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...
Physical Therapist Vacation Coverage | CMS Locum Tenens Guidelines 2022
Physical Therapist Vacation Coverage Options? There are 2 primary options that exist for a private practice physical therapy clinic to hire an outside physical therapist to treat Medicare beneficiaries while another physical therapist is on vacation, maternity leave,...
United Healthcare Requires 59 Modifier for CPT Code 97530 and CPT Code 97140 Combo
News 2022: Unitedhealthcare Requires 59 Modifier for Therapy Services Despite the recent changes to the NCCI edits no longer requiring CPT Code 97530 to require a 59 modifier when billed on the same date of service and by the same therapist as CPT Code 97140 some...
Physical Therapy Business Checks for Medicare PECOS
It may seem a little crazy, but YES, in 2022 Medicare still expects new business owners to have paper business checks. If you are submitting your Medicare provider enrollment via PECOS you are asked to either upload a copy of a voided business check or a letter from...
CashPT for Medicare Beneficiaries as After Care
CashPT for Medicare Beneficiaries Who Want Something Better This is a copy/paste of a post I shared on Facebook on September 9, 2022: "Medicare (and many other 3rd party payers) still pay the same rate for 97161, 97162, and 97163. ... I love simple cases. Easy fixes...
Physical Therapy Walk-In Evaluations
The following is a Facebook post from 09/07/2022 ... We all know how much we LOVE to people-watch....Airports, coffee shops, malls. We see every idiosyncrasy....Why then do we think every initial evaluation... even the easy ones, requires 60 minutes and multiple...
Medicare Definition of a Treatment Day Outpatient Physical Therapy
Medicare's Definition of a Treatment Day Medicare defines a treatment day as a single calendar day. A physical therapist might deliver multiple treatment sessions in a single treatment day. For the purposes of physical therapy progress reports, Medicare Part B...
Can a physical therapist bill Medicare for a progress note?
Can a physical therapist bill Medicare for a progress report or discharge summary? No, a physical therapist can not bill Medicare for a progress note. It is important you realize a progress note is not a physical therapy reevaluation. A progress report is not a...
PT School: (5) Great Reasons NOT to Go and (1) Reason to Go
1. The Crushing Debt No surprise here, the debt associated with PT school is crushing the life out of many new graduate DPTs. The Student Loan Planner website published that the average physical therapist debt is approximately $96,000. A 2020 APTA article suggests...
Medicare physical therapy cap 2022
What is the Medicare therapy threshold (formerly the therapy cap) for physical therapy in 2022? The 2022 Medicare therapy financial threshold for physical therapy is $2,150. Keep in mind that services delivered for speech-language pathology in the same calendar year...
5 Best Side Hustles for Physical Therapists in 2022
Side Hustles for Physical Therapists in 2022 These are 5 simple side hustles for physical therapists that may be used to either supplement your full-time income or replace your full-time income. Every physical therapist should have a side hustle! As a physical...
