Why You Might Get a Superbill for Therapy
Key takeaways:
If your therapist doesn’t accept insurance, you may still be able to get partially reimbursed by submitting a superbill for out-of-network care.
A superbill is a detailed receipt from your therapist that you can submit to your insurance company for potential reimbursement. It usually includes information about your therapist’s credentials and the type of service you received, dates of service, and diagnosis and billing codes.
Before starting therapy, ask your therapist and insurance provider about their process for creating and handling superbills.
Table of contents
Paying for therapy can be confusing, especially if your therapist doesn’t take insurance. One study found that more than 1 in 4 people (28%) who received mental health therapy in the U.S. used an out-of-network therapist. That means they had to pay out of pocket and may have requested reimbursement from their insurance. One way to do that is by using a document called a superbill.
What is a superbill for therapy?
A superbill is a detailed receipt from your therapist that you can submit to your insurance company to ask for reimbursement. It includes information such as your therapist’s credentials and the type of service you received, billing and diagnosis codes, and dates of service.
Superbills are typically used when you see an out-of-network therapist — meaning, one who doesn’t bill your insurance company directly. If your insurance offers out-of-network benefits, you may be able to get reimbursed for part of the cost after submitting a superbill.
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Before your first session, check with your insurance provider to confirm whether you have out-of-network coverage, whether prior authorization is needed, and what portion of the cost they may reimburse. Medicare recipients generally do not have out-of-network benefits, so a superbill may not be an option.
Reimbursement isn’t guaranteed, but if your plan offers out-of-network benefits and accepts superbills, make sure you fill one out correctly. A superbill could help lower the overall cost of therapy.
Why do some therapists use superbills?
Many therapists choose not to work directly with insurance companies due to administrative challenges, delayed payments, or low reimbursement rates. One study found that mental health professionals are significantly more likely to be out of network than physical health professionals. This limits access for people relying on insurance.
To help bridge that gap, some therapists offer superbills as a way for clients to seek partial reimbursement. This gives people more flexibility to choose the therapist they want. While the therapist won’t handle the claims process, providing a superbill allows clients with out-of-network benefits to recover some of their costs.
Do you have to pay out of pocket for therapy up front?
Therapists decide how and when they like to receive payments. During a consultation with a new therapist, it is important to ask how they take out-of-pocket payments. For example, some mental health professionals may require payment at the end of each appointment. Others may require payment at the end of each month.
How much can you expect to be reimbursed after you submit a superbill?
Your insurance company will process your reimbursement according to the details of your plan.
Interested in therapy but don’t have insurance? Here are some tips to get free or low-cost mental health therapy.
Does Medicare cover therapy? While Medicaid does cover mental health services, your coverage and the eligibility criteria will depend on the state you live in.
Looking for a therapist? Here’s how to find a therapist that’s right for you.
Depending on your insurance carrier’s policies and your plan, several factors can determine how much you are reimbursed. These factors include:
How much your insurance company will reimburse for therapy services, which is usually based on what they’d pay an in-network therapist
Your out-of-network benefit level
Whether you have met your out-of-network care deductible for the year
Your coinsurance rate for out-of-network care, meaning the percentage of charges your insurance company expects you to pay
Here’s an example of how you might be reimbursed by your insurance company based on these factors:
You paid your therapist $120 for a 45-minute therapy session out of pocket and submitted a superbill to your insurance carrier.
Your insurance company decides the amount allowed for this service is $100, which is the maximum they will consider for reimbursement.
Your plan determines that your coinsurance is 40% (or $40) for this therapy session.
You have met your deductible for the year and are therefore eligible to be reimbursed.
When processed, your insurance carrier will reimburse you $60 for your therapy session.
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In most cases, your insurance company won’t reimburse 100% of what you paid to your therapist. On average, people who see an out-of-network therapist pay $60 per session. Depending on where you live and your therapist’s fees, you could pay much more.
Who creates a superbill?
Your therapist would be the one to create a superbill for you. There are different types of mental health professionals who offer therapy:
Psychologists
Counselors and psychotherapists (therapists)
Clinical social workers
Psychiatrists
Psychiatric nurse practitioners
Mental health or substance use clinics or facilities
Your therapist may offer superbills monthly. But you will need to talk to them to find out when you should expect to get your superbill. A therapist can agree to give a client a superbill, but they don’t have to provide one.
Sometimes, other types of healthcare professionals will provide you with a superbill. For example, you may be able to submit a superbill for physical therapy.
Do you have to ask your therapist for a superbill, or do they send it automatically?
If your therapist agrees to give you a superbill, they will determine how you receive it. There are different ways to deliver superbills. Your therapist may have an electronic medical record system that sends out superbills. They may also have a system that gives clients the ability to download superbills through a portal.
What information is required on a superbill?
Insurance carriers have specific requirements for how healthcare professionals should complete superbills. If any information is missing, the insurer may deny the claim or follow up to get more information before they send payment.
Here are some items that are typically included on a superbill:
Client contact information: This may include your name, address, date of birth, and phone number, as well as unique identifiers requested by the insurer.
Information about the healthcare professional: This may include your therapist’s name, practice location, state license number, phone number, and email address. Your therapist should also include their 10-digit National Provider Identifier (NPI) and employer identification number (EIN) for tax purposes.
Diagnosis: A superbill needs to include your diagnosis in the form of an ICD code. The International Classification of Diseases (ICD) diagnostic code shows what you’re being treated for and helps your insurance company validate that treatment is medically necessary.
CPT code(s): Current Procedural Terminology (CPT) codes are used by healthcare professionals to describe specific medical and diagnostic services that a client receives. This will tell your insurance company what kind of services you’ve received, such as a 45-minute individual therapy session or a 90-minute initial consultation with a psychiatrist.
Dates of service: Your therapist should include all of the dates they worked with you. If there are multiple dates of service, the most relevant procedure code should be listed by each date.
Itemized list of costs: The service amount should be included next to each date and procedure code. The total balance should reflect the costs of all services performed. Your therapist should also include how much you’ve paid out of pocket.
Referrer identification: If applicable, your therapist must include the contact information of the healthcare professional that referred you.
You can ask your insurance company for a list of what is required on your superbill before submitting it. And if anything is missing, you can ask your therapist to update the superbill.
What do you do with your superbill once it’s filled out?
If your therapist provides you with a completed superbill, you can submit it to your insurance provider. Your insurance provider can give you instructions on how to submit a superbill. Follow these guidelines and call them if you have any questions.
Below are some common ways to submit a superbill:
Upload it through your insurance company’s online portal. (Look for a “submit claims” option.)
Mail it in.
Send a fax.
Once your superbill has been accepted, your insurance carrier will send payment. Most of the time, your insurance company will reimburse you directly.
Is there a time limit for submitting your superbill for reimbursement?
Yes, there is a time limit for submitting superbills. But it is important to check with your insurance carrier for their specific time frame. These guidelines are also sometimes determined by state health insurance laws. Typical time limits range for 90 days to a few years.
What happens if your insurance company denies your superbill?
If your insurance company denies your superbill, first find out why. Your insurance company must explain why your claim was denied. Look for a description of the provided reason in your explanation of benefits (EOB).
A superbill can be denied for many reasons, including:
Missing information
Incorrect billing or diagnosis codes
Late submission of the claim
Lack of coverage for submitted services
Determination that the services aren’t medically necessary
If your claim for reimbursement is denied, you have several options. If your superbill was missing information, you may need to resubmit a corrected claim. Then, your insurance company can reprocess it.
You can also appeal a denied claim. Your insurance company must let you know the process for appealing the decision. First, you’ll submit an appeal to your insurance company, which means formally asking them to reconsider. If they deny your claim again, you may have the option to appeal to your state’s insurance regulators. This allows you the opportunity to have your claim reviewed by an independent party.
The bottom line
If you receive services from an out-of-network mental health professional, it’s important to ask if they can provide a superbill. This document may allow you to receive reimbursement from your insurance company for therapy services you pay out of pocket. Be sure to check with your insurer first to understand what’s covered and what the reimbursement process involves.
Why trust our experts?
American Psychological Association. (2023). Psychotherapy codes for psychologists.
Argus Medical Management. (2013). Insurance timely filing limits.
Benson, N. M., et al. (2020). Prices and cost-sharing in-network vs. out-of-network for behavioral health, 2007-2017. Health Affairs.
Centers for Medicare & Medicaid Services. (2024). National Provider Identifier Standard (NPI).
Davenport, S., et al. (2019). Addiction and mental health vs. physical health: Widening disparities in network use and provider reimbursement. Milliman.
Garrett, P., et al. (2011). EMR vs EHR – What is the difference? Health IT Buzz.
HealthCare.gov. (n.d.). Appealing a health plan decision.
National Alliance on Mental Illness. (n.d.). The doctor is out.
Xu, W. Y., et al. (2019). Cost-sharing disparities for out-of-network care for adults with behavioral health conditions. JAMA Network Open.
