How to Bill Insurance as a Therapist: The Complete Guide

Billing insurance as a therapist is one of the most confusing parts of running a private practice. Whether you are going in-network, staying out-of-network, or trying to decide between the two, this guide explains the full process — from credentialing to claim submission — in plain language.

Two Ways to Bill Insurance

There are fundamentally two different billing relationships a therapist can have with insurance companies:

1. In-network (paneled): You contract with the insurer, agree to their fee schedule, and submit claims directly on behalf of your clients. The insurer pays you directly.
2. Out-of-network (OON): You have no contract with the insurer. Clients pay you out-of-pocket and you provide them with a superbill, which they submit to their insurer for direct reimbursement.

For a detailed comparison of the tradeoffs of each approach, see private pay vs insurance for therapists.

Path 1: Going In-Network

Step 1: Get Your NPI

You must have a Type 1 (individual) NPI before applying to any insurance panels. Apply for free at nppes.cms.hhs.gov. The process takes about 10 business days. Your NPI is permanent — you keep it for your entire career regardless of where you practice.

Step 2: Get Your Taxonomy Code

Your taxonomy code identifies your specialty within the NPI system. Register it in your NPPES profile. Common mental health taxonomy codes include 101YM0800X (counselor, mental health) and 1041C0700X (social worker, clinical).

Step 3: Get Credentialed With Payers

Credentialing is the process of applying to join an insurer's provider network. You will need to submit:

• Your license (verified current and in good standing)
• Malpractice insurance certificate
• NPI and taxonomy code
• Practice address and contact information
• Work history and education
• References

Credentialing takes 60–180 days. You cannot see in-network clients until credentialing is complete. Many therapists use a credentialing service to manage the paperwork.

Step 4: Submit Electronic Claims

Once credentialed, you submit claims electronically using the 837P transaction format — most EHR and billing software handles this for you. Each claim must include:

• CPT code matching the session type (e.g., 90837 for 60-minute individual therapy)
• ICD-10 diagnosis code
• Date of service, place of service code, and units
• Client member ID and provider NPI

Path 2: Billing as an Out-of-Network Provider

The OON path is simpler administratively — there is no credentialing, no fee schedule negotiation, and no prior authorization in most cases.

Step 1: Set Your Fee

As an OON provider, you set your own rate. Research market rates in your area and consider your credential level, specialization, and the populations you serve.

Step 2: Collect Client Insurance Information at Intake

Even as an OON provider, you should collect the client's insurance information so you can help them verify their OON benefits and generate accurate superbills.

Step 3: Generate a Superbill After Each Session

After each session (or at the end of the month), provide your client with a superbill. The superbill must include your NPI, taxonomy code, EIN, license number, CPT code, ICD-10 diagnosis code, place of service, session date, fee charged, and amount paid.

Step 4: Your Client Submits to Their Insurer

The client submits the superbill through their insurer's member portal or by mail. The insurer processes it as an OON claim and reimburses the client directly, minus any outstanding deductible and coinsurance.

Common CPT Codes for Therapist Billing

• 90791 — Psychiatric diagnostic evaluation (initial intake)
• 90832 — Individual psychotherapy, 30 minutes
• 90834 — Individual psychotherapy, 45 minutes
• 90837 — Individual psychotherapy, 60 minutes
• 90847 — Family therapy with patient present
• 90853 — Group psychotherapy

Common ICD-10 Codes for Therapist Billing

• F41.1 — Generalized Anxiety Disorder
• F32.1 — Major Depressive Disorder, single episode, moderate
• F43.10 — PTSD, unspecified
• F33.1 — Recurrent depressive disorder, current episode moderate
• F40.10 — Social anxiety disorder

Should You Go In-Network or Stay OON?

In-network paneling guarantees a stream of referrals but locks you into lower negotiated rates, more administrative work, and potential audits. OON gives you fee autonomy and less paperwork, but requires clients who can float the upfront costs and navigate insurance claims themselves. Many therapists in full-fee practices find OON more sustainable as a long-term business model.

How Superbilled Helps

For OON therapists, Superbilled removes the most tedious part of the superbill workflow. Enter your provider profile once and generate a compliant PDF for each client in under a minute. No spreadsheets, no Word templates, and no worrying about missing a required field.