The superbill and the CMS-1500, explained
An educational explainer of the superbill an out-of-network practice gives patients, and the standard CMS-1500 claim form. Payer rules vary; confirm current requirements.
Current as of July 7, 2026. Laws, payer rules, and billing codes change, so confirm the current requirements for your jurisdiction and setting before you rely on it.
What's inside
What a superbill is
A superbill is an itemized receipt an out-of-network clinician gives a patient so the patient can seek reimbursement from their insurer. The practice is not billing the insurer; the patient is.
What a superbill usually contains
- Practice and clinician details: name, address, NPI, tax ID or EIN, and license
- Patient details and the dates of service
- Diagnosis codes (ICD-10-CM) and service codes (CPT), with the fee for each
- Place of service, and the total charged and paid
The CMS-1500
The CMS-1500 is the standard paper claim form for professional services from non-institutional providers. Many practices submit electronically in the equivalent 837P format, but the CMS-1500 fields are the shared language of a claim.
Notes for the clinician
- Give patients a clear superbill and explain that reimbursement is set by their plan and is not guaranteed
- Keep codes, documentation, and fees aligned
- Provide a Good Faith Estimate to uninsured or self-pay patients when required
- Confirm current payer and CMS rules
About this resource
This reference is part of the shrinkiatry resource library, a set of free, clinician-facing references and examples. It's reviewed by Shariq Refai, MD, MBA, FAPA, a board-certified psychiatrist, on a quarterly schedule. Next scheduled review: October 1, 2026. First published July 7, 2026, last reviewed July 7, 2026.
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