What goes on a superbill template, and who can issue one?

A superbill is an itemized receipt that a client sends to their insurer to ask for out-of-network reimbursement. UnitedHealthcare lists seven items it needs on a superbill, including diagnosis codes and a place of service code¹, and says missing information can delay or stop payment².

Free superbill generator

Everything you type stays in this browser tab. OneSomatic does not receive it. Close the tab and it is gone.

Practitioner

Name

Credential (optional)

License number (optional)

License state (optional)

2-letter state code.

Phone

Practice address

NPI (optional)

10 digits. We check the check digit.

Tax ID (EIN)

Client

Name

Date of birth

Address

Service 1

Date of service

CPT or HCPCS code

Code only.

Place of service02 Telehealth, not in the client's home10 Telehealth in the client's home11 OfficeOther code

Modifier (optional)

ICD-10-CM codes

1 to 4 codes, separated by commas.

Units

Charge (USD)

Amount paid (USD)

Add a service

Total charges

$0.00

Total paid

$0.00

Balance

$0.00

Signature

Practitioner name for the signature

Date

Download PDFBlank template (PDF)Example (PDF)

The generator above makes three PDFs: one filled from your entries, one blank to print, and one example marked "EXAMPLE". The sections below explain each field and why insurers ask for it.

What is a superbill, and when does a client need one?

A client needs a superbill when they pay you directly and want their plan to pay some of it back. UnitedHealthcare says a member may need to submit their own claim when a provider collects payment up front. It also says an out-of-network provider can submit a claim for the member, and that the member may have to if the provider is unwilling¹.

A superbill asks for payment. It does not guarantee it. The client's plan decides what it covers, so tell clients this before the first session.

Which fields does a superbill need?

Each insurer names the fields in its own member instructions. The three we checked overlap, but their lists differ.

What each field does:

• Client name and date of birth. All three insurers ask for the patient name^{1, 3, 4}. None of the three superbill lists names date of birth. UnitedHealthcare's claim form asks for it in the member section². Use the name on the insurance card.
• Practitioner name, address, credential and license number. Cigna asks for the professional's name, credentials and address³. None of the three lists asks for a license number. If you hold no license, leave the license field blank. Do not write a training certificate in its place.
• Tax ID. UnitedHealthcare and Cigna both ask for the provider's tax ID^{1, 3}. On an IRS Form W-9, a sole proprietor who has an EIN may enter either the SSN or the EIN⁵. Whether an insurer accepts either one on a superbill is unknown. Check with the plan.
• NPI (optional). The National Provider Identifier (NPI) has 10 digits⁶. To get one, the applicant certifies that they are a health care provider as defined at 45 CFR § 160.103⁷. The generator checks the number's check digit.
• Date of service. One line per session.
• Procedure code (CPT or HCPCS) and modifier. This code tells the insurer what service took place. The American Medical Association holds the copyright in CPT⁸, so the generator shows codes only, without descriptions.
• Place of service code. This two-digit CMS code says where the service took place⁹. CMS lists 11 as office, 10 as telehealth with the patient at home, and 02 as telehealth with the patient somewhere other than home⁹. CMS says to check each payer's reimbursement policy for these codes⁹.
• Diagnosis code (ICD-10-CM). ICD-10-CM is the US code set for medical diagnoses¹⁰. A diagnosis is a clinical decision. Only enter one that a qualified clinician made.
• Units, charge and amount paid. UnitedHealthcare asks for the units and the billed amount for each procedure code¹. The generator adds up the totals and the balance.
• Signature and date. Your signature confirms that the services took place as listed.

What does a completed superbill look like?

This example uses invented values. It shows codes as formats only, not as advice on which code to use. The example PDF in the generator follows the same layout.

Missing information can delay or stop payment². Still, never guess a code. Leave the line blank and ask the client's plan what it needs.

Can a somatic practitioner without a state license issue a superbill?

You can write one. Whether an insurer pays it is a separate question, and the sources we checked do not answer it.

What the sources say:

• UnitedHealthcare needs diagnosis codes and procedure codes, and says that missing information can delay or stop payment^{1, 2}.
• Cigna asks for the professional's credentials³.
• An NPI applicant must certify that they are a health care provider as defined at 45 CFR § 160.103⁷.

What we could not confirm:

• Whether any of these insurers pays a claim from a practitioner without a state license. Unknown.
• Whether a practitioner without a license counts as a health care provider for an NPI. Unknown. We did not read the regulation's text.
• Which procedure codes, if any, fit unlicensed somatic work. Unknown. Never use a code for a service that your license does not cover. Never use a psychotherapy code without a license.

If you hold no license, we found no source that says an insurer will pay. Ask the client to call the number on their insurance card before the first session. The plan's answer is the one that counts.

If you are licensed, enter your license and use the codes that fit your scope.

When should I use practice software or the insurer's claim form instead?

This generator suits occasional superbills. Three other routes fit other cases.

• Practice software. If you write superbills every week, software that builds them from your calendar and invoices may save retyping. Our practice software guide compares the options, and SimplePractice alternatives covers tools for cash-pay work.
• The insurer's own claim form. Aetna lets the client ask the provider to complete the provider section of its form instead of attaching bills⁴. If a client brings that form, fill it in.
• The provider submits the claim. UnitedHealthcare says out-of-network providers can submit claims for members¹. The generator only makes the PDF. It does not submit anything.

Your entries in the generator stay in this browser tab. OneSomatic does not receive them. For self-pay clients who ask about cost, see good faith estimates.

Sources

1. UnitedHealthcare, "How to submit a claim". Checked October 14, 2026.
2. UnitedHealthcare, "Medical Claim Form" (member instructions). Checked October 14, 2026.
3. Cigna, "Medical Claim Form" (591692c Rev. 11/2023). Checked October 14, 2026.
4. Aetna, "Medical Benefits Claim Instructions and Form". Checked October 14, 2026.
5. IRS, "Instructions for the Requester of Form W-9" (Form W-9, Rev. March 2024, Part I note on sole proprietors). Checked October 14, 2026.
6. CMS, "NPPES NPI Registry". Checked October 14, 2026.
7. CMS NPPES, "Apply for an NPI" help page. Checked October 14, 2026.
8. American Medical Association, "FAQ: Editorial Panel & CPT overview". Checked October 14, 2026.
9. CMS, "Place of Service Code Set". Checked October 14, 2026.
10. CDC National Center for Health Statistics, "ICD-10-CM". Checked October 14, 2026.