Practice business tool
Good Faith Estimate generator for therapists
The No Surprises Act requires a written Good Faith Estimate for every self-pay client. Fill in your details and expected services, and print or save a clean estimate with all the required elements. Everything stays in your browser — nothing is sent to us.
What a Good Faith Estimate is — and why self-pay therapists need one
The No Surprises Act (effective January 1, 2022) requires health care providers to give uninsured and self-pay clients a written estimate of expected charges before care. For a private-pay or out-of-network therapy practice, that means every cash-pay client should receive a Good Faith Estimate at intake. It protects the client from surprise bills, and it protects you: a complete, honest estimate is your record if a charge is ever questioned.
The required elements
- Client name and date of birth.
- Your name and credentials, National Provider Identifier (NPI), and Tax ID (TIN), plus the practice address and state.
- An itemized list of expected services, each with a CPT code, an ICD-10 diagnosis code, the fee, and the quantity expected over the estimate period.
- The total expected charges and the date of the estimate.
- The required disclaimers, including that it is only an estimate, that it is not a contract, and the patient-provider dispute-resolution right if billed $400 or more above the estimate.
The tool above assembles all of these. Enter your own expected fees — a Good Faith Estimate reflects what you charge, not what insurers reimburse.
Make it part of the workflow, not a yearly scramble
The cleanest way to stay compliant is to generate the estimate at intake and keep a copy in the chart. See how a private-pay EHR handles intake, fees, and superbills together, and use the revenue leak calculator to make sure the codes on your estimate match the sessions you actually provide.
Frequently Asked Questions
Do therapists have to give a Good Faith Estimate? +
Yes. Under the federal No Surprises Act, providers must give a Good Faith Estimate of expected charges to every uninsured or self-pay client, in writing, when services are scheduled or on request. This applies to private-pay and out-of-network therapy practices.
What has to be on a therapy Good Faith Estimate? +
The client's name and date of birth; your name, NPI, and Tax ID (TIN); the practice address and state; an itemized list of expected services with CPT codes, diagnosis (ICD-10) codes, the fee for each, and quantity; the total expected charge; the estimate date; and the required No Surprises Act disclaimers, including the patient-provider dispute-resolution right if billed $400 or more above the estimate.
When do I have to provide it? +
For a scheduled service, within one business day of scheduling if the service is at least three business days out, or within three business days if scheduled 10+ days out. On request, within three business days. Many practices simply provide one at intake and update it annually or when the plan changes.
What is the $400 rule? +
If a self-pay client is billed at least $400 more than their Good Faith Estimate for a provider, they can dispute the difference through the federal patient-provider dispute resolution process, generally within 120 days of the bill. That is why an honest, complete estimate protects you as much as the client.
Is my information stored anywhere? +
No. This tool runs entirely in your browser. Nothing you type — provider details, client name, fees — is sent to or stored by CoralEHR. You print or save the finished estimate yourself.
Is this legal advice? +
No. This is a free template tool to help you produce a Good Faith Estimate that includes the standard required elements. The disclaimer language follows the CMS template; confirm it against the current official CMS Good Faith Estimate template and your state rules, and consult counsel for your specific obligations.
Keep going
Good Faith Estimates, built into intake
CoralEHR keeps client intake, fees, documentation, and superbills in one chart — so compliance is part of the workflow, not a separate spreadsheet.
See CoralEHR for private pay