# Dr. Sarah Bennett, PsyD

## Provider Info

- **License:** PSY-12345  
- **NPI:** 9876543210  
- **Address:** Wellness Center, 450 Post St, Suite 500, San Francisco, CA 94102  
- **Phone:** (415) 555-0199  
- **Email:** dr.bennett@wellness.com  
- **Website:** www.wellness-drbennett.com

## INVOICE

- **Invoice Number:** MED-2024-001  
- **Date:** April 29, 2026  
- **Due Date:** April 29, 2026  
- **Terms:** Due on Receipt

## Patient Information

- **Patient Name:** Jane Patient  
- **DOB:** April 11, 1985  
- **Address:** 789 Recovery Rd, San Francisco, CA 94110

### Diagnosis Code (ICD-10)

- F41.1 (Generalized Anxiety Disorder)

| # | Date | CPT  | Description                         | Qty | Fee      | Amount   |
|---|------|------|-------------------------------------|-----|----------|----------|
| 1 | April 29, 2026 | 90837 | Psychotherapy, 60 minutes             | 1   | $180.00  | $180.00  |
| 2 | April 29, 2026 | 90847 | Family Psychotherapy                   | 1   | $200.00  | $200.00  |

**Subtotal:** $380.00  
**Total Due:** $380.00  
**Amount in Words:** Three Hundred Eighty Only

### Provider Note

This document serves as a receipt for professional services rendered. It may be submitted to your insurance company for out-of-network reimbursement (Superbill).

**Payment Method:** Credit Card / FSA Card

This is a computer generated invoice; no signature required.

## Superbills Made Simple

If you're in private practice, you know the drill: patients pay you, then submit to insurance themselves. Here's how to make that process painless.

### What's a Superbill, Anyway?

It's the invoice your patient gives to their insurance company to get **reimbursed for out-of-network care**. Include CPT codes, diagnosis codes, and your NPI - insurance needs all of it.

### Your Data Stays Here

This tool runs **entirely in your browser**. Patient information never touches our servers. It's not a replacement for your EHR, but it's safer for quick documentation needs.