No-Show Policy for Therapists: Fees, Billing, and Best Practices

Therapists can and should charge for no-shows — but insurance will not reimburse these fees. Here is how to set a legally sound no-show policy, document it properly, and collect effectively without damaging the therapeutic relationship.

Can Therapists Charge for No-Shows?

Yes. There is no federal law prohibiting therapists from charging cancellation or no-show fees. The ability to charge for reserved time that was not used is a standard business practice. However, there are two important caveats:

• Insurance will not reimburse no-show fees. CPT codes are only valid for services actually provided. A no-show is not a covered service, so there is no CPT code to bill. The fee must be collected directly from the client — it cannot appear on a superbill for insurance reimbursement.
• In-network contracts may limit your ability to charge. If you are credentialed and contracted with an insurer, some participation agreements prohibit charging copays or fees beyond what the contract allows. OON providers have no such restriction.

Typical No-Show Fee Ranges

No-show fees in private practice typically range from $75 to $150. Many practices charge their full session fee. The appropriate amount depends on your market, your session fee, and your clinical judgment about what is fair while maintaining the therapeutic relationship.

Some practices use a tiered policy: first late cancellation/no-show is waived or charged at a reduced rate ($50); repeat occurrences are charged the full fee.

What to Include in Your No-Show Policy

Your policy should be written, given to clients at intake, and signed. Cover:

• How much advance notice is required to cancel without charge (typically 24 or 48 hours)
• The specific fee for late cancellation (within the cancellation window)
• The fee for a no-show (no contact at all)
• Whether any exceptions apply (medical emergency, first offense waiver)
• How the fee will be collected (credit card on file, invoice, etc.)
• Clarification that insurance does not cover this fee and the client is personally responsible

Intake Paperwork Language

Include clear language in your informed consent or financial agreement. Example language:

“Appointments cancelled with less than 24 hours' notice, and appointments at which you do not appear, will be charged a $[X] late cancellation/no-show fee. This fee is your personal responsibility and is not covered by insurance. By signing this agreement, you authorize [Practice Name] to charge the credit card on file for this amount.”

Credit Card on File Systems

The most effective way to collect no-show fees is to have a credit card on file and a signed authorization to charge it. Practice management systems and dedicated billing platforms (including Stripe-based solutions) support this. The authorization language in your intake paperwork must specifically cover no-show charges — a generic credit card authorization for session fees may not cover it.

Clients who dispute no-show charges with their credit card company (“chargebacks”) are less likely to win if you have a signed policy and a documented attempt to contact the client before and after the missed session.

Documentation Best Practices

When a no-show occurs:

1. Note in the client's record that the session was a no-show and the date/time
2. Document any attempt you made to contact the client before or during the appointment
3. Send a written notification of the fee charged (email or portal message)
4. Do not create a clinical note for services that were not rendered

Therapeutic Relationship Considerations

A well-communicated policy protects the relationship more than it harms it. Clients who understand the policy upfront are far less likely to be surprised or upset by a charge. Frame the policy as a way to protect the session time you hold for them specifically — and for allowing clients on a waitlist to be seen.

For related practice policies, see the guide on how to set your therapy fee and the sliding scale guide for handling reduced-fee clients who need flexibility.