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Physical Therapy Invoice Template

CPT codes, timed units, referral and NPI — what a claim actually needs. Free PDF.

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A physical therapy invoice is usually a claim document before it is a bill. The patient submits it, or their plan does, and it is rejected for what is missing rather than for what it costs — so the codes, the units and the provider identifiers matter more here than the wording of any line.

INVOICE Issued
Invoice number:INV-0001
Date of issue:August 2, 2026
Date due:August 16, 2026
Currency:USD
Issued by
Meridian Physical Therapy
220 Wellness Parkway
Suite 3
53703 Madison, WI
United States
billing@meridianpt.example
Bill to
Katarzyna Nowak
18 Lakeside Drive
53562 Middleton, WI
United States
k.nowak@example.com
Amount due
$741.00
Due in 14 days · Aug 16, 2026
For your claim
Provider NPI 1497203845, practice tax ID 39-2048817. Referred by Dr. L. Okafor for post-operative rotator cuff rehabilitation, diagnosis M75.101. Four treatment visits and one evaluation are covered by this invoice.
Description Qty Rate Tax Amount
97110 — Therapeutic exercise
Two units per visit, four visits
8$42.00—$336.00
97140 — Manual therapy
One unit per visit, four visits
4$48.00—$192.00
97162 — PT evaluation, moderate complexity
Initial assessment and plan of care
1$165.00—$165.00
97014 — Electrical stimulation, unattended
Two visits
2$24.00—$48.00
Subtotal$741.00
Total$741.00
Amount due $741.00
Terms
Payable on receipt. This document is a superbill: submit it to your plan for reimbursement under your out-of-network benefit.
Invoice #INV-0001 · Meridian Physical Therapy · Page 1 of 1

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How to invoice as a physical therapy →

What to put on a physical therapy invoice

  • Your NPI number and, where the plan wants one, the practice tax ID
  • The date of each visit and the total timed units billed
  • CPT codes for what was performed — therapeutic exercise, manual therapy, modalities
  • The referring provider and the diagnosis code, where the plan requires a referral
  • Whether the visit was an evaluation or a treatment, which are billed differently
  • The patient's responsibility after any insurance payment, stated plainly

Questions

Why do CPT codes belong on a patient-facing invoice?

Because the patient is often the one submitting it. A superbill without codes is returned by every plan, and the patient then has to come back and ask — which costs your front desk more time than putting them on did.

How are timed units billed?

Most therapeutic codes bill in 15-minute units under the 8-minute rule, so a 38-minute session is not simply "one visit". Showing the units is what makes the total reconcilable against the plan's own maths.

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