Therapy Cancellation Policy: A No-Show Template to Copy

A therapy cancellation policy does two jobs. It protects the hour you hold for each client, and it tells clients, before anything goes wrong, exactly what happens when they can't come. Below is a cancellation and no-show policy you can copy, one field per line, with the choices most therapists weigh: 24 or 48 hours, a full or partial fee, a first-time grace, switching to video instead of canceling, and emergencies. After it you'll find how to explain the policy at intake and in your consent form, the limits that Medicare, Medicaid, insurer contracts and the Good Faith Estimate put on missed-session fees, what the ACA, NASW and APA codes ask, scripts for enforcing it kindly, and what research says about reminders.

What your cancellation policy has to decide

Whatever wording you use, a therapist cancellation policy answers the same ten questions. If a client can't answer them after reading yours, it isn't finished.

How much notice counts as an on-time cancellation, and how the client gives it.
What counts as late, what counts as a no-show, and what happens when someone arrives late.
The fee for a late cancellation and for a no-show, if you charge one.
How the fee is paid: a card on file, an invoice, or kept from a session paid in advance.
Any grace, such as waiving the first one.
Alternatives to canceling: rescheduling in the same week, or meeting by video.
Exceptions: illness, emergencies, unsafe travel, disability-related absences.
Insurance and public programs: who can be charged and who can't.
Repeated misses: what happens after the third one.
Changes: how much notice you give before the policy changes.

A no-show and cancellation policy template you can copy

Put this in the fees section of your consent form, or keep it as a one-page policy the client signs with it. Fill in the brackets, delete the options you don't use, and keep the wording plain: a client should understand it in one read. The text is ours, so copy and adapt it freely.

Cancellation and missed session policyTemplate · 30 parts to fill in

CANCELLATION AND MISSED SESSION POLICY

Practice: [practice name]Therapist: [name, license, state]Effective date: [MM/DD/YYYY]

WHY THIS POLICY EXISTSYour session time is held for you alone.When a session is missed without notice, no one else can use it.Notice lets me offer the time to someone who is waiting.

HOW TO CANCEL OR RESCHEDULENotice needed: at least [24 / 48] hours before your sessionFor Monday sessions: by [noon on the Friday before]How to tell me: [phone / text / email / client portal]Notice counts from: the time your message reaches meTime zone for all times: [Eastern Time]

WHAT THE TERMS MEANLate cancellation: less than [24 / 48] hours' noticeNo-show: not arriving within [15] minutes, with no messageLate arrival: the session still ends at the usual time

FEESLate cancellation fee: $[amount] ([full fee / half / flat fee])No-show fee: $[amount] ([full fee / half / flat fee])First late cancellation or no-show: [waived once / no grace]Grace renews: [every 6 months / every 12 months / never]Sliding-scale clients pay: [your sliding fee / $ ]Couples and family sessions: [same fee / $ ]

HOW FEES ARE PAIDPayment: [card on file / invoice / kept from a prepaid session]Charged on: [the day of the session / within 2 business days]Prepaid session canceled on time: [refunded / moved]Prepaid session canceled late: [kept as the fee / part refunded]

CARD AUTHORIZATIONI authorize [practice name] to charge the card I providefor fees under this policy. I can cancel this in writing.

INSTEAD OF CANCELINGVideo: if you can't come in, we can meet by video insteadVideo condition 1: you are in [state] during the sessionVideo condition 2: you are somewhere privateVideo condition 3: a telehealth consent is on fileSame-week reschedule: [fee waived / fee still due]

WHEN THE FEE IS WAIVEDSudden illness, yours or a dependent'sA medical, family or safety emergencyUnsafe travel, such as severe weather (in-person sessions)Absences related to a disability: we will agree on a planI decide exceptions case by case and apply them consistently.I will not ask for a doctor's note.

INSURANCE AND PUBLIC PROGRAMSInsurance does not pay for missed sessions.Any fee under this policy is billed to you, not your plan.Medicare: fees apply the same way as for every clientMedicaid: if you have Medicaid, these fees do not applyOther plans: [any plan whose contract limits these fees]

REPEATED MISSED SESSIONSAfter [3] late cancellations or no-shows in [60] days,we will talk about what is getting in the way.We may change your time, meet less often or by video,or I will help you find a provider whose times suit you.

WHEN I CANCELIf I cancel with less than [24] hours' notice,I will offer you a make-up time within [7] days.

CHANGES TO THIS POLICYI will give you [30] days' written notice before it changes.

AGREEMENTI have read this policy and had a chance to ask questions.Client name: [ ]Client signature and date: [ ]Parent or guardian, if the client is a minor: [ ]Person responsible for fees, if not the client: [ ]Therapist signature and date: [ ]

Three parts of the template are there for legal and ethical reasons rather than style: the card authorization, the insurance and public program lines, and the promise to apply exceptions consistently. The sections below explain each choice.

How to choose your options

If you want one common starting point: 24 hours' notice, half your fee for a late cancellation, your full fee for a no-show, the first one waived, video offered when it fits, and illness and emergencies always waived. Then adjust it to your practice.

24 or 48 hours' notice

24 hours is the most common window and the easiest for clients to remember. 48 hours gives you a real chance to offer the slot to someone on a waitlist, which matters most when you have one. Some practices use 72 hours for long or specialized sessions.

Two details trip people up:

The Monday problem.With a 24-hour window, a 9 a.m. Monday session can be canceled at 9 a.m. Sunday, when you're unlikely to see the message, let alone fill the slot. A line such as "by noon on the last business day before" fixes it.
Time zones.If you see clients by video in other time zones, name the time zone your policy uses.

Full fee, partial fee or flat fee

Full fee. Simple and honest about what you lose: the hour was held and can't be resold at short notice. It is the hardest fee for clients to accept.
Half the fee (or another percentage). A middle ground many therapists use for late cancellations, keeping the full fee for no-shows. With a $160 session, a 50% fee is $80.
A flat fee, such as $50 for any late cancellation. Easy to explain, and the same for every client, which helps if you see Medicare clients (see below).

Whatever you choose, keep the fee at or below your session fee and tie it to the time you lost. The NASW asks that fees be "fair, reasonable, and commensurate with the services performed," and the ACA asks counselors to consider clients' financial status when setting fees. For clients on a sliding scale, charging their sliding fee rather than your full rate is one way to keep the policy fair; our sliding fee schedule example includes a line for it.

A first-time grace

Waiving the first late cancellation or no-show costs you one fee and buys a lot of goodwill. It also turns the first charge into a conversation ("this one's waived, and here's how it works next time") instead of a surprise. Decide whether the grace renews, for example once every six months, and write it down so you apply it the same way for everyone.

Switching to video instead of canceling

Offering video when a client can't come in (a sick child at home, a broken-down car, a snowstorm) saves many sessions. It only works if a few conditions are met first:

The client's location.In general your license has to cover the state the client is in during the session. A client traveling out of state may not be someone you can see that day. Check your board's rules and any compact you practice under.
A private place.Ask where the client is and whether anyone can overhear, as you would at the start of any video session.
Consent on file.Have a telehealth consent signed in advance, so a last-minute switch doesn't depend on paperwork. Our informed consent example includes a telehealth section.
Insurance.If you bill insurance, check that the plan covers video sessions and how to code them.
Clinical fit.Some sessions don't move well to video, and a client who is too unwell to talk should get the illness exception, not a video call.

A session that moves to video is a session, not a cancellation, so no fee applies.

Emergencies and other exceptions

Name the usual exceptions (sudden illness, a medical or family emergency, unsafe travel for in-person sessions) and say you decide others case by case. Two choices in the template are worth explaining:

No doctor's notes.Asking for proof of illness means asking clients to share health information they may not want to, and it turns a fee into a dispute. Most therapists take the client's word.
Disability-related absences.Under the Americans with Disabilities Act, a "professional office of a health care provider" is a public accommodation (28 CFR 36.104), and public accommodations "shall make reasonable modifications in policies, practices, or procedures" when needed for people with disabilities, unless the change would fundamentally alter the service (28 CFR 36.302). A client whose condition makes some absences unavoidable may need a different arrangement. How this applies to your practice, including a practice that works only by video, is a question for a lawyer.

Keep a short note each time you waive a fee. Consistency is what makes a policy fair, and for Medicare clients it is also a rule.

Late arrivals

Most policies end the session at its usual time when a client arrives late, so the next client isn't kept waiting. Say how long you'll wait before treating it as a no-show (15 minutes is common), and whether you'll message the client during that time.

Repeated missed sessions

A run of missed sessions is often clinical information, not only a scheduling problem: avoidance, ambivalence about therapy, a crisis, or a schedule that doesn't fit the client's life. Talk about it in session first (see the scripts below), then adjust: a different time, every other week, video, or a pause.

If you reach the point of ending treatment, the ethics codes set conditions. The ACA allows termination "when clients do not pay fees as agreed upon" and asks for "pretermination counseling" and referrals when necessary (A.11.c). The NASW allows ending services over an unpaid balance only if the financial arrangements were clear, the client "does not pose an imminent danger to self or others," and the consequences have been discussed with the client (1.17(c)). The APA asks psychologists to provide pretermination counseling and suggest other providers where appropriate (10.10(c)).

When you cancel

A policy that only binds clients reads as one-sided. Say what you'll do if you cancel at short notice, such as offering a make-up time that week. It costs little and shows the policy is about time, not penalties.

Legal and payer limits on missed-session fees

This is where most cancellation policies go wrong, and where most guides say the least. Check each of these before you charge anyone.

Medicare: allowed, if you treat every client the same

CMS allows missed-appointment charges to Medicare beneficiaries "provided that they do not discriminate against Medicare beneficiaries but also charge non-Medicare patients for missed appointments." The amount "must be the same as the amount that they charge non-Medicare patients." CMS describes the fee as "not a charge for a service itself" but "a charge for a missed business opportunity" (Medicare Claims Processing Manual, chapter 1, section 30.3.13).

Two practical points follow:

Bill the client, never Medicare."Medicare itself does not pay for missed appointments, so such charges should not be billed to Medicare," and such claims are denied (MLN Matters MM5613).
Apply the policy evenly.If you waive fees for some private-pay clients and charge Medicare clients, or the reverse, you're outside the rule. Written exceptions applied case by case to everyone are the safest pattern; ask a lawyer how to document them.

Medicare Advantage plans are private plans with their own provider contracts, so read the plan's terms as well.

Medicaid: generally no fees

Medicaid is different. Colorado's Medicaid agency puts it plainly: "Federal and state policies prohibit charging Medicaid members for missed or canceled appointments." It adds that providers "cannot bill Medicaid members for scheduling appointments or ask members to sign forms accepting financial liability for missed appointments," and gives the reason: "missed appointments are not a distinct, reimbursable Medicaid service, but are considered a part of providers' overall cost of doing business" (Colorado HCPF policy statement). North Carolina's billing rules say the same in one line: "Providers may NOT bill Medicaid beneficiaries for missed appointments" (NC Medicaid).

What this means for your no-show policy for Medicaid patients:

Don't charge Medicaid clients missed-session fees, and don't ask them to sign a policy that says you will. The template's Medicaid line tells them the fees don't apply.
The rule rests on CMS guidance, grounded in Medicaid's payment-in-full requirement (42 CFR 447.15); North Carolina notes there is no CMS regulation on the point itself. Your state's Medicaid provider manual and any Medicaid managed care contract are the documents that bind you.
Clients with two kinds of coverage are a gray area. Colorado says a fee may be charged in some circumstances when Medicare or commercial insurance is primary. Other states may differ; ask before you charge.

You can still ask Medicaid clients for notice. The script for that conversation is below.

Insurance contracts

No insurer pays for a session that didn't happen, and a missed session must never be billed as if it took place. The APA asks psychologists to report "the nature of the service provided" and "the fees, charges, or payments" accurately to payors (6.06). The fee is between you and the client.

If you're in network, your contract may also limit what you can charge the plan's members beyond copays and coinsurance, or set conditions for missed-appointment fees, such as a written policy the member agreed to in advance. Read the member billing section of each contract and provider manual before you set your fee. Employee assistance programs and other third-party programs often set their own rules too. Out of network, the fee is generally governed by your agreement with the client.

The Good Faith Estimate

If a client is uninsured or paying for themselves, you generally owe them a Good Faith Estimate under the No Surprises Act: "a notification of expected charges for a scheduled or requested item or service" (45 CFR 149.610). A client can start a dispute if total billed charges are "at least $400 more" than the estimate, where a billed charge is "the amount billed by a provider or facility for an item or service" (45 CFR 149.620).

The rule doesn't directly address missed-session fees. CMS's Medicare manual treats a missed-appointment fee as a charge for a missed business opportunity rather than for a service, which suggests it isn't an "item or service" charge, but that is our reading, not guidance. The cautious path is to state the fee in writing alongside the estimate, for example as a note on it with a copy of your policy, so the client sees it before the first session. Whether a missed-session fee could count toward the $400 threshold is a question for a lawyer. Our Good Faith Estimate template for therapists covers the deadlines, the required fields and the dispute process.

Card authorization and collections

Get written permission before you charge a stored card for a missed-session fee. The template's authorization line is a starting point; your payment processor may have its own requirements.
Collections need warning. If you might send an unpaid fee to collections or take legal action, the ACA asks you to say so in your informed consent documents, inform clients "in a timely fashion of intended actions and offer clients the opportunity to make payment" (A.10.d). The APA asks psychologists to "first inform the person that such measures will be taken and provide that person an opportunity to make prompt payment" (6.04(e)). Share only the minimum information a collector needs.

What the ethics codes say about fees

None of the major codes forbids a cancellation fee. All of them ask for clear terms, agreed early, and fees that are fair.

Counselors (ACA Code of Ethics, 2014).Counselors "inform clients about fees and billing arrangements, including procedures for nonpayment of fees" as part of informed consent (A.2.b). In setting fees they "consider the financial status of clients and locality," and may adjust fees that "create undue hardship" (A.10.c). Collections need the warning described above (A.10.d).
Social workers (NASW Code of Ethics).Fees should be "fair, reasonable, and commensurate with the services performed," with "consideration" given to "clients' ability to pay" (1.13(a)). Informed consent covers "relevant costs" in "clear and understandable language" (1.03(a)), and ending services over nonpayment has conditions (1.17(c)).
Psychologists (APA Ethics Code)."As early as is feasible," psychologists and clients "reach an agreement specifying compensation and billing arrangements" (6.04(a)). Fee practices are "consistent with law" (6.04(b)), fees are not misrepresented (6.04(c)), and fees are part of informed consent to therapy, with "sufficient opportunity for the client/patient to ask questions" (10.01(a)).

Put together: write the policy down, go over it before the first session, give the client a chance to ask about it, charge amounts you can defend as fair, and follow the law and your payer contracts. A fee that surprises a client is an ethics problem before it is a billing problem.

Where the policy should appear

In your consent form, in the fees section, signed before the first session. Our informed consent example has a "Fees, payment and cancellation" section you can extend with the template above.
In your intake paperwork, sent with the intake form so the client reads it before the first session, not in the waiting room. Our guide to the therapy intake form explains what belongs in the intake packet and what belongs in consent.
On your website or booking page, in a sentence or two near your fees, so people know the terms before they book.
With the Good Faith Estimate for self-pay clients, as described above.

What to say in the first session

A written policy is not the same as an understood one. Thirty seconds near the start of the first session saves most disputes later. For example:

"Before we start, one practical thing. Your Tuesday 4:00 time is held just for you. If you need to cancel or move it, let me know at least 24 hours ahead by text or email, and there's no charge. With less notice, or if a session is missed, the fee is $80. I waive the first one, and I always waive it for illness or emergencies. If you can't get here but you're well enough to talk, we can often switch to video instead. Does that seem fair? What questions do you have?"

What to write in the record

Note that you reviewed the policy, any questions, and how the client agreed. An invented example:

"Reviewed cancellation policy with client before the session: 24-hour notice, $80 late cancellation and no-show fee, first one waived, video option when client is in Ohio. Client asked whether a sick child counts as an emergency; explained it does. Client signed the policy electronically before the session."

If the policy changes, give the notice your policy promises, collect a new signature, and note it.

Scripts for enforcing the policy kindly

Enforcing a policy kindly means saying the same thing every time, warmly and briefly, without apologizing for having it. These messages are invented examples; change the details to fit.

The first late cancellation (grace): "Hi Maya, thanks for letting me know. Since it's less than 24 hours' notice, this would normally carry the late cancellation fee, but your first one is waived. Would Thursday at 5:00 work instead?"

Charging the fee: "Hi Maya, thanks for telling me. Because today's session was canceled with less than 24 hours' notice, the $80 late cancellation fee from our policy will be charged to your card on file tomorrow. I know that's not welcome news. Would Thursday at 5:00 work for your next session?"

A no-show: check in first. "Hi Daniel, I had you down for 4:00 today and didn't see you. I hope you're OK. Let me know when you can and we'll find a time this week." Send the fee notice separately, later, once you've heard back or a day has passed. If the client has recent risk or a safety plan, follow it rather than waiting on a reply.

Waiving it: "I'm so sorry to hear about your dad. Please don't worry about the fee; it's waived. Take the time you need, and reply whenever you're ready to set a new time."

Repeated misses, in session: "I've noticed we've missed three of our last six sessions. I'm not raising it to scold you. I'd like to understand what's getting in the way, because it may be connected to what we're working on. Would a different time, every other week, or video make it easier?"

A client disputes the fee: "I understand it's frustrating. The policy we went over on March 3 says sessions canceled with less than 24 hours' notice carry the fee, and I apply it the same way for everyone. If something happened that I don't know about, tell me and I'll look at it again."

A client asks you to bill insurance for it: "I can't bill your insurance for a session that didn't happen; claims have to describe a service that took place. The fee is between us, and it's in the policy you signed."

A client with Medicaid: "Because you have Medicaid, I don't charge missed-session fees. What I do ask is a quick message if you can't make it, so I can offer the time to someone on my waitlist."

You cancel late: "Hi Maya, I'm sorry, I have to cancel tomorrow's session because I'm unwell. Could I offer you Friday at 10:00 or Monday at 4:00 instead?"

Reminders reduce no-shows: what the research shows

A policy deals with missed sessions after they happen. Reminders prevent some of them. The evidence is good for text messages and thinner for email:

Text reminders, Cochrane review (2013).Eight randomized trials with 6,615 participants. Moderate-quality evidence from seven studies found text reminders improved attendance compared with no reminders (risk ratio 1.14). Attendance was 67.8% with no reminders and 78.6% with text reminders, and text reminders worked about as well as phone calls (Gurol-Urganci and colleagues).
Text notifications, meta-analysis (2016).26 studies, 21 in the main analysis, all using text messages. Patients who got notifications were 23% more likely to attend (67% vs 54%) and less likely to miss without notice (15% vs 21%). More than one notification worked better than one. Only two of the studies were in mental health settings (Robotham and colleagues, BMJ Open).
Mental health clinics (2012).At four community mental health clinics in London, missed appointments made up 36% of appointments in a period with no reminders, and 26% and 27% in the two later periods with text reminders, a relative drop of 25% to 28%. It compared periods rather than randomizing, and community psychiatry differs from private practice (Sims and colleagues, Psychiatric Services).
Email reminders.A Cochrane review of email for appointment reminders found no studies that met its criteria (Atherton and colleagues, 2012). A 2026 before-and-after study of 272,331 appointments in one hospital's urology department found email reminders that included a link to cancel were associated with fewer missed appointments (adjusted odds ratio 0.76) (Santillan and Giunta). That is promising, not proof for therapy.

What to take from it:

Reminders help, and they don't replace a policy.Even with reminders, some sessions are missed; the policy says what happens then.
Time the reminder so a client can still cancel on time.With a 24-hour policy, a reminder that arrives two days ahead gives a client who can't come a chance to cancel in time, without a fee.
Say how to cancel in the reminder.The email study's reminders included a cancel link. A reminder that makes canceling easy turns some no-shows into on-time cancellations, which you can refill.
None of these studies tested reminders in solo private practice.Expect a smaller or larger effect in yours, and track your own no-show rate for a few months.

Common mistakes

Charging Medicaid clients, or having them sign a policy that says you will.
Billing a missed session to insurance as if it happened.
Charging Medicare clients differently from everyone else.
Burying the policy in the last page of the paperwork and never saying it out loud.
A fee above your session fee, or a policy with no exception for illness.
Waiving for clients you like and charging the rest. Uneven enforcement is how fair policies become unfair ones.
Charging a stored card without written permission for that kind of charge.
Changing the policy mid-treatment without notice and a new signature.

How this works in TranqBay

TranqBay is practice software for therapists in private practice: a practice website with online booking, and video sessions. Three parts of it touch your cancellation policy:

You choose how bookings start.Confirm each booking yourself, or let clients book straight away. If you confirm each one, you see every request before it becomes a session.
Clients pay before the session.Clients pay by card when they book, or once you confirm their request. Because payment is settled in advance, write the policy's prepaid lines (what happens to a session paid for and then canceled, on time or late) carefully, and check how cancellations and refunds work in your account before you promise either.
Reminders go out by themselves.They go by email to you and your client before every session. Your policy still does the rest: the notice window, the fee and the exceptions.

At practice.tranqbay.health you can see the booking page your clients would use and where confirming, payment and reminders sit, which helps you decide where your policy's short version belongs before you set anything up.

Questions to take to a health care lawyer

Does your state limit cancellation or no-show fees, or require particular wording or notice?
What do your insurer contracts (commercial, Medicare Advantage, Medicaid managed care, employee assistance programs) say about billing members for missed sessions?
For Medicaid clients, what does your state's provider manual say, and can you charge clients who also have Medicare or private insurance?
For Medicare clients, does your policy and your record of waivers meet CMS's requirement to treat every client the same?
Should a missed-session fee appear on the Good Faith Estimate, and could it count toward the $400 dispute threshold?
Is your card authorization wording enough for your payment processor, and for how long does it last?
How does the ADA's reasonable modification rule apply to your practice, including a practice that only works by video?
What can you share with a collection agency, and what consumer debt rules apply in your state?
When can you end treatment over missed sessions without risking a claim of abandonment under your board's rules?
For minors and couples, who is responsible for the fee, and who has to sign?

Frequently asked questions about therapy cancellation policies

Can therapists charge for missed sessions?

Generally yes, if the client agreed to the policy in advance, the fee is reasonable, and nothing in your state law or payer contracts forbids it. The big exception is Medicaid: clients with Medicaid generally can't be charged. Medicare clients can be charged only if you charge everyone the same way.

What is a reasonable late cancellation fee for therapy?

Common choices are your full session fee, half of it, or a flat fee. Many therapists charge less for a late cancellation than for a no-show. Keep it at or below your session fee, and consider your sliding-scale clients' rates.

Can I charge a no-show fee if the client uses insurance?

Usually you can charge the client, never the insurer. Insurers don't pay for sessions that didn't happen. If you're in network, check your contract first: some limit what you can charge members beyond their copay or coinsurance.

Can I charge Medicaid clients for no-shows?

Generally no. Medicaid agencies such as Colorado's and North Carolina's say providers can't bill Medicaid members for missed or canceled appointments, and Colorado adds that you can't ask them to sign a form accepting the fee. Clients who also have Medicare or private insurance may be treated differently; check your state's rules.

Can I charge Medicare clients a missed appointment fee?

Yes, under CMS policy, if you also charge non-Medicare clients and the amount is the same. Bill the client directly; Medicare doesn't pay these fees.

Does a no-show fee go on the Good Faith Estimate?

The federal rule doesn't say directly. The cautious approach is to put the fee and your policy in writing with the estimate so a self-pay client sees it before the first session, and to ask a lawyer whether it could count toward the $400 dispute threshold.

Should my policy be 24 or 48 hours?

24 hours is the most common and the easiest for clients. 48 hours gives you time to fill the slot, which is worth it if you keep a waitlist. Whichever you choose, add a rule for Monday sessions.

Can I charge a client's card without asking each time?

Only with the client's written permission for that kind of charge, given in advance. Telling the client each time you charge it is good practice; the scripts above show a short message for it.

What should I do when a client keeps canceling?

Raise it in session, curious rather than punitive, because missed sessions often say something clinically. Then change what you can: the time, the frequency, video. If nothing works, follow your code's rules on ending treatment and offer referrals.

Who pays the fee for a minor or a couple?

Whoever your policy names. Have the parent, guardian or person paying sign the policy, and for couples say whether one partner canceling counts as a late cancellation for the session.

Copy the template, choose your options, and read it as a client would: is every line clear, fair and the same for everyone? Then check the three places it can't override, which are Medicaid, Medicare and your insurer contracts, and say it out loud in the first session.

If you also want booking, video sessions and email reminders in one place, see how TranqBay works for private practice: you can look at the booking page clients would use and how payment works when they book or once you confirm. If you're deciding whether to join, this page explains how joining TranqBay works.