The Superbill: A Supercharged Guide for Physical Therapists

If you’re a physical or rehab therapist, you’ve likely seen patients who are either self-paying or responsible for out-of-pocket medical expenses. If you haven’t seen one yet, chances are you will sooner than later. When that time comes, the patient will need a superbill to seek appropriate reimbursement from their insurance company.

Whether you’re looking to prepare for that day or need to brush up on superbill fundamentals, this guide is for you.

What Is a Superbill for Therapy?

A superbill is a detailed statement of medical services, such as therapeutic interventions rendered to a patient. It’s often used in situations where the patient is responsible for self-paying or out-of-pocket costs. The superbill provides a comprehensive breakdown of the medical procedures performed, the corresponding codes (e.g., ICD-10, CPT), and the charges associated with each procedure.

Superbills are important for several reasons.

• Insurance reimbursement: A superbill provides a detailed breakdown of services, which is necessary for patients to submit claims to their insurance providers for reimbursement.
• Patient record: The superbill acts as a comprehensive record of the medical services received, helping patients track their healthcare expenses and understand the costs associated with their treatment.
• Billing and payment: Superbills serve as a basis for billing and payment, ensuring that both the patient and the healthcare provider have a clear understanding of the charges and payments that are due.
• Tax purposes: Superbills can be used as documentation for tax deductions related to medical expenses.
• Legal purposes: In case of disputes or legal proceedings, the superbill can serve as evidence of services provided and their associated costs.

Superbills may include a wide variety of medical services.

• Office visits: Consultations, physical exams, and follow-up appointments.
• Procedures: Surgical procedures, biopsies, and endoscopies.
• Diagnostic tests: X-rays, blood tests, MRIs, and CT scans.
• Treatments: Chemotherapy, radiation therapy, and physical therapy.
• Prescriptions: Medications and supplies.
• Hospital stays: Room and board, nursing care, and surgical fees.

Essentially, any medical service that is provided and billed to the patient can be included on a superbill.

5 Important Things to Know About Superbills

1. CPT Codes

CPT stands for Current Procedural Terminology. These codes are essential for accurate billing and insurance reimbursement and are used to classify and report medical procedures and services, ensuring that providers are compensated appropriately.

2. ICD-10 Codes

ICD-10 stands for the International Classification of Diseases, 10th Revision. These codes are often included on superbills to provide additional context for the rendered services. These codes classify diseases and health conditions, helping to identify the underlying reasons for the patient’s treatment. By including ICD-10 codes, the superbill provides a more complete picture of the patient’s condition and services provided.

3. Accuracy

It’s paramount to ensure that the information on the superbill is accurate and complete. Errors can lead to delays in reimbursement, incorrect payments, and potential legal complications. Double-checking the accuracy of the information on the superbill is essential to avoid these issues.

4. Digitization

Many healthcare providers now use electronic superbills, which can streamline the billing process and reduce errors. Electronic superbills often allow for easier integration with electronic health records (EHRs), improving efficiency and accuracy. Additionally, electronic superbills can be easily shared with patients and insurance companies, reducing paperwork and improving patient access to their medical information.

5. Patient Access

Patients should have easy access to their superbills to review the details of the services provided and the associated charges. This information can help patients understand their healthcare expenses and make informed decisions about their treatment. Some healthcare providers may offer online portals or other methods for patients to access their superbills electronically.

How to Create a Superbill

1. Gather Patient Information

Collect essential patient details, including:

• Full name
• Contact information (address, phone number, email)
• Insurance information (provider name, policy number, group number)
• Date of birth
• Referring physician (if applicable)

2. Record Rendered Services

Document each therapy session or procedure, noting:

• Date of service
• Time spent
• Description of the treatment or procedure
• Location of service (e.g., in office, home, outpatient facility)

3. Assign Appropriate Medical Codes

Determine the appropriate CPT and ICD-10 codes for each service rendered. Proper reporting using these codes ensures accurate billing and reimbursement. Use reliable CPT and ICD-10 codebooks or online resources to find the correct codes.

A Note on CPT and ICD-10 Codes

CPT and ICD-10 codes are both important for billing and documentation in physical and rehab therapy, but they serve different purposes.

CPT codes are used to classify and report medical procedures and services. They provide a detailed description of the specific interventions provided by the therapist. For example:

• Therapeutic exercises like strength training, range of motion exercises, and balance training.
• Manual therapy such as massage, mobilization, and manipulation.
• Modalities like ultrasound, electrical stimulation, and hot/cold therapy.
• Functional training such as activities of daily living, gait training, and sports-specific training.

ICD-10 codes are used to diagnose medical conditions and diseases. They provide a classification system for various health conditions that may require physical or rehab therapy. For example:

• Musculoskeletal disorders like sprains, strains, fractures, and arthritis.
• Neurological conditions such as stroke, spinal cord injuries, and Parkinson’s disease.
• Orthopedic conditions like joint replacements and amputations.
• Chronic pain conditions such as fibromyalgia and chronic fatigue syndrome.

In essence, CPT codes describe what the therapist did, while ICD-10 codes describe why the therapy was needed. Both codes are essential for accurate billing, insurance reimbursement, and medical record documentation.

4. Calculate Charges

Calculate the charges associated with each service based on your fee schedule and the rates set by the insurance provider. Consider factors such as the time spent, the complexity of the treatment, and any additional materials or equipment used.

5. Create a Detailed Statement

Prepare a clear and concise statement that outlines the services provided, the corresponding CPT codes, and the charges for each service. The statement should be easy to read and understand for both the patient and the insurance company. Consider using a standardized superbill template to ensure consistency and accuracy.

6. Include Relevant Additional Information

Depending on your practice’s requirements and the patient’s insurance plan, you may need to include additional information on the superbill, such as:

• Modifiers to indicate specific circumstances or variations in the service provided
• Insurance claim information, such as the patient’s insurance ID number and the provider’s NPI number
• Additional clinical notes

7. Review And Verify

Carefully review the superbill to ensure that all information is accurate and complete. Double-check the CPT and ICD-10 codes, charges, and any other relevant details. Consider having another staff member review the superbill as a second pair of eyes to catch any errors.

8. Provide a Copy to the Patient

Give the patient a copy of the superbill so they can submit it to their insurance provider for reimbursement. You should also keep a copy of the superbill for your records.

9. Consider Using Software or a Template

Utilizing software or a template can streamline the process of creating superbills and reduce the risk of errors. Many EHR systems include built-in superbill generators, making it simpler to create and manage these documents.

10. Update Your Fee Schedule Regularly

Ensure that your fee schedule is up to date and reflects the current costs of providing your services. Regularly review and update your fee schedule to avoid undercharging or overcharging patients.

Superbill Template

You can use the following simplified superbill example as a template for creating your own.

Patient Information

• Patient Name: John Doe
• Date of Birth: 01/01/1980
• Insurance Company: Acme Health Insurance
• Policy Number: 123456789
• Group Number: 000111
• Referring Physician: Dr. Jane Smith

Provider Information

• Provider Name: Dr. David Johnson
• NPI Number: 1234567890
• Practice Name: ABC Physical Therapy
• Address: 123 Main Street, Anytown, USA
• Phone Number: (555) 555-5555

Services Rendered

Date of Service	Procedure Code	Description	Units	Charge
10/15/2024	97162	Evaluation and treatment	1	$150.00
10/16/2024	97110	Therapeutic exercise, therapeutic activity	30 minutes	$90.00
10/17/2024	97140	Manual therapy	15 minutes	$60.00

Total Charges: $290.00

Insurance Information

• Patient’s responsibility:
  • Co-payment: $20.00
  • Deductible: $100.00
  • Out-of-pocket Maximum: $1,000.00
• Insurance paid: $224.00
• Patient balance: $56.00

Notes:

• The patient has met their deductible for the year.
• The insurance company has paid 80% of the covered charges, and the patient is responsible for the remaining 20%.

Additional Information:

• ICD-10 Codes:
  • M54.51 – Vertebrogenic low back pain
• Modifiers:
  • 25 – Evaluation and management
  • 59 – Multiple procedures on the same day

How to Submit a Superbill to Insurance

To better understand your patient’s healthcare experience and deliver high-quality care, it’s helpful to know the process they must follow to submit superbills to their insurance providers. Below are the steps they typically take to get reimbursed for their healthcare expenses.

1. Obtain the Superbill

The patient will obtain a copy of the superbill from you or staff members in your therapy office. The patient should ensure it is complete and accurate, including all relevant information such as patient information, your provider information, the services rendered, appropriate CPT and ICD-10 codes, and associated charges.

2. Check Insurance Coverage

The patient will verify their insurance coverage for the services listed on the superbill. This information can usually be found in their insurance policy, on their insurance provider’s website, or by contacting their insurance provider directly. They may also contact their insurance provider to get clarification on the superbill submission process.

3. Complete the Insurance Claim Form

The patient will obtain the necessary claim form from their insurance provider. This form will typically require information about themselves, their provider, the services rendered, the ICD-10 and CPT codes, and the charges. They’ll fill out the form as accurately as possible using the information from the superbill as a guide.

At this step, you may be contacted by the patient with questions or clarifications regarding their superbill. So be sure you and your staff have a process in place for addressing follow-up patient concerns about this document.

4. Attach the Superbill

The patient will attach a copy of the superbill to the completed claim form. This will provide the insurance company with the necessary details to process their claim.

If necessary, they may also include any supporting documentation, such as medical records or test results, to support their claim. Again, they may reach out to your office for assistance.

5. Submit the Claim

The patient will mail the completed claim form and attached superbill to the address provided by their insurance company. They may also be able to submit their claim online, or through a mobile app if their insurance provider has developed a digital superbill submission process.

6. Track the Claim

The patient will keep track of the status of their claim. Their insurance company may provide online tools or a phone number for them to check claim status. If they haven’t received a response within a reasonable time, they’ll need to follow up with their insurance provider to ensure they are properly reimbursed.

The Superbill Is Super Easy When You’re in the Know

The superbill is a super useful tool for the billing process. By following the above steps and using appropriate tools and resources, you can efficiently create accurate superbills that facilitate timely reimbursement and maintain accurate financial records for your practice.