What insurers look for on a therapy superbill
When a client submits your superbill for out-of-network reimbursement, the claims processor is checking it against the same data points a standard claim form carries. For counseling and psychotherapy that means your name and license type, your individual (Type 1) NPI, a Tax ID, the client’s diagnosis in ICD-10-CM, and one line per session with a date, a CPT code, a place of service and the fee you charged. When something is missing, the claim usually stalls while the insurer asks for more information.
Two fields cause most of the trouble for LPCs, LMFTs and LCSWs. The first is the diagnosis, because a superbill without one is not a claim. The second is session length, because the individual psychotherapy codes are defined by minutes, and a code that does not match the documented time can be recouped later.
Common therapy CPT codes and when to use them
| Code | Use it when |
|---|---|
| 90791 | Intake or diagnostic assessment at the start of care, before treatment begins |
| 90832 | Individual session with 16 to 37 minutes of psychotherapy |
| 90834 | Individual session with 38 to 52 minutes, which covers the typical 45 or 50 minute hour |
| 90837 | Individual session with 53 minutes or more |
| 90846 | Family or couples session where the identified client is not in the room |
| 90847 | Family or couples session with the identified client present |
| 90853 | Group psychotherapy, one line per group member |
| 90839 / 90840 | Crisis session: 90839 covers roughly the first hour (30 to 74 minutes), and 90840 is added for each further 30 minutes |
| 90785 | Add-on when communication factors genuinely complicate an intake, individual or group session |
| 96127 | A scored standardized screener such as the PHQ-9 or GAD-7, one unit per instrument |
A few rules of thumb. Under 16 minutes of psychotherapy, there is no individual psychotherapy code to report. 90785 is not a catch-all for a hard session: CPT ties it to specific situations, such as caregivers whose conflict or emotions interfere with the work, a mandated report made during the session, or play equipment needed to communicate with a young child. It is never used on its own, never with the crisis codes, and not for interpretation alone. The family codes are written as 50-minute services, and some payers publish their own minimum time, so check before billing a short family session.
For a deeper look at the longest individual code, and how it differs from 90834, see the CPT 90837 guide.
Telehealth, place of service and modifiers
Place of service 11 is your office. For video sessions, many plans want POS 10 when the client is at home and POS 02 when the client joins from somewhere else, such as their workplace. Some commercial plans instead ask for POS 11 plus modifier 95 so the session is treated like an office visit. Audio-only sessions are covered by some plans and not others; where they are, modifier 93 is common. A few payers still ask for the older GT modifier. Rules differ by plan, so check the client’s plan once and code every session the same way. Our guide to place of service codes for telehealth walks through the options.
Documentation that backs up the superbill
The superbill is a summary, not your clinical record. Insurers that review out-of-network claims may ask for notes, so keep these consistent with what you bill:
- Start and stop times for every psychotherapy session, especially 90837.
- A diagnosis that matches your assessment and treatment plan, listed in the same order on the superbill.
- Who attended family and couples sessions, and which person is the identified client.
- The screener name and score for each 96127 unit.
Also talk to your client about the diagnosis before you hand over the superbill. They will be sharing it with their insurer, and some clients would rather pay privately once they understand that.
Therapy-specific gotchas
- Couples work. Plans pay for treatment of a diagnosed condition. If the work is purely about the relationship, coverage is often unavailable, and stretching a diagnosis to make it reimbursable creates real risk.
- License level. Some plans do not reimburse pre-licensed associates or certain license types out of network. Check before issuing superbills under an associate license.
- Deductibles. Out-of-network reimbursement usually starts only after the client meets a separate deductible. Coverage varies by plan, so suggest clients ask about it at intake.
- Self-pay clients. If a client is paying privately, you may also owe them a Good Faith Estimate under the No Surprises Act.
How to fill this therapy superbill template
- Provider details. Enter your practice name, your name, credentials (LMFT, LPC, LCSW, LMHC and so on), license number, address, phone, email, individual NPI and Tax ID. The NPI field checks the check digit, so a typo is flagged right away.
- Client details. Copy the name, date of birth and address, then the insurance carrier, member ID and group number from the client’s card.
- Diagnoses. Add up to 12 ICD-10 codes. They are lettered A to L, with the primary diagnosis as A.
- Sessions. Add one line per session with the date, CPT code, modifier if needed, place of service, diagnosis pointer (for example “A” or “A, B”), units and fee. Typing in the code field suggests the codes above and fills in the description.
- Payment. Enter the amount the client has paid. The balance is calculated for you.
- Sign and check. Type your signature, add any notes, and review the checklist, which flags missing required fields.
- Print or save. Use Print / Save as PDF for a US Letter copy.
If you bill a full caseload each month, export clients and sessions from your EHR and use CSV import to print one superbill per client in a single batch. The steps are in our EHR CSV import guide.
Make your superbill now
Load the sample to see a finished therapy superbill, then replace it with your own details in the generator above. Everything stays in your browser. For more context, read our therapy superbill guide, or see the psychologist template if you also bill psychological testing.