A therapy practice owes a Good Faith Estimate to every client who pays out of pocket, including a client who has insurance and chooses not to use it. The practice gives it in writing. It is due 1 business day after booking a session that is 3 to 9 business days away, and 3 business days after booking one that is 10 or more business days away. A client's request also starts a 3-business-day clock.
The rule is 45 CFR 149.610, which carries out section 2799B-6 of the Public Health Service Act and has applied since January 1, 2022. The eCFR's version history for section 149.610 shows its latest amendment on October 7, 2021. The Federal Register lists two documents since June 1, 2024 that affect 45 CFR part 149. Both are rules on the independent dispute resolution process between plans and providers, published June 4 and August 28, 2026, and neither mentions section 149.610 or 149.620.
Which therapy clients are owed a Good Faith Estimate?
A therapy practice owes a Good Faith Estimate to each "uninsured (or self-pay) individual", and the rule counts an insured client who does not want a claim filed as self-pay. The definition is in 45 CFR 149.610(a)(2)(xiii).
(B) An individual who has benefits for such item or service under a group health plan, or individual or group health insurance coverage offered by a health insurance issuer, or a health benefits plan under chapter 89 of title 5, United States Code but who does not seek to have a claim for such item or service submitted to such plan or coverage.
Paragraph (A) covers a client with no benefits for the service. The two together mean three kinds of therapy client are owed an estimate:
- the client with no coverage
- the client whose therapist is out of network and who will not file a claim
- the client who has coverage and asks the practice not to bill it
A client whose sessions the practice bills to a plan is not owed one under this rule.
Paragraph (A) names a Federal health care program, such as Medicare or Medicaid, and paragraph (B) does not. So a client with Medicare or Medicaid benefits for the session fits neither paragraph, and this rule does not require an estimate for that client. The statute agrees, because it applies to a person who is "not enrolled in a Federal health care program". A practice should ask each new client about coverage and about whether the client wants a claim filed. The rule requires both questions in 45 CFR 149.610(b)(1)(i) and (ii).
Who in a therapy group practice owes the Good Faith Estimate?
The duty falls on the "convening provider". 45 CFR 149.610(a)(2)(ii) defines it.
Convening health care provider or convening health care facility (convening provider or convening facility) means the provider or facility who receives the initial request for a good faith estimate from an uninsured (or self-pay) individual and who is or, in the case of a request, would be responsible for scheduling the primary item or service.
The rule does not say whether that is the clinician or the practice when a front desk takes the call and books the session. We read it this way: the practice should treat the duty as its own, because the practice takes the request and books the first session. We did not find a CMS statement that settles the point for group practices.
A practice that sends a client to an outside provider for a related service, such as a psychiatrist, may have to ask that provider for estimate information. 45 CFR 149.610(a)(2)(iii) calls them "co-health care providers", and 45 CFR 149.610(b)(1)(v) requires the convening provider to ask them for estimate information. CMS's FAQs about Good Faith Estimates, Part 3 say on page 1 that HHS is extending "enforcement discretion, pending future rulemaking" for estimates that leave out the expected charges of co-providers, so the requirement stands in the rule but HHS is not enforcing it for those charges, and the practice still has to give its own estimate for its own services. A therapy practice that books its own sessions for its own clinicians has no co-provider.
When does a therapy practice have to give a Good Faith Estimate?
A therapy practice has to give the estimate no later than 1 business day after booking a session scheduled at least 3 business days ahead, and no later than 3 business days after booking one scheduled at least 10 business days ahead. 45 CFR 149.610(b)(1)(vi) sets both deadlines, and a third for a client's request.
(A) When a primary item or service is scheduled at least 3 business days before the date the item or service is scheduled to be furnished: Not later than 1 business day after the date of scheduling;
(B) When a primary item or service is scheduled at least 10 business days before such item or service is scheduled to be furnished: Not later than 3 business days after the date of scheduling; or
(C) When a good faith estimate is requested by an uninsured (or self-pay) individual: Not later than 3 business days after the date of the request.
Read alone, paragraphs (A) and (B) overlap for a session booked 10 or more days out. CMS resolves it on its page What is a good faith estimate, last modified October 5, 2026. The table follows that page.
Three examples show how the clock runs. Each counts Monday through Friday, and no federal holiday falls in these spans.
- A client books on Monday, October 19, 2026 for Monday, November 9, 2026. The session is 15 business days away, so the estimate is due by Thursday, October 22, 2026.
- A client books on Monday, October 19, 2026 for Monday, October 26, 2026. The session is 5 business days away, so the estimate is due by Tuesday, October 20, 2026.
- A client asks on Monday, October 19, 2026 what therapy would cost, without booking. The estimate is due by Thursday, October 22, 2026.
The Good Faith Estimate due-date calculator on this site takes a booking date and a session date and returns the due date and the paragraph of the rule it comes from. It needs no account, and the dates stay in the browser.
The rule does not define "business day", and we found no definition in 45 CFR part 149 or in CMS's FAQs. It also does not say whether the days between booking and session are counted with or without the booking day. A booking that lands on the 2-day or 3-day edge is the one to settle in the practice's own written procedure. Choose the reading that gives the client the estimate sooner.
A cost question is a request. 45 CFR 149.610(b)(1)(iv) says providers "shall consider any discussion or inquiry regarding the potential costs of items or services under consideration as a request for a good faith estimate." A client who asks the front desk what a session costs has started the 3-business-day clock.
The rule requires the estimate in writing. 45 CFR 149.610(e) allows paper or electronic delivery, as the client prefers, and an electronic copy must be one the client can save and print. A client who asks by phone may be told the figures aloud, but the written estimate must still follow.
What must a therapy practice tell clients about Good Faith Estimates before anyone asks?
A therapy practice must tell every self-pay client that a Good Faith Estimate is available, in writing and aloud. 45 CFR 149.610(b)(1)(iii) sets three duties for the notice.
- The written notice must meet this standard, from paragraph (A).
Written in a clear and understandable manner, prominently displayed (and easily searchable from a public search engine) on the convening provider's or convening facility's website, in the office, and on-site where scheduling or questions about the cost of items or services occur;
- It must be given orally when a session is scheduled and when a cost question comes up.
- It must be offered in accessible formats and in the languages spoken by the people considering or booking care.
CMS publishes a model notice of the right to receive a good faith estimate.
What must a Good Faith Estimate for therapy contain?
A Good Faith Estimate for therapy must contain the client's name and date of birth, a description of the service, an itemized list with codes and charges, the provider's identifiers and location, a list of separately scheduled services under its own disclaimer, and four more disclaimers. The full list is in 45 CFR 149.610(c)(1), summarized here.
Paragraph (c)(1)(iv) states the codes-and-charges item this way.
Applicable diagnosis codes, expected service codes, and expected charges associated with each listed item or service;
"Expected charge" is defined in 45 CFR 149.610(a)(2)(v) as "the cash pay rate or rate established by a provider or facility for an uninsured (or self-pay) individual, reflecting any discounts for such individuals". A practice that sets a sliding-scale fee for a client puts that fee on the estimate, not the full rate.
The diagnosis code is the item therapy practices find hardest, because a client may be booked before an assessment. The rule asks for the "applicable" diagnosis code. It does not say what to enter when none has been made, and we found no CMS answer for that case in the FAQs we read.
How can one Good Faith Estimate cover weekly therapy sessions?
A therapy practice may issue one Good Faith Estimate for recurring sessions, as long as the estimate states the expected timeframe, frequency and total number of sessions and covers no more than 12 months. This is the rule in 45 CFR 149.610(b)(1)(x).
(B) The scope of a good faith estimate for recurring primary items or services must not exceed 12 months. If additional recurrences of furnishing such items or services are expected beyond 12 months (or as specified under paragraph (b)(vii) of this section), a convening provider or convening facility must provide an uninsured (or self-pay) individual with a new good faith estimate, and communicate such changes (such as timeframes, frequency, and total number of recurring items or services) upon delivery of the new good faith estimate to help patients understand what has changed between the initial good faith estimate and the new good faith estimate.
Paragraph (A) of the same rule requires the estimate to state "the expected scope of the recurring primary items or services".
CMS's FAQs about Good Faith Estimates, Part 2, dated April 5, 2022, name counseling in question 3. They say a provider who expects to furnish recurring services, "such as periodic counseling services or physical therapy services", may issue a single estimate for them. The same FAQs say that a practice that does not use a single estimate must, on a request or a booking after the first visit, give a new estimate for the sessions it expects.
For weekly therapy, the estimate would state the start date, a weekly frequency, the number of sessions and the per-session fee. A client who stays in treatment past the 12 months needs a new estimate, and the practice must point out what changed.
When does a therapy practice have to give a new Good Faith Estimate?
A therapy practice has to give a new Good Faith Estimate when it expects or learns of a change in the scope of the one it gave. The new one is due no later than 1 business day before the affected session. The rule is 45 CFR 149.610(b)(1)(vii). The rule gives examples of such changes.
(such as anticipated changes to the expected charges, items, services, frequency, recurrences, duration, providers, or facilities)
Three events in a therapy practice fit that list.
- The client moves from weekly to twice-weekly sessions, or adds a service such as a group.
- The fee changes, for example when a sliding-scale reduction ends and the client's rate rises.
- The client is reassigned to a clinician who bills at a different rate.
A client who first asks for an estimate and then books a session is owed a new estimate within the 1-day or 3-day deadline in the table above, under 45 CFR 149.610(b)(1)(ix).
An honest mistake does not by itself break the rule. 45 CFR 149.610(f)(3) says a provider does not fail to comply "solely because, despite acting in good faith and with reasonable due diligence" it makes an error or omission, if it corrects the information as soon as practicable. If services were already furnished, the client may still dispute a bill that is far above the estimate.
How long must a therapy practice keep a Good Faith Estimate?
A therapy practice must keep a Good Faith Estimate as part of the client's medical record, and must give the client a copy of any estimate issued in the last 6 years on request. Both duties are in 45 CFR 149.610(f)(1).
A good faith estimate issued to uninsured (or self-pay) individual under this section is considered part of the patient's medical record and must be maintained in the same manner as a patient's medical record. Convening providers and convening facilities must provide a copy of any previously issued good faith estimate furnished within the last 6 years to an uninsured (or self-pay) individual upon the request of the uninsured (or self-pay) individual.
The 6 years is the window in which a client can ask for a copy. The rule does not set a retention period for the estimate. It points to the practice's record-keeping rules, so the estimate is kept for as long as the client's record is. It carries a date of birth and diagnosis codes, so the practice stores it in the client's chart, not in its scheduling or marketing tools.
What happens if a client's bill is $400 or more above the Good Faith Estimate?
A client whose bill from a provider is at least $400 more than that provider's total expected charges on the Good Faith Estimate may start the federal patient-provider dispute resolution process. The threshold is defined in 45 CFR 149.620(a)(2)(ii).
Substantially in excess means, with respect to the total billed charges by a provider or facility, an amount that is at least $400 more than the total amount of expected charges listed on the good faith estimate for the provider or facility.
CMS's page for providers, Providers: payment resolution with patients, last modified August 26, 2026, states the same threshold in plainer words. It says the process is "available for uninsured (or self-pay) consumers who get a bill from a provider that's at least $400 more than the expected charges on the good faith estimate."
Two details matter for a therapy practice.
- The client starts the process by a notice to HHS "postmarked within 120 calendar days of receiving the initial bill containing charges for the item or service that is substantially in excess of the expected charges in the good faith estimate", under 45 CFR 149.620(c)(1). The total billed charges count the provider's charges for the primary service and the services furnished with it, "regardless of whether such items or services were included in the good faith estimate", under 45 CFR 149.620(a)(2)(iii).
- A client who was not given an estimate has no estimate to dispute against. CMS tells clients on its estimate page, last modified October 5, 2026: "You can't dispute your bill without an estimate." The page says: "If you didn't get a good faith estimate, and you think you should have, submit a complaint." It adds that when a client submits a complaint, "you're still responsible for paying the bill." We did not confirm a penalty amount for a missed estimate, and this guide states none.
For weekly therapy the threshold is easy to reach if the fee changes and no new estimate is issued. At a $60 gap between the estimated and actual per-session fee, the difference passes $400 in the seventh weekly session. That is our arithmetic ($60 times 7 is $420), not a figure from CMS.
Is there a Good Faith Estimate template for therapy?
CMS publishes a model Good Faith Estimate form that a therapy practice can fill in, and its own instructions say that using it counts as good faith compliance with the notice requirements. The form is Model Notice: Good Faith Estimate for Health Care Items and Services, listed on CMS's overview of rules and fact sheets, last modified October 14, 2026.
The form's instructions say: "HHS considers use of the model notice to be good faith compliance with the good faith estimate requirements to inform an individual of expected charges." They also say that use of the form is not required, and that to start the dispute process an estimate must meet "all of the requirements under 45 CFR 149.610". The copy we read prints an Office of Management and Budget expiration date of November 2025 in its header. We found no replacement form, so check cms.gov for the current version before the practice adopts it.
The CMS form is general. A therapy practice adapts it with its own session codes, fee, session count and timeframe, and adds the clinician's name, National Provider Identifier and office location.
What to do this week
- Add two questions to the intake script: does the client have coverage for therapy, and does the client want a claim filed. Record the answer for each new client.
- Write the practice's business-day rule down: which days count, whether federal holidays count, and which way a booking on the 2-day or 3-day edge is treated.
- Put a notice of the right to a Good Faith Estimate on the website, at the front desk and on the scheduling page, and add a line for staff to say aloud when booking and when a client asks about cost.
- Treat any question about cost as a request, and log the date it was made.
- Fill in the CMS model form for the practice's usual case, one clinician and weekly sessions for up to 12 months, so a staff member can finish it in minutes.
- Pick one person to issue each estimate and one place in the client's chart to file it.
- Set a reminder at the day the estimate is due, and a second at 12 months for any recurring estimate.
- List clients now on a sliding scale or a self-pay rate and check that each has an estimate that matches the current fee.
Where Practice Pillar fits
Practice Pillar, software for therapy group practices, states on its client balances page that each Good Faith Estimate a practice owes has a due date and is flagged before it is late. A spreadsheet with the booking date, the session date and a column for the due date can hold the same deadlines.
Sources
- 45 CFR 149.610, Requirements for provision of good faith estimates of expected charges for uninsured (or self-pay) individuals, Electronic Code of Federal Regulations. Text current through October 16, 2026. The eCFR version history for this section shows its latest amendment on October 7, 2021. Checked October 19, 2026.
- 45 CFR 149.620, Requirements for the patient-provider dispute resolution process, Electronic Code of Federal Regulations. Text current through October 16, 2026. Checked October 19, 2026.
- 42 U.S.C. 300gg-136 (Public Health Service Act §2799B-6), Cornell Legal Information Institute copy of the United States Code. Checked October 19, 2026.
- What is a good faith estimate, Centers for Medicare & Medicaid Services. Page last modified October 5, 2026. Checked October 19, 2026.
- Providers: payment resolution with patients, Centers for Medicare & Medicaid Services. Page last modified August 26, 2026. Checked October 19, 2026.
- No Surprises Act overview of rules and fact sheets, Centers for Medicare & Medicaid Services. Page last modified October 14, 2026. Checked October 19, 2026.
- FAQs about Consolidated Appropriations Act, 2021 implementation: Good Faith Estimates for uninsured (or self-pay) individuals, Part 2, Centers for Medicare & Medicaid Services, April 5, 2022.
- Model notice: Good Faith Estimate for health care items and services and Model notice: right to receive a good faith estimate, Centers for Medicare & Medicaid Services. Checked October 19, 2026.
- Federal Register API query for documents affecting 45 CFR part 149 published on or after June 1, 2024, run October 19, 2026. It returned the June 4, 2026 final rule and the August 28, 2026 correction on independent dispute resolution operations. The full text of both was searched, and neither mentions 149.610 or 149.620.
Changes to this guide
- Added that HHS is exercising enforcement discretion, pending future rulemaking, on estimates that leave out co-provider charges (CMS FAQ part 3, page 1).
- Published, signed by Practice Pillar Editorial Staff.
- First draft. Checked against 45 CFR 149.610 and 149.620 as the eCFR showed them on October 16, 2026 (latest amendment October 7, 2021, per the eCFR version history), PHS Act §2799B-6 (42 U.S.C. 300gg-136), the CMS pages last modified August 26 and October 5, 2026, and CMS's FAQs and model form.
This guide explains the rules it cites. It is not legal advice.