Good faith estimates for uninsured and self-pay patients: what CMS requires
Under the No Surprises Act, health care providers and facilities must give uninsured or self-pay individuals a good faith estimate of expected charges when they schedule an item or service or ask for one. The federal rule, 45 CFR 149.610, defines a provider by scope of practice under state law rather than by profession. ASHA’s private-practice page tells SLPs who serve individual clients that they will need to provide one. This page quotes CMS and the rule; it copies no dollar thresholds, penalties, or sample-form figures.
Quoted from official pages checked November 10, 2026. Confirm current requirements, fees, and dates on those sites. This page is not legal advice and does not guarantee eligibility, certification, or licensure.
Sources read on November 10, 2026: CMS’s consumer good faith estimate guide, CMS’s No Surprises Act overview of rules and fact sheets, 45 CFR 149.610 on eCFR (up to date as of November 6, 2026), and ASHA’s Private Practice in Speech-Language Pathology page. CMS’s model notices, FAQs, and dispute-resolution guidance are linked from the CMS overview page; they were not opened, and nothing is quoted from them.
Who must give one
CMS’s overview page states: “Providers, facilities and air ambulance providers are also required to give uninsured (or self-pay) individuals good-faith estimates of expected charges for scheduled health care services”. The rule’s scope states that it “sets forth requirements for health care providers and health care facilities related to the issuance of good faith estimates of expected charges for uninsured (or self-pay) individuals (or their authorized representatives), upon request or upon scheduling an item or service.”
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, including a provider of air ambulance services.” It does not list professions by name. ASHA’s page tells private-practice SLPs: “If you serve individual clients, you’ll need to provide them a good-faith estimate before starting services or at any time during treatment.” The CMS pages and rule text read for this site do not list occupational therapists, physical therapists, or speech-language pathologists by name.
Who counts as uninsured or self-pay
The rule covers two groups. One is an individual who does not have benefits for an item or service under a group health plan, group or individual health insurance coverage, a Federal health care program, or a federal employees’ health benefits plan. The other is: “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.”
Telling patients and timing
The rule requires convening providers to inform all uninsured or self-pay individuals that estimates are available. That information must be “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”, and “Orally provided when scheduling an item or service or when questions about the cost of items or services occur”. It also states that 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”.
On timing, the rule states: “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”. And: “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”. CMS’s consumer guide states: “When you schedule care 0-2 business days in advance, you aren’t entitled to get a good faith estimate.”
Recurring services
The rule states: “A convening provider or convening facility may issue a single good faith estimate for recurring primary items or services if the following requirements are met”. The estimate “must include, in a clear and understandable manner, the expected scope of the recurring primary items or services (such as timeframes, frequency, and total number of recurring items or services)”. And: “The scope of a good faith estimate for recurring primary items or services must not exceed 12 months.”
CMS’s consumer guide lists what an estimate might not include, among them: “Items or services related to your care that are scheduled separately, like pre-surgery appointments, or physical therapy in the weeks after surgery.” It states: “Good faith estimates only list expected charges for a single provider or facility.”
Disputes and complaints
CMS’s consumer guide states: “You’ll need a good faith estimate if you need to dispute your bill. You can’t dispute your bill without an estimate.” It also states: “If you didn’t get a good faith estimate, and you think you should have, submit a complaint.” The dispute process has its own eligibility rules and fees on CMS’s pages; they are not copied here.
What this page does not do
It gives no dollar thresholds, penalty amounts, or sample-form figures, and it does not decide whether any practice or patient is covered. It is not legal, billing, tax, or compliance advice. Confirm current rules with the agency that publishes them, your employer, and your state board.