reimbursement is a percentage of the plan's allowed amount rather than of your fee, which is how 60% coverage arrives as 42% of what they paid.

DrinCloud generates superbills as a PDF with your NPI, EIN, CPT and ICD-10 codes and the running balance, built from the sessions and payments already in the chart, with no claims engine and nothing to submit. See how our superbills work, what the system looks like for a therapy practice, or open the live demo and try it yourself with no sales call.

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