invoices - DOCX / PDF
Acupuncture Invoice
Acupuncture treatment invoice with CPT codes for insurance, session types, and herbal prescriptions
Your Company Name
Your Address
INVOICE
Client Name
Client Address
Invoice #
Date / Due Date
| Description | Qty | Rate |
|---|---|---|
| Provider information | ||
| Patient information | ||
| Treatment type | ||
| CPT codes | ||
| ICD-10 diagnosis | ||
| Session duration | ||
| Herbal formula | ||
| Supplement | ||
| Package discount | ||
| Superbill |
Subtotal
Tax
Total
Notes / Payment Terms
For licensed acupuncturists billing self-pay and insurance patients.
What’s Included
- Provider information (name, LAc, NCCAOM cert, NPI)
- Patient information and insurance details
- Treatment type (acupuncture, electroacupuncture, cupping, moxibustion)
- CPT codes (97810, 97811, 97813, 97814)
- ICD-10 diagnosis codes
- Session duration (initial eval vs. follow-up)
- Herbal formula prescription and dispensing fee
- Supplement recommendations and cost
- Package discount (5, 10, 20 session bundles)
- Superbill format for out-of-network reimbursement
State license number and NCCAOM certification displayed. Sliding scale option noted.
Add your practice information and set session rates in PDFb2.
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