Guide to Submitting a Physical Therapy Superbill for Payment
A superbill is a detailed invoice that includes all the information needed for an insurance company or third-party payer to process a claim for services rendered. The superbill typically includes codes for the diagnosis, procedures, and services provided. Here's a step-by-step guide on how to prepare and submit a physical therapy superbill.
Step 1: Have a referral from your provider
Step 2: Gather Patient and Treatment Information
Before completing the superbill, make sure to have the following information on hand:
Patient details:
Full name
Date of birth
Insurance policy number
Insurance group number (if applicable)
Patient’s primary care physician (if required by insurance)
Treatment details (this will be given to you each visit):
Date of service
Type of service (e.g., evaluation, manual therapy, modalities, exercises)
Duration of treatment or session length (e.g., 30 minutes, 60 minutes)
ICD-10 diagnosis codes for the patient's condition
CPT (Current Procedural Terminology) codes for the physical therapy services provided
Step 3: Receive the FIlled out Superbill
Most physical therapy clinics use a standard format for their superbills, but make sure to verify with the payer if any specific format is needed. Ensure the following details are filled out accurately:
Clinic Information:
Clinic name and address
National Provider Identifier (NPI) number for the physical therapist or clinic
Tax ID number
Contact information for any billing inquiries
Patient Information:
Patient’s full name
Patient’s date of birth
Patient’s insurance provider and policy number
The date(s) of service
Diagnosis Codes (ICD-10 Codes):
Each diagnosis the physical therapist has identified for the patient should be listed with the appropriate ICD-10 code. These codes are used to describe the patient’s medical condition and justify the need for physical therapy treatment.
Procedure Codes (CPT Codes):
Include the CPT codes for the services provided.
Modifiers (if applicable):
Modifiers may be added to CPT codes to indicate specific circumstances, such as multiple visits or unusual services.
Quantity of Service Provided:
This is typically represented in units. For example, if a patient received 30 minutes of therapy, it would typically be coded as one unit for certain procedures.
Total Charges:
List the charges associated with each procedure or service rendered, including the total amount due for each service. Ensure that charges are accurate and align with any contracted rates or standard fees.
Step 4: Review and Double-Check the Superbill
Before submitting the superbill, double-check all the information. Make sure:
The correct codes (ICD-10 and CPT) are used.
The insurance details are accurate.
The amount billed reflects the services provided.
Dates and times are correct.
Errors in coding, patient information, or charges can delay the processing or cause a claim to be rejected.
Step 5: Submit the Superbill for Payment
There are two main ways to submit a superbill for payment:
Submit Directly to the Insurance Company (Paper Claim)
If submitting a paper claim, you may need to fill out a CMS-1500 claim form, HCFA-1500, or another specific claim form required by your insurance provider.
Attach the completed superbill to the claim form.
Send the completed claim form and superbill to the insurance company's billing address. Make sure to retain a copy for your records.
Some insurance companies may require you to submit additional documentation, such as a physician’s referral or authorization for physical therapy services.
Submit Electronically (Electronic Health Record System)
Many physical therapy clinics use an Electronic Health Record (EHR) or Practice Management (PM) system to submit claims electronically.
From within the EHR/PM system, upload the superbill with the correct ICD-10 and CPT codes.
Confirm that all fields are filled out and accurate.
Submit the claim directly through the system to the insurance company. This process often includes automatic verification to ensure accuracy before submission.
Step 5: Track the Claim Status
After submission, keep track of the claim status. Some insurance providers allow you to check claim status online, or you may need to contact the insurer to verify the progress. Be prepared to:
Follow up on rejected claims: If the insurance company rejects the claim, they will typically provide a reason (e.g., coding error, missing information). Correct any errors and resubmit the claim.
Provide additional documentation: In some cases, the insurance company may request additional documentation, such as progress notes, additional diagnoses, or further justification of medical necessity.
Step 6: Payment or Denial
Once the claim is processed, the insurance provider will send either:
An explanation of benefits (EOB): This document outlines how much of the claim was covered, what the patient owes, and whether any adjustments have been made.
Payment: If the claim is approved, you will receive payment for the services rendered. Payments may come in the form of a check or electronic deposit.
If the claim is denied, you'll need to investigate the reason, correct any issues, and potentially resubmit the claim. Always appeal denials if you feel the claim was wrongly denied.