A superbill is an itemised receipt from your therapist containing everything your insurer needs: their name and NPI number, their license, the dates of service, the CPT codes, the diagnosis code, and what you paid.
You pay the therapist directly. You submit the superbill to your insurer. They reimburse a share to you, usually by direct deposit or cheque. That’s the whole mechanism.
The arithmetic that decides everything
Reimbursement is a percentage of an allowed amount, not of what you paid. The allowed amount is what your insurer has decided the service is worth in your area, and in California it’s frequently well below Bay Area fees.
So: a $225 session, a plan reimbursing 70 per cent, an allowed amount of $150. You get $105 back, not $157. Your effective cost is $120.
That still turns an unaffordable fee into a manageable one for a lot of people, and it’s why finding out the allowed amount before you start is worth twenty minutes on the phone.
The deductible
Out-of-network deductibles are usually separate from and higher than in-network ones — often $1,000 to $5,000. Nothing is reimbursed until it’s met.
Two practical consequences. Starting therapy in January means paying full price for the first stretch, and starting in September may mean you’ve already met it through other care. And if you’re near the deductible, the effective cost of the rest of the year drops sharply, which is worth knowing before you decide you can’t afford to continue.
The codes
90791 is the initial diagnostic assessment. 90834 is a 45-minute session.90837 is 53 minutes or more, and it’s the one most therapists here use.90847 is family or couples therapy with the patient present — and coverage for it’s patchy.
Ask which code your therapist bills, and ask your insurer about that specific code. The allowed amounts differ between them.
The diagnosis
A superbill requires a diagnosis code. There’s no reimbursement without one, and it becomes part of your insurance record.
For most people this is unremarkable — an adjustment disorder or a mild anxiety code — but it’s worth knowing rather than discovering. If you’ve reasons to prefer no diagnosis on file, say so; your therapist can explain what they would be putting down, and you can decide to pay privately without a superbill.
Practical points
Ask for superbills monthly rather than at year end, and submit them promptly — most plans have a filing deadline, often 90 days to a year. Several services will submit on your behalf for a percentage, which is worth it for some people and not for others. Keep copies.
And use an HSA or FSA if you’ve one. Therapy is an eligible expense, and paying with pre-tax money is a straightforward 20 to 40 per cent discount depending on your bracket — before any reimbursement at all.