Doctors who bill clients directly include independent physicians in cash-pay or direct primary care practices, concierge doctors, telehealth providers, occupational medicine and independent medical examiners, aesthetic and cosmetic physicians, and locum or consulting doctors. They invoice patients, employers, law firms, and other organizations for visits, exams, procedures, reports, and membership fees. Insurance-billed work follows claim rules and is mostly outside this page, which focuses on direct patient and client billing.
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Invoice_1001_Client_2026-10-14.pdf
Pricing depends on the practice model. Direct primary care practices usually charge a monthly membership fee that covers visits and basic services, with labs and procedures billed separately or at cost. Cash-pay and concierge practices often charge a flat fee per visit based on length, such as a 20-minute follow-up or a 60-minute new patient visit. Procedures like joint injections, skin biopsies, or vasectomies are typically flat fees that include supplies. Independent medical examiners, expert witnesses, and consulting doctors bill hourly or per report, often with a retainer and separate rates for record review, exam, report writing, deposition, and testimony. Locum doctors bill hourly or per shift to the staffing agency or facility. Aesthetic practices price per unit (such as neurotoxin) or per treatment. Many practices publish a fee schedule so patients know the price before the visit.
| Service | Priced | Typical range |
|---|---|---|
| New patient visit, cash-pay (45-60 min) | per visit | $200-450 |
| Established patient follow-up (15-30 min) | per visit | $100-250 |
| Direct primary care membership (adult) | per month | $75-150 |
| Telehealth visit | per visit | $75-200 |
| Independent medical exam with report | flat fee | $750-2,500 |
| Medical record review for legal cases | per hour | $300-600 |
| Procedure, e.g. joint injection or skin biopsy (supplies included) | per procedure | $150-500 |
| Locum tenens coverage | per hour | $100-250 |
Typical US ranges. Rates vary by region, experience, and job size.
| Description | Qty | Rate | Amount |
|---|---|---|---|
| New patient comprehensive visit (60 min), 03/12 | 1 visit | $325.00 | $325.00 |
| Point-of-care labs: A1c and lipid panel | 1 set | $45.00 | $45.00 |
| Joint injection, right knee (includes supplies) | 1 procedure | $225.00 | $225.00 |
| Follow-up telehealth visit (20 min), 03/26 | 1 visit | $125.00 | $125.00 |
| Completion of employer physical form | 1 form | $40.00 | $40.00 |
| Total | $760.00 | ||
Notes: Payment due at time of service or within 14 days of invoice date. This itemized statement can be submitted to your insurer for possible out-of-network reimbursement; reimbursement is not guaranteed. Accepted: card, HSA/FSA card, check, or bank transfer.
Identifies the correct patient and is typically required if the patient submits the statement for reimbursement. Avoid putting diagnoses on invoices that others may see.
Patients, insurers, and HSA/FSA administrators need exact dates to process or verify charges.
Out-of-network claims and HSA/FSA reimbursement often require procedure codes. Include diagnosis codes only when the patient needs a superbill.
Required by most insurers for reimbursement and useful for patient tax records.
Itemizing shows what the visit fee covers and avoids disputes over surprise charges.
Shows the true balance due and prevents double billing for prepaid memberships.
Law firms and carriers require this to approve payment and match your invoice to the file.
Cash-pay practices commonly collect payment at the time of service by card, HSA/FSA card, or bank transfer, and keep a card on file with the patient's written consent. Membership practices bill monthly or annually in advance. For IMEs, expert work, and record review, doctors usually require a retainer or full payment before the exam or testimony, with remaining balances due in 15 to 30 days. Late fees are less common with patients but are used with law firms and organizations; state them in writing in advance and check state rules on interest and collections. Provide a written good faith estimate for uninsured and self-pay patients, which the No Surprises Act requires in many cases.
Medical balances are much harder to collect after the patient leaves. Keep a card on file with signed consent and charge the agreed fee at the end of the visit.
Listing prices for visits, common procedures, forms, and records requests reduces disputes and phone calls. Include fees for missed appointments and after-hours calls.
Attorneys often pay slowly. Require payment before an IME, deposition, or testimony, and bill cancellations and late notices under a written fee agreement.
Self-pay patients with out-of-network benefits or HSA/FSA accounts will ask for a document with codes and dates. Offering it on request saves staff time later.
Invoices should list services and amounts, not clinical detail. Share only the minimum information needed and follow HIPAA rules for any outside party.
In most states you can if the patient was told the policy in writing beforehand. Common fees are $25 to $100 or a percentage of the visit. Many doctors waive the first one.
A superbill is an itemized statement with CPT and diagnosis codes, your NPI, and tax ID. Self-pay patients use it to seek reimbursement from their insurer. It is not a guarantee of payment, and you can provide it on request.
HSA rules have limited the use of HSA funds for DPC memberships in some cases, though recent law changes have addressed this. Check current IRS guidance. FSA treatment varies by plan, so tell patients to check with their administrator.
Charge a flat fee per form or a per-page fee for record copies. Many states cap what you can charge for copies of a patient's own records, so check your state rules before setting fees.
Medical services are generally exempt in most states, but retail products such as supplements or skincare sold in the office are often taxable. Check with your state department of revenue or a tax professional.
Send a Doctor estimate for approval, then turn it into an invoice when the work is done.
Doctor estimate template