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.
Read the full guide
Medical Invoice Guide: What to Include, How to Write One, and Common Mistakes Write clear medical invoices for insurance reimbursement. Learn what to include, how to write one, and avoid common billing mistakes. Read the guide →Related templates & variants
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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.