Superbills, CPT codes and the Good Faith Estimate

Check what you learned

10 questions from this lesson. Answers are checked as you go; nothing is recorded.

1. 1 / 10

   What is the primary purpose of a superbill for an out‑of‑network therapist?

   ATo replace the CMS‑1500 form for Medicare billingBTo act as an itemized receipt that the client files with their planCTo serve as a claim that the insurer must payDTo provide a legal contract between therapist and client
   Hint

   Look at the definition of a superbill in the lesson.

2. 2 / 10

   Which of the following fields must appear on every superbill?

   ATherapist’s Medicare provider numberBTherapist’s bank routing numberCTherapist’s NPI and Tax IDDClient’s insurance policy number
   Hint

   Check the list of required information for the provider.

3. 3 / 10

   Which CPT code represents a 45‑minute individual psychotherapy session?

   A90791B90834C90837D90847
   Hint

   Refer to the four most used CPT codes described.

4. 4 / 10

   What Place of Service code should be used for telehealth provided in the patient’s home?

   A95B02C11D10
   Hint

   Look at the POS codes table.

5. 5 / 10

   When must a Good Faith Estimate be delivered for a session scheduled at least 10 business days out?

   ANo later than 1 business day after schedulingBWithin 5 business days after the client requests itCAt the time of the first sessionDNo later than 3 business days after scheduling
   Hint

   Check the timing rules for GFE delivery based on scheduling lead time.

6. 6 / 10

   Which element is NOT required in the content of a Good Faith Estimate?

   ATherapist’s NPI and Tax IDBItemized list of expected services with chargesCA signed contract for servicesDClient’s name and date of birth
   Hint

   Review the list of required sections for the GFE.

7. 7 / 10

   If the scope of therapy changes after a Good Faith Estimate has been issued, when must a new estimate be provided?

   AWithin 7 days of the changeBAt least 1 business day before the next sessionCAt the next scheduled sessionDOnly if the client requests a new estimate
   Hint

   Look for the rule about changes in scope.

8. 8 / 10

   Which statement best describes the relationship between a superbill and the client’s insurance plan?

   AThe superbill obligates the plan to pay the provider directlyBThe superbill guarantees the client will receive the full fee backCThe superbill does not obligate the plan; reimbursement depends on the plan’s out‑of‑network termsDThe superbill replaces the need for any plan communication
   Hint

   Consider the lesson’s description of what a superbill does not do.

9. 9 / 10

   Under Oregon’s balance billing law, when is an out‑of‑network therapist prohibited from billing a client for services?

   AFor emergency services delivered at an in‑network facilityBFor services delivered at an in‑network facility that are not emergenciesCOnly when the client has no insuranceDFor any non‑emergency service in the therapist’s own office
   Hint

   Check the carve‑out described in the balance billing statute.

10. 10 / 10

    What is the threshold for a bill to be considered “substantially in excess” of the Good Faith Estimate according to CMS?

    AMore than $400 above the estimateBMore than 20 percent above the estimateCAny amount over the estimateDMore than $100 above the estimate
    Hint

    Refer to the CMS fact sheet mentioned in the lesson.