Superbill
DefinitionAn itemized, coded receipt a self-pay patient submits to their own insurer for out-of-network reimbursement; the practice does not file the claim.
A superbill is a receipt with the codes an insurer needs: provider name, credentials, NPI and tax ID; patient name and date of birth; date of service; CPT codes with units; ICD-10 diagnosis codes; place of service; the charge and the amount paid. The patient pays you, then files it with their plan for any out-of-network reimbursement.
When a superbill is not the right tool:
- In-network patients. A payer contract normally requires you to file the claim and collect only the member's cost share.
- Medicare. Section 1848(g)(4) of the Social Security Act requires providers to submit claims for covered services to Medicare beneficiaries, and CMS contractors monitor compliance (CMS Claims Processing Manual, Ch. 1). Registered dietitians are among the practitioners who may opt out of Medicare and use private contracts instead (42 CFR 405.400).
Set expectations before the first visit: out-of-network reimbursement depends on the member's plan, often after an out-of-network deductible, and many HMO and EPO plans pay nothing out of network.