Free Superbill Template and Generator (CMS-1500 Aligned)
A superbill is an itemized record of one patient visit: who was seen, when and where, which services were provided, the diagnosis codes behind them, and what was charged. Practices hand one to patients who file their own out-of-network claims, and billing staff use the same data to build the claim. We found no CMS or NUCC standard superbill form, so what a payer expects depends on the payer.
The generator below builds a superbill in your browser, checks it against the items that UnitedHealthcare, Cigna and Medicare’s CMS-1490S ask for, and prints or saves it as a PDF. Every field is mapped to the CMS-1500 item it feeds, with the source for each rule.
Superbill generator
Payer coverage
Share of each payer’s itemized-bill list that your superbill covers (lists in the table below).
Checks
Superbill field map: where each field lands on the CMS-1500
Each row ties a superbill field to the CMS-1500 item it feeds and to the source for the rule. Medicare rules come from CMS Chapter 26; the NUCC manual covers the form itself. Payers can differ from both, and the NUCC’s own advice is to follow the most current federal, state or payer instructions (NUCC FAQ). 30 rows, checked 3 October 2026.
| Superbill field | CMS-1500 item | What the rule says | Source |
|---|---|---|---|
| Provider | |||
| Billing provider name, address, phone | 33 | Billing provider name, address, ZIP code and telephone number. Medicare marks this required; the NUCC manual says Item 33 identifies the provider requesting payment and should always be completed. | CMS Ch. 26 §10.4 · NUCC manual v13.0 |
| Billing provider NPI | 33a | NPI of the billing provider or group. Medicare marks this required. | CMS Ch. 26 §10.4 |
| Rendering provider NPI | 24J | Rendering provider’s NPI, entered in the unshaded part of the service line. For a service furnished incident to a physician or non-physician practitioner when the person who ordered it is not supervising, Medicare says to enter the supervisor’s NPI. | CMS Ch. 26 §10.4 |
| Tax ID (EIN) | 25 | Federal Tax ID (EIN or SSN) of the provider or supplier, with the matching box checked. Cigna also lists the provider Tax ID among the items an itemized bill must show. | CMS Ch. 26 §10.4 · Cigna claim form |
| Service location (if not the office) | 32, 32a | Name, address and ZIP code of the facility when services were furnished in a hospital, clinic, laboratory or other facility that is not the patient’s home or the physician’s office. Item 32a is the facility’s NPI when Medicare claims processing policy requires it. | CMS Ch. 26 §10.4 |
| Referring or ordering provider | 17, 17b | Name of the referring or ordering physician (Item 17) and the NPI of the referring, ordering or supervising physician or practitioner (Item 17b). Medicare requires physicians and practitioners who order services or refer beneficiaries to report this. | CMS Ch. 26 §10.4 |
| Patient and insurance | |||
| Patient name | 2 | Last name, first name and middle initial, if any, as shown on the patient’s Medicare card. Medicare marks this required. | CMS Ch. 26 §10.2 |
| Date of birth and sex | 3 | The patient’s 8-digit birth date (MM, DD, CCYY) and sex. | CMS Ch. 26 §10.2 |
| Patient address and phone | 5 | Mailing address and telephone number: street on the first line, city and state on the second, ZIP code and phone on the third. | CMS Ch. 26 §10.2 |
| Patient account number | 26 | The account number assigned by the provider’s accounting system. Optional for Medicare; it helps the provider identify the patient. | CMS Ch. 26 §10.4 · NUCC manual v13.0 |
| Member or beneficiary ID | 1a | For Medicare, the patient’s Medicare Beneficiary Identifier, whether Medicare is the primary or secondary payer (required). For other payers, follow that payer’s instructions. | CMS Ch. 26 §10.2 · NUCC FAQ |
| Policyholder name | 4 | Name of the insured when insurance is primary to Medicare. When the insured and the patient are the same person, Medicare says to enter SAME. If Medicare is primary, leave it blank. | CMS Ch. 26 §10.2 |
| Relationship to policyholder | 6 | Check the box for the patient’s relationship to the insured when Item 4 is completed. | CMS Ch. 26 §10.2 |
| Other coverage and group number | 11 | Medicare requires Item 11. Completing it states that the physician or supplier made a good-faith effort to determine whether Medicare is the primary or secondary payer. | CMS Ch. 26 §10.2 |
| Related to employment or an accident | 10a–10c | Check YES or NO to show whether employment, auto liability or other accident involvement applies to one or more services on the claim, and enter the state postal code. | CMS Ch. 26 §10.2 |
| Date of current illness, injury or pregnancy | 14 | An 8-digit (MM, DD, CCYY) or 6-digit (MM, DD, YY) date. | CMS Ch. 26 §10.4 |
| Prior authorization number | 23 | For Medicare, the Quality Improvement Organization prior authorization number for procedures that require QIO prior approval. Other payers set their own authorization rules. | CMS Ch. 26 §10.4 · NUCC FAQ |
| Patient or representative signature | 12, 13 | Item 12: the patient or authorized representative signs and dates, unless the signature is on file. Item 13: the signature, or the statement “signature on file,” authorizes payment of medical benefits to the physician or supplier. | CMS Ch. 26 §10.3 |
| Services and diagnoses | |||
| Date of service | 24A | A 6-digit or 8-digit date for each procedure, service or supply; required for Medicare. NUCC asks for the From and To dates. UnitedHealthcare asks for its list “for each date of service.” | CMS Ch. 26 §10.4 · NUCC manual v13.0 · UnitedHealthcare form |
| Place of service (POS) | 24B | The two-digit code from the Place of Service code list; required for Medicare. See the full CMS list below. | CMS Ch. 26 §10.4 · CMS POS code set |
| Procedure code (CPT or HCPCS) | 24D | The procedure, service or supply as a HCPCS code. Medicare says to show applicable modifiers with the code and that the form can capture up to four. | CMS Ch. 26 §10.4 · CMS HCPCS page |
| Modifiers | 24D | Up to four 2-character modifiers per service line. See our CPT modifiers cheat sheet for what each modifier means. | NUCC manual v13.0 · CMS Ch. 26 §10.4 |
| Diagnosis codes | 21 | Diagnosis codes to the highest level of specificity, in priority order. The 02/12 form takes up to 12 codes (A–L) and an ICD indicator, where 0 means ICD-10-CM. Do not report ICD-9-CM and ICD-10-CM codes on the same claim. | CMS Ch. 26 §10.4 · NUCC manual v13.0 |
| Diagnosis pointer | 24E | The letter from Item 21 that links the line to its diagnosis. Medicare says to enter one reference letter per line; the NUCC manual allows the reference letters A–L, up to four characters. Follow the payer you are billing. | CMS Ch. 26 §10.4 · NUCC manual v13.0 |
| Charge for the line | 24F | The charge for each listed service. On paper claims NUCC asks for amounts without commas or dollar signs. | CMS Ch. 26 §10.4 · NUCC manual v13.0 |
| Units or days | 24G | The number of days or units. Medicare says to enter 1 when only one service is performed. NUCC permits decimals for fractional units. | CMS Ch. 26 §10.4 · NUCC manual v13.0 |
| Totals and sign-off | |||
| Total charges | 28 | The total of all charges in Item 24F. | CMS Ch. 26 §10.4 · NUCC manual v13.0 |
| Amount paid | 29 | The two sources define it differently. Medicare: the total the patient paid on covered services only. NUCC: the total the patient and/or other payers paid on covered services only. | CMS Ch. 26 §10.4 · NUCC manual v13.0 |
| Accept assignment | 27 | Check the box that shows whether the provider or supplier accepts assignment of Medicare benefits. This item is specific to Medicare. | CMS Ch. 26 §10.4 |
| Provider signature and date | 31 | Medicare: signature of the provider or representative plus a date; required. NUCC: the legal signature of the practitioner or supplier, a representative’s signature, “Signature on File” or “SOF.” | CMS Ch. 26 §10.4 · NUCC manual v13.0 |
What payers ask for on an itemized bill
Three primary documents list what a patient-submitted bill must show. They overlap but do not match, which is why the generator covers the union. Charge, diagnosis and the procedure or service appear on all three lists, and the date of service appears on all three as well. Patient name, place of service, provider name and provider address each appear on two.
| Item | CMS-1490S (01/18) | UnitedHealthcare (8/18) | Cigna (Rev. 11/2023) |
|---|---|---|---|
| Patient name | Not listed | Listed | Listed (plus primary customer name) |
| Date of service | Listed | Asked “for each date of service” | Listed (mm/dd/yyyy) |
| Place of service | Listed | Listed (code) | Not listed |
| Diagnosis | Description of illness or injury | Diagnosis codes (ICD-10) | Diagnosis code (ICD format) |
| Procedure or service | Description of each surgical or medical service or supply | Procedure codes (CPT, HCPC) | Type of service / procedure code |
| Modifiers | Not listed | “Any applicable modifiers” | Not listed |
| Units | Not listed | Listed | Not listed |
| Charge | Charge for each service | Billed amount for each procedure code | Charge for the service |
| Provider name | Doctor’s or supplier’s name | Not listed | Name and credentials |
| Provider address | Listed | Not listed | Listed |
| Provider NPI | If known | Not listed | Not listed |
| Provider Tax ID | Not listed | Not listed | Listed |
The CMS-1490S list also asks for the ordering and referring provider’s legal name, and NPI if known, for clinical laboratory, imaging center and DMEPOS claims, and a copy of the primary insurer’s explanation of benefits for Medicare secondary claims. UnitedHealthcare says missing information can delay or stop payment of the claim. Cigna says it cannot accept receipts, balance due statements and cancelled checks in place of the itemized bill.
Code sets a superbill relies on
| Code set | What to know | Source |
|---|---|---|
| ICD-10-CM (diagnoses) | The FY 2027 code set applies to encounters from October 1, 2026 through September 30, 2027. Codes may be 3 to 7 characters, with the decimal after the third character. Report each code at the highest level of specificity documented. For outpatient visits, list first the condition chiefly responsible for the services provided. | CMS ICD-10 page (modified 09/08/2026) · FY 2027 Official Guidelines, I.A.2, I.B.2, IV.A |
| CPT (procedures, Level I HCPCS) | Maintained by the AMA CPT Editorial Panel. CMS describes CPT codes as five numeric digits. This page does not reproduce CPT code descriptions; use your licensed CPT source. | AMA CPT Editorial Panel (updated Jan. 23, 2026) · CMS HCPCS page (modified 10/02/2026) |
| HCPCS Level II | CMS maintains Level II codes. Each is a single letter followed by four digits. CMS lists quarterly HCPCS file updates. | CMS HCPCS page (modified 10/02/2026) |
| Place of service | Two-digit CMS code on every service line. The CMS list currently has 52 codes; the full list is below. | CMS POS code set (modified 02/17/2026) |
| NPI | A 10-digit identifier: nine digits plus a check digit. The generator runs the CMS check-digit test, which catches typing errors but cannot show that an NPI is active or belongs to the person you named. | CMS check-digit document · CMS NPI fact sheet (Dec. 2024) |
| Modifiers | Up to four 2-character modifiers per service line on the 02/12 CMS-1500. | NUCC manual v13.0 |
Superbill completeness checklist
Run through these before a superbill leaves the office. Each line names the CMS-1500 item and where the rule comes from.
CMS place of service codes
The 52 codes below are the CMS Place of Service Code Set as listed on cms.gov (page last modified 02/17/2026, checked 3 October 2026). The generator’s place of service menu uses the same list.
Showing 52 of 52 codes
| Code | Name (as listed by CMS) | Source |
|---|---|---|
| 01 | Pharmacy | CMS |
| 02 | Telehealth Provided Other than in Patient's Home | CMS |
| 03 | School | CMS |
| 04 | Homeless Shelter | CMS |
| 05 | Indian Health Service Free-standing Facility | CMS |
| 06 | Indian Health Service Provider-based Facility | CMS |
| 07 | Tribal 638 Free-standing Facility | CMS |
| 08 | Tribal 638 Provider-based Facility | CMS |
| 09 | Prison/Correctional Facility | CMS |
| 10 | Telehealth Provided in Patient's Home | CMS |
| 11 | Office | CMS |
| 12 | Home | CMS |
| 13 | Assisted Living Facility | CMS |
| 14 | Group Home | CMS |
| 15 | Mobile Unit | CMS |
| 16 | Temporary Lodging | CMS |
| 17 | Walk-in Retail Health Clinic | CMS |
| 18 | Place of Employment - Worksite | CMS |
| 19 | Off Campus-Outpatient Hospital | CMS |
| 20 | Urgent Care Facility | CMS |
| 21 | Inpatient Hospital | CMS |
| 22 | On Campus-Outpatient Hospital | CMS |
| 23 | Emergency Room – Hospital | CMS |
| 24 | Ambulatory Surgical Center | CMS |
| 25 | Birthing Center | CMS |
| 26 | Military Treatment Facility | CMS |
| 27 | Outreach Site/Street | CMS |
| 31 | Skilled Nursing Facility | CMS |
| 32 | Nursing Facility | CMS |
| 33 | Custodial Care Facility | CMS |
| 34 | Hospice | CMS |
| 41 | Ambulance - Land | CMS |
| 42 | Ambulance – Air or Water | CMS |
| 49 | Independent Clinic | CMS |
| 50 | Federally Qualified Health Center | CMS |
| 51 | Inpatient Psychiatric Facility | CMS |
| 52 | Psychiatric Facility-Partial Hospitalization | CMS |
| 53 | Community Mental Health Center | CMS |
| 54 | Intermediate Care Facility/Individuals with Intellectual Disabilities | CMS |
| 55 | Residential Substance Abuse Treatment Facility | CMS |
| 56 | Psychiatric Residential Treatment Center | CMS |
| 57 | Non-residential Substance Abuse Treatment Facility | CMS |
| 58 | Non-residential Opioid Treatment Facility | CMS |
| 60 | Mass Immunization Center | CMS |
| 61 | Comprehensive Inpatient Rehabilitation Facility | CMS |
| 62 | Comprehensive Outpatient Rehabilitation Facility | CMS |
| 65 | End-Stage Renal Disease Treatment Facility | CMS |
| 66 | Programs of All-Inclusive Care for the Elderly (PACE) Center | CMS |
| 71 | Public Health Clinic | CMS |
| 72 | Rural Health Clinic | CMS |
| 81 | Independent Laboratory | CMS |
| 99 | Other Place of Service | CMS |
What happens after the superbill is handed over
- The patient uses the payer’s own form. UnitedHealthcare’s medical claim form says it is for out-of-network claims only, and tells members to mail it to the address on the back of their Health Plan ID card (UnitedHealthcare form).
- The superbill or invoice goes with it. UnitedHealthcare asks members to attach the superbill or invoice and any receipts of payments. Cigna requires an itemized bill and does not accept a receipt in its place (UnitedHealthcare, Cigna).
- Original Medicare works differently. A person filing their own claim sends Form CMS-1490S with the itemized bill, a letter explaining why they are filing, and supporting documents such as notes from the doctor (Medicare.gov).
- The clock keeps running. Cigna says it must receive the claim within 180 days of the service unless the plan or state law allows more time. Deadlines vary by payer; our timely filing limits page lists them (Cigna form).
Practices that would rather not build superbills and chase out-of-network claims themselves can hand the work to BilNow. Related: mental health billing services, out-of-network billing and pricing: 2.7% of collections, no setup fee and no long-term contract.
More free tools from BilNow
Frequently asked questions
What is a superbill?
A superbill is an itemized record of one patient visit: who was seen, when and where, which services were provided, the diagnosis codes behind them, and what was charged. Practices give one to patients who file their own out-of-network claims, and billing staff use the same data to build a claim. We found no CMS or NUCC standard superbill form. UnitedHealthcare's member claim form does use the term, asking members to get a Superbill or Invoice from their provider.
Is a superbill the same as a CMS-1500?
No. The CMS-1500 (02/12 version) is the claim form whose completion rules the NUCC publishes in its 1500 instruction manual, currently version 13.0 (July 2025). A superbill is a practice-designed record. This page maps each superbill field to the CMS-1500 item it feeds.
What information must a superbill include?
It depends on the payer. UnitedHealthcare tells members to ask for a superbill or invoice that shows, for each date of service, the patient name, diagnosis codes (ICD-10), procedure codes (CPT, HCPC) with any applicable modifiers, units, the billed amount and the place of service code. Cigna and the CMS-1490S ask for overlapping but different items, compared in the table above. The generator covers all of them.
Can a patient send a superbill to insurance?
Some payers take patient-filed claims. UnitedHealthcare's medical claim form says it is for out-of-network claims only and asks members to attach the superbill or invoice and any receipts of payments. Cigna's form takes itemized bills. For Original Medicare, a person filing their own claim uses Form CMS-1490S with an itemized bill, an explanatory letter and supporting documents. Whether a plan pays depends on the plan, which this page does not cover.
Is a receipt enough instead of a superbill?
Not for Cigna. Its claim form says it cannot accept receipts, balance due statements and cancelled checks in place of the itemized bill. UnitedHealthcare asks for the superbill or invoice together with any receipts of payments.
How long does a patient have to file?
It varies by payer and plan. Cigna's form says it must receive the claim within 180 days from the date of service unless the plan or state law allows more time. UnitedHealthcare's form does not state a deadline. For payer filing deadlines, see the timely filing limits page on this site.
How many diagnoses and service lines fit on one CMS-1500?
The 02/12 form takes up to 12 diagnosis codes (A to L) and has six service lines in section 24. The generator allows up to 12 lines and warns when you pass six, because a claim built from it would need a second form.
Which ICD-10-CM code set applies right now?
The FY 2027 code set, which CMS says applies to patient encounters from October 1, 2026 through September 30, 2027 (checked 3 October 2026). The guidelines say to report each code at the highest number of characters available and to the highest level of specificity documented in the medical record.
How does the generator check an NPI?
It runs the check-digit test CMS publishes: an NPI is 10 digits, and the check digit is calculated as if the prefix 80840 were in front of the number. This is a format check. It can flag a mistyped number but cannot show that an NPI is active or belongs to your provider; confirm that in NPPES.
Which place of service code do I use for telehealth?
CMS lists two telehealth codes: 02, Telehealth Provided Other than in Patient's Home, and 10, Telehealth Provided in Patient's Home. Which one a payer expects, and how it pays, is set by each payer's telehealth policy, so check the payer before you assign it.
Does the generator save or send what I type?
No. It runs in your browser: nothing you type is sent to BilNow or stored, and reloading the page clears the form. Print, copy and CSV all happen on your device. Follow your organization's privacy policy before you enter patient details on any web page.
Method and sources
We read each source below on 3 October 2026 and recorded the version or last-modified date it shows. Medicare rules come from the CMS Medicare Claims Processing Manual, Chapter 26. General CMS-1500 rules come from the NUCC 1500 instruction manual. Payer requirements come from the payers’ own member claim forms. Where sources differ, the page shows the difference instead of picking one.
What we left out: CPT code descriptions (use your licensed CPT source), any payer rule we could not trace to one of these documents, and state law on patient-filed claims. The Medicare instructions in the field map apply to Medicare Part B claims; other payers can ask for more or less. This page is general information, not legal, billing or coding advice, and your payer contracts and plan documents control.
When each source was last checked
| Item | Value | Link | Date |
|---|---|---|---|
| ICD-10-CM code set in force | FY 2027: encounters October 1, 2026 to September 30, 2027 | Source | CMS page modified 09/08/2026 |
| CMS Place of Service code set | 52 codes | Source | CMS page modified 02/17/2026 |
| NUCC 1500 instruction manual | Version 13.0 (July 2025), for the 02/12 form | Source | Checked 3 October 2026 |
| Medicare CMS-1500 instructions | Chapter 26, Rev. 12779 (08-09-24) | Source | Checked 3 October 2026 |
| UnitedHealthcare member claim form | Form dated 8/18 | Source | Checked 3 October 2026 |
| Cigna medical claim form | Rev. 11/2023; 180-day filing window unless plan or state law allows more | Source | Checked 3 October 2026 |
| CMS-1490S (patient-filed Medicare claim) | Version 01/18 | Source | Checked 3 October 2026 |
| HCPCS reference page | CMS page modified 10/02/2026 | Source | Checked 3 October 2026 |
Source list
- CMS. Medicare Claims Processing Manual, Chapter 26: Completing and Processing Form CMS-1500 Data Set. www.cms.gov. Rev. 12779, issued 08-09-24. Checked 3 October 2026.
- National Uniform Claim Committee (NUCC). 1500 Health Insurance Claim Form Reference Instruction Manual. www.nucc.org. Version 13.0, July 2025; applies to the 02/12 form. Checked 3 October 2026.
- NUCC. NUCC FAQ: My payer has given me different instructions than the manual. www.nucc.org. Answer: refer to the most current federal, state or other payer instructions. Checked 3 October 2026.
- UnitedHealthcare. Medical Claim Form (UHCEW753537-000). prod.member.myuhc.com. Form dated 8/18. Checked 3 October 2026.
- Cigna. Medical Claim Form (591692c). www.cigna.com. Rev. 11/2023. Checked 3 October 2026.
- CMS. Form CMS-1490S, Patient’s Request for Medical Payment. www.cms.gov. Version 01/18; OMB 0938-1197. Checked 3 October 2026.
- Medicare.gov. Filing a claim. www.medicare.gov. No page date shown. Checked 3 October 2026.
- CMS. Place of Service Code Set. www.cms.gov. Page last modified 02/17/2026. Checked 3 October 2026.
- CMS. ICD-10 (2027 code sets). www.cms.gov. Page last modified 09/08/2026. Checked 3 October 2026.
- CDC / NCHS. ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027. ftp.cdc.gov. Effective October 1, 2026 to September 30, 2027. Checked 3 October 2026.
- CMS. Healthcare Common Procedure Coding System (HCPCS). www.cms.gov. Page last modified 10/02/2026. Checked 3 October 2026.
- American Medical Association. CPT overview and code approval. www.ama-assn.org. Page updated January 23, 2026. Checked 3 October 2026.
- CMS. Requirements for National Provider Identifier (NPI) and NPI Check Digit. www.cms.gov. Undated PDF. Checked 3 October 2026.
- CMS. The National Provider Identifier (NPI) Fact Sheet. www.cms.gov. December 2024. Checked 3 October 2026.
- CMS. National Plan and Provider Enumeration System (NPPES). nppes.cms.hhs.gov. Lookup tool; not a dated document. Checked 3 October 2026.
How to cite this page
Plain text
BilNow Editorial Team. “Free Superbill Template and Generator (CMS-1500 Aligned).” BilNow, 2026. https://bilnow.com/free-superbill-template/. Sources checked 3 October 2026.
APA style
BilNow Editorial Team. (2026). Free superbill template and generator (CMS-1500 aligned). BilNow. https://bilnow.com/free-superbill-template/
Link (HTML)
<a href="https://bilnow.com/free-superbill-template/">Free superbill template and generator (BilNow)</a>
About BilNow. BilNow is a US medical billing company that works with 300+ providers across 50+ specialties and 100+ EHRs. If claim submission and follow-up take time your team does not have, you can talk to us.