Late-cancellation and no-show policy for therapists: wording you can copy

A therapy practice's late-cancellation policy should say how much notice a client must give, what counts as a late cancellation or a no-show, what the fee is, how emergencies are handled, and how to rebook. Agreed in writing at intake and repeated in every reminder, it lets the practice apply the same rule to every client without having to argue it each time.

What the ethics codes ask

The APA Ethics Code says psychologists and the people they serve should reach "an agreement specifying compensation and billing arrangements" as early as is feasible, and that fee practices must be consistent with law.¹ Its standard on informed consent to therapy lists fees among the things clients are told about early in the relationship.¹

The ACA Code of Ethics asks counselors to inform clients about "fees and billing arrangements, including procedures for nonpayment of fees" as part of informed consent. It also says counselors consider a client's financial situation when setting fees, and may adjust them, when legally permissible, where the usual fee would cause undue hardship.²

So a late-cancellation fee that is explained at intake, agreed in writing, and applied as written sits comfortably within both codes. A fee a client first hears about after missing a session does not.

What the policy should say

These parts are our recommendation. Only the Medicare and Medicaid points further down are rules.

• The notice period. How many hours before a session a client can cancel or reschedule without a fee. Choose enough notice to offer the time to someone else, for example 24 or 48 hours.
• What counts as a late cancellation, and what counts as a no-show. For telehealth, say how many minutes after the start time a session counts as missed.
• The fee. Whether it is the full session fee or part of it, and that it is charged the same way every time.
• How it is paid. If you keep a card on file for this, say so and get the client's written authorization.
• Emergencies and illness. Decided by the therapist, case by case, and written down.
• Rebooking. How a client who missed a session books the next one.

Adapt this sample to your practice, and check your state's rules, including Medicaid's, before charging any fee.

Medicare, Medicaid and insurance

Required by Medicare: a practice may charge Medicare patients for missed appointments only if its missed-appointment policy applies equally to all patients, and the amount charged to Medicare patients must be the same as the amount charged to non-Medicare patients. Medicare treats the charge as one for "a missed business opportunity," not for a service.³

Check your state (Medicaid): check your state's Medicaid rules before charging Medicaid clients anything.

Our recommendation for insured clients: a missed session is not a session, so the fee is charged to the client, not billed to the insurer. Check your payer contracts for anything they say about missed-appointment charges.

Messages you can copy

The policy only works if clients see it before it matters. These carry it at the moments it is needed.

Keep the first message after a miss about the client, not the fee. The fee can follow in a separate, plain message, or in the next statement.

What can run by itself

These parts can be set up to run by themselves, inside the practice software, forms and messaging a practice already uses:

• The policy at intake. The intake forms carry the policy and the client signs it, so nobody has to remember to bring it up.
• Reminders that state the notice period and take a one-letter reply to confirm or reschedule.
• Rebooking after a cancellation or a missed session.
• A log of late cancellations and no-shows, so the practice can see how often they happen.

What stays with the therapist

• Waiving or charging the fee. Including for illness, emergencies and a client's first late cancellation.
• The conversation. A pattern of missed sessions can be a clinical matter as much as a billing one.
• Hardship. Adjusting fees for a client who cannot afford them, as the ACA code allows.

Count it first

For two weeks, keep a tick list: every late cancellation, every no-show, and every hour that went unfilled because of one. If you tried the tally in our front-desk article, use its "Reminders and no-shows" column. It gives you a number to compare once the policy and the reminders are in place. For practices that are not therapy-only, our general no-show policy article covers the same ground for medical offices.

Missed sessions are one of four front-desk jobs worth automating. Another that comes up often in therapy practices is records requests, where psychotherapy notes sit outside the patient's right of access, and our vet reminders article shows the same reminder messages built for a clinic.

Questions therapists ask