Medical Invoice & Superbill Template
A superbill is the invoice patients submit to their insurer for out-of-network reimbursement — and it only works if the codes are right. This template captures the provider's NPI and tax ID, each service with its CPT code and fee, the ICD-10 diagnosis codes, and the amount paid, so a claim isn't rejected on a technicality.
Last reviewed 2026-07-08
Template preview
- Provider:
- Dr. S. Nguyen · NPI 1234567890 · Tax ID 12-3456789
- Patient:
- Patient Name · DOB 1990-04-12
- Superbill #:
- SB-2026-058
- Date of service:
- 2026-06-30
- Diagnosis (ICD-10):
- F41.1, Z71.9
| Service (CPT) | Units | Fee | Amount |
|---|---|---|---|
| Psychotherapy, 60 min (90837) | 1 | $200.00 | $200.00 |
| Initial evaluation (90791) | 1 | $250.00 | $250.00 |
| Total charges | $450.00 | ||
| Patient paid | −$450.00 | ||
| Balance | $0.00 | ||
How to fill in each field
Provider identifiers
Include the provider name, NPI number and tax ID — insurers require them to process a claim.
Common mistake: Leaving off the NPI, which causes the reimbursement claim to be rejected.
CPT service codes
List each service with its CPT/procedure code, units and fee.
Common mistake: Describing services in plain English with no CPT code — insurers can't adjudicate it.
ICD-10 diagnosis codes
Record the diagnosis code(s) that justify the services rendered.
Common mistake: Missing or mismatched diagnosis codes, a common reason claims are denied.
Amount paid
Show what the patient actually paid so they can claim the correct reimbursement.
Common mistake: Omitting payment status, leaving the insurer unsure what was paid.
Related templates & variants
This is the medical/superbill variant of our invoice. It is a billing template, not medical or insurance advice — verify coding with your billing specialist. General services use the freelance version.
Download a professional invoice template in Word, Excel, CSV or Google Docs. Includes a field-by-field guide, tax-line examples and common billing mistakes to avoid.
A freelance invoice template for hourly and fixed-project work. Track billable hours, rates and deposits. Download in Word or Excel with a field-by-field guide.
A free Excel invoice template with auto-calculating totals and tax. Download the .xlsx, or copy the table. Includes formulas and a field-by-field guide.
Recommended tools
Prefer software to a file?
Quick invoicing app if you just need to bill patients and track payments.
Try Invoice Simple →Some links are affiliate links — we may earn a commission at no cost to you. Full disclosure.
Frequently asked questions
What is a superbill?+
A superbill is an itemized receipt from a healthcare provider containing the provider's identifiers, CPT service codes, ICD-10 diagnosis codes and fees. Patients submit it to their insurer to claim out-of-network reimbursement.
Is a superbill the same as an invoice?+
A superbill is a specialized invoice. It includes everything a standard invoice has, plus the medical coding (CPT and ICD-10) and provider identifiers an insurer needs to process a reimbursement claim.
What needs to be on a superbill?+
Provider name, NPI and tax ID; patient name and date of birth; date of service; CPT codes with fees; ICD-10 diagnosis codes; and the amount the patient paid.
Sources & further reading
- Superbills 101: what info needs to be on it (Valant)— valant.io
- What is a superbill and how do they work (CareCloud)— carecloud.com
We review authoritative guidance when building each template. Links are for reference only.