No Surprises Act & Good Faith Estimates

If you were surprised by the No Surprises Act, you weren't alone. This law went into effect January 1, 2022 and contains a complex set of mandates for all licensed or certified psychotherapists (regardless of accepting insurance or not). 

Don’t panic! As a TherapyAppointment user, there's good news: we've automated most of the process within Online Forms. Simply update our provided template and set the form to Auto-Assign to send to new clients automatically.

To learn more about this law in general and how it impacts therapists, click here

This includes:

  • When a Good Faith Estimate (or GFE) is necessary
  • Timelines for compliance
  • and the information required to be in a GFE
info Note: On April 1st, 2022, clarifications to this law were made by CMS.
description You can read the synopsis here.

What's included in this article:

Using and Updating TherapyAppointment's Provided "Good Faith Estimate" Template

To comply with this new requirement, we suggest you include a Good Faith Estimate as one of your required new client intake documents. We've created a template to make it easy → here's how to use it:
1. Log into your TherapyAppointment account as an owner or manager 
2. Access  the Good Faith Estimates template within Online Forms. Go to:
  • Practice Settings (left menu)
  • Online Forms (top tab)
  • Click (top right):
  • Click the center button

  • In the search field (top left) type good
  • Find the section TherapyAppointment-Provided Templates
  • Under it, find the Good Faith Estimate
  • Click (bottom right in that section)

  • The template should then be loaded:

  • Modify the template to match your own practice and your own fees
demography Client information will be automatically filled in when the form is submitted

Their information will be pulled automatically from the client's profile. They don't have to enter anything here!

The following data will automatically load after submission:

  • Client Legal Name (First, Last)
  • Date of birth
  • Client Address

task Auto-Assign

Auto-Assign to new clients if this is the only Good Faith Estimate Form your practice requires.

Click (save) then the button in the upper right corner:

warning Have multiple providers that need more than one GFE?

Do not share with practice and set to auto-assign if your practice needs more than one Good Faith Estimate form. Instead, have those providers create the form initially with the steps in this article.

Once saved, any staff can edit the form. Ensure shared with practice is not checked.

If the form is set to auto-assign and shared with practice, it will be sent to every client created in the system

brightness_alert Warning:

You must configure this form to comply so please thoroughly review the form and enter any necessary information (ex: type 2 NPI and TIN)

disabled_by_default Assign at Intake Without a Diagnosis/Treatment Plan

If assigning prior to meeting the client for the first time, you likely will not have a diagnosis and an expected course of treatment.

Diagnosis: This is actually to your advantage! Simply report the diagnosis of R69 which translates as diagnosis deferred → no need for tailoring to this particular client. 

What if the referral is not for psychotherapy? What if, for example, you are being asked to perform a standardized psychological evaluation? Then you should substitute appropriate CPT codes, descriptions, and prices for such an evaluation to the best of your ability.

Course of Treatment: This is a Good Faith Estimate, so giving a total of an average course of therapy is sufficient for a client you have not met. APA reports that, on average, psychotherapy lasts for 18 sessions, making this a reasonable estimate.

mail To Comply by Mail:

So, if you prefer to do this the Luddite way (on paper and mailed to them promptly), your form for traditional psychotherapy could look like this:

[Your Practice Name]
Good Faith Estimate

Name: ________________________________ Date of Birth: _________________

You have been referred to my office for treatment. I’m required to give you a Good Faith Estimate of the cost of treatment if you are uninsured or don’t want to use insurance for this care. Since we haven't met, and don’t yet know if you want to use insurance for your treatment, the information below is based on “fee for service” (out of pocket) rates. 

If you DO intend to use insurance, check with your insurance carrier to find out what your copayment or coinsurance rates will be–they are likely to be much smaller. 

Since I have not yet evaluated your difficulties or symptoms, I must at this point estimate your course of treatment based upon the national average for a course of psychotherapy, which is 18 encounters. 

This initial estimate is valid for 12 months, but you are entitled to receive an update on this estimate at any time upon request.

Current ICD-10 diagnosis: R69 (diagnosis deferred).

Anticipated treatment: 

1 session of CPT 90791 (diagnostic evaluation) at [Your rates here]
17 weekly sessions of CPT 90834 (psychotherapy, 45 minutes) at [Your rates here] per session
Total of estimated "fee for services" treatment without insurance:  [Your rates here]

This is just a rough estimate based on national averages. The duration of our work together can be longer or shorter depending upon your symptoms, your work between sessions, and your response to treatment. 

Unless required by a court order (an extremely rare situation), you are free to discontinue treatment at any time, and free to discuss any other modifications to treatment modalities, frequency, or duration. You are ultimately in control of your own healthcare; I am just here to provide help at your request.

Location of treatment: All sessions will take place in my office at [Your address here/Online]

My identifying information: 

[Your name here], [Credentials]
National Provider Identifier: [NPI number here]
Tax ID Number: [Tax ID number here] ( do not provide your social security number if you are using this for your practice's Tax ID Number)

This information should not be constituted as legal advice. Information surrounding compliance of the No Surprises Act is vague at this point. If you have questions about compliance and regulations, please visit or speak to your practice's attorney.