What’s on the medical invoice template
Extra fields on this template: Patient, Provider NPI, Diagnosis (ICD-10).
| Service | Qty | Rate | Amount |
|---|---|---|---|
| Office visit, established patientCPT 99214 · [date of service] | 1 | $165.00 | $165.00 |
| Electrocardiogram, 12-leadCPT 93000 · [date of service] | 1 | $60.00 | $60.00 |
| Blood drawCPT 36415 · [date of service] | 1 | $15.00 | $15.00 |
| Comprehensive metabolic panelCPT 80053 · [date of service] | 1 | $45.00 | $45.00 |
| Total | $285.00 | ||
Example prices in US dollars. Replace them with your own; in the generator, any currency works.
What to put on a medical invoice
- The practice’s name, address, tax ID and the treating provider’s NPI.
- The patient’s name and date of birth, and the guarantor if someone else is paying, such as a parent.
- Each service on its own line with the date of service and its CPT or HCPCS code.
- The diagnosis code (ICD-10) the services relate to.
- Payments already made, such as a copay or prepayment at check-in, and the balance due.
- How to pay and who to call with billing questions.
Invoice or superbill?
A superbill is an itemized statement a patient sends to their own insurer to claim out-of-network reimbursement. Insurers need the same details this template already has: provider NPI and tax ID, dates of service, CPT and ICD-10 codes, and fees. So one document can do both jobs: the patient pays you from it and claims from it. Mark it paid once you’ve received payment, because most insurers reimburse only for services the patient has already paid for.
Good faith estimates and privacy
Under the No Surprises Act, uninsured and self-pay patients have the right to a good faith estimate of expected charges before scheduled care. If the final bill is substantially higher than the estimate, currently $400 or more, the patient can dispute it. Use the estimate template for the good faith estimate, and keep the invoice in line with it.
A medical invoice contains protected health information. Send it securely, through your patient portal or encrypted email, not as a plain attachment. The free generator builds the PDF in your browser; the details you type aren’t sent to Billsato.
Frequently asked questions
Do medical services have sales tax?
Medical services are generally exempt from sales tax in the US. Some items sold alongside them, such as cosmetic products, may be taxable depending on the state.
What is the difference between a CPT code and an ICD-10 code?
A CPT code says what was done (for example, an office visit or a blood draw). An ICD-10 code says why: the diagnosis. Insurers need both to process a claim.
Can I use this template for therapy or dental bills?
Yes. Replace the lines with your services and codes (for example CPT 90837 for a 60-minute psychotherapy session, or the CDT codes dentists use) and keep the provider and patient details.