How to create a superbill for cash based therapy, out of network claims Office Ally Practice Mate

What is a superbill for therapy? Physical Therapy, Occupational Therapy, Speech-Language Pathology

A superbill is a document created by the healthcare provider that includes all of the required billing information. It often includes CPT codes for services rendered, charges, units, and the NPI of the rendering provider. It includes the billing provider’s NPI and Tax ID as well.

A superbill may be given to a patient who plans to submit it to an insurance company for the reimbursement of out of network services, or it may be given to an internal billing department who will turn that information into a formal CMS 1500 form and submit that claim to an insurance company.

A superbill is just another way to say invoice and receipt. The best example of a superbill is the CMS 1500 claim form.

What should be included on a superbill?

A superbill should contain the following elements:

• Provider name, address, telephone number, and fax number
• Provider’s group NPI as the billing provider and personal NPI as the rendering provider
• Provider’s tax ID or employer identification number
• Patient information: name, address, telephone, date of birth, gender
• Patient insurance information is available
• Referring provider if available
• Treatment diagnosis
• Date of service
• CPT Codes, Number of Units Billed, Total Amount Charged per CPT Code
• Treatment location listed as facility address or patient’s home address

How does a cash-based therapist create a CMS 1500 superbill?

Watch the video below to see how you can create a free Office Ally account and create CMS 1500 superbills for your cash-based physical therapy or occupational therapy clients.

What does a CMS 1500 form look like?

Here is an image of a CMS 1500 form. These forms may be purchased from Amazon or other retailers. 

Can I create my own superbill? 

Yes, but it is not recommended. 

If you hope to provide your patient with a superbill that will be submitted to an insurance company for possible out of network reimbursement then the best practice advice is to use a CMS 1500 as it is a universally accepted form.

It is also recommended that you submit an IRS W-9 form in addition to a copy of the physician referral, your initial evaluation, and other supporting documentation.

More Lessons...