Medical Economics, Vol. 96, Issue 11

By: Andrew H. Selesnick and Gemma Karapetyan

“There is no Current Procedural Terminology code for late cancellations or missed appointments. When a patient does not cancel with adequate notice or fails to show for an appointment, payers, both government and commercial, refuse to reimburse because they do not consider it a medically necessary or covered service. In other words, a no-show falls outside the umbrella of what payers will reimburse, leaving the practice holding the bag.

While payers may not reimburse for no-shows, they also often do not prevent physicians from imposing financial penalties. Unless the physician has entered into a contract with a payer that prohibits late cancellation or no-show charges, the patient can be held directly liable if certain conditions are followed.  Under CMS guidelines, Medicare also allows a no-show fee (assuming there is no contract that says otherwise) if the practice follows the rules.”