A Missed Therapy Appointment Is Not a Psychotherapy Claim
Separate an attendance fee from a clinical service
A client misses a scheduled counseling appointment. The therapist reserved the time, but psychotherapy was not delivered. The billing system should not convert the reserved slot into a completed clinical claim.
Medicare's Claims Processing Manual, Chapter 1, section 30.3.13, permits certain missed appointment charges when the policy applies equally to Medicare and non-Medicare patients. Medicare does not pay for the missed appointment, and the charge should not be submitted as a Medicare service. This is a Medicare policy, not universal permission under every plan or state rule. [1]
Check the agreement before applying the fee
A practice should review each relevant payer contract and program restriction before charging. Do not assume a Medicare rule authorizes a Medicaid fee or overrides a commercial agreement.
Give clients an understandable attendance policy before the issue arises. Explain the cancellation window, charge, and how to contact the office when circumstances interfere. Staff should know who can approve an exception and how to document the decision.
Keep the fee in an administrative account category rather than using a psychotherapy code to make the ledger balance. The clinical record should accurately show whether any service occurred.
Distinguish a missed visit from a disrupted visit
A client who never joins a telehealth appointment presents a different billing question from one who receives a brief service before the connection fails. For the latter, review the actual work, duration, and applicable reporting rules. Do not automatically charge a full session or classify every technical failure as a no-show.
Consider whether reminders, accessible cancellation options, or scheduling changes could address repeated attendance problems. A financial policy should not replace clinical review of a client's difficulty accessing treatment.
Audit the EHR's automation. A missed appointment should not create a completed note, insurance claim, and patient service balance merely because the original calendar entry had a billing code attached. A clear distinction protects the client and gives the practice a defensible account of what happened.
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