Abortion Invoice Generator
Fill in the clinic, patient and visit details and list each service with its billing code, then download a US Letter PDF or PNG. Prefer the short printed receipt? Switch the style above.
EDITOR
Receipt details
Edit your receipt below, then download the same clean layout as PDF or PNG. Enter amounts and totals manually.
An itemized invoice for records and reimbursement
An abortion invoice is the full-page itemized bill a clinic's billing office prints. It shows the clinic letterhead with NPI and Tax ID, the patient and visit, each service with its date, billing code and amount, what insurance or an assistance fund covered, the amount paid and the balance. With the balance at zero it also serves as an itemized payment receipt for HSA/FSA, insurance or travel-assistance reimbursement.
How to use this receipt
| Step | Details |
|---|---|
| 1 | Enter the clinic name, address, phone, NPI and Tax ID, and upload a logo if you have one. |
| 2 | Add the receipt or invoice number, issue date and account number. |
| 3 | Fill in the patient details and the visit: date of service, provider, visit type and location. |
| 4 | List each service with its date, CPT or HCPCS code, quantity and amount. |
| 5 | Enter the totals, payments and balance, add the payment details, then download the PDF or PNG. |
FAQs
What should an abortion invoice include?
The clinic name, address and provider identifiers such as NPI and Tax ID, the patient name and date of birth, the date of service, each service with its billing code and amount, any insurance or assistance payment, the amount paid and the balance. HSA/FSA administrators and insurers usually require these details.
Which billing codes appear on it?
Medication abortion is often billed as HCPCS S0199. Related services have their own codes, such as 76817 for a transvaginal ultrasound, 81025 for a urine pregnancy test, 86901 for Rh typing and 90385 or J2790 for Rh immune globulin. Use the codes on the clinic's own records.
Is it a receipt or an invoice?
Both. With the amount paid filled in and a zero balance it works as an itemized payment receipt; with a balance due it is an invoice. For the short printed receipt, switch to the 80 mm style above.
Does it calculate totals?
No. Amounts and totals are entered manually so they match the clinic's actual charges, discounts and payments.
Are the example details real?
No. The clinic, patient, codes and amounts in the example are fictional.
Sources and references
- KFF — variability in reimbursement rates for abortion services (median charges)
- Reproductive Health Access Project — coding for medication abortion
- Planned Parenthood of Illinois — financial information