Good Faith Estimate / No Surprises Act Calculator
Enter the expected number of sessions and your fee per session to estimate a course-of-treatment total and the point at which a client's final bill would qualify for a dispute.
Good Faith Estimate Calculator
Estimate the total cost of a course of treatment and the No Surprises Act dispute threshold
Total Estimated Cost
$1,800
12 sessions × $150
Dispute Threshold (PPDR)
$2,200
Estimate + $400
If the final bill reaches $2,200 or more, the client may be eligible to dispute it through the patient-provider dispute resolution (PPDR) process within 120 calendar days.
Ready to generate the actual, NSA-compliant Good Faith Estimate PDF for this client?
Create This GFEThis calculator is an estimate for planning purposes only. Your actual Good Faith Estimate must use the client's real information and your actual charged fee, and should be generated as a proper written document before the first scheduled service.
What Is a Good Faith Estimate?
A Good Faith Estimate is a written notice of expected cost that the federal No Surprises Act requires providers to give uninsured and self-pay clients before their first scheduled service. It must include the expected CPT codes, session frequency, and total cost, along with required legal disclosures.
How This Calculator Works
The calculator multiplies the expected number of sessions by the fee per session to produce a total estimated cost. It then adds the $400No Surprises Act dispute threshold to show the dollar amount at which a client's final bill would become eligible for patient-provider dispute resolution (PPDR), which must be started within 120 calendar days of the bill.
Generate the Actual Good Faith Estimate
This calculator is for planning only. When you are ready to issue the real document, Superbilled generates an NSA-compliant Good Faith Estimate PDF, complete with your NPI, license number, itemized codes, and the required dispute-resolution language, in under 2 minutes.