How to Submit a Superbill to Medicare for Therapy Reimbursement

Medicare Out-of-Network Process

Traditional Medicare (Parts A & B) does not use a superbill reimbursement model for OON providers. Therapists must enroll as Medicare providers (either participating or non-participating) to bill Medicare. Non-participating providers can charge up to 115% of the Medicare fee schedule (limiting charge) and must provide an Advance Beneficiary Notice (ABN). Enrolled providers submit claims through the appropriate Medicare Administrative Contractor (MAC) for the state.

Common Denial Reasons

• ✗Therapist is not enrolled as a Medicare provider — enrollment is required to bill Medicare
• ✗Beneficiary has Medicare Advantage (Part C), which uses different billing rules than traditional Medicare
• ✗Service not covered under Medicare Part B mental health benefit (e.g., marriage counseling)
• ✗Missing or incorrect Medicare Beneficiary Identifier (MBI) on the claim

Tips for Getting Reimbursed by Medicare

• ✓Therapists who are not Medicare-enrolled cannot use a superbill model — clients will be fully responsible for the fee
• ✓If you opt out of Medicare, you must have a signed private-pay contract with each Medicare beneficiary before treatment
• ✓Medicare Advantage plans (Part C) have separate rules — some do cover OON mental health with higher cost-sharing
• ✓The Medicare MBI replaced the old SSN-based Health Insurance Claim Number — use the correct identifier