CPT codes for psychologists: A complete billing guide
If you run a private practice, you have probably wrestled with whether to get credentialed with health insurance companies. Deciding on getting paneled with health insurance payers can bring in referrals, but it also comes with capped rates and administrative hoops.
Fortunately, staying out-of-network does not mean turning away clients who rely on insurance. Many people have PPO plans with out-of-network coverage. Learning how to bill out of network lets you welcome these clients while keeping your standard full fee.
When clinicians look into how to bill out-of-network insurance, three main options stand out.
Option 1: Client-submitted reimbursement using superbills
Most out-of-network therapists go with superbills. Understanding how superbills for therapy work helps you guide your clients through the process. Your practice collects full private-pay fees upfront at the time of service and issues a detailed monthly superbill.
Using superbills keeps your administrative work light because the client handles the submission. When you walk clients through how to submit a superbill to insurance, let them know their health plan uses this paperwork to decide how much money to send back to them.
Pros: Minimal administrative overhead for the clinician.
Cons: Puts the administrative burden on the client, which can create a barrier for individuals experiencing acute stress or mental health challenges.
What details belong on a superbill?
Incomplete receipts get turned down quickly, which bogs down how out-of-network reimbursement works for your client.
To keep things running smoothly, every superbill should list:
The client’s name, date of birth, address, and insurance policy details
Your name, Tax ID (TIN), NPI, and practice address
The dates of service, CPT procedure codes (like 90837), and ICD-10 diagnosis codes
The total fee charged and the amount the client already paid
A note stating that reimbursement checks should be sent directly to the client
How do you create a superbill?
You do not need to make these receipts by hand; using EHR software streamlines billing out-of-network insurance via automated superbills.
Inside SimplePractice, you simply:
Go to the billing tab in your client’s profile.
Click Create and select Superbill.
Pick the date range for the sessions you want to include.
Send the document straight to your client through the client portal or by email.
Many major health plans offer digital claim uploads, making submitting a superbill to insurance a quick process for patients seeking prompt reimbursement.
Understanding these documentation steps helps you set clear expectations when explaining how to bill out of network to new private-pay clients.
Option 2: Automated third-party claims processing
Another approach is using a third-party claim automation platform that works alongside or integrates with your EHR. For clinicians looking into how to bill out of network without taking on extra paperwork, these tools automatically extract session data and file claims directly to the payer.
Pros: Bridges the gap between high clinician workload and high client friction by automating claim generation.
Cons: May incur a small transaction percentage fee or a monthly platform subscription cost.
Option 3: Electronic courtesy claims (Box 27 = No)
If you want to offer an extra layer of service, understanding how to bill out-of-network insurance using electronic courtesy claims takes the paperwork stress off your clients. Learning how to get out-of-network claims paid directly also helps keep patients in care longer.
Can out-of-network providers bill insurance directly?
Yes, you can file electronic claims directly to private insurance companies on behalf of your clients using SimplePractice insurance features and the standard CMS-1500 layout.
When filing through SimplePractice:
Enter your client’s insurance details as usual.
Head to the billing tab and choose Enable additional fields.
Select No for Accept Assignment.
Mastering this setting is a key part of billing out of network because it directs the reimbursement check to your client rather than your practice.
Choosing No for Accept Assignment marks "No" in Box 27 on the electronic claim form. This tells the clearinghouse and insurance company to send the reimbursement check to the client instead of your practice while you collect full payment upfront.
This also affects Box 13, which is where "Signature on File" (or the patient's actual signature) is entered to authorize direct payment to the provider. For in-network claims, this line is typically completed since the practice is being paid directly. But when billing out of network with Box 27 set to No, Box 13 is left blank—since there's no assignment of benefits to authorize.
Pros: High client satisfaction and no extra fees for third-party billing apps.
Cons: Potential claim rejections depending on carrier policies, and requires initial clearinghouse setup for non-contracted payers.
Key compliance rules for out-of-network billing
Before billing out-of-network clients, keep these mandatory regulatory steps in mind:
Always issue a Good Faith Estimate (GFE): Under the federal No Surprises Act, you must provide a clear written cost breakdown upfront before the first session for uninsured or self-pay clients. A clear GFE ensures full transparency from day one when learning how to bill out of network.
Verify out-of-network benefits (OON VOB): Advise clients to call their insurer to verify OON deductibles and CPT pre-authorizations before deciding how to bill out-of-network insurance.
Mind special payer and state rules: Mind special payer and state rules: If you don't enroll as a Medicare provider, you must formally opt out and sign private contracts with any Medicare clients you see, or you risk being required to repay claims. This requirement became more urgent for mental health counselors and MFTs specifically, since these license types only became eligible to enroll in Medicare Part B on January 1, 2024. TRICARE works differently: certified marriage and family therapists must sign a formal participation agreement with TRICARE rather than complete simple registration, and providers who don't participate generally can't file claims to TRICARE on the client's behalf at all—the client typically pays in full and files for reimbursement themselves, similar to a superbill. Additionally, stay informed on state-specific surprise billing legislation that may apply locally.
Answers to common out-of-network billing questions
Here are quick answers to the questions clinicians hear most often about out-of-network care.
Does insurance pay for out-of-network care?
Many commercial PPO plans do cover out-of-network care, but usually only after the client meets a higher deductible. According to CMS, consumers who receive care from an out-of-network provider typically face higher costs than they would with an in-network provider, since their health plan usually doesn't cover the full out-of-network cost.
Insurers also calculate reimbursements based on their "Usual, Customary, and Reasonable" (UCR) fee schedule rather than your full rate. Explaining these terms helps clients understand how out-of-network reimbursement works before they start therapy.
What to do when insurance is out-of-network?
When a new client has an out-of-network plan, take these three steps:
Check their benefits: Find out their out-of-network deductible, coinsurance rate, pre-authorization requirements, and coverage limits.
Provide a Good Faith Estimate: Give private-pay clients a written cost estimate before care begins.
Set billing expectations: Decide whether you will issue monthly superbills, use third-party processing, or submit electronic courtesy claims .Laying out a clear billing plan from day one gives your clients a smooth blueprint for how to get out-of-network claims paid by their insurance carrier.
Establishing these steps early gives your practice a structured approach for billing out of network efficiently.
Can clients negotiate out-of-network bills?
Yes, clients have a couple of options to help manage out-of-network costs:
Single-Case Agreements (SCAs): If an in-network therapist is not available, clients can ask their insurance company for an SCA. An SCA allows you to treat the client while being reimbursed at in-network rates, giving you another tool when evaluating how to bill out of network.
Sliding scale fees: You can offer sliding-scale rates or prompt-pay discounts for clients who need financial flexibility.
Sharing these steps gives clients clear ideas on how to get out of network claims paid or reduced when money is tight.
Sources
APA Services. (2026). Enrollment in Medicare.
Behave Health. (n.d.). Single case agreement.
Centers for Medicare & Medicaid Services. (2024). Professional paper claim form (CMS-1500).
Centers for Medicare & Medicaid Services. (2024). What is a good faith estimate?
Honigman LLP. (2024). Medicare now covering services provided by marriage and family therapists and mental health counselors.
TRICARE / Humana Military. (2026). TRICARE certification and network information.
How SimplePractice streamlines running your practice
SimplePractice is HIPAA-compliant practice management software with everything you need to run your practice built into the platform—from booking and scheduling to insurance and client billing.
If you’ve been considering switching to an EHR system, SimplePractice empowers you to streamline appointment bookings, reminders, and rescheduling and simplify the billing and coding process—so you get more time for the things that matter most to you.
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