Insurance Billing and Superbilling

2 min read · Updated February 12, 2026

Insurance billing covers the process of submitting claims to insurance companies for therapy reimbursement, while superbilling provides clients with documentation to seek out-of-network reimbursement.

Insurance Billing Basics

Therapists bill insurance through two primary paths: in-network claims (submitted directly to the insurer) and superbills (provided to clients for out-of-network reimbursement). Your billing approach shapes your effective session rate, administrative burden, and client accessibility.

In-Network Billing

How It Works

You contract with insurance panels, agree to their fee schedule, and submit claims for reimbursement. The insurer pays the contracted rate minus the client’s copay or coinsurance.

Common CPT Codes for Therapy

Code	Description	Typical Duration
90791	Diagnostic evaluation (intake)	45-60 min
90834	Individual psychotherapy	45 min
90837	Individual psychotherapy	60 min
90847	Family/couples therapy (client present)	45-60 min
90853	Group psychotherapy	45-60 min

Documentation for Claims

Insurance claims require progress notes that demonstrate medical necessity. Each note should include diagnosis codes, treatment interventions, and measurable progress toward treatment plan objectives. Using standardised outcome measures like the PHQ-9 and GAD-7 strengthens medical necessity documentation.

Superbills for Out-of-Network Clients

A superbill is a detailed receipt that clients submit to their insurance for partial reimbursement. Clients with PPO plans often receive 50-80% reimbursement.

Required Superbill Fields

Therapist’s name, credentials, NPI number, and tax ID
Client’s name, date of birth, and insurance information
Date of service
CPT code and diagnosis code (ICD-10)
Session fee charged
Amount paid by client

Choosing Your Billing Model

Model	Pros	Cons
In-network	Steady referrals, accessible to insured clients	Lower rates, administrative burden, claim denials
Out-of-network with superbills	Full fee control, less admin	Smaller client pool
Private pay only	Maximum control, zero insurance admin	Smallest client pool

Many therapists use a hybrid model: one or two well-reimbursing panels plus superbills for out-of-network clients. For a complete analysis, see our therapy session fees guide and superbilling guide.

Billing Documentation

Related Resources

Sliding Scale Fee Structure

A sliding scale fee structure is a tiered pricing system where therapy session fees are adjusted based on the client's household income, expanding access while maintaining practice viability.

Session Documentation

Session documentation is the process of recording clinical information from therapy sessions, including notes, assessments, and treatment updates.

Treatment Plans

A treatment plan is a structured document that outlines a client's diagnoses, therapeutic goals, interventions, and measurable objectives to guide the course of therapy.