A superbill is a detailed receipt from your therapist or psychiatrist that contains the information your insurer needs to process an out-of-network claim. You pay the clinician, send the superbill to your insurance company, and if your plan has out-of-network benefits and your deductible is met, the plan may reimburse part of what you paid.
Part of our guide: Getting Started With Mental Health Care
It is not an official government form, and getting one does not guarantee payment. It is simply how your care gets translated into the codes insurers use. The steps below explain how to submit one and what to do if the claim comes back denied. This is general information, not legal or tax advice.
What is on a superbill
A superbill generally carries the same details as the standard professional claim form, the CMS-1500, so your insurer can match it to a claim. You should expect to see:
| Item | What it means | Why the plan needs it |
|---|---|---|
| Your name, birth date and member ID | Identifies you and your policy | Matches the claim to you |
| Date(s) of service | Each session date | Sets deadlines and benefit year |
| Procedure code (CPT) | Type of service | Sets the allowed amount |
| Diagnosis code (ICD-10) | The condition being treated | Supports medical necessity |
| Clinician name, license and NPI | Who treated you | Confirms an eligible provider |
| Tax ID and practice address | Who billed | Identifies the billing entity |
| Charges and amount paid | What you paid | Basis for repayment |
CPT and ICD-10 are code sets adopted under HIPAA. The CMS mental health billing booklet lists psychiatric diagnostic evaluation as 90791 and 90792, and psychotherapy with patient codes including 90832, 90834 and 90837. Medication visits and other services may use different codes, so ask your clinician’s office which apply to you. An NPI is a unique 10-digit number used to identify health care providers. Check that every item is filled in; a missing code or NPI is an easy reason for a claim to bounce.
Before you submit: check four things
- That you have out-of-network benefits. A superbill cannot create coverage your plan does not have. See how out-of-network benefits work in New York.
- Your deductible status. Submit claims even before your deductible is met, since allowed amounts generally count toward it.
- Whether a referral or pre-approval is required. Your plan can tell you.
- Whether the practice already files for you. If so, you do not need to submit anything yourself.
How to submit a superbill, step by step
- Get the superbill. Ask your clinician’s office how they provide it. Many practices post them in a patient portal.
- Find your plan’s claim process. Log in to the member portal or app, or call the number on your card. Look for “submit a claim” or “member reimbursement.” Some plans require their own claim form as a cover page.
- Attach the superbill and proof of payment if requested. Keep a copy of everything.
- Submit it and save the confirmation or, for mail, send it in a way you can track.
- Watch for the Explanation of Benefits. This statement shows the allowed amount, what went to your deductible and what the plan will pay.
- Look for your payment. Reimbursement generally goes to you, since you already paid the clinician. Compare it with the Explanation of Benefits.
Monthly or batch submissions work fine if your plan allows them. Just pick a routine you will stick to, because deadlines apply.
The timing rules in New York
For state-regulated coverage, New York’s Department of Financial Services (DFS) says the law requires insureds to submit claims within 120 days after the date of service, unless it was not reasonably possible. In that case, the outer limit is one year after the proof was otherwise due, except when an insured lacked legal capacity. Your plan’s Certificate of Coverage may state its own terms, so check it. Plans that are self-funded by an employer follow their own documents.
After a claim arrives, New York’s prompt payment law generally gives regulated insurers 30 days to pay claims submitted electronically and 45 days for those sent by paper or fax. If the plan disputes the claim, it must notify you in writing within 30 days. Delays beyond that may be something you can raise with DFS through a prompt pay complaint.
Keep a simple record
A small log saves trouble later. For each session, note the date, the date you submitted the claim, any confirmation number and what the plan paid. If you need to appeal or file a complaint, this record shows what happened and when.
Why the check may be smaller than you expected
Reimbursement is based on your plan’s allowed amount, which may be lower than what you paid. DFS says you are responsible for the difference between the billed charge and the allowed amount, plus any coinsurance. Early in the year, a claim may produce no payment at all and simply count toward your deductible. To set expectations ahead of time, ask your plan for an approximate reimbursement amount for the specific code.
If your claim is denied
Read the reason first. Some denials are paperwork problems, such as a missing code, an incorrect member ID or a late filing. Ask the office for a corrected superbill and resubmit it.
For a coverage denial, the steps in state-regulated plans are:
- Internal appeal. You or your designee can submit one within 180 days. Follow the instructions in the denial letter.
- External appeal. If the plan upholds a denial that qualifies, such as one based on medical necessity, you can ask for review by an independent medical expert through DFS. New York’s Insurance Law and DFS’s external appeal page give you four months from the final denial, while DFS’s 2025 consumer guide says 120 days. Four months is the legal deadline in the statute, but 120 days is the safer date to plan around. Check your letter, use the earliest date you see, and do not wait until the end.
- Complaint. DFS investigates insurance complaints involving licensed insurers, though it cannot act as your lawyer.
A dispute about how much a plan pays may not qualify for external appeal, so ask. If your employer self-funds your plan, DFS lacks jurisdiction to assist, and your plan documents will describe the appeal route; your benefits team can point you to them.
Privacy: what your insurer sees
A claim shares your diagnosis and service dates with your insurer. For some people, especially on an employer plan, that is worth thinking about. Paying privately is one alternative. Under federal rules, if you pay in full out of pocket, a provider must agree to your request not to disclose that service to your health plan for payment or health care operations, unless disclosure is otherwise required by law. Separately, most uses of psychotherapy notes require your authorization. Your clinician can explain how this works in practice.
Tax-advantaged accounts and deductions
The IRS lists fees paid to psychiatrists and psychologists among deductible medical expenses, to the extent total unreimbursed costs exceed 7.5 percent of adjusted gross income and you itemize. HSA funds can pay for medical care not compensated by insurance or otherwise. If you have an FSA, ask its administrator. Avoid claiming the same expense twice, and check with a tax professional.
Superbills at Mind Body Seven
For many clients with Cigna, Aetna or BCBS plans, Mind Body Seven files out-of-network claims for them. For other carriers, such as UnitedHealthcare, superbills are available in the patient portal. The practice does not accept Medicare or Medicaid. Details are on our fees and insurance page. You can also read about our out-of-network psychiatry care. Before starting, it can help to read questions to ask your insurer and whether integrative psychiatry is covered.
FAQs
Is a superbill the same as a receipt?
A simple receipt shows what you paid. A superbill adds the procedure and diagnosis codes and the clinician identifiers an insurer asks for. A plain receipt often is not enough for a claim.
Can my clinician leave off my diagnosis?
Insurers generally need a diagnosis code to process a claim, so leaving it off usually means no reimbursement. If that is a concern, talk with your clinician about it before you decide whether to submit.
Can I submit old sessions?
Possibly, but deadlines apply. Check your plan’s filing limit, and submit as soon as you can. If you missed a deadline for a good reason, explain that in writing.
Does a superbill work for couples or family therapy?
Sometimes. Coverage and code rules vary by plan, and some plans look closely at who was in the room and which diagnosis applies. Ask your plan before you rely on reimbursement.
