Quick answer: Outpatient clinics miss about 23% of appointments on average (2018 review, 105 studies). Reminders are the best-evidenced fix: across 29 studies they cut non-attendance by a weighted 34%, with staff calls (39%) ahead of automated SMS or voice (29%), though a Cochrane review found texts and calls similar. Add a second reminder, a reply that confirms, cancels or rebooks, and calls to high-risk patients.
If you are asking “how do I reduce patient no-shows at my clinic”, this is a clinic manager’s playbook built from systematic reviews in Health Policy, the Journal of Telemedicine and Telecare, the Cochrane Library and BMJ Open. It gives a baseline to compare your rate against, a cost calculator you can rerun with your own numbers, and every lever a clinic controls ranked by evidence: SMS and phone reminders, two-way confirmation, targeted calls, open access, transport, overbooking, waitlist backfill and fees. For US practices it adds the HIPAA, Medicare and Medicaid rules on what you can send and charge. We read every source on 22 October 2026.
Where Zian fits
Zian runs the reminder, confirm and reschedule loop as a conversation rather than a broadcast. Its Appointment Show-Specialist agent follows up between booking and visit by voice call, SMS and WhatsApp, and its AI receptionist answers inbound calls 24/7, so a patient who calls back at 9pm to move the appointment reaches an agent that can rebook. SmartReach AI™ chooses the message, channel and timing for each follow-up, the job behind the “text everyone, phone the patients a text does not reach” rule above. PrecisionPitch AI™ split-tests scripts and approaches against real outcomes, the kind of wording test Hallsworth ran by hand. Zian works in 30+ languages and connects to HubSpot, Salesforce, HighLevel and Zapier. It books from inbound and outbound conversations (see our AI appointment setting overview), and the same loop drives show rates for booked sales calls. Across the platform, 50,769+ qualified sales appointments have been set.
One honest limit: Zian is in a partnership-application beta and does not publish paid-plan prices. If reminders will carry patient information, ask about a business associate agreement and how Zian connects to your scheduling system before any patient data reaches the agent.
What is a normal no-show rate for an outpatient clinic?
A large review puts it at about 23%. Dantas and colleagues reviewed 105 studies across medical specialties for Health Policy in 2018. They found “the average no-show rate is of the order of 23%, being highest in the African continent (43.0%) and lowest in Oceania (13.2%)”. Reminder trials give a similar figure for clinics that send no reminders. In Hasvold and Wootton’s 2011 review of 29 studies, the median non-attendance rate in the control groups was 23.1%.
| Baseline figure | Value | Study, year | What it measures |
|---|---|---|---|
| Average no-show rate, all specialties | about 23% | Dantas et al., Health Policy, 2018 (105 studies) | Average across the studies reviewed |
| Highest region | 43.0% (Africa) | Dantas et al., 2018 | Regional average |
| Lowest region | 13.2% (Oceania) | Dantas et al., 2018 | Regional average |
| No-reminder control groups | median 23.1% (quartiles 15.4% to 27.0%) | Hasvold and Wootton, J Telemed Telecare, 2011 (29 studies) | Hospital appointments, no reminder sent |
| No-notification control groups | 21% no-show | Robotham et al., BMJ Open, 2016 | Pooled no-show rate without a text notification |
| Attendance with no reminder | 67.8% | Gurol-Urganci et al., Cochrane review, 2013 | Attendance rate, not no-show rate |
Before you compare yourself, check what your system counts. Robotham’s team analysed attendance and no-shows separately because “some unattended appointments may be cancelled or rescheduled in advance, in which case they are not classifiable as ‘no shows’”. Only a cancellation leaves you time to refill the slot. Dantas also lists who misses most often: younger adults, lower socioeconomic status, living far from the clinic and no private insurance. The determinants reported most often were long lead time and earlier no-shows.
The number to compare yourself against: in the middle half of Hasvold and Wootton’s no-reminder control groups, clinics lost between 15.4% and 27.0% of appointments. A clinic already sending reminders should be well below that range.
What do patient no-shows cost a clinic? A worked calculation
Run this first: it tells you how much effort each lever is worth. Clinic size, working days and visit value are illustrative, so replace them with your own. The rates and reductions come from the studies named in each row, and a script did the arithmetic.
Inputs: 80 booked appointments a day (illustrative) × 240 clinic days a year (illustrative) = 19,200 appointments a year, at an average visit value of US$150 (illustrative). Baseline no-show rate: 23.1%, the median control rate in Hasvold and Wootton’s review. 19,200 × 0.231 = 4,435 missed appointments a year, about 18.5 empty slots a day, with a gross slot value of 4,435 × US$150 = US$665,280.
| Scenario | Cited effect | New no-show rate | Missed appointments a year | Appointments recovered | Gross value recovered (US$150 a visit) |
|---|---|---|---|---|---|
| No reminders (baseline) | Median control rate 23.1% (Hasvold and Wootton, 2011) | 23.1% | 4,435 | 0 | 0 |
| Automated SMS or voice reminders | 29% relative cut (Hasvold and Wootton, 2011) | 16.4% | 3,149 | 1,286 | US$192,931 |
| Any reminder, weighted mean | 34% relative cut (Hasvold and Wootton, 2011) | 15.25% | 2,927 | 1,508 | US$226,195 |
| Manual staff phone calls | 39% relative cut (Hasvold and Wootton, 2011) | 14.1% | 2,705 | 1,730 | US$259,459 |
| Already texting; rewrite the message | 11.1% to 8.4% (Hallsworth et al., 2015, Trial One) | 8.4% | 2,131 to 1,613 | 518 | US$77,760 |
| Add automated calls for high-risk patients | 11.3% to 9.6% among high-risk patients (Kavanaugh et al., 2026) | 9.6% (high-risk group) | 17 fewer per 1,000 high-risk appointments | 17 per 1,000 | US$2,550 per 1,000 high-risk appointments |
Three cautions. First, this applies a weighted-mean reduction to a median baseline, a simplification; your own baseline matters more. Second, gross slot value is not profit: a slot refilled from a waitlist was never lost. Third, the gap between automated reminders (US$192,931) and staff calls (US$259,459) is about US$66,500 a year in this example. Hasvold and Wootton put the average cost of using SMS, automated calls or phone calls at €0.41 per reminder (€0.90 for a phone reminder, €0.14 for SMS or an automated call), though cost was not measured formally in any of the studies. Price your own staff hours against that gap before you choose.
The rule of thumb: at a 23.1% baseline, each 1,000 appointments a clinic books carries about 231 empty slots. Automated reminders win back about 67 of them, and staff calls about 90.
Reminders reduce no-shows: timing, channel and number
Reminders have the strongest evidence on this page. The Cochrane review by Gurol-Urganci and colleagues (2013) pooled seven trials with 5,841 participants. It found “moderate quality evidence” that text reminders improved attendance compared with no reminder (risk ratio 1.14, 95% CI 1.03 to 1.26). Attendance was 67.8% with no reminder, 78.6% with text reminders and 80.3% with phone-call reminders. Robotham’s 2016 meta-analysis in BMJ Open found patients who received notifications were “25% less likely to ‘no show’” (15% against 21%).
Cochrane’s own conclusion should temper expectations. The quality is “low to moderate”, and the evidence “still remains insufficient to conclusively inform policy decisions”. Reminders work on average; how much they help depends on your patients.
Channel: SMS against a phone call
Here the studies differ. Cochrane found text reminders “had a similar impact to phone call reminders” (risk ratio 0.99), and two studies found the cost per attendance 55% and 65% lower for text messages. Hasvold and Wootton found manual phone calls more effective than automated reminders (39% against 29% of baseline). Robotham found that “voice notifications appeared more effective than text notifications at improving attendance”, but no-show rates were not significantly different (15% for text, 13% for voice). Our reading is to text everyone and phone the patients a text does not reach.
Timing: when to send the reminder
Timing evidence is thin. Hasvold and Wootton found “no difference in non-attendance rate, whether the reminder was sent the day before the appointment or the week before”, and the median reminder in their studies went out 2.75 days ahead. Hallsworth’s trials sent them five days ahead; nine of Robotham’s studies sent them within 48 hours. Since timing barely changes attendance, choose it for what the answer lets you do: a reminder several days out leaves time to refill a cancelled slot, and one 24 to 48 hours out catches the patients who forgot.
Wording: say what a missed appointment costs
Hallsworth and colleagues ran two randomised trials with about 20,000 UK hospital outpatients (PLoS One, 2015). A text that stated the cost of a missed appointment to the health system cut the no-show rate to 8.4%, against 11.1% for the hospital’s existing message. The second trial replicated it (8.2%). Making the same point in general terms was significantly less effective (9.9%). The authors flag their limits: one location in England, and accurate phone records for only 20% of eligible patients. For US practices relying on the FCC’s healthcare-message exemption, messages may not include “accounting, billing, debt-collection, or other financial content”, so check a cost-stating message with your adviser before you copy it.
Number: send more than one
Robotham’s team found that “multiple notifications were significantly more effective at improving attendance than single notifications”. Attendance was 78% against 52% with more than one notification (risk ratio 1.49), and 62% against 55% with one (risk ratio 1.09). For the no-show outcome both had the same risk ratio, 0.75, so the benefit shows up in attendance rather than the no-show count. Two touches is a reasonable default.
For US practices, reminder calls and texts fall under the Telephone Consumer Protection Act. The FCC’s healthcare-message exemption (47 CFR 64.1200(a)(9)(iv)) has eight conditions, among them no more than one message a day and three a week per patient, an opt-out in every message, no billing or other financial content, and no charge to the patient. We worked through each one in our guide to AI receptionists and TCPA reminder rules for US medical offices. If you send reminders on WhatsApp, Meta’s template, opt-in and 24-hour window rules apply, set out step by step in our WhatsApp appointment reminders setup guide.
Make every reminder a two-way confirm, cancel or rebook
A reminder that asks for nothing back tells you nothing. The typical text in Robotham’s review gave the date, time and clinician and asked the patient to “answer NO if you do not intend to come”. That reply is worth more than the reminder, because it turns a future no-show into a cancellation while there is still time to fill the slot.
Penn Medicine tested this at scale. A text survey of 186 patients who had missed appointments found the top reason was “I did not know I had an appointment” (22%). Penn then added an automated voice call that let patients confirm, cancel or reschedule, on top of text reminders, for patients its electronic health record model flagged as high risk. In a 2024 randomised trial of 59,994 such patients, reported in NEJM Catalyst in 2026, the no-show rate was 9.6% with the call against 11.3% with texts alone, and completed appointments rose from 75.9% to 77.8%. The effect is modest, 1.7 percentage points, and measured only in high-risk patients.
Ask for a commitment too. In two UK general practices, Martin, Bassi and Dunbar-Rees had staff booking by phone ask patients to repeat the time and date back. No-shows fell 3.5% the following month. Having patients write the time on the appointment card themselves cut them 18% against the previous six months. Adding waiting-room signs about how many patients did attend brought the combined fall to 31.7% against the previous 12 months. These were uncontrolled before-and-after comparisons, so treat them as cheap things to try, not proven effect sizes.
The quotable version: a reminder becomes a no-show reduction tool only when the patient can cancel or rebook in the same reply.
Want the confirm, cancel and rebook loop run for you? Zian’s Appointment Show-Specialist and 24/7 AI receptionist handle reminder follow-up by voice call, SMS and WhatsApp, and answer the patient who calls back to reschedule. Apply For Partnership
Call your high-risk patients first
You do not need to phone every patient. Prior no-show history and long lead time, Dantas’s top determinants, are in your own records. Oikonomidi and colleagues’ 2023 rapid systematic review in JAMIA looked at interventions targeted by a prediction model. It found moderate-certainty evidence that targeted phone-call reminders reduced no-shows (three trials, median risk ratio 0.61), and that patient navigators did too (one trial, risk ratio 0.55). Targeted text reminders had a smaller effect (median risk ratio 0.91), but with high-certainty evidence.
A simple version works without a model. Flag anyone with a no-show in the last 12 months, or anyone booked several weeks out, and give those patients a call as well as the texts everyone gets. Penn found the largest effect among the patients in the highest risk quartile.
Shorten the lead time: open access and same-day slots
Long lead time predicts no-shows, so booking closer to the visit is a lever. Rose, Ross and Horwitz’s 2011 review of advanced (open) access scheduling in Archives of Internal Medicine covered 24 studies. It found that “no-show rates improved only in practices with baseline no-show rates higher than 15%”. A 2024 review of open-access scheduling in outpatient clinics found a significant fall in no-shows in 10 of 16 articles, while six did not show one. The authors tied success to needs assessment, design around real needs and staff training.
Threshold: below a 15% no-show rate, the open-access evidence does not promise a no-show gain. Above it, holding back a share of same-day slots is worth testing.
Remove the reasons patients cannot come: transport and cost
Some no-shows are not forgetting. Syed, Gerber and Sharp’s 2013 review of 61 US studies concluded that transportation barriers are “an important barrier to healthcare access, particularly for those with lower incomes or the under/uninsured”. In two of the studies they reviewed, 25% of patients had missed an appointment because of transportation problems. The authors add that the significance of these barriers “is uncertain” because studies measured them so differently.
The practical move is to ask. A reminder reply option such as “I can’t get there” routes the patient to a telehealth slot, a closer site or whatever transport help you can offer, instead of a silent no-show. Penn’s approach, texting patients who missed and asking why, costs almost nothing and shows which barriers your clinic has.
Overbooking and waitlist backfill: absorbing no-shows you cannot prevent
Overbooking does not reduce your no-show rate; it moves the cost onto the patients who turn up. Oikonomidi’s review found the effect of predictive model-based overbooking “uncertain”. Martin and colleagues warned that overbooking “can have knock-on effects that ultimately disadvantage patients” and does not deal with the cause. If you overbook, limit it to sessions where your own data shows a stable no-show rate, and track waiting times.
Waitlist backfill is the better absorber, and it depends on the two-way reminder above. A cancellation that arrives days ahead is a slot you can offer to the next patient on the list. We found no trial measuring backfill itself; its value depends on the cancellation lead time your earlier reminder creates.
Can a clinic charge a no-show fee or take a deposit?
Often, but not for everyone, which makes deposits a weak lever for many US practices. Medicare allows missed-appointment charges under conditions; Colorado’s Medicaid agency says Medicaid does not. Neither the CMS article nor Colorado’s statement mentions deposits taken in advance, so these rules are about charges for a missed appointment.
| Patient’s coverage | Can the practice charge for a missed appointment? | Conditions | Source |
|---|---|---|---|
| Medicare | Yes | The policy must apply to non-Medicare patients too, at the same amount. Medicare does not pay the fee, so bill the patient, not Medicare (claims are denied with reason code 204) | CMS, MLN Matters MM5613 (Medicare Claims Processing Manual, ch. 1, §30.3.13) |
| Medicare, hospital inpatient missing an outpatient appointment | No | CMS says charging would violate 42 CFR 489.22 | CMS, MM5613 |
| Medicaid only | No, in Colorado’s published policy | Colorado says CMS “has consistently advised” that Medicaid members must not be charged; Colorado adds that members cannot be asked to sign forms accepting financial liability | Health First Colorado (HCPF) policy statement |
| Medicaid plus Medicare or commercial insurance as primary payer | In some circumstances (Colorado) | Under the primary plan’s rules | Health First Colorado (HCPF) policy statement |
Colorado’s statement covers its own program, so check your state Medicaid agency’s policy and your commercial payer contracts before you introduce a fee. None of the reviews we read measured what a fee or deposit does to no-show rates, so it sits at the bottom of the evidence ranking below.
Which no-show interventions work best? Ranked by evidence
Every lever on this page, ranked by the strength of the evidence behind it.
| Rank | Intervention | Best cited effect | Evidence behind it | The catch |
|---|---|---|---|---|
| 1 | Text-message reminders | Attendance RR 1.14 vs no reminder; no-shows 21% to 15% | Cochrane review (7 RCTs, 5,841 people); BMJ Open meta-analysis (21 studies) | Evidence quality low to moderate |
| 2 | Staff phone-call reminders | 39% of baseline vs 29% for automated | Systematic review, 29 studies | Staff time; Cochrane found SMS similar to calls (RR 0.99) |
| 3 | More than one reminder | Attendance 78% vs 52% (RR 1.49) vs 62% vs 55% for one | Meta-analysis subgroup | No-show RR the same (0.75) for one or several |
| 4 | Targeted calls to high-risk patients | Phone calls median RR 0.61; automated call plus SMS 11.3% to 9.6% | Rapid systematic review (3 RCTs); Penn RCT, 59,994 patients | Penn effect 1.7 points, high-risk patients only |
| 5 | Reminder wording | 11.1% to 8.4% when the SMS stated the cost of a missed appointment to the health system | Two RCTs, one NHS trust | Single location; accurate phone records for 20% of eligible patients |
| 6 | Shorter lead time / open access | Fall in 10 of 16 articles | Two systematic reviews | Improved only where baseline exceeded 15% |
| 7 | Patient commitment (read-back, patient writes the card) | 3.5%, 18%, and 31.7% combined with norm signage | Before-and-after, two UK practices | No control group |
| 8 | Transport help | 25% missed an appointment due to transport (two studies) | Review of 61 US studies | Measures the barrier, not the fix |
| 9 | Overbooking | Effect “uncertain” | Rapid systematic review | Absorbs no-shows; burdens patients who attend |
| 10 | Waitlist backfill | No trial found | Operational practice | Recovers slots; does not lower the rate |
| 11 | Missed-appointment fees and deposits | No effect size found in the reviews we read | Billing rules only | Medicaid-only patients excluded in Colorado’s policy, citing CMS |
What to change first: if you send no reminders, start with two texts per appointment, one several days out and one within 48 hours, each with a reply that cancels or rebooks. Then add a phone call for patients with a recent no-show. Rewrite the wording after that. Leave overbooking and fees until last.
What may a reminder say under HIPAA?
Less than most templates contain. The HIPAA Privacy Rule’s minimum necessary standard (45 CFR 164.502(b) and 164.514(d)) generally requires covered entities to take “reasonable steps to limit the use or disclosure of, and requests for, protected health information to the minimum necessary to accomplish the intended purpose”. HHS lists six exceptions, including “disclosures to the individual who is the subject of the information” and disclosures to a provider for treatment. A reminder the patient reads is a disclosure to that patient, so in our reading the standard bites earlier: on which staff see the schedule and which fields you hand to the reminder system or vendor. For uses inside the practice, HHS says policies must identify the staff who need access and “the categories or types of protected health information needed”; routine disclosures can follow standard protocols limited to the minimum necessary.
The real risk is someone else hearing it. HHS’s FAQ on leaving messages says the Privacy Rule does not stop providers leaving voicemail, but covered entities “should take care to limit the amount of information disclosed on the answering machine”, for example “leaving only its name and number and other information necessary to confirm an appointment, or ask the individual to call back”. For messages left with a family member, it points to professional judgement and 45 CFR 164.510(b)(3). If a patient has asked to be contacted by other means or at another location, HHS says the provider must accommodate that request if it is reasonable (45 CFR 164.522(b)). Our practical rule: name the clinic, date and time, and leave out the specialty and the procedure.
Patient no-shows: frequently asked questions
How do I reduce no-show rates in my outpatient clinic?
Start with reminders. In Hasvold and Wootton’s review of 29 studies, they cut non-attendance by a weighted 34% of baseline. Send two, one several days out and one within 48 hours, with a reply that confirms, cancels or rebooks. Then phone patients with a recent no-show.
What is the average patient no-show rate?
About 23%. A 2018 review of 105 studies in Health Policy found an average no-show rate “of the order of 23%”, highest in Africa (43.0%) and lowest in Oceania (13.2%). Read the Dantas et al. abstract on PubMed.
Do text message reminders reduce no-shows?
Yes. The Cochrane review by Gurol-Urganci and colleagues found text reminders improved attendance compared with no reminder (risk ratio 1.14) and had a similar effect to phone calls (risk ratio 0.99). Its authors rate the evidence low to moderate quality.
Are phone call reminders better than SMS?
The reviews differ. Hasvold and Wootton found manual phone calls more effective than automated SMS or voice reminders (39% against 29% of baseline). Cochrane found text and phone reminders similar. A practical split is to text everyone and phone the patients at highest risk.
How far in advance should a clinic send appointment reminders?
Timing matters less than people think. Hasvold and Wootton found no difference between a reminder sent the day before and one sent the week before. Send one several days out, so a cancellation can be refilled, and one within 48 hours for patients who forgot.
Does overbooking reduce no-shows?
No. Overbooking absorbs no-shows rather than preventing them, and a 2023 rapid systematic review in JAMIA rated the effect of predictive model-based overbooking as uncertain. Fix reminders and confirmation first.
Can a US clinic charge Medicare or Medicaid patients a no-show fee?
Medicare patients, yes, if the policy and amount are the same for every patient and Medicare is not billed, but not a hospital inpatient who misses an outpatient-department appointment (CMS, MLN Matters MM5613). Medicaid-only patients, no in Colorado: its Medicaid agency says CMS has consistently advised against it, so check your own state’s Medicaid policy.
Ready to run reminders, confirmations and reschedules as one conversation? Zian is in a partnership-application beta, and each of its three listed plans, including Intel + Widgets (Free Forever), starts with a partnership application. Apply For Partnership
Where every figure on this page comes from
Clinic size, working days and visit value in the calculator are illustrative inputs, not sourced figures.
| Figure | Who published it | Link | Date read |
|---|---|---|---|
| Average no-show about 23%; Africa 43.0%; Oceania 13.2%; lead time and prior no-show as top determinants | Dantas et al., Health Policy, 2018 | pubmed.ncbi.nlm.nih.gov | 22 October 2026 |
| Reminders cut non-attendance by a weighted 34% of baseline; automated 29%, manual 39%; median control rate 23.1% (quartiles 15.4% to 27.0%); median reminder 2.75 days ahead; no difference day vs week before; €0.41 per reminder (€0.90 phone, €0.14 SMS or automated) | Hasvold and Wootton, Journal of Telemedicine and Telecare, 2011 | pmc.ncbi.nlm.nih.gov | 22 October 2026 |
| Text reminders RR 1.14 vs none (7 studies, 5,841 people); RR 0.99 vs phone; attendance 67.8%, 78.6%, 80.3%; cost per attendance 55% and 65% lower; evidence low to moderate | Gurol-Urganci et al., Cochrane Database of Systematic Reviews, 2013 | pubmed.ncbi.nlm.nih.gov | 22 October 2026 |
| No-shows 15% vs 21% (RR 0.75); multiple notifications 78% vs 52% (RR 1.49), single 62% vs 55% (RR 1.09); voice 13% vs text 15% no-show; nine studies sent at 48 hours or less | Robotham et al., BMJ Open, 2016 | pmc.ncbi.nlm.nih.gov | 22 October 2026 |
| Cost-stating SMS 8.4% vs 11.1%; Trial Two 8.2%; general terms 9.9%; sent five days ahead; 20% phone records | Hallsworth et al., PLoS One, 2015 | pmc.ncbi.nlm.nih.gov | 22 October 2026 |
| Automated call added to SMS for high-risk patients: 9.6% vs 11.3%; completions 77.8% vs 75.9%; 59,994 patients; 22% did not know they had an appointment | Kavanaugh et al. (Penn Medicine), NEJM Catalyst, 2026 | pubmed.ncbi.nlm.nih.gov | 22 October 2026 |
| Targeted phone calls median RR 0.61; navigators RR 0.55; targeted SMS RR 0.91; overbooking effect uncertain | Oikonomidi et al., JAMIA, 2023 | pubmed.ncbi.nlm.nih.gov | 22 October 2026 |
| Open access: no-show improved only where baseline exceeded 15% (24 studies) | Rose, Ross and Horwitz, Archives of Internal Medicine, 2011 | pubmed.ncbi.nlm.nih.gov | 22 October 2026 |
| Open access: significant fall in 10 of 16 articles | Mazaheri Habibi et al., Health Science Reports, 2024 | pubmed.ncbi.nlm.nih.gov | 22 October 2026 |
| Read-back 3.5%; patient-written card 18%; combined with norm signage 31.7%; overbooking knock-on effects | Martin, Bassi and Dunbar-Rees, Journal of the Royal Society of Medicine, 2012 | pmc.ncbi.nlm.nih.gov | 22 October 2026 |
| Transport: 61 US studies; 25% missed an appointment due to transport in two studies | Syed, Gerber and Sharp, Journal of Community Health, 2013 | pmc.ncbi.nlm.nih.gov | 22 October 2026 |
| Minimum necessary standard wording and its exceptions | US Department of Health and Human Services, Office for Civil Rights | www.hhs.gov | 22 October 2026 |
| Voicemail and family-member reminder messages; 45 CFR 164.510(b)(3); confidential-communication requests, 45 CFR 164.522(b) | US Department of Health and Human Services, HIPAA FAQ 198 | www.hhs.gov | 22 October 2026 |
| TCPA healthcare-message exemption: one message a day, three a week, opt-out in every message, no financial content, free to the patient | Federal Communications Commission, 47 CFR 64.1200(a)(9)(iv) (eCFR) | www.ecfr.gov | 22 October 2026 |
| Medicare missed-appointment charges; reason code 204; 42 CFR 489.22 inpatient exception | Centers for Medicare & Medicaid Services, MLN Matters MM5613 | www.cms.gov | 22 October 2026 |
| Medicaid-only members may not be charged for missed appointments | Colorado Department of Health Care Policy & Financing (Health First Colorado) | hcpf.colorado.gov | 22 October 2026 |