What has to appear on a Good Faith Estimate
Eleven required elements, several of which are fixed disclaimers. Here is each one and what it means for a private practice.
Reviewed August 2026 · Not legal advice
The content requirements sit at 45 CFR § 149.610(c)(1). Several are fixed disclaimers whose wording you do not have to invent. The rest are facts about you, the client, and the care you expect to provide.
Facts you supply
The client
Name and date of birth. That is the whole identification requirement — a Good Faith Estimate is a billing document, not a clinical record, and nothing about the client’s history belongs on it.
The care
A description of the primary item or service, then an itemized list of the items and services you reasonably expect to furnish, each with a service code and its expected charge. For a therapy practice that usually means one line per session type: an intake, then a run of individual sessions. Which codes apply is covered in CPT codes used in therapy estimates.
Diagnosis codes are required where applicable. At a first session you frequently have not assigned one, and inventing a diagnosis to fill a field would be worse than leaving it blank. Practices commonly note that a diagnosis has not yet been established.
You
Your name, your National Provider Identifier, your Tax Identification Number, and the location where care will be furnished. The TIN is the part solo practitioners flinch at, since for many it is a Social Security number. Getting an EIN from the IRS is free, takes about ten minutes online, and lets you put a business number on client-facing documents instead.
The total
The sum of expected charges. This is the number the entire document turns on: it is what the $400 dispute threshold is measured against. An estimate that lists a single $150 session when you expect to see the client weekly for a year understates the total by an order of magnitude, and understating it is the failure mode that actually costs practices something. See the $400 rule.
Disclaimers the estimate must carry
The remaining elements are statements that must appear, whatever your practice looks like:
- That there may be additional items or services the client would need, which have to be scheduled or requested separately and are not reflected here.
- That the estimate is only an estimate, and actual items, services or charges may differ.
- That the client has a right to initiate the patient-provider dispute resolution process if the billed charges exceed the estimate by at least $400, along with how to start it — and that starting it does not affect their care.
- That the estimate is not a contract and does not oblige the client to obtain the care listed.
Where care will involve another provider you do not bill for, the estimate also has to list those items separately and say so.
Keeping a copy
The estimate must be provided in writing, on paper or electronically as the client prefers, and in a way they can save and print. It also has to be kept in the same manner as medical records and reissued to the client on request for at least six years.
That retention duty is the quiet one. A practice that emails a PDF and keeps no copy has met the delivery requirement and failed the record one — and if a dispute arrives two years later, the estimate is the only document that helps you.
EstimateHarbor is not a law firm and this page is not legal advice. It summarises the federal rule at 45 CFR § 149.610 as we read it, for general information. Your state may impose additional requirements, and how the rule applies to your practice is a question for your own counsel or professional association.