Superbilling ABA Therapy


Superbill Defined

A superbill is a receipt for services from an out-of-network healthcare provider that details the services performed for a client. As an out-of-network Applied Behavior Analysis (ABA) provider, you are not contracted or subcontracted (such as in the case of a Single Case Agreement) with an insurer. You establish your rates for services and bill the client directly. The client pays you out-of-pocket for services and then a superbill could be submitted to their insurance company. A portion of the client’s payments may be reimbursed (paid back) for qualifying services.


Why Your Practice May Choose Superbills

Getting credentialed with an insurer can make services more accessible to clients, especially if they cannot afford to pay out-of-pocket. However, joining an insurer’s network or complying with their requirements for services may be a laborious process, especially since each insurer has its own procedures and rates.


Superbills provide an opportunity for your clients to receive ABA therapy from an out-of-network provider, alleviating some of the out-of-pocket costs for services. This is a great option for you if you do not want to join an insurer’s network or are waiting to be accepted in-network.


Determine Eligibility for Superbilling ABA Therapy

It is important for the client to know what their benefits are before beginning services. ABA therapy or out-of-network providers may not be covered by their insurance plan. If ABA therapy and out-of-network benefits are included in their policy then part of their costs may be covered. The key to getting any portion of their out-of-pocket costs reimbursed is through a superbill. 


To learn if a client is eligible for ABA therapy and has out-of-network benefits, either you or the client can contact member or customer service (the number is located on their insurance card) and conduct a verification of benefits (VOB) to learn more about the client’s individual plan. If the client’s insurance company confirms that they are eligible for ABA therapy and have out-of-network benefits, they may be reimbursed for some out-of-pocket costs. Each plan is different, and prior authorization may be needed to access benefits. Note that Medicare recipients do not have out-of-network benefits and will not be eligible for a superbill. 


Once the client has this information, they can make a more informed decision about working with you. If a client's plan does not cover ABA services with an out-of-network provider, they may still choose to continue with non-reimbursable private pay services. In this case, you must comply with the No Surprises Act and provide a Good Faith Estimate for private pay services.


If the client’s plan does cover ABA services for out-of-network providers then set up a superbill payment plan. 


Set Up Superbill Payment System

A superbill claim can be submitted to the insurer by either you or the client (although it’s recommended the client be responsible for submissions to reduce your non-billable time). When a superbill is received, the insurer assumes the client has already paid for services rendered and that the payment is, therefore, reimbursement, which is typically paid directly to the client. As such, a superbill statement should only be provided to the client or submitted to the insurer after payment for services has been made, otherwise, there is no guarantee of payment. Billing practices should be discussed prior to the onset of services and be included in the agreement for services.


What to Include in Your ABA Therapy Superbill

In order for a client to receive reimbursement, they must provide a detailed invoice with specific information about the services rendered. A complete superbill includes all of the following information:

  • Client's identifying information: Name, date of birth, address, phone number, and any other information the insurer requires. 

  • Practice information: Name of your practice, office address, and any other identifying information the insurer routinely requests.

  • Referrer identification: If a medical provider referred the client to you, include this provider’s information and address and their National Provider Identification (NPI) number.

  • ICD code: Diagnostic ICD-10 codes that qualify the client for services.

  • CPT code: American Medical Association codes that identify treatment procedures. If a modifier is used for services then also include this with each code.


Key Takeaways

Superbilling is a relatively new concept to billing for ABA therapy. Here are the key takeaways from this process:

  • The client pays you, you provide a detailed invoice, and the insurance company’s process for submitting an invoice for reimbursement is completed

  • Reimbursement for the client’s out-of-pocket costs is based on specifics of their insurance plan and whether out-of-network providers and ABA service codes are covered by their plan

  • You, as the out-of-network provider, are not contracted or subcontracted with the insurer



Next Steps

TreSource offers ABA providers numerous resources to establish, operate, and thrive in practice. If you would like assistance with establishing and operating your practice, check out the following resources: 

  1. Downloadable Tools: Download a free infographic on how to superbill here: LINK
  2. Document Libraries: Our libraries have a compilation of templates, forms, and tools utilized in an ABA practice. Learn more here: LINK
  3. CEU Course: Earn 1.0 BACB CEU while learning about how to superbill. Enroll here: LINK
  4. The Independent Behaviorist Podcast: Focuses on hot topics related to the ABA industry. Learn more here: LINK
  5. TreSource.com: Directory for ABA providers. Join for free here: LINK
  6. The Business of Behavior: The Behaviorist's Roadmap to Independent Practice. Learn more here: LINK
  7. ABA Business Mentorship Services: Ongoing guidance to establish and operate your practice. Learn more here: LINK


References

  1. Superbill template: What to include in your mental health superbill.(2019, October 7). Retrieved from https://www.goodtherapy.org/for-professionals/business-management/insurance/article/what-is-a-superbill-and-how-do-i-put-one-together 
  2. What is a superbill for therapy?. (n.d.). Retrieved from https://www.goodrx.com/insurance/health-insurance/superbill-therapy


Updated April 8, 2024 - By Charity Steele, MS, BCBA