Free template
Free superbill template
A clean, printable superbill template your clients can submit to their insurer for out-of-network reimbursement. Free, no signup, with prompts for every required field.
Superbill
Provider: ______________________
Client: ______________________
Date range: ______________________
Provider details
Your name and credentials, licence number, NPI, tax ID (EIN), practice address, and contact details.
Client details
Client name, date of birth, and address, as the insurer will need them.
Diagnosis
The diagnosis and its ICD-10 code(s).
Services rendered
For each session: date of service, CPT or service code, a short description, and the fee.
Payment summary
Total charged, amount the client paid, and any balance.
A filled-in example
Provider details
Jordan Ellis, LCSW · NPI 1234567890 · EIN 12-3456789 · 12 Main St · (555) 123-4567
Client details
Client: A. Client · DOB 01/01/1990 · 34 Oak Ave
Diagnosis
F41.1 Generalized anxiety disorder
Services rendered
05/12/2026 · 90837 · Psychotherapy, 60 min · $150
Payment summary
Total: $600 · Paid: $600 · Balance: $0
Want the full breakdown? Read: Simplify your billing process
More free templates: SOAP Note · Progress Note · Client Intake Form · Treatment Plan · DAP Note · BIRP Note · Informed Consent Form · Discharge Summary
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