Guides · Billing guide
What is a superbill? A guide with a free template
By Javier Alvarez · Updated · 7 min read
| Who gets one | A patient who paid you directly and has out-of-network benefits |
|---|---|
| Who files it | The patient, usually attached to the plan's member claim form |
| Who gets paid | The patient (you were already paid) |
| Core fields | NPI, tax ID, date and place of service, CPT and units, ICD-10, charges, amount paid |
| Typical MNT codes | 97802 (first visit), 97803 (follow-ups), per 15 minutes |
| Example member deadline | Cigna: 180 days from the service, unless the plan or state allows more |
| Wrong tool when | You're in network with the plan, or it's covered Medicare MNT |
A superbill is the bill you hand a patient who paid you at the visit, written in the language an insurer reads: codes, units, identifiers. The patient sends it to their plan and asks for out-of-network reimbursement. If the plan pays, the money goes to the patient, because you've already been paid.
To make one now, open the free superbill template: it has every field below, a one-click filled example, and prints on one letter page. The rest of this guide explains each field, shows a filled sample for a nutrition visit, and covers when a superbill is the wrong tool.
I've done the insurance billing for two dietitian practices since May 2026. A superbill carries the same data as the claims I work on for them. The difference is who sends it, who waits for the answer, and who gets the check.
Who uses a superbill
Superbills are for patients who pay you directly and have a plan with out-of-network benefits, usually a PPO or a POS plan. HMO and EPO plans generally cover out-of-network care only in an emergency (HealthCare.gov), so a superbill from an HMO member often comes back as $0.
On your side, superbills fit a cash-pay or hybrid practice: you set your fee, collect it at the visit and skip the claim follow-up. The trade-offs of that model are in superbill vs. insurance claims and cash pay vs. insurance: the real math.
Every field a payer needs
A payer turns your superbill into its own claim record, so it looks for the same data a CMS-1500 carries (NUCC instructions). Cigna's member claim form is a useful real example: it won't accept receipts, balance-due statements or cancelled checks in place of an itemized bill, and lists what the bill must include (Cigna medical claim form, Rev. 11/2023). The table puts the two side by side.
| Field | On Cigna's required list? | Notes for a nutrition visit |
|---|---|---|
| Provider name and credentials | Yes | "Jane Example, MS, RDN, LD" and the practice name |
| Provider address | Yes | The address where you saw the patient, or your practice address for telehealth |
| Tax ID | Yes | Use your EIN, not your Social Security number, since the paper leaves your hands |
| NPI | Not on Cigna's list | Add it anyway: the CMS-1500 needs a rendering NPI and many plans won't process without one. Individual (Type 1), plus the group's Type 2 if you bill as an entity (Type 1 vs Type 2) |
| Patient name and policyholder name | Yes (patient and primary customer) | Exactly as on the insurance card; add date of birth and member ID with its prefix |
| Date of service | Yes, as mm/dd/yyyy | One line per date |
| Procedure code and units | Yes ("type of service/procedure code") | 97802 for the first MNT visit, 97803 for follow-ups, in 15-minute units (units calculator) |
| Diagnosis code (ICD-10) | Yes | The condition you treated, with pointers from each line; see Z71.3 for the counseling code and its order |
| Charge for each service | Yes | Your fee for that line |
| Place of service | Not on Cigna's list | 11 office, 10 telehealth with the patient at home, 02 telehealth elsewhere (CMS POS codes); modifier 95 if the plan uses it |
| Amount paid and balance | Not on Cigna's list | Add it: amount, date and method of payment, and a zero balance due, so the plan sees the patient paid you |
| Referring provider and NPI | Only if the plan requires a referral | Ask the plan on the benefits call |
| Signature | Not on Cigna's list | Sign it, or add a line that the information is accurate |
Two habits prevent most callbacks. Copy the member ID with its prefix exactly as printed, and point each service line to the diagnosis that supports it. A lone BMI code (Z68) or a counseling code with no condition behind it is a common reason a plan says no; the BMI to Z68 code finder gets the pair right.
A filled sample for a nutrition visit
An invented example: a 60-minute first MNT visit in the office for an adult with prediabetes and class 1 obesity, paid in full at the visit. No real patient or practice.
Superbill, sample (all data invented)
| Section | Field | Value |
|---|---|---|
| Provider | Rendering provider | Jane Example, MS, RDN, LD |
| Provider | Practice and address | Example Nutrition LLC, 100 Example St, Springfield, ST 00000 |
| Provider | NPI (individual) | 1234567893 (example number) |
| Provider | Tax ID (EIN) | 00-0000000 (fake) |
| Provider | Taxonomy | 133V00000X (Dietitian, Registered) |
| Patient | Name, date of birth | TEST, PATIENT A, 01/01/1980 |
| Patient | Plan, member ID | Example PPO, XYZ000000000 |
| Visit | Date of service | 10/06/2026 |
| Visit | Place of service | 11 (office) |
| Diagnoses | A | R73.03 Prediabetes |
| Diagnoses | B | E66.811 Obesity, class 1 |
| Diagnoses | C | Z68.31 BMI 31.0 to 31.9, adult |
| Diagnoses | D | Z71.3 Dietary counseling and surveillance |
| Line 1 | CPT, units, pointer | 97802 × 4 units, pointer ABCD (60 minutes falls in 53 to 67) |
| Line 1 | Charge | $180.00 ($45 per unit) |
| Payment | Paid | $180.00 by card on 10/06/2026, balance $0.00 |
| Signature | Provider | Signed and dated |
The order of the diagnoses matters to some plans. A few want a wellness code like Z71.3 first when the visit runs through the preventive benefit, and others pay nutrition counseling on the condition. The Z71.3 page has the payer-by-payer detail, and preventive vs. medical benefits explains the routing. For telehealth, the same line would read POS 10 (patient at home) and, for plans that ask for it, modifier 95.
Duo Practice drafts the note from your recorded session, with the CPT code, units and ICD-10 codes it supports, so the paperwork matches the chart. Try Duo Practice free
How the patient files it
- Before the first visit, the patient calls the plan and asks: do I have out-of-network benefits for nutrition counseling (97802 and 97803) with my diagnosis? What is my out-of-network deductible and how much is met? What percentage do you pay, and of what amount? Do I need a referral? Our benefits verification checklist has the full list.
- After the visit, you give the patient the superbill and a receipt.
- The patient files it: the plan's member claim form from the member portal or the phone line, with the superbill attached, or an upload where the plan offers one. Cigna, for example, asks members to mail the form and itemized bills to the address on the ID card and to keep copies.
- The plan sends an Explanation of Benefits (EOB) showing the allowed amount, what went to the deductible and any payment.
Deadlines are short on some plans. Cigna's form says it must receive the claim within 180 days of the service unless the plan or state law allows more time. A stack of superbills sent once a year can miss that window, so tell patients to file monthly. The timely filing calculator turns a date of service into a deadline.
Why a superbill comes back as $0
A superbill is a request, and the plan decides. The usual reasons for a $0 answer:
- No out-of-network benefits (common on HMO and EPO plans).
- The out-of-network deductible isn't met. The plan processes the claim, credits it to the deductible and pays nothing, which still helps the patient later in the year.
- Nutrition counseling isn't a covered benefit for that diagnosis, or only as a preventive benefit with specific codes.
- The diagnosis doesn't support the service, or the BMI code is listed alone.
- A missing NPI or tax ID, or a name that doesn't match the card.
- The plan's visit limit is used up, or a required referral isn't on file.
The plan pays a share of its allowed amount, not of your fee. A patient who paid $180 can get back much less even when everything is approved. Put that in writing before the first visit. When a denial does come back, the denial code checker explains the code on the EOB.
When a superbill is the wrong tool
You're in network with the patient's plan. Your contract generally requires you to file the claim and collect only the patient's cost share (copay, coinsurance, deductible). File the claim; collecting the cost share is covered in copays, coinsurance and deductibles.
It's covered Medicare MNT. Medicare pays medical nutrition therapy only to a registered dietitian or nutrition professional enrolled in Medicare, who must accept assignment (CMS Claims Processing Manual, ch. 4, §300.3). The dietitian files that claim. Read the Medicare MNT guide before you offer a Medicare beneficiary a superbill. Medicare Advantage plans set their own out-of-network rules.
You want the payer's money to reach you. With a superbill the patient carries the risk and the paperwork, and some patients won't bother. If most of your patients have the same few plans, going in network can pay more over a year. That math is in cash pay vs. insurance, and if you'd rather not run the claims yourself, our insurance billing service for dietitians costs 3.9% of what the insurer pays on each claim, with no monthly fee.
Rules that protect you
Give a good faith estimate. Under the No Surprises Act, providers generally must give uninsured or self-pay patients a good faith estimate of expected charges when they schedule care at least 3 business days ahead or when they ask for one (CMS). A superbill patient is a self-pay patient.
Code what you documented. If a plan asks for records, the note has to support the codes and units on the superbill exactly as it would for a claim you filed. The CPT code finder checks the code, units and POS for one visit.
