Does Medicare allow providers to bill a patient for a missed appointment?

Answer:
Yes. According to the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 30.3.13, CMS’ policy is to allow physicians, providers, and suppliers to charge Medicare beneficiaries for missed appointments, provided that they do not discriminate against Medicare beneficiaries but also charge non-Medicare patients for missed appointments. The amount charged for missed appointments must be the same for Medicare beneficiaries and non-Medicare patients. 

The charge for a missed appointment is not a charge for a service itself (to which the assignment and limiting charge provisions apply), but rather is a charge for a missed business opportunity. Therefore, if a physician's or supplier's missed appointment policy applies equally to all patients (Medicare and non-Medicare), then the Medicare law and regulations do not preclude the physician or supplier from charging the Medicare patient directly.

Medicare does not make any payments for missed appointment fees/charges that are imposed by providers, physicians, or other suppliers. Charges to beneficiaries for missed appointments should not be billed to Medicare.

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Provider Contact Center: 888-355-9165

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TTY: 877-715-6397

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