Is couples therapy covered by insurance? CPT code 90847 guide
As a therapist, you may have heard a colleague talk about out-of-network receipts or had a client ask for billing documentation. Naturally, you might ask yourself: What is a superbill for therapy?
This article answers the primary question—what is a superbill?—and details why these documents matter for your private practice growth.
For many clients, therapy costs remain a primary reason for early treatment discontinuation.
When clients receive reimbursement from their health insurance plan, treatment becomes significantly more accessible.
Unfortunately, both clinicians and clients struggle with how out-of-network insurance claims operate when a therapist isn't credentialed or paneled with a specific payer network.
Developing a working knowledge of this core billing document is a great starting point for any growing practice.
What is a superbill?
A superbill for insurance is a specialized itemized invoice created for out-of-network clients or patients who want to seek reimbursement directly from their health plan.
When defining what is a superbill, it essentially serves as a comprehensive receipt showing all services rendered, total session fees, and payments received.
Unlike standard practice invoices, an ICD-10 superbill includes explicit clinical details required by insurance claims departments, such as diagnostic classification and procedure codes.
By reviewing these details, insurance companies determine whether a client's plan covers the rendered care.
When to provide a superbill
Looking at the formal superbill definition, these documents apply exclusively to out-of-network care.
You would not issue one to a client if you maintain an in-network provider contract with their health insurance company.
Out-of-network clients typically pay you directly out-of-pocket as private pay therapy clients.
For private pay clients with out-of-network benefits, you issue a superbill for therapy that breaks down dates of service and session rates.
The client then submits this document to their insurer for potential reimbursement. Alternatively, your practice can submit the documentation on the client's behalf.
Some insurance plans also require clients to attach a dedicated claim form containing employer details, subscriber IDs, and home address verification.
Can all clients get therapy insurance reimbursement?
Clients should contact their insurance carrier before starting care to verify their out-of-network mental health benefits.
Typically, preferred provider organization (PPO) or point of service (POS) plans offer out-of-network reimbursement options.
However, clients with high out-of-network deductibles must meet those spending thresholds before receiving insurance checks.
Many insurance carriers assign separate deductibles for in-network and out-of-network care.
Additionally, coverage can vary based on service delivery formats, such as remote video sessions or telephone care.
What does a superbill look like?
Here is a sample image showing a customizable superbill template:
What to include on a superbill
A complete mental health invoice requires fundamental practice details, licensing identifiers, tax information, client identifiers, and clinical codes.
Because insurance payers process these files, every document must pair proper session details with valid ICD diagnosis codes and CPT codes.
Here is what you must list on a complete superbill template:
Practice and clinician information
Provider full name, degree, professional license type, and license number.
Employer Identification Number (EIN) or Social Security Number (SSN), and National Provider Identifier (NPI).
Physical office street address, phone number, and professional email (avoid PO Boxes, which trigger payer claim rejections).
For telehealth appointments, list your physical office location address on record.
Client information
Full legal name and date of birth.
Current diagnostic code using the active ICD-10 superbill formatting standard (diagnostic descriptions are optional).
Session and billing details
Itemized dates of service listed on separate lines.
Centers for Medicare & Medicaid Services (CMS) Place of Service codes (e.g., POS 10 for telehealth in a patient home, POS 02 for tele-behavioral health outside the home, or POS 11 for office visits).
Exact CPT procedure codes and required modifiers (e.g., Modifier 95 for synchronous video or Modifier 93/FQ for audio-only encounters).
Exact session charges and payment amounts collected.
Clinician signature (digital signatures are widely accepted).
Understanding what is a superbill ensures you prepare compliant documentation that protects your client's financial claims.
What happens after submitting a superbill?
Once submitted, the insurance payer reviews the claim details against the client's policy guidelines.
Processing timelines range from two weeks to two months depending on the carrier.
After processing, the payer issues an Explanation of Benefits (EOB) outlining approved amounts, applied deductibles, and total reimbursement payouts.
Tips for creating therapy superbills
Knowing what a superbill is can help you create accurate, complete documentation for clients seeking reimbursement from their insurance.
Issue documents in a secured PDF
Always export your documentation as secured PDF files to prevent accidental or fraudulent alterations of fees or procedure codes.
Encourage frequent claim submissions
Advise clients to submit their out-of-network paperwork monthly rather than waiting until the end of the year. Regular submission prevents large-batch payer audits and catches coding issues early.
Educate private pay clients
Many clients do not realize their PPO plans offer out-of-network reimbursement. Explaining what is a superbill during intake helps clients make therapy more affordable.
Frequently asked questions about superbills
How do reduced session fees affect superbills?
If you offer a sliding scale or reduced fee, you must list the actual fee charged and collected. Listing your full standard rate when a client paid less constitutes insurance fraud.
Can I inflate rates for a bigger reimbursement?
No. Inflating session rates on billing documentation to maximize a client's insurance payout is illegal and violates insurance fraud regulations.
Should I sign a payer's W-9 form?
Yes. Insurers often require a signed IRS W-9 form to verify tax identification details before issuing reimbursement checks to clients. Signing a W-9 does not obligate you to join the insurance network.
Can I issue documentation before collecting session payment?
No. A valid superbill for therapy functions as an official receipt of payment rendered. Clients cannot claim insurance reimbursement for services they have not yet paid for.
Can insurers request my progress notes?
Yes. Submitting claims for out-of-network care allows payers to audit care quality or request documentation supporting medical necessity. Out-of-network clinicians should always maintain thorough therapy progress notes to defend diagnosis choices and treatment plans.
Should clinicians submit out-of-network claims directly?
If a client pays in full upfront, submitting claims on their behalf offers a helpful service with minimal practice risk. However, courtesy billing should only occur after collecting full session fees directly from the client.
Sources
Centers for Medicare & Medicaid Services. (2026). Place of Service Code Set.
Internal Revenue Service. (2024). Form W-9: Request for Taxpayer Identification Number and Certification.
Substance Abuse and Mental Health Services Administration. (2024). National Survey on Drug Use and Health (NSDUH).
How SimplePractice streamlines running your practice
SimplePractice is HIPAA-compliant practice management software with everything you need to run your practice built into the platform—from booking and scheduling to insurance and client billing.
If you’ve been considering switching to an EHR system, SimplePractice empowers you to run a fully paperless practice—so you get more time for the things that matter most to you.
Try SimplePractice free for 30 days. No credit card required.
