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Good Faith Estimates for pediatric therapy (No Surprises Act)
If you treat self-pay or uninsured families, the No Surprises Act requires you to give a Good Faith Estimate (GFE) of expected charges. Here's the practical version for pediatric therapy practices.
Who must receive a GFE
Uninsured clients and insured clients who choose not to use their insurance (classic private-pay therapy) are entitled to a GFE. It applies to essentially all licensed providers, including SLPs, OTs, PTs, and BCBAs in private practice.
When and how to deliver it
- On request: within 3 business days of a family asking
- Visit booked 3–9 business days out: GFE within 1 business day of scheduling
- Visit booked 10+ business days out: GFE within 3 business days of scheduling
- Visit booked less than 3 business days out: no GFE required for that visit
- In writing — paper or electronic — and keep a copy for your records
- For recurring therapy, one GFE can cover an episode of care up to 12 months; issue a new one when frequency or fees change
What it must include
- Child's name and date of birth
- Description of the primary service and expected CPT codes
- Expected charges per service and total for the episode (e.g., 92507 × 40 visits × $150)
- Provider name, NPI, and TIN
- A disclaimer that the estimate is not a contract and actual costs may differ
If actual billing exceeds the estimate by $400 or more, families can dispute through the federal patient-provider dispute resolution process — one more reason to refresh GFEs when plans of care change.
FAQ
Do GFEs apply if the family submits superbills for OON reimbursement?
Yes — a family paying you directly and self-submitting claims is generally treated as self-pay for GFE purposes. Provide the estimate and keep issuing superbills as usual.
Is there a template?
CMS publishes model notices, and your GFE can be a simple document following the required elements above. Store a signed copy in the client's file.
More practice guides
Educational content only — not billing, legal, or tax advice. Verify payer policies and regulations for your state and situation.