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Bob Walsh and Norm Dasenbrook
Apr 19, 2011

A cost-Effective Strategy When Billing Clients

We have had hundreds of requests by ACA members for a fairly simple form that we have shared with counselors and we think it may be a good idea to share with our blog readers. We recomment the Superbill. “Superbill” is a term for a billing format for the counselor who wants to handle billing in a simplified manner. Using this strategy allows the client to submit the bill directly to the insurance company.

The superbill form is all the client needs to file their own insurance; it removes the counselor from the billing loop and saves money on computer billing software and even postage. It is particularly good for the new provider starting on a shoestring. A superbill is usually one page and must contain the clinician’s name; the practice name and address; phone number; date and place of service; as well as client information; TAX ID; NPI number; state license number; checklist of CPT codes; a place to write DSM or ICD diagnosis codes; the charge for service and the payment; balance due; and signature of the clinician (see the example below). Any local printer can make three attached pages with NCR carbonless paper. One copy goes in the client file to keep record of payment. Two copies are given to the client: One is a receipt for personal records, and the other can be sent to the insurance company so the client can be reimbursed by their insurance plan. With the superbill, the counselor can ask for payment at the time of the session and save money by not purchasing billing software. Here is our example of the superbill.

Example of receipt form
This 3-part form is printed on carbonless paper, 5 ½”X 8 ½”. The white copy for insurance, yellow copy for client, and pink copy for office use.

Name of therapist
City, State, Zip

Office phone number
State license number
Tax ID number
NPI number

Client Name _________________________________
Address ____________________________________
Insurance ID #________________________________
Client DOB__________________________________
Insured’s Name and DOB________________________
Profession Service Rendered on __________________
Place of Service ______________________________
Diagnosis: ___________________________________

____90801Diagnostic Evaluation45-50min_______
____90804Individual psychotherapy 25-30 min _______
____90806Individual psychotherapy 45-50min_______
____90831Telephone consult _______
____90847Family psychotherapy_______
____90853Group psychotherapy _______
____Care Summary report_______

Today’s Charges_______
Thank youPayment_______
Balance due _______


Norm Dasenbrook and Bob Walsh are counselors in private practice, consultants, and authors (

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1 Comment

  1. 1 Chloe Cooper 02 Oct
    I am a Licensed Associate Counselor and under supervision for 3200 hours in AZ before I will be an Independent level.  I work for an Agency and contract with a third party for my supervision.  On the Super Bill form does my Supervisor need to sign off, or just the owner of the Agency where I work?
    Thank you.


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