No-show fees by state: Medicaid is off-limits, everywhere.

CMS bars no-show billing of Medicaid and Medicare recipients nationally. Private-pay rules are mostly permissive but a small number of states (Massachusetts, New York, California) add layered consumer-protection or parity rules. This page is a starting reference, not legal advice.

Sources: 42 CFR 447.15, CMS IOM Pub 100-04 chapter 1, Massachusetts DOI bulletin 2009-09.

Not legal advice. Confirm current state rules with your medical board, dental board, or counsel before billing a no-show fee.

FOLIO · Federal floor

The federal rule, plain English

Two federal rules set the floor for what any practice in any state may charge a patient for missing an appointment. The first is Medicaid. Section 1902(a)(25) of the Social Security Act, implemented at 42 CFR 447.15, requires that any provider participating in a state Medicaid program accept the Medicaid payment as payment in full for covered services. CMS interprets a no-show fee as an additional charge connected to a covered service, which falls within the rule, and every state Medicaid manual issued in the past 20 years repeats the prohibition explicitly. Practices that bill a no-show fee to a Medicaid recipient risk recoupment, fraud-and-abuse exposure, and program-integrity action up to disenrollment.

The second is Medicare. CMS Internet-Only Manual Pub 100-04, chapter 1, section 30.3.13 permits no-show fees for Medicare patients only if (a) the fee is billed to the patient directly and never to Medicare, (b) the practice charges the same fee to all patient categories (not a higher Medicare-specific fee), and (c) the practice has a written no-show policy disclosed in advance. Most practices avoid the operational complexity and waive the fee for Medicare patients altogether.

For private-pay and commercial-plan patients, federal law is permissive. State law governs. Most states have no statutory cap on the fee, leaving the matter to medical and dental licensing boards and to contract law. A small number of states have layered consumer-protection or parity rules that affect what the fee may look like in practice. The state-by-state register below summarises both the Medicaid prohibition (which applies everywhere) and the private-pay nuance per state.

State	Medicaid no-show fee	Private-pay rule	Notes
Alabama	Prohibited	No statutory cap	Board of Medical Examiners requires written policy disclosure at intake
Alaska	Prohibited	No statutory cap	DHSS Medicaid manual reaffirms no fees to recipients
Arizona	Prohibited (AHCCCS)	No statutory cap	AHCCCS provider manual section 940 prohibits beneficiary balance billing
Arkansas	Prohibited	No statutory cap	Standard CMS rule applies; Medicaid manual mirrors federal language
California	Prohibited (DHCS)	No statutory cap, parity rule applies	DHCS bars Medi-Cal fees; CMA guidance: same fee across all payers, in writing
Colorado	Prohibited	No statutory cap	Health First Colorado provider bulletin reaffirms no balance billing
Connecticut	Prohibited (HUSKY)	No statutory cap	DSS provider manual: no balance billing including missed-visit fees
Delaware	Prohibited (DMMA)	No statutory cap	Standard CMS rule; informed consent at intake recommended
Florida	Prohibited (AHCA)	No statutory cap	Florida Board of Medicine guidance: fee must be proportionate to actual cost
Georgia	Prohibited (DCH)	No statutory cap	Composite Medical Board: disclosure at intake required
Hawaii	Prohibited (Med-QUEST)	No statutory cap	Med-QUEST provider handbook prohibits balance billing
Idaho	Prohibited	No statutory cap	Idaho DHW Medicaid manual standard CMS language
Illinois	Prohibited (HFS)	No statutory cap	IDFPR Medical Practice Act: fee schedule must be posted; dental board echoes
Indiana	Prohibited	No statutory cap	FSSA provider bulletin reaffirms no fees to Medicaid recipients
Iowa	Prohibited (IME)	No statutory cap	Standard CMS rule applies to Iowa Health Link
Kansas	Prohibited (KanCare)	No statutory cap	KDHE provider manual; written policy at intake
Kentucky	Prohibited	No statutory cap	DMS provider manual standard CMS rule
Louisiana	Prohibited	No statutory cap	LDH Medicaid bulletin reaffirms no recipient billing
Maine	Prohibited (MaineCare)	No statutory cap	DHHS provider manual; disclosure at intake standard
Maryland	Prohibited (MDH)	No statutory cap	MDH provider manual standard CMS language
Massachusetts	Prohibited (MassHealth)	Limited on state-regulated plans	DOI bulletin 2009-09: limited to actual cost on state-regulated commercial plans
Michigan	Prohibited (MDHHS)	No statutory cap	MDHHS provider manual; LARA dental board requires disclosure
Minnesota	Prohibited (MHCP)	No statutory cap	DHS provider manual standard CMS rule
Mississippi	Prohibited	No statutory cap	DOM provider bulletin reaffirms no recipient balance billing
Missouri	Prohibited (MO HealthNet)	No statutory cap	MMAC provider manual standard CMS language
Montana	Prohibited	No statutory cap	DPHHS provider manual standard CMS rule
Nebraska	Prohibited (Heritage Health)	No statutory cap	DHHS provider bulletin reaffirms federal rule
Nevada	Prohibited	No statutory cap	DHCFP provider manual standard CMS rule
New Hampshire	Prohibited	No statutory cap	DHHS Medicaid provider manual standard CMS language
New Jersey	Prohibited (NJ FamilyCare)	No statutory cap	DMAHS provider bulletin reaffirms no recipient billing
New Mexico	Prohibited (Turquoise Care)	No statutory cap	HCA provider manual standard CMS rule
New York	Prohibited (eMedNY)	OAG guidance suggests fees at co-pay equivalent	Office of Attorney General has issued informal guidance discouraging high fees for primary care
North Carolina	Prohibited (NC Medicaid)	No statutory cap	DHHS Medicaid provider bulletin reaffirms federal rule
North Dakota	Prohibited	No statutory cap	DHHS provider manual standard CMS rule
Ohio	Prohibited	No statutory cap	ODM provider manual standard CMS rule
Oklahoma	Prohibited (SoonerCare)	No statutory cap	OHCA provider manual reaffirms federal rule
Oregon	Prohibited (OHP)	No statutory cap	OHA provider guide standard CMS language
Pennsylvania	Prohibited	No statutory cap	DHS provider manual reaffirms no recipient balance billing
Rhode Island	Prohibited	No statutory cap	EOHHS provider manual standard CMS rule
South Carolina	Prohibited (Healthy Connections)	No statutory cap	SCDHHS provider manual standard CMS language
South Dakota	Prohibited	No statutory cap	DSS Medical Services provider manual standard CMS rule
Tennessee	Prohibited (TennCare)	No statutory cap	TennCare provider bulletin reaffirms federal rule
Texas	Prohibited (HHSC)	No statutory cap	TMB and TSBDE: fee must be disclosed in writing; reasonable and proportionate
Utah	Prohibited	No statutory cap	DHHS provider manual standard CMS rule
Vermont	Prohibited (Green Mountain Care)	No statutory cap	DVHA provider manual standard CMS language
Virginia	Prohibited	No statutory cap	DMAS provider manual standard CMS rule
Washington	Prohibited (Apple Health)	No statutory cap	HCA provider guide reaffirms federal rule
West Virginia	Prohibited	No statutory cap	BMS provider manual standard CMS rule
Wisconsin	Prohibited (BadgerCare)	No statutory cap	DHS provider handbook standard CMS language
Wyoming	Prohibited	No statutory cap	DOH provider manual standard CMS rule

FOLIO · Practical limits

What private-pay fees usually look like in practice

Despite the absence of statutory caps in most states, market practice and licensing-board expectations cluster fees around predictable ranges. Primary care: $25 to $75 for a missed visit, almost always at the lower end. Specialty visits: $50 to $150, with cardiology, neurology, and behavioral health typically at the upper end. Dental hygiene and routine: $35 to $75. Restorative dental: $100 to $250. Surgical no-shows (where an OR slot is forfeited): $250 to $500, sometimes more for complex procedures, with the rationale that the actual cost incurred by the practice and surgical center is substantially higher.

Practices that try to charge above these ranges often find collection difficult. Small-claims courts in most jurisdictions treat the fee under contract-of-adhesion principles, asking whether the patient understood the term and whether the amount is reasonable relative to actual practice cost. A $200 fee for a missed primary-care 15-minute slot is unlikely to survive that test. A $500 fee for a missed 90-minute pre-op or a 4-hour OR slot generally will.

FOLIO · Disclosure

Informed-consent language that holds up

For a no-show fee to be collectable, the patient must have agreed to the fee in advance, in writing, with the amount and the trigger clearly stated. Best practice has four parts. Part one: a signed no-show policy at intake, included in the new-patient packet, with the fee amount, the notice window (typically 24 hours), and the trigger (missed without notice, or cancelled within the notice window). Part two: a visible posting at the practice (waiting room or check-in counter) restating the policy. Part three: a re-confirmation at booking, often inside the appointment confirmation message, with the fee amount restated. Part four: a final reminder before the appointment that quotes the fee one more time.

Sample policy language that meets the standard in most states: If you miss your appointment without providing at least 24 hours of advance notice, a $50 no-show fee will be billed to the credit card on file or to your account. This fee does not apply to emergencies (please call to explain) or to Medicaid recipients. If you anticipate being unable to attend, call our office or reply STOP to the reminder text to release your appointment slot for another patient.

For the reminder disclosure, sample language: Reminder: appointment with Dr. [name] on [date] at [time]. A $50 no-show fee applies if missed without 24-hour notice. Reply C to confirm, R to reschedule. The fee notice in the reminder satisfies the contemporaneous-notice element that some courts look for.

FOLIO · TCPA overlay

How TCPA interacts with fee-disclosure reminders

The Telephone Consumer Protection Act (TCPA) governs automated calls and texts to patient mobile numbers. The 2012 FCC Healthcare Provider Exemption permits healthcare appointment reminders without explicit prior express written consent, provided the message is short, free to the patient, and limited to specified categories including appointment confirmations and reminders. Fee-disclosure language inside a reminder text is generally still covered by the exemption because the fee is a term of the appointment, not unrelated commercial content. Some practices choose to separate the fee notice into a distinct message to be safe, but this is not required by current FCC interpretation.

Where TCPA does bite is collection messaging. If a patient misses an appointment and the practice sends an automated text to inform them of the fee and request payment, that message is a debt-collection communication, not an appointment reminder, and falls outside the healthcare exemption. Such messages require either prior express written consent under TCPA or human-initiated outreach. The safest pattern is: automated appointment reminders fine, manual phone call or letter for fee collection.

Card-on-file authorisations partly sidestep this. If the patient has signed a credit-card authorisation at intake allowing the practice to charge the no-show fee directly to the card, the practice may charge the fee without further communication and the TCPA collection question does not arise. The patient then has chargeback rights via their card issuer, which is its own dispute path but does not require the practice to send TCPA-regulated collection messages.

FOLIO · Related

FOLIO · Margin notes

Frequently asked questions

Can a doctor charge a no-show fee to Medicaid patients?+

Generally no. Federal Medicaid guidance from CMS treats no-show fees billed to Medicaid beneficiaries as additional charges for a covered service, which is prohibited under section 1902(a)(25) of the Social Security Act and 42 CFR 447.15. State Medicaid manuals (e.g. California DHCS, New York eMedNY, Texas HHSC) repeat the prohibition explicitly. A practice may discharge a chronically no-show Medicaid patient under standard patient-abandonment protections, but it may not bill the missed-visit fee. The same restriction applies to Medicare Part B per CMS Internet-Only Manual Pub 100-04, chapter 1, section 30.3.13, which permits no-show fees only if billed to the patient (not Medicare) and only at the same amount the practice charges other payer categories.

How much can a practice charge for a no-show fee?+

Common practice is $25 to $75 for primary care and $50 to $150 for specialty visits, with surgical no-shows often $250 to $500. There is no federal cap on private-pay fees, but several state medical boards (notably California, Florida, and New York) have informally indicated that fees above the practice's typical visit reimbursement raise consumer-protection concerns. Most state dental boards (Texas, California, Illinois) similarly suggest the fee should be reasonable and proportionate to actual cost. The fee should be disclosed in writing at intake and re-confirmed at booking time for the policy to be enforceable.

Do patients have to sign a no-show policy for it to be enforceable?+

In practice, yes. Most state consumer-protection statutes require clear advance disclosure of any fee not customarily associated with healthcare service to make the fee enforceable in collections. Best practice is a written policy signed at intake, displayed visibly at the practice, and re-confirmed at booking via the appointment confirmation (SMS or email). Some practices include the fee in the reminder text itself ('a $50 fee applies if you miss this appointment without 24-hour notice'), which adds another layer of consent. The signed policy plus the reminder disclosure is generally sufficient to support collection in small-claims court if the patient disputes.

Are there states where no-show fees are explicitly prohibited or capped?+

Yes, partially. Massachusetts Division of Insurance bulletin 2009-09 limits no-show fees on patients holding state-regulated commercial plans to actual cost incurred (interpreted as $25 to $50 typical). New York's Office of the Attorney General has issued guidance discouraging fees above a typical co-pay equivalent for primary care. California requires the fee be the same regardless of payer (you cannot charge a private-pay patient a higher no-show fee than you would charge a commercial-plan patient if you charged one at all). Most other states leave the matter to professional licensing boards and contract law, with no explicit statutory cap.