Free tool
What no-shows actually cost your practice
A missed session does not feel like a business problem in the moment. It feels like a free hour — time for notes, a walk, a breath. The cost only shows up in aggregate: two empty hours a week, at a private-practice fee, quietly adds up to more than many therapists spend on rent. You cannot decide what to do about a number you have never looked at.
This calculator looks at it. Enter your weekly sessions, your fee, and the share of sessions that no-show or late-cancel without being filled or charged, and see the cost per week, per month, and per year — then try an assumption for what a written policy might claw back. For the fuller story, read what a no-show actually costs you.
Completely private: everything runs in your browser — nothing you type is sent or stored anywhere.
1. Your numbers
Count sessions that went unpaid — missed or cancelled late and neither refilled nor charged. Not sure? Skim your last month of appointments and count.
2. What it costs you
3. What a written policy might recover
Practices that put a signed cancellation policy in place — reminders, a card on file, fees applied consistently, a telehealth fallback — usually miss fewer sessions and collect fees on some of the rest. How much that is worth varies practice to practice, so pick your own assumption below. This is an illustration, not a prediction or a promise.
The prerequisite
None of this happens without a policy that exists in writing and gets signed at intake. Draft the policy in 5 minutes — plain-language clauses, your fees and exceptions, with a signature line.
This calculator is arithmetic on the numbers you enter — useful for seeing the size of the problem, not a prediction of results. Missed-session fees are constrained by some payer contracts (most state Medicaid programs prohibit them), so check yours before charging.
No-show questions, answered
What is a typical no-show rate for a therapy practice?
There is no single number — it varies with your setting, payer mix, and how long clients wait for an appointment. Published studies of outpatient mental health care report missed-appointment rates anywhere from roughly 10 to 25 percent, with community clinics at the high end. Established private practices with reminders, a card on file, and a signed policy often run well under 10 percent. Track your own rate for a month or two; your number matters more than any benchmark.
Should I charge for late cancellations and no-shows?
Many therapists do, and the fee matters less than the agreement: a written policy, signed at intake, applied the same way every time. A fee you improvise after the first missed session feels punitive; one that was agreed to in advance is just a policy. Note that some payer contracts — most state Medicaid programs in particular — prohibit missed-session fees, so check before you charge.
Can I bill insurance for a no-show?
No. CPT codes describe services you actually delivered, so a missed session cannot go on a claim. If you charge a missed-session fee, it is billed to the client directly, and your policy should say so in writing.
What actually reduces no-shows?
The unglamorous basics: automated reminders a day or two out, a short gap between booking and appointment, a card kept on file, a telehealth option for the days the commute is the obstacle, and a written policy you enforce kindly the first time it is tested. None of them is a cure on its own; together they move the rate meaningfully in most practices.
Is a missed hour really lost revenue if I catch up on notes?
The hour is not wasted, but it is not paid. Notes, billing, and emails were going to get done either way — in time you had already set aside for them. Unless you refill the slot with another client or collect a missed-session fee, the revenue attached to that hour is simply gone, which is what this calculator measures.
What is the difference between a no-show and a late cancellation?
A late cancellation is notice inside your cancellation window — 24 or 48 hours is common — and a no-show is no notice at all. Practices often charge more for a no-show, since it leaves zero chance to refill the hour. This calculator counts them together because the revenue math is the same: the hour went unpaid.
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Running the practice is the other half of the job. Practice Harbor is an EHR built by a psychologist — scheduling, reminders, and billing that quietly reduce your no-shows for you.
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