Your Medical Practice
Provider
Dr. Your Name, MD
123 Medical Center Drive
City, State 00000
NPI #: 0000000000
billing@yourpractice.com
+1 (555) 000-0000
City, State 00000
NPI #: 0000000000
billing@yourpractice.com
+1 (555) 000-0000
Patient
Patient Full Name
456 Patient Street
City, State 00000
DOB: January 1, 1990
patient@email.com
City, State 00000
DOB: January 1, 1990
patient@email.com
| Description | Qty | Rate | Amount |
|---|---|---|---|
|
Office Visit — Established Patient CPT 99213 — Level 3 evaluation and management |
1 | $150.00 | $150.00 |
|
Comprehensive Blood Panel CPT 80053 — Complete metabolic panel |
1 | $85.00 | $85.00 |
|
Flu Vaccination CPT 90686 — Influenza vaccine, quadrivalent |
1 | $45.00 | $45.00 |
|
Medical Supplies & Disposables Gloves, syringes, and materials used during visit |
1 | $20.00 | $20.00 |
Subtotal
$300.00
Tax (0%)
$0.00
Insurance Adjustment
$0.00
Total Due
$300.00
Payment Details
Accepted: Cash, Check, Credit Card
Make checks payable to: Your Practice Name
Online payment: yourpractice.com/pay
Questions: billing@yourpractice.com
Make checks payable to: Your Practice Name
Online payment: yourpractice.com/pay
Questions: billing@yourpractice.com
Notes
This invoice may be submitted to your insurance for reimbursement.
Keep a copy for your records.
For billing questions, call +1 (555) 000-0000.
Keep a copy for your records.
For billing questions, call +1 (555) 000-0000.
Thank you for choosing our practice. Your health is our priority.
Medical Invoice FAQ
What should a medical invoice include?
A medical invoice should include the provider's name, practice name, NPI number, and contact info; the patient's name and date of birth; a unique invoice number; date of service; itemized services with CPT codes; individual costs; any insurance adjustments; and total amount due from the patient.
Can patients submit this to their insurance company?
Yes. An itemized medical invoice with CPT codes can function as a superbill that patients submit to their insurance for out-of-network reimbursement. Make sure each procedure has its CPT code listed in the description field.
Are medical services subject to sales tax?
In most US states, medical services are exempt from sales tax. However, some medical supplies or cosmetic procedures may be taxable depending on your state. Consult a healthcare accountant to confirm your obligations.
Is this medical invoice template free?
Yes, completely free — no account required, no watermark. Edit for each patient and download as many times as needed.
How do I download this as a PDF?
Click the green "Download PDF" button. Your browser's print dialog opens — select "Save as PDF" as the destination. The sidebar and toolbar are hidden so only the clean invoice is saved.