Gondley Consulting
Superbills for out-of-network therapy clients: what to put on them, the place of service codes, and when to send them
Ayush Gondley · 6 November 2026 · 5 min read
One clear sheet a month, and the client does the claiming.
Key takeaways
- A superbill is an itemised receipt an out-of-network client sends to their health plan to claim part of what they paid. Plans reject the ones with missing details, so a complete one saves the client, and your front desk, a second round.
- It should carry the client's details, your name, credentials, National Provider Identifier and tax ID, and for each session the date, the service code, the diagnosis code, the place of service, the fee and what was paid.
- Place of service comes from CMS's code set: 11 for the office, 10 for telehealth with the client at home, and 02 for telehealth with the client somewhere other than home.
- Whether a client who claims back with a superbill counts as self-pay for the good faith estimate depends on whether they are seeking to have a claim submitted to their plan. Our recommendation is to give them an estimate anyway.
Out-of-network clients pay you in full and claim part of it back from their plan. What they need from you is one document, the superbill, and what they usually get is a receipt that the plan sends back asking for codes. A template filled in from your records, sent once a month, removes the back-and-forth.
What goes on a superbill
Plans differ in what they ask for, but our recommendation is to include all of the following, since a superbill with everything on it is rarely returned:
- The client: name, date of birth, address, and their plan's member ID if they give it to you.
- You: the practice and clinician's name, credentials and license number, address and phone, National Provider Identifier (NPI) and tax ID.
- Each session: the date, the service code you would bill (the procedure code for the type and length of session), the diagnosis code, the place of service code, and the fee.
- Payment: what the client paid and when, and that the balance is zero if they paid in full.
- Your signature or a statement that the services were provided as listed.
Use the same service and diagnosis codes you have in the client's record, and keep the superbill consistent with the good faith estimate you gave them, as in our good faith estimate guide.
Place of service codes
CMS's place of service code set gives the codes most therapy practices need:1
| Code | Where the session took place |
|---|---|
| 11 | Office: where the professional routinely sees patients on an ambulatory basis |
| 10 | Telehealth provided in the patient's home |
| 02 | Telehealth provided other than in the patient's home |
Code 10 took effect on 1 January 2022, and code 02's description changed at the same time to cover telehealth with the patient somewhere other than home.1 Our recommendation is to record where the client was for every telehealth session, since the code follows the client's location.
The good faith estimate for these clients
The No Surprises Act rule treats as self-pay anyone without coverage for the service, or anyone with coverage who is not seeking to have a claim submitted for it, and it asks providers to find out which applies when a session is booked.2 A client who pays you and later sends a superbill to their plan sits close to that line, and the rule does not name them. Our recommendation is to give these clients a good faith estimate anyway, as in our guide: it costs nothing extra, and it comes from the same client record as the superbill, so the codes and fees match. This is not legal advice.
When to send it
Our recommendation is once a month, in the first week, covering every session the client attended and paid for in the month before. Monthly suits most clients' claims, keeps each superbill short, and gives the front desk one fixed day for it. Send one on request too, for clients whose plan has a filing deadline coming up.
Messages you can copy
Replace the words in brackets. Keep health details in the attachment, not in the email itself, as in our guide to emailing patients.
At intake · one question on the form
Will you be asking your health plan to reimburse you for sessions with us? [ ] Yes, please send me a monthly superbill [ ] No. If yes, please give us your plan's member ID, so we can put it on the superbill.
The monthly email · first week of each month, with the superbill attached
Hello [Name], attached is your superbill from [Practice] for your sessions in [month]. You can send it to your health plan to request reimbursement, usually through the plan's website or app. If your plan asks for anything else, reply here and we will help.
When a plan returns it · the reply to the client
Hello [Name], thank you for letting us know. We have added [what the plan asked for] and attached a new superbill for [month]. Please send this one to your plan instead of the first.
New clients' details for the superbill come from our new patient intake checklist.
What can run by itself
- The superbill, filled in from your scheduler and payments for the month: dates, codes, place of service and amounts paid.
- The monthly email, sent only to clients who said yes at intake, with the superbill attached.
- The copy for your records, filed in the client's chart, as in our front desk automation guide.
- A check before sending that every session has a place of service code and a diagnosis code.
What stays with your team
- The codes, which are the clinician's to choose.
- Questions about coverage, which the client takes up with their plan.
- A returned superbill, where someone reads what the plan asked for.
More of what we write for practices is on the blog.
Questions practices ask
What should a therapy superbill include?
The client's details, the provider's name, credentials, NPI and tax ID, and for each session the date, service code, diagnosis code, place of service, fee and amount paid.
What place of service code is used for telehealth?
CMS's code set has 10 for telehealth provided in the patient's home and 02 for telehealth provided other than in the patient's home. The office is 11.
How often should superbills be sent?
Our recommendation is monthly, in the first week, covering the previous month's paid sessions, plus on request.
Do out-of-network clients need a good faith estimate?
The rule covers clients without coverage, or with coverage who are not seeking to have a claim submitted. Clients who claim back with a superbill are not named, so our recommendation is to give them an estimate anyway.
Should the superbill go by email?
It can, as an attachment, with the email itself kept short, and through the patient portal for clients who prefer it.
Sources
- Centers for Medicare & Medicaid Services, Place of service code set.
- Code of Federal Regulations, 45 CFR 149.610, definition of uninsured (or self-pay) individual.
About the author
Ayush Gondley founded Gondley Consulting, which automates front-desk work for small US medical, therapy and veterinary practices. Before that he was a marine engineer at Maersk, keeping complex systems running at sea. Gondley Consulting on LinkedIn
