How To: Set Up Supervision


Any user in TherapyNotes may be assigned as a Supervisor for Clinicians or Interns. Supervisors may need to review their supervisees' notes or provide feedback on notes outside of a formal supervision session, and supervisees may even need to bill a service using their supervisor's credentials (also known as "incident-to" billing). This is especially effective when an intern is providing a billable service, although each payer will have their own guidelines on what qualifies as an incident-to service. When in doubt, consult your contracts or contact the payer to verify eligibility to bill as a supervisor.

Supervisors in TherapyNotes may have the ability to access their assigned supervisees' notes, review and approve their supervisees' notes, or review and co-sign notes for their supervisees. You may also set whose information (the rendering provider, the supervisor, or both) is included on claims.

Assign supervisors and set up supervision

Role Required: Practice Administrator

To assign the role of Supervisor to a user:

  • Click Staff > Staff Name
  • Click anywhere on the Roles box to edit the user's roles
  • Select the Supervisor checkbox
  • Click the Save Changes button

To configure supervision settings for supervisees:

  • Click Staff > Staff Name
  • Click anywhere on the User Information box to edit
  • From the Supervision dropdown, select the appropriate supervision permissions


Access patient notes and co-sign notes for selected payers: The Supervisor can view all client notes but does not approve or co-sign the note before it is entered in the client record. However, this setting may be overridden per payer.
Must review and approve all notes: Whenever the supervisee completes a note, a To-Do list item will be generated for the Supervisor to approve the note before it is entered in the client record.
Must review and co-sign all notes: Whenever the supervisee completes a note, a To-Do list item will be generated for the supervisor to co-sign the note. This action is required to bill under the supervisor's credentials.

  • Once a level of supervision is selected, the Billing and Supervisors dropdowns appear
  • From the Billing dropdown, select how the supervisee can bill insurance
  • From the Supervisors dropdown, select the appropriate Supervisor for the supervisee. You may select more than one Supervisor as needed - the supervisee will need to choose which Supervisor is need for each session in the header of the relevant note
  • Click the Save Changes button

If you selected Bill as clinician unless otherwise selected in a payer's settings from the Billing dropdown, follow the steps below to configure Bill as Supervisor per payer.

To edit supervision billing settings per payer:

Note: Only Practice Administrators who also have the role of Practice Biller may change Supervisor Billing settings per payer.

  • Click Staff > Staff Name > Billing tab
  • Click anywhere on the Payers box to edit
  • In the Supervisor Billing column, select the preferred billing method from the dropdown. Select Bill as Clinician to include only the rendering provider's information on claims, Include Clinician and Supervisor to include information for both the rendering provider and the supervisor, or Bill as Supervisor (Incident-To) to include only the supervisor's information.
  • Click the Save Changes button

Configure supervision for specific notes

Occasionally, you may need to change the Supervision settings on a per-note basis, such as when there are two possible Supervisors for a date of service. You may also need to go back to notes that were completed prior to turning on the setting, or edit the note after your billing contract changed.

Role Required: Clinician (who originally created the note) or Supervising Clinician

To edit supervision billing settings per note:

  • When creating or editing a note, click anywhere on the note header or click Edit in the upper right corner of the note header to open it


  • From the Supervisor dropdown, select the Supervisor associated with the note
  • From the dropdown below, select the level of supervision required for the session
  • Click the Update Note Header button

The changes will take effect after the supervisee signs the note. The new supervisor will see a prompt to approve or co-sign the note in their To-Do list.

Have more questions? Submit a request


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    Bridgit Pankonin

    This was not helpful. I have all this set up. If you read my question, it says I need a CPT code billing modifier showing the service was supervised. If you could answer that it would be very helpful

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    Unfortunately we cannot provide which billing modifier to use. I can provide you with a good resource to take a look at. Please visit:
    I would advise that you contact the insurance company to be sure of which modifier to use as they are able to provide that to you.

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    Nilda Wotton

    Hi Bridgit at the moment we are not billing through Therapy Note yet but when I bill under the Supervisor I use billing modifier "HO" When I bill the Supervisor I use "AJ" hope this helps. Nilda Wotton- Living Water Counseling Center

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    Bridgit Pankonin

    Thanks Nilda. Where did you find those modifiers?

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    Bridgit Pankonin

    Thanks Nilda. Where did you find those modifiers?

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    Bridgit Pankonin

    I found the codes. Neither of those is appropriate for me. I am a Licensed Professional Counselor and supervisor is Licensed Professional Clinical Counselor.
    Thanks anyway

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    Traci Peters

    The modifier HO is for Blue Care Network and BCBSM here.

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    Bonnie Hedlund

    I direct a 501(c) training clinic. We do no insurance billing at this time. we have 4 pre-degree students who need to keep notes under their supervisors but who are volunteers. We have 3 Interns (post-degree) who get paid a percentage of what they collect from clients. Then there are 2licensed therapists.Do the volunteers have to pay a monthly fee, and do the Interns pay the same fee as a licensed practitioner?

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    In order for the volunteers to have the access to complete notes, they would need to be entered into the system as interns. We offer reduced pricing for non-profit organizations. The charge for clinicians is $25 per month, whereas the fee for interns is $20 per month with a provided 501c3. If you have any other questions, please contact our Success Team at 215-658-4550, or by email at Thank you.

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    Carol Anne Robinson

    What do supervisors billing for for pre lincensed therapist do at tax filing time? Do we need to fill out a 1099 for them.. If so which one. I looked on IRS website and there appear to be several of them. Also, do we present a copy of that 1099 to our accountants for deduction, since we do not get that money. Thanks!

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    We would recommend that you consult with a tax professional with experience in this for an answer, especially since state/local tax laws may differ. If you have any other questions, please contact our Success Team at 215-658-4550 or by email at Thank you.