How to generate a superbill for Out of Network reimbursement

When I was starting out in private practice , I got conflicting messages about whether LPC Interns (Oregon’s provisional counseling license) could give clients superbills for out of network reimbursement. Some folks said if you couldn’t get paneled you couldn’t do superbills. But other folks said it works just fine.

So I decided to try it myself, and was entirely successful in helping clients get reimbursed for out of network mental health services from me, a provisionally licensed counselor (at the time - I’m licensed now, woohoo).

There’s nothing fancy to make it happen. Many insurance companies reimburse out of network and don’t really care about what someone’s specific license status is, as long as they provide the following:

1. A National Provider Identifier number or NPI.

2. A license number, even an intern license number.

3. An EIN - Employer ID Number. You could use your SSN, but don’t.

4. A valid procedure code, or CPT code.

I’m going to walk you through this process now!

But first…

Superbill etiquette and disclaimers

Before you even get started, have your client asked their insurance company the following:

• Do you reimburse for out of network mental health providers, including [whatever your particular license/provisional license is]? If so, what percent do you reimburse?

• What is my yearly deductible and have I met it?

• What is the process for submitting superbills for reimbursement?

Be sure to explain to your client that you aren’t responsible for whether they get reimbursed by the insurance company, that you’ll do your best to provide the necessary documentation, but can’t work directly with the insurance company on their behalf.

I’d like to point out that even if you follow my guide, you may run into issues that I couldn’t possibly predict, so you are responsible for using this guide competently.

Get yer NPI:

Get your National Provider ID number, or NPI. You should not have to pay to get this. If you do, you’ve landed on a scam website and are getting scammed. Let me repeat, you should not have to pay to get your NPI! Simple go to the US Govt’s Health and Human Services site and apply! - https://nppes.cms.hhs.gov/#/

A bunch of people have asked me what code to use. It depends on your license, but if you’re a mental health counselor it may be - 101YM0800X. A good way to check this is to Google a colleague in your state who is the same degree and license type as you, and add the word “NPI” - so, “Bob Dobbs NPI,” for example, and see what taxonomy code they’re using. And remember, in the words of my favorite professor, “Look around and see what people around you are doing, but remember they might be doing it wrong.” Hah!

Get yer EIN:

In order for your client to be reimbursed, your superbill needs a tax ID on it that identifies you. You could use your SSN here but I sure as heck wouldn’t recommend that! Go get an Employer ID from the IRS at their website - https://www.irs.gov/businesses/small-businesses-self-employed/apply-for-an-employer-identification-number-ein-online - note that’s the link for self employed folks, like single member LLCs or sole proprietors. When you generate your EIN, go write it down in 100 places, e-mail it to yourself, print it out, because if you lose it it’s hard to find out from the IRS what it was.

CPT codes:

Now you need to figure out what CPT codes you’re using. Here are the common ones for mental health:

• 90791 - Initial psychotherapy intake, 60+ minutes

• 90834 - Individual psychotherapy, 38-52 minutes

• 90837 - Individual psychotherapy, 53+ minutes

• 90847 - Family psychotherapy, 90 minutes

There are some insurance companies that won’t cover anything other than 90791 and 90834, but that seems to be only if you’re actually paneled with them, not if you’re an out of network provider.

Place of service codes:

You need to identify the location of the service provided. I usually use 02 for telehealth, 11 for office. You can find more info here: https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set

Diagnosis:

You will likely need to determine a diagnosis and put that in the superbill. I hope if you’re here you know how to determine a diagnosis.

Now, create the superbill!

Click here to download the superbill template I made. It’s in MS Word format.

Edit the file, entering the date of the invoice, and putting your info in the Provider area. Then put the client’s info in the Client area. Then put their diagnosis in the appropriate spot. You can add multiple diagnosis, and number them 1, 2, 3, etc.

Then in the area below that put in the dates of service, what diagnosis you were treating, what CPT code was used, a description of that code, the place of service in parentheses, your fee, and what they paid.

Then at the bottom put a total, and be sure to put the client’s name where it says “Make payments to.” If you don’t do that, the insurance company will try to pay you, which you don’t want.

Here’s a handy-dandy picture that shows you what to do:

It could be easier

If you have an EHR, like SimplePractice, you can autogenerate superbills that get sent out monthly to your clients. Then you don’t have to edit any of this stuff yourself. Well, you’ll still need an EIN, an NPI, and a license number. :)

Did you find this guide helpful? If so, let me know!