Yes, for most clients, and never for a Texas Medicaid client. Medicare lets a practice charge its patients for a missed appointment as long as it charges everyone else the same fee. Texas Medicaid says its clients "cannot be charged for the client's failure to keep an appointment". The Texas counselor rules allow a bill for an unkept appointment, and the fee has to be in the informed consent the client signs before services begin.
Getting this wrong is a billing violation, not a policy choice. A practice with Medicaid, Medicare and commercial clients on one schedule needs one written policy that treats each payer by its own rule. The front desk has to know which rule applies before it charges a card.
This post reads federal rules, the Texas Medicaid manual and the Texas counselor rules as they stood on the day it was published. It isn't legal advice, and your network contracts may add terms.
What does Medicare allow?
Medicare allows the fee and does not pay it. The claims manual says "CMS's policy is to allow physicians and suppliers 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 amount "must be the same as the amount that they charge non-Medicare patients" (Medicare Claims Processing Manual, chapter 1, §30.3.13).
The manual calls the fee "a charge for a missed business opportunity", not a charge for a service. So it never goes on a Medicare claim. You bill the client directly.
What does Texas Medicaid allow?
Nothing. A Medicaid client's missed-appointment fee is $0. The provider manual says "In accordance with current federal policy, Texas Medicaid and Texas Medicaid clients cannot be charged for the client's failure to keep an appointment. Only billings for services provided are considered for payment" (TMHP, Texas Medicaid Provider Procedures Manual, Provider Enrollment and Responsibilities, October 2026, §1.7.12).
So a practice that charges everyone a fee must carve out its Medicaid clients. That includes members of Texas Medicaid managed care plans, who are Texas Medicaid clients, unless a plan tells you otherwise in writing. It also includes a client covered by both Medicare and Medicaid: treat them as a Medicaid client and do not charge the fee.
Does the carve-out break Medicare's same-fee-for-everyone condition? The manual's concern is that Medicare patients are not singled out, and we read an exception the Medicaid manual requires as not singling them out. The Medicare manual does not address it directly, so confirm with your attorney.
What do the Texas counselor rules say?
They allow the bill and ask for notice. The rules list what a counselor may not bill, then add "However, nothing in this rule should be construed to prevent a licensee from submitting a bill for an unkept appointment" (22 TAC §681.37(a)(5)). Before providing services, a counselor must get a signed informed consent that includes "fees and arrangements for payment", and must tell the client in writing about any change "prior to initiating the change" (22 TAC §681.35).
So a new fee, or a higher one, starts only after each current client has the change in writing. These are the LPC rules. LMFTs and social workers have their own boards' rules, so read the one for each license in your practice.
What about commercial plans?
Read your network agreement. We found no public rule from the large Texas commercial plans on charging members for missed appointments. If the agreement is silent, ask the plan in writing before you charge its members.
Does a fee reduce missed appointments?
We found no study that answers it for outpatient therapy. The evidence on missed sessions is about reminders and the wait before the first visit, which the post on missed first sessions covers. A fee may still be fair to the clinician whose hour was held. Judge it by what happens to your own late-cancel rate, counted the same way before and after.
What about the card on file?
If you charge a card on file, let your card processor store it. The card security standards body says the security code on the back is not needed for card-on-file transactions, "and storage for these purposes is prohibited under PCI DSS Requirement 3.2" (PCI Security Standards Council, November 2, 2017). In version 4.0.1 of the standard, the same rule is Requirement 3.3.1.2. Never write a card number or code in a note, a spreadsheet or an email.
What should the policy say?
Keep it to one page the client signs with the informed consent. Fill in the parts in parentheses.
A session canceled with less than (24) hours' notice, or missed, is charged (amount). The fee is the same for every client, with one exception required by law: clients covered by Texas Medicaid, including Medicaid managed care, are never charged it. (Role) may waive the fee for an emergency or illness. The fee is charged to the card on file or added to your balance, and it is never billed to your insurance.
Post the fee in your ledger as a charge that can never go on a claim, and flag every Medicaid client so the front desk cannot charge one by mistake.
What to do this week
- Sort your active clients by payer type: Medicaid, Medicare, commercial and self-pay. Count a client with both Medicare and Medicaid as Medicaid.
- Write one missed-appointment policy that names the fee, the notice window and the Medicaid exception.
- Check that your informed consent form includes the fee, and give the policy in writing to every current client before you charge it.
- Read each network agreement for a rule on charging members, and ask any plan whose agreement is silent.
- Count late cancellations and no-shows for four weeks before the policy starts and four weeks after, the same way both times.
Sources
- Medicare Claims Processing Manual, chapter 1, §30.3.13, Charges for missed appointments, Centers for Medicare and Medicaid Services, Rev. 3510.
- Texas Medicaid Provider Procedures Manual, Provider Enrollment and Responsibilities, TMHP, October 2026, §1.7.12.
- 22 Texas Administrative Code §681.37, billing and financial arrangements.
- 22 Texas Administrative Code §681.35, informed consent.
- Can CVC be stored for card-on-file or recurring transactions?, PCI Security Standards Council, November 2, 2017.
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