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Medical invoice template

Practices that bill patients directly, such as therapists, physical therapists and out-of-network specialists, need an invoice the patient can pay and often send to their insurer. With dates, CPT and diagnosis codes, the NPI and the practice tax ID, this one doubles as a superbill.

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Medical invoice · example

FromClearwater Counseling, PLLC
ToJordan Avery
CurrencyUSD
DescriptionQtyPriceAmount
11 Sep: diagnostic evaluation (CPT 90791), office (POS 11)1$220.00$220.00
18 Sep, 25 Sep, 2 Oct: psychotherapy, 53+ minutes (CPT 90837), telehealth (POS 10)3$180.00$540.00
Total$760.00

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How to use the medical invoice

  1. Enter the practice name, address, NPI and tax ID.
  2. Add the patient and their billing address.
  3. List each service by date with its CPT code and fee.
  4. Add diagnosis codes and the place of service, then save and issue.

Fields a superbill needs

FieldExample
Provider and practiceName, credentials, address, phone
NPIIndividual NPI, and the group NPI if used
Tax IDPractice EIN
PatientName, date of birth, address
Date of serviceOne line per visit
Place of serviceOffice (11), or telehealth (02 or 10)
ProcedureCPT code, such as 90837 for psychotherapy of 53 minutes or more
DiagnosisICD-10 code
Fee and amount paidCharge per line, and payments received

Getting paid by self-pay patients

Many practices take payment at each visit and hand over the superbill as a paid statement. Others invoice monthly, as in the example. Either way, record each payment against the invoice so the balance is right if the patient questions it or their insurer asks for proof of payment.

Questions

What is a superbill?

An itemised statement a provider gives a patient who pays directly, so the patient can claim out-of-network reimbursement from their insurer. Insurers look for the provider's NPI and tax ID, dates of service, CPT procedure codes, ICD-10 diagnosis codes, fees and proof of payment.

Do I need to give self-pay patients a Good Faith Estimate?

Under the No Surprises Act, providers must give uninsured and self-pay patients a Good Faith Estimate of expected charges for scheduled services. If the final bill is at least $400 above the estimate, the patient can dispute it.

What patient information should the invoice include?

Only what is needed to bill: the patient's name and address, dates, services and, for a superbill, diagnosis codes. Send it through a channel the patient has agreed to, and keep it with their records.

Is sales tax charged on medical services?

Professional medical services are generally exempt from sales tax. A few states tax cosmetic procedures, and products sold in a practice can be taxable.

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