Superbill Instructions
Version 3.2

These forms have been designed for use by the IBCLC as a receipt for lactation services, which implies a clinical level of care beyond the normal course of breastfeeding, appropriate to the IBCLC level of training and certification.

Your superbill purchase includes two versions: one for the mother (or lactating parent) and one for the baby. We no longer offer a combined form because insurance companies consider the child and parent to be separate patients, and are more likely to reimburse when a separate superbill is submitted for each of them. If there are multiple babies, one form should be provided for each baby.

The ICD-10 and CPT codes provided on these superbills are those most likely to be reimbursed by insurance companies for RN IBCLC and non-RN IBCLC services. Codes in bold are those most commonly accepted and should be used when possible. If you prefer different or additional codes, I can modify your form for a small fee.


If you plan to give a hard-copy superbill to your clients (rather than an electronic copy), consider having them professionally printed in three-part carbonless forms such as these (search on carbonless or NCR forms for other companies that provide this service online). The top white and middle yellow copies can be given to the client and the pink copy kept for your files, as noted at the bottom of the forms. A copyright release, which may be required by the professional printer, has been included in your purchase.


Open the superbill in Adobe Acrobat Reader (free). Enter info by typing in the shaded areas (the shading won’t show up when the form is signed or printed).

Tip:  If you often fill in the same info, you can “pre-populate” a version. Just fill in the fields, don’t sign it, and save it with a different file name.

When all the info has been entered, the superbill can be signed, locking the form from further edits.

IMPORTANT:  No further information can be added at this point, so be sure you’ve completely finished filling out the form before signing it.

To sign the superbill, click on the Fill and Sign function:


Then click on the fountain pen icon:


This allows you to type a signature in a cursive font or use an image of your actual signature that you can upload.

 Tip:  Saving the file under a different name will retain the entered information (but if you’ve signed it, you won’t be able to edit it).


There are eight (8) elements to a correctly completed superbill that is eligible for reimbursement.  All elements must be completed.


 1. List your name, credential, business name, contact information, tax identification number, and NPI number on the form.

  • The tax ID number and NPI number are necessary for insurance
    • NPI application codes:    174N00000X for non-RN IBCLC and 163WL0100X for RN IBCLC
  • If you purchased the customized header, this information is already incorporated on your form.
  • If you purchased the non-customized superbills, open them in Adobe Acrobat Reader (free) and add the information in the shaded areas at the top (the shading will not show up when the form is printed). To avoid having to do this each time, you can enter the information once and save the document as a PDF with a different file name. Please note that the superbill forms are password-protected, so no changes other than the information at the top (and fillable forms) are

2. Select one (only one) primary ICD-10 diagnosis.

  • The secondary diagnosis is optional and can include more than one, but each secondary diagnosis must be supported by adequate clinical charting.

3. Select at least one CPT code.

  • Unless you spent considerably more time with the parent or the baby, it is best to split your fee evenly between the two superbills. Then divide up the fee portion on each superbill among multiple CPT codes or put it all on one code.
  • Using multiple CPT codes is the key to maximizing reimbursement.
    • IBCLCs should use 99203 (clinical) and 99404 (counseling) for all initial visits that are 90 minutes or more that include a detailed history, examination, and assessment of the main breastfeeding
    • Then use other code combinations by looking at the medical decision making, time spent, and new patient follow up visits.
    • Keep in mind that it doesn’t really matter if “breastfeeding counseling” sounds less professional than “lactation consultation.” It’s just a coding game to the insurance companies. The CPT code to use is the one most likely to be paid, no matter what it is.
    • Learning which codes the insurance companies in your area tend to pay will help you maximize reimbursement for your clients. A call to the companies or polling past clients may provide this information.
  • You can add modifiers to further specify the CPT code.
    • 33 = Preventive or diagnostic For lactation services, this modifier is usually used with the counseling (99401-99404) and educational codes.
    • 25 = Significant and separately identifiable evaluation and management service by the same practitioner on the same day of the procedure or other service (an additional service). Using this modifier links two CPT codes together as two (or more) services that are each necessary, such as clinical assessment (99201-99204) and counseling (99401-99404). According to CPT, separate, significant evaluation and management (E/M) work that goes above and beyond the work normally associated with a preventive or brief visit is additionally billable, which typically happens when the client says, “Oh, by the way …” just when the visit is ending. The 25 code indicates to the insurance company you should be paid for both Used correctly, it results in being paid appropriately for the actual amount of time spent with the client.
      • Note that this does not mean you must always use 25 modifier with the 99401-99404 (counseling) codes when you combine them with the 99201-99214 (clinical) codes. The counseling codes can be used in addition to the clinical code but without the 25 modifier when only a brief history was taken (counseling), but it was not a separate and significant

4. Enter the fee and amount paid.

  • Divide the the total amount of the consult fee in half between the mother and infant superbills.
  • List the fee in the fee column space to the left of the CPT code and enter the total in the lower right area.
  • You can enter any other purchases or rentals on the right side and add them to the total
  • Mark the form of payment provided at the bottom (check, credit card, cash, etc) the same on the mother form as well as the infant form.
  • Example: Mother provides Check#1234 for total amount of $200. Add $100 fee to correct spaces on the form with Check #1234 on the mother and then do the very same on the infant form.

5.  Sign and date the form in the lower left-hand space.

  • If using a fillable version, see the instructions above under “Fillable Version.”

6. Give the client a copy of the superbill.

  • Fillable versions are easily emailed.
  • If you had the superbills printed on three-part carbonless paper (a very handy option), give the top white and middle yellow copies to the client and keep the pink copy for your There are instructions to this effect at the bottom of the forms.
  • Even if you give a hard-copy of the form, clients often appreciate having an electronic version to submit to insurance and keep for their records.

 Tip:  To save scanning a hard-copy form, use the TurboScan app on your smartphone.


7.  Complete the top portion.

8.  Sign and date the form in the “Release” box on the right-hand


Finally, please send me any feedback, positive or negative, about how the forms work for you and your clients so I can make further improvements to increase reimbursements and your clients’ satisfaction with your services!