Under the No Surprises Act rule at 45 CFR 149.610, providers must give uninsured and self-pay patients a written good faith estimate when they schedule at least 3 business days ahead or ask for one. Information about the right to an estimate must be prominently displayed on the practice website, in the office and where scheduling happens, and given orally.
Last verified: November 9, 2026.
General information, not legal advice. This summarizes federal rules and CMS materials as we read them on November 9, 2026. State laws may add requirements, and federal rules in this area are still being developed. Confirm your obligations with qualified counsel. Nothing here guarantees compliance.
Who must give a good faith estimate, and to whom
The federal good faith estimate (GFE) rule is at 45 CFR 149.610, implementing section 2799B-6 of the Public Health Service Act (added by the No Surprises Act).
Who it applies to. The rule defines a "health care provider" as "a physician or other health care provider who is acting within the scope of practice of that provider's license or certification under applicable State law," plus health care facilities. That definition is not limited to physicians, which is why the rule is widely applied to licensed therapists, dentists, chiropractors and other clinicians as well.
Which patients. GFEs are owed to:
Uninsured individuals: people not enrolled in a group health plan, individual coverage, a federal health care program or FEHB, as described in the CMS model form instructions.
Self-pay individuals: people who have coverage but are not seeking to file a claim with it.
The second group is easy to miss. An insured patient who chooses to pay cash for a visit is a self-pay individual for GFE purposes.
The convening provider. The provider who receives the request or is responsible for scheduling the primary service is the "convening provider" and is responsible for issuing the GFE.
When the estimate is due
The regulation sets three deadlines:
| Situation | GFE due |
|---|---|
| Service scheduled at least 3 business days in advance | No later than 1 business day after scheduling |
| Service scheduled at least 10 business days in advance | No later than 3 business days after scheduling |
| Patient requests a GFE (without scheduling) | No later than 3 business days after the request |
CMS's consumer page states the practical consequence: when care is scheduled 0 to 2 business days in advance, the patient is not entitled to a GFE for that scheduling.
Two other rules that affect front-desk workflows:
Cost questions count as requests. The regulation says convening 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 patient asking "how much will this cost?" can start the 3-business-day clock.
Recurring services. A single GFE can cover recurring services, such as a course of therapy, if it states the expected scope (timeframes, frequency, total number). Its scope cannot exceed 12 months; after that, a new GFE is required.
Providers must also give a copy of any GFE issued within the last 6 years when the patient asks.
The website requirement: what the rule actually says
This is the part most practice websites get wrong. The regulation says information about the availability of GFEs for uninsured or self-pay individuals must be:
(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; (B) Orally provided when scheduling an item or service or when questions about the cost of items or services occur; and (C) Made available in accessible formats, and in the language(s) spoken by individual(s) considering or scheduling items or services.
Read closely, that means:
Required: a website notice about the right to a GFE that is clear, prominently displayed and findable by a public search engine.
Required: the same information posted in the office and where scheduling or cost questions happen, and given orally at those moments.
Required: accessible formats and the languages your patients speak.
Not specified: exact wording, page location, font size or whether you must publish prices.
"Easily searchable from a public search engine" is the phrase that rules out common shortcuts: a notice only inside a scanned PDF, behind a patient-portal login, or as an image of text may not meet it.
What to publish (required vs optional)
Required: the notice of the right to a GFE. A plain-language notice that uninsured and self-pay patients can receive a good faith estimate, how to ask for one, and that they may dispute a bill that is substantially higher. CMS published a model GFE form and patient-facing materials; the model 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," and that its use is not required. A practice-specific website notice can draw on the same language.
A sample structure (have counsel review before use):
Your right to a Good Faith Estimate. You have the right to receive a Good Faith Estimate explaining how much your medical care will cost. If you don't have insurance or are not using insurance, we must give you a Good Faith Estimate for scheduled services when you schedule at least 3 business days ahead or when you ask. To request one, call [phone] or email [address]. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. For more information, visit www.cms.gov/nosurprises or call 1-800-985-3059.
The $400 threshold and the 1-800-985-3059 number come from the CMS model GFE disclaimer, which also says disputes must be started within 120 calendar days of the original bill.
Optional: self-pay prices. The GFE rule does not require posting prices on your website. Publishing typical self-pay rates or ranges is a business decision. It can reduce cost-question calls and help patients compare, but anything you publish should match what your GFEs actually say. If you publish prices, label them as typical and point to the GFE process for a personal estimate.
Where on the site to put it
Because the rule says "prominently displayed," place the notice where patients make cost and scheduling decisions, not only where lawyers look:
A dedicated page such as /good-faith-estimate or within /fees, in HTML text so search engines can index it.
The booking or scheduling page, near the "Book" button or intake form.
The fees, insurance or self-pay page, if you have one.
The site footer, with a link titled clearly, for example "Good Faith Estimate notice."
New-patient pages and intake emails, linking to the notice.
Translate it into the languages your patients speak, make sure it works with screen readers, and test that a search for "[practice name] good faith estimate" finds it after it is indexed.
Common mistakes
The notice is only a PDF or an image. It may not be "easily searchable," and image text is not accessible.
It is buried in a privacy policy or terms page that patients never open.
No self-pay information at all. Insurance logos but nothing for cash-pay patients.
"We're out of network, so it doesn't apply." Out-of-network and cash practices see many self-pay patients; the rule turns on the patient's payment status, not your network status.
Front-desk scripts ignore cost questions. A cost question can count as a GFE request, so staff need to log it and route it.
Stale numbers. Published price ranges that no longer match your GFEs.
What has changed, and what is still pending
Uninsured and self-pay GFEs have applied since January 1, 2022, according to the CMS FAQs and secondary sources we reviewed.
Co-provider estimates are not enforced. The rule requires a GFE to include expected charges from co-providers and co-facilities. In a December 2, 2022 FAQ, HHS extended enforcement discretion for GFEs that omit those charges, "pending future rulemaking," and said any new rule would include a prospective applicability date. We found no later CMS notice ending that discretion as of November 9, 2026.
GFEs for insured patients and the Advanced Explanation of Benefits (AEOB) are separate No Surprises Act provisions. As of an October 2025 HFMA report, CMS had not implemented them, and Congress was pressing for rules. Watch cms.gov/nosurprises for any rulemaking; it could change workflows for insured patients but does not remove current obligations to uninsured and self-pay patients.
Errors made in good faith. The rule says a provider does not fail to comply solely because of an error or omission made in good faith with reasonable due diligence, provided it corrects the information as soon as practicable. If services are furnished before the error is fixed, the patient may still use dispute resolution if billed charges are substantially higher.
How ClinicStats checks insurance and self-pay information
The free ClinicStats scan includes a check called Insurance or self-pay prices stated, in the Bookable sub-score. As published on the methodology page, it passes when the site names the insurance plans accepted or states self-pay prices, and is borderline when insurance is mentioned only in general terms.
Be clear on what it does not do: it does not look for a GFE notice and is not a compliance assessment. It tells you whether a patient can find basic cost information on your homepage. For placing cost and booking information where patients will see it, our website conversion guide covers layout. You can run the free scan to see how your site reads today.