What is included in a superbill?
It's important that the bill you receive from your healthcare provider has all the required fields so that your insurer can process your reimbursement quickly and correctly. At minimum, the following fields should be present:
- Patient’s full name
- Provider’s full name and credentials
- NPI (National Provider Identifier) – a 10-digit ID issued by CMS (Centers for Medicare & Medicaid Services) used to identify healthcare providers in the U.S.
- Provider’s Tax ID (TIN or EIN) – used by insurers to issue payment
- Provider’s address and phone number
- Organization NPI – optional, for group practices or clinics
- Date(s) of service
- Place of Service Code (POS) – a 2-digit number indicating where the service took place (e.g., 11 = Office, 02 = Telehealth)
- CPT code(s) – 5-digit procedure codes for what service was provided (e.g., 90834 = 45-minute psychotherapy)
- Modifier(s) – 2-character codes added to CPTs to describe specifics of service (e.g., 95 = Telehealth, GT = Audio/video session) This is optional
- Diagnosis code(s) – ICD-10 codes explaining the medical reason for the visit (e.g., F32.1 = Major depressive disorder, moderate)
- Units – the number of times the service was provided (e.g., 1 unit per session)
- Amount charged or paid
- Indication that the patient paid (e.g., “Paid in Full” or receipt). Some insurers may require this.