Free Medical Invoice Template
A free, professional medical invoice template you can download as Word, Excel, PDF, or use in Google Docs and Sheets. Suitable for clinics, private practices, and independent providers, it includes fields for procedure (CPT) codes, diagnosis (ICD-10) codes, and insurance details. Use it for patient statements, superbills, or self-pay billing.
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| Description | Qty | Unit price | Amount |
|---|---|---|---|
| Office visit — established patient (CPT 99213) | 1 | $145.00 | $145.00 |
| Comprehensive metabolic panel (lab) | 1 | $85.00 | $85.00 |
| Electrocardiogram / EKG (CPT 93000) | 1 | $60.00 | $60.00 |
| Vaccine administration | 1 | $40.00 | $40.00 |
| Medical supplies | 1 | $25.00 | $25.00 |
| Subtotal | $355.00 | ||
| Sales tax (8%) | $28.40 | ||
| Total | $383.40 | ||
Example figures — every field is editable in the download.
Who uses this template
- ✓Private medical practices and clinics
- ✓Independent physicians and specialists
- ✓Physical therapists and chiropractors
- ✓Out-of-network providers issuing superbills
- ✓Concierge and direct-pay medicine practices
What to include
- ✓Patient name, date of birth, and account number
- ✓Provider name, NPI, and clinic Tax ID/EIN
- ✓Date(s) of service
- ✓CPT/HCPCS procedure codes with descriptions
- ✓ICD-10 diagnosis codes
- ✓Charges, insurance payments, and patient balance
- ✓Place of service and rendering provider
Available in 5 formats
Word (.docx)
Fully editable in Microsoft Word, Google Docs, Apple Pages and LibreOffice — best for quick text edits.
Excel (.xlsx)
Line totals, subtotal and tax calculate automatically — best if you want the math done for you.
A clean, print-ready, fixed layout — best for emailing a finished invoice to a client.
Google Docs / Sheets
Open in your browser, then File → Make a copy to edit and share with your team.
Invoicing tips for medical
- ✓ Include CPT and ICD-10 codes so patients can submit to insurance or HSA/FSA accounts
- ✓ Add your NPI and clinic Tax ID — out-of-network patients need them for reimbursement
- ✓ Show the difference between billed charges, insurance adjustments, and the patient's responsibility
- ✓ Label the document a 'superbill' if it's for the patient to file a claim themselves
- ✓ Keep patient statements HIPAA-aware: share only the minimum necessary information
Medical invoice FAQ
What is a superbill?
A superbill is an itemized receipt with CPT and ICD-10 codes that an out-of-network patient submits to their insurer for reimbursement. It includes the provider's NPI and Tax ID so the claim can be processed.
Are CPT and ICD-10 codes required on a patient invoice?
They aren't required for a simple self-pay receipt, but they're strongly recommended. Patients need them to claim insurance reimbursement or to use HSA/FSA funds.
Do medical services include sales tax?
Most professional medical services are exempt from sales tax in the US, though some medical supplies or retail products sold may be taxable depending on your state.
How do I show insurance payments on the invoice?
List the total billed charges, then a line for the insurance payment or contractual adjustment, leaving the remaining patient balance (copay, coinsurance, or deductible) as the amount due.
Related invoice templates
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