Each line is a date of service, one of the common psychotherapy CPT codes, the fee you charge, the ICD-10 code you type, and the amount already paid. Charges, payments, and the balance are added in the page. The printout is a statement for the client, not a claim you file.
Practice name, NPI, tax ID, and the client’s name stay in this browser. Saving a bill sends only a count. Verify codes and payer rules before you use the page with a real bill.