Can you charge a cancellation/no show fee to Medicare patients?

July 9, 2023

CMS’s policy for missed appointment charges can be found in the Medicare Claims Processing Manual, Chapter 1, Section 30.3.13.

CMS’s policy is to allow providers to charge Medicare beneficiaries for missed appointments, provided that they do not discriminate against Medicare beneficiaries but also charge non-Medicare patients for missed appointments. The charge for a missed appointment is not a charge for a service itself (to which the assignment and limiting charge provisions apply), but rather is a charge for a missed business opportunity. Therefore, if a provider’s missed appointment policy applies equally to all patients (Medicare and non-Medicare), then the Medicare law and regulations do not preclude the provider from charging the Medicare patient directly.

Medicare does not make any payments for missed appointment fees/charges that are imposed by providers. Charges to beneficiaries for missed appointments should not be billed to Medicare.

If you have some payers (e.g., work comp payers) that do not allow you to charge patients a cancellation/no show fee, you cannot apply the fee policy equally to all patients and therefore cannot charge Medicare patients.