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Good Faith Estimates for self-pay patients: a checklist for practices

A staff member reviews a binder in the back office of a medical practice

Practices that offer cash-pay elective treatments have a federal requirement to build into the front desk routine: the Good Faith Estimate. Under the No Surprises Act rules (45 CFR 149.610), health care providers must tell self-pay patients that an estimate is available and give them one in writing, on set timelines. This guide is for practice owners, office managers and front desk teams. It covers who counts as self-pay, when the estimate is due, what goes in it and a simple workflow.

  1. SearchAn adult looks for care near them.
  2. Your pageWhat you treat, who sees them, one way to book.
  3. Call or formThey call or send a request.
  4. Front deskBooks the visit and never guesses a cause.
  5. Clinical teamThe clinician decides the plan.
How a new patient request reaches your practice.

1. Know who counts as self-pay

The rule covers people who have no coverage for the item or service, and people who have coverage but do not want a claim submitted for it. The practice that schedules the main service has to find out which applies, by asking whether the person has coverage and, if they do, whether they want a claim submitted. For elective treatments that a patient’s insurance does not cover, the people you schedule may fall into this group, so ask every time and record the answer.

2. Tell people an estimate is available

The rule says self-pay patients must be told that a Good Faith Estimate is available when they schedule or ask for one. That information must be:

  • written clearly and displayed prominently on your website (and easy to find from a public search engine), in the office, and where scheduling or cost questions happen;
  • given out loud when scheduling, or when someone asks about cost;
  • available in accessible formats and in the languages spoken by the people considering or scheduling care with you.

One line matters most for the front desk: the rule says any discussion or inquiry about the potential cost of items or services should be treated as a request for a Good Faith Estimate. A caller asking “how much is it?” counts.

3. Meet the deadlines

The written estimate is due on these timelines, counted in business days:

  • Service scheduled at least 3 business days ahead: no later than 1 business day after scheduling.
  • Service scheduled at least 10 business days ahead: no later than 3 business days after scheduling.
  • Estimate requested without scheduling: no later than 3 business days after the request.

If someone who received an estimate on request then schedules, they get a new estimate for the scheduled service on the scheduling timelines. If the scope changes after scheduling, for example the expected charges, services, number of sessions or providers, a new estimate is due no later than 1 business day before the service. For recurring services, such as a series of sessions, one estimate can cover up to 12 months if it states the expected scope clearly, such as the timeframe, frequency and total number of sessions.

4. Put the required items in it

A Good Faith Estimate for a self-pay patient must include, among other items:

  • the patient’s name and date of birth;
  • a plain-language description of the main service and, if scheduled, its date;
  • an itemized list of the items and services reasonably expected for that period of care, grouped by provider or facility;
  • applicable diagnosis codes, expected service codes and the expected charge for each item;
  • the name, National Provider Identifier and Tax Identification Number of each provider or facility, and where the services will be furnished;
  • a list of related services that will be scheduled separately, with the required disclaimer above it;
  • disclaimers that it is only an estimate, that other recommended services may be scheduled separately, that it is not a contract, and that the patient may start the patient-provider dispute resolution process if billed charges are substantially higher, with instructions and a statement that using that process will not affect the quality of their care.

The rule defines the expected charge as your cash pay or self-pay rate, reflecting any discounts for self-pay patients. CMS publishes guidance and resources for providers on its No Surprises provider page, which is a good place to check for current forms and guidance.

5. Deliver it in writing

The estimate must be in writing, on paper or electronically, as the patient asks. An electronic estimate must be one the patient can save and print. You can go over it by phone or in person if the patient asks, but that does not replace the written copy.

6. Keep a copy

The rule treats an issued Good Faith Estimate as part of the patient’s medical record, to be kept in the same way. If a patient asks, you must give them a copy of any estimate issued to them in the last 6 years.

7. Keep estimates accurate

Under the dispute rule (45 CFR 149.620), a self-pay patient can start patient-provider dispute resolution with HHS if a provider’s or facility’s total billed charges are at least $400 more than the expected charges on its estimate. The patient has 120 calendar days from receiving the first bill with those charges. The estimate rule also says that an error or omission made in good faith, with reasonable due diligence, is not a failure to comply on its own, if you correct it as soon as practicable. The practical answer is to base estimates on your current self-pay fees, issue a new one when the plan changes, and check bills against the estimate before they go out.

8. When other providers are involved

If another provider or facility is reasonably expected to furnish items or services together with your main service, the rule has extra steps for including their charges, with 1 business day deadlines for requesting and receiving their information. If that applies to you, check the current CMS guidance with counsel before you set up the process.

A simple front desk workflow

  1. On every new patient call or web request, ask whether the person has coverage and, if so, whether they want a claim submitted. Record the answer.
  2. When cost comes up, say that a written Good Faith Estimate is available, and log it as a request.
  3. Prepare the estimate from your current self-pay fee list, using a template your counsel has reviewed.
  4. Send it on paper or electronically, as the patient prefers, and note the date sent against the deadline.
  5. When the plan changes, issue a new estimate and record why.
  6. Keep every estimate with the patient record, and check the final bill against it.

Our new patient phone script and consultation to treatment guides show where this fits in the call and the consultation.

Where MediLeadGen fits

MediLeadGen sends practices requests from patients interested in cash-pay elective treatments. Each request goes to one practice only, with consent naming that practice, at a fixed price per delivered request. Because these treatments are cash-pay, a clear Good Faith Estimate process helps your team answer the cost question well from the first call.

See how it works for practices

Questions practices ask

Who has to get a Good Faith Estimate?

Self-pay patients: people with no coverage for the item or service, or people with coverage who do not want a claim submitted. The practice has to ask about coverage when someone schedules or asks about cost (45 CFR 149.610).

When is the Good Faith Estimate due?

For a service scheduled at least 3 business days ahead, within 1 business day after scheduling; at least 10 business days ahead, within 3 business days; and on request, within 3 business days of the request.

Does a phone question about price count as a request?

Yes. The rule says any discussion or inquiry about the potential cost of items or services should be treated as a request for a Good Faith Estimate.

Can we give the estimate over the phone?

You can go over it by phone if the patient asks, but you still have to provide it in writing, on paper or electronically, in a form the patient can save and print.

What happens if the bill is higher than the estimate?

If a provider’s or facility’s total billed charges are at least $400 more than its estimate, a self-pay patient can start the patient-provider dispute resolution process within 120 calendar days of the first bill with those charges (45 CFR 149.620).

General information for practice teams, not legal advice. Federal rules and guidance can change, and state law may add requirements; check with counsel. Last reviewed October 2026.

More resources

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