Do You Need a Price List? The Transparency Rules for Uninsured Patients (45 CFR § 149.610)

Uninsured and self-pay patients ask a simple question: “What is this visit going to cost me?” For small practices, the regulatory answer lives in 45 CFR 149.610, which requires health care providers and facilities to issue written good faith estimates of expected charges when an uninsured or self-pay patient schedules an item or service or requests an estimate.

These good faith estimates must be timely, accurate, and include specific data elements, from the patient’s identifiers to the expected charges, discounts, and disclaimers about possible variation. The rule does not require a public “menu” of all prices posted in the waiting room, but it does require you to have enough internal structure that your staff can generate individualized estimates on demand.

Failure to provide compliant estimates can expose small practices to complaints and enforcement under the No Surprises Act, and it can open the door to the patient–provider dispute resolution process if actual bills exceed the estimate by at least 400 dollars. For small clinics working with tight margins, investing a little time in a lean price list and GFE workflow is far cheaper than facing a dispute or corrective action.

The No Surprises Act is often associated with hospital balance billing and out-of-network emergencies, but it also created new obligations for everyday office-based practices. When a patient has no health coverage, or chooses not to use it, you are now expected to give them a clear, written estimate of what they can expect to pay before care is delivered in most scheduled situations.

This is more than customer service. It is a federal requirement designed to protect uninsured and self-pay individuals from unexpected bills. For a small clinic, the practical question is whether you need a formal posted fee schedule or “price list” to comply. Under 45 CFR 149.610, the law does not force you to post every price on your website or front door, but it does effectively push you to standardize your cash rates so that your estimates are consistent and defensible.

That means the real compliance task is to translate your current informal pricing habits into a simple internal schedule and a short process your team can follow at intake and scheduling.

Understanding Legal Framework & Scope Under 45 CFR 149.610

45 CFR 149.610 sits in Part 149, Subpart G, which covers protection of uninsured or self-pay individuals. It implements section 2799B-6 of the Public Health Service Act, giving patients the right to receive a good faith estimate of expected charges for scheduled or requested items or services when they are uninsured or choose to pay out of pocket.

Several core concepts matter for small practices:

• Uninsured or self-pay individual: This includes people who have no health plan as well as those who have coverage but elect not to bill it and will pay you directly.

• Convening provider or facility: The provider or facility that receives the request for a good faith estimate, or with whom the item or service is scheduled, is responsible for issuing the estimate.

• Scope: The requirement applies when the item or service is scheduled at least 3 business days in advance, or when the patient requests an estimate. If the service is scheduled less than 3 business days before, or is not scheduled at all (for example, urgent walk-ins), the GFE rule does not apply, though you may still voluntarily quote a cash price.

The regulation sets specific deadlines. If the service is scheduled at least 10 business days ahead, you must provide the good faith estimate within 3 business days of scheduling or receiving the request. If scheduled 3 to 9 business days ahead, you must provide it within 1 business day.

The good faith estimate itself must contain all the elements listed in 45 CFR 149.610(c). These include: patient identifiers, a description of the primary item or service and any reasonably expected ancillary services, billing and diagnostic codes if known, expected charges that reflect any discounts or sliding fees, and required disclaimers about variation, additional services, and the patient’s right to dispute bills that exceed the estimate by at least 400 dollars.

Federal rules set the baseline, but states may impose additional price transparency or charity care requirements. The federal GFE rule does not prevent you from following stricter state standards, but if your state process falls short of the federal requirements, you are still considered out of compliance under 45 CFR 149.610. Understanding this structure allows a small practice to design one coherent approach that satisfies both state and federal expectations and reduces back-and-forth with payers and regulators.

Multiple federal actors share responsibility for enforcing the No Surprises Act. For the uninsured and self-pay GFE requirements, the Department of Health and Human Services, primarily through CMS and related components, oversees provider compliance. States can also play a role through their insurance departments or health agencies, especially if they operate complaint systems for medical billing issues.

Common triggers for review related to 45 CFR 149.610 include:

• Complaints from uninsured or self-pay patients who were never informed of their right to an estimate, or who received no written estimate before a scheduled service.

• Disputes where the final bill exceeds the expected charges in the good faith estimate by at least 400 dollars and the patient initiates the patient–provider dispute resolution process under 45 CFR 149.620.

• Patterns of billing complaints suggesting that uninsured patients are quoted one price verbally and billed significantly more later, or that discounts are applied inconsistently.

Enforcement responses can range from technical assistance to corrective action plans, civil monetary penalties in serious or repeated cases, and reputational harm as advocacy groups and media focus on noncompliant billing practices. For small practices, the best defense is consistent processes and clear documentation that show a good faith effort to follow 45 CFR 149.610.

Even though these requirements arise from the No Surprises Act rather than HIPAA, regulators increasingly look at pricing transparency and patient communication alongside privacy and security. The controls below help a small practice demonstrate that it has a pragmatic system for uninsured and self-pay estimates that aligns with 45 CFR 149.610.

Each control includes how to implement it, what proof to retain, and a low-cost option suitable for lean operations.

1. Build an internal uninsured and self-pay fee schedule

• How to implement: Start by listing your 20 to 30 most common services and assigning a standard cash rate for each, including any prompt-pay or sliding fee discounts your practice offers. Make sure these amounts are realistic and internally consistent, because 45 CFR 149.610 defines expected charges as the cash amounts you reasonably anticipate billing for the services, including discounts.

• Evidence to retain: Dated fee schedule with approval notes; documentation of discount policies; any board or owner sign-offs.

• Low-cost method: Use a spreadsheet stored in a shared drive; update it twice a year and lock editing to one or two responsible staff members.

2. Add an uninsured/self-pay screening question to scheduling and check-in

• How to implement: Train front desk staff to ask whether the patient has coverage and whether they plan to use it. If the patient has no coverage or chooses not to use it, staff should mark them as uninsured or self-pay in the EHR, triggering the good faith estimate workflow required by 45 CFR 149.610(b).

• Evidence to retain: Updated registration scripts or forms; screenshots of EHR fields; sample completed intake forms showing the self-pay flag.

• Low-cost method: Add a single line to your existing registration form and give staff a short script to keep next to the phone.

3. Use a standardized good faith estimate template that mirrors 45 CFR 149.610(c)

• How to implement: Create a one- or two-page form that captures all required data elements: patient identifiers, description of the scheduled item or service, anticipated ancillary services, relevant codes if available, expected charges, discounts, and the required disclaimers about variability, additional services, and the 400 dollar dispute threshold.

• Evidence to retain: Blank template; several completed examples; links or references to the underlying regulation or HHS appendix used to design the form.

• Low-cost method: Adapt one of the free templates published by HHS and professional associations, customizing only your clinic’s identifying information and cash rates.

4. Embed timeline reminders directly into your scheduling process

• How to implement: Configure your scheduling system or a simple task list to flag when a good faith estimate is due. For services scheduled 3 to 9 business days ahead, the system should prompt staff to issue the estimate within 1 business day; for those scheduled at least 10 business days out, within 3 business days.

• Evidence to retain: Screenshots of workflow rules; examples of calendar tasks; logs showing GFE issue dates relative to scheduling dates.

• Low-cost method: Use a color-coded column in your scheduling spreadsheet that shows “GFE due by” dates, and have your front office check it daily.

5. File each good faith estimate in the patient’s record and track corrections

• How to implement: Treat every good faith estimate as part of the medical record, storing it in the EHR or paper chart. When you discover an error, issue a corrected estimate as soon as possible and document the correction, consistent with 45 CFR 149.610(f).

• Evidence to retain: Copies of good faith estimates, both initial and corrected, linked to the relevant encounters; a simple log of corrections with dates and reasons.

• Low-cost method: If you use paper charts, staple the most recent estimate to the front of the chart before the visit, then move it into the main record after billing.

6. Train staff on handling short-notice visits and when GFEs are not required

• How to implement: Provide a short training that explains when GFEs are mandatory and when they are not. Make clear that if a visit is scheduled less than 3 business days out or is unscheduled and urgent, you may offer a quick cash quote as a service, but you are not obligated to produce a full GFE under 45 CFR 149.610.

• Evidence to retain: Training agenda and slides; sign-in sheets; a one-page staff reference sheet summarizing the rules.

• Low-cost method: Incorporate this into a regular staff huddle and record the session on a smartphone for those who miss it.

These controls show regulators that your practice has a reasonable, structured approach to uninsured and self-pay pricing, directly aligned with 45 CFR 149.610, even without a public poster of every price.

Case Study

A small multi-specialty clinic in a semi-rural area sees a mix of insured and uninsured patients. Historically, cash prices were negotiated informally. Front desk staff would quote “about 100 dollars” for an office visit, clinicians sometimes waived charges, and there was no written record of what had been promised.

After the No Surprises Act took effect, an uninsured patient scheduled a scheduled minor procedure two weeks in advance. Over the phone, staff told him it would be “around 400 dollars.” No written good faith estimate was provided. The procedure required supplies and additional lab work, and the final bill came to 980 dollars. Angry and confused, the patient sought help from a consumer advocate, who informed him of the new right to a good faith estimate and to dispute bills that exceed the estimate by at least 400 dollars.

The patient initiated the patient–provider dispute resolution process. The selected dispute resolution entity requested documentation of any GFE and how the charges had been calculated. The clinic had no written estimate, no internal fee schedule, and inconsistent notes on discounts. The dispute entity compared the verbal quote to the final bill and sided with the patient, reducing the amount owed and instructing the clinic to implement compliant GFE processes.

In response, the clinic:

• Created a basic uninsured fee schedule for common services.

• Implemented a one-page good faith estimate template and timelines for delivery.

• Trained staff to document each estimate in the record and to explain it clearly to patients.

Within months, the clinic saw fewer billing disputes and more patients expressing appreciation for clear pricing. The same controls that brought them into compliance with 45 CFR 149.610 also improved trust and cash flow.

Reviewing this table once a year helps a small clinic confirm that its GFE process is not just on paper but functioning in everyday operations.

Common Audit Pitfalls to Avoid Under 45 CFR 149.610

A few recurrent mistakes drive most GFE-related complaints and enforcement issues. Focusing on them can prevent small problems from becoming regulatory headaches.

• Assuming that small practices are “too small” to be covered by GFE rules and ignoring 45 CFR 149.610 altogether. Legal reference: 45 CFR 149.610 applies broadly to providers and facilities furnishing items or services to uninsured or self-pay individuals. Practical consequence: a single complaint can force you to build a program under tight scrutiny instead of on your own timeline.

• Giving only verbal ballpark quotes to uninsured patients and never issuing written estimates. Legal reference: 45 CFR 149.610(b) and (e) require written GFEs in paper or electronic form for scheduled or requested services. Practical consequence: patients are more likely to use the dispute resolution process when the bill differs from vague verbal expectations, and you will have no documentation to defend your charges.

• Failing to include discounts or sliding fees in the expected charges. Legal reference: 45 CFR 149.610(a)(2)(v) requires that expected charges reflect any applicable discounts. Practical consequence: the GFE may systematically overstate liability, undermining patient trust and increasing dispute risk when actual charges are lower or adjusted at the last minute.

• Ignoring timelines and delivering GFEs late or on the day of service. Legal reference: 45 CFR 149.610(b)(1) sets clear 1- and 3-business-day deadlines depending on how far in advance the service is scheduled. Practical consequence: regulators may view late estimates as ineffective, and patients will not have the opportunity to make informed decisions based on cost.

• Not treating GFEs as part of the medical record and failing to retain them. Legal reference: 45 CFR 149.610(e)(1) and (f)(1) state that GFEs are part of the medical record and must be maintained and retrievable for six years. Practical consequence: if a dispute arises, you may be unable to show what was originally estimated, weakening your position in any review or PPDR proceeding.

By correcting these errors early, a small practice greatly reduces the odds of formal enforcement and builds a more predictable relationship with uninsured patients around cost.

Price transparency for uninsured and self-pay patients should not live only in the billing office. Leadership should designate an owner for No Surprises Act and GFE compliance, even if it is a part-time responsibility layered onto an existing role. That person should understand the basic requirements of 45 CFR 149.610 and keep an eye on CMS and HHS updates.

Staff training can be short and practical. Front desk and scheduling staff need to know when to trigger the GFE process and how to explain it to patients in plain language. Clinicians should be aware that adding significant extra services might require an updated estimate when there is time to do so. Billing staff should routinely spot-check whether estimates were issued and stored correctly. Simple metrics, such as the number of GFEs issued per month, disputes received, and average time from scheduling to estimate, help leadership see whether the process is working or needs attention.

When pricing transparency is framed as part of patient respect and not just regulatory overhead, staff are more likely to embrace it and patients are more likely to pay promptly because they feel they were treated fairly.

For small practices, the question is not just “Do we need a price list?” but “Can we produce accurate, timely good faith estimates for uninsured and self-pay patients as 45 CFR 149.610 requires?” The regulation does not mandate a glossy public menu of every fee, but it does require a disciplined internal approach to expected charges, timelines, documentation, and communication.

By standardizing cash rates, building a simple GFE template, and training staff on when and how to use it, you can meet your No Surprises obligations without adding new headcount or expensive software. The same structure that keeps you compliant also improves patient trust, reduces disputes, and makes your revenue more predictable.

Concrete next steps for a small clinic:

1. Draft or update a short policy that commits to issuing written good faith estimates for uninsured and self-pay patients and references 45 CFR 149.610.

2. Build a simple internal fee schedule for your most common services, including discounts, and use it as the backbone for all GFEs.

3. Create a one-page GFE template that includes all required elements and disclaimers, and test it with a few upcoming appointments to confirm it is easy to use.

4. Configure scheduling and intake to identify uninsured and self-pay patients and remind staff when a GFE must be delivered within the 1- or 3-business-day windows.

5. Start saving every issued GFE in the medical record, and set a simple reminder to review a handful of them each quarter for accuracy and completeness.

Recommended compliance tool:

A shared “Uninsured and Self-Pay Estimates” folder containing your fee schedule, GFE template, procedures, and training materials.

Advice: Pick one half-day in the next month and require that every uninsured or self-pay patient scheduled for that session receive a written good faith estimate; then debrief with your staff about what worked and what needs adjustment.

• 45 CFR § 149.610 – Requirements for provision of good faith estimates
  

• 45 CFR Part 149 – Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters
  

• No Surprises Act – Good Faith Estimate Guidance