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Sample ICD-10 Superbill for Family Planning Related Services

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 Billing and Coding Title X Family Planning Program
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This sample superbill template has been updated with ICD-10 and CPT codes commonly used by reproductive health care providers. It is recommended that providers check with their payers regarding the use of codes and modifiers, and if needed, this template can be modified. This template is intended for agencies with an electronic health record (EHR) looking to verify or confirm common ICD-10 and CPT codes.


The printer-friendly version of template, available under Supplemental Materials, is intended for agencies without an EHR and for those agencies that want to download and print this template.

Supplemental Materials

Printer-Friendly Version (XLS)178.37 KB
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