Question 1

What's the difference between a medical invoice and a superbill?

Accepted Answer

A medical invoice is simply the bill for services rendered. A "superbill" is a US term for an invoice built specifically so an out-of-network patient can submit it to their insurer for reimbursement — it adds fields insurers require: patient date of birth, insurance member/group ID, your NPI, diagnosis (ICD-10) codes, and CPT/HCPCS procedure codes per line. This generator supports both — just leave the insurance-specific fields blank for a simple private-pay invoice.

Question 2

Do doctors and therapists charge VAT or GST on their services?

Accepted Answer

Usually not. Medical care provided by a registered health professional is exempt from VAT in the EU (Art. 132(1)(b)-(c) VAT Directive), the UK (VAT Notice 701/57), and GST-free in Australia and exempt in Canada. The exemption is generally purpose-based — it must be genuine diagnosis, treatment or care, not cosmetic work. Brazil (municipal ISS), Japan (private/self-pay care) and Malaysia (services to foreign patients) are the main exceptions among our 39 markets — see the country-specific notice on your invoice for the applicable rate and legal basis.

Question 3

What must be on a private practice invoice for a patient to claim insurance reimbursement?

Accepted Answer

At minimum: your practice details and registration number, the patient's name (and date of birth, if requested), the date each service was provided, a description of the service, the fee charged, and ideally a procedure code. Some insurers also want a diagnosis code. Add these using the Patient DOB, Provider registration, Insurance/member ID, Diagnosis code and Treatment date fields, plus the Code column on each line.

Question 4

Do I need to put diagnosis (ICD-10) codes on the invoice — and is that a privacy problem?

Accepted Answer

Only add a diagnosis code if your patient's insurer specifically requires it for reimbursement — it's an optional field. Diagnosis information is sensitive health data under GDPR and HIPAA, so use the minimum necessary: a code alone, not a full clinical description, and only when the patient needs it for a claim.

Question 5

What are CPT codes, GOÄ-Ziffern or Medicare item numbers, and where do they go?

Accepted Answer

These are the standard procedure/tariff codes insurers use to identify exactly what service was billed — CPT/HCPCS in the US, GOÄ-Ziffer in Germany, Medicare item numbers in Australia, TARDOC positions in Switzerland/Liechtenstein, INAMI/RIZIV nomenclature codes in Belgium. Enter them in the narrow "Code" column next to each line item; leave it blank if your market or invoice doesn't need one.

Question 6

How do I invoice as a psychotherapist or physiotherapist without being VAT-registered?

Accepted Answer

If your services are exempt (which most therapy and physiotherapy is, across our markets), you don't charge VAT at all — set the tax rate to 0% and, where your country requires it, add the legal exemption wording this tool prefills (e.g. France's mandatory "TVA non applicable — art. 261-4-1° du CGI"). You still need a valid, sequentially numbered invoice; VAT registration isn't required to invoice for exempt care.

Question 7

Is cosmetic treatment like Botox or laser therapy VAT-exempt?

Accepted Answer

Generally no. Tax authorities across the EU, UK, Australia and Canada draw the exemption at genuine therapeutic purpose — diagnosing, treating or curing a condition. Purely aesthetic procedures with no medical necessity are standard-rated, and several tax authorities (the UK's HMRC in particular) actively audit aesthetic and medspa clinics on this point. If a treatment has no medical indication, mark that line item taxable at your standard rate.

Question 8

Can my patient use this invoice for tax deductions or insurance/HSA claims?

Accepted Answer

That depends entirely on their tax authority or insurer's own rules, not on this tool — but a complete invoice with your registration number, the service date, a clear description and the fee charged covers what most reimbursement schemes ask for (e.g. US HSA/FSA claims, Canadian medical expense tax credit receipts, or Japan's 医療費控除 deduction).

Question 9

How should I number my invoices as a solo practitioner?

Accepted Answer

Use a sequential, gap-free numbering scheme with no repeats — this is a legal requirement in several markets (France requires it for notes d'honoraires, for example, with a per-mention fine for missing required elements). A simple running counter (e.g. 2026-001, 2026-002) satisfies this everywhere.

Question 10

What is the GOÄ Steigerungsfaktor and when must I justify it? (Germany)

Accepted Answer

Under §12 GOÄ, German private-practice fees are calculated as a base fee multiplied by a factor (Steigerungsfaktor) reflecting case difficulty, typically between 1.0 and 2.3. Charging above 2.3x requires a brief written justification on the invoice itself. This tool doesn't calculate the multiplier automatically — enter the multiplied fee as the rate and note the factor (e.g. "GOÄ 65, Faktor 2,3") in the description or Code column.

Description	Quantity	Rate	Amount
Initial consultation (30 min)	1	€0.00	€0.00
Follow-up consultation (15 min)	1	€0.00	€0.00
Therapy session (50 min)	1	€0.00	€0.00
Physiotherapy treatment session	1	€0.00	€0.00
Blood draw + laboratory panel	1	€0.00	€0.00
Vaccination / injection administration	1	€0.00	€0.00
Telehealth consultation	1	€0.00	€0.00
Medical report / certificate fee	1	€0.00	€0.00

Subtotal	€0.00

Total	€0.00

Medical Invoice Generator

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Free invoicing app

Free medical invoice generator & superbill template

What should a private practice invoice or superbill include?

Do medical services carry VAT or sales tax?

Procedure codes: CPT, GOÄ-Ziffer and their equivalents

FAQs about medical invoices and superbills