Our office charges a no-show fee. Can we charge a Medicaid patient whose ride never came?

Generally no, whatever the reason for the miss. North Carolina Medicaid, restating CMS, tells providers they cannot charge a Medicaid patient for a missed visit, since CMS counts missed visits as an ordinary business cost rather than a separate Medicaid service. Texas Medicaid's October 2026 manual says the same, citing current federal policy. Medicaid providers also accept the state's payment as payment in full.

Can a Medicare patient be charged when the ride failed?

Only under a missed-appointment policy that applies equally to Medicare and non-Medicare patients, at the same amount. CMS treats the fee as a charge for a missed business opportunity, and it is never billed to Medicare. Because the policy has to treat Medicare and non-Medicare patients alike, an exception for a ride that never came should apply to both groups the same way.

Who should report the missed pickup, the clinic or the patient?

Both can. The clinic can call the broker or health plan ride line the same day with the trip details. A formal grievance belongs to the patient, who can file it orally or in writing at any time with a Medicaid health plan. A provider may file one on the patient's behalf with the patient's written consent where state law permits.

What is the deadline for a Medicaid health plan to answer a transportation grievance?

Each state picks its own deadline, but federal rules allow no more than 90 calendar days after the plan gets the grievance. Ask the plan for the grievance reference number so the clinic or patient can follow up.

Does a missed dialysis ride count differently?

In some programs, yes. Florida's Medicaid health plan contract says no member on a standing order may miss a visit because the transporter was late, never came, or canceled. The contract's examples are dialysis, cancer, and methadone treatments. The state counts each miss separately, based on the complaints it gets. Liquidated damages run $2,500 per missed appointment when a late ride caused it, and $5,000 per breach of a timeliness standard.

Patient missed appointment due to transportation

A ride failure is not a patient no-show

When the ride never came, the patient did not skip the visit. The transportation company or the program that books the rides failed to deliver them. Recording the miss that way protects the patient from a fee or a no-show flag, and it gives the ride program a complaint it has to act on.

The distinction matters because federal Medicaid policy treats patient no-shows and transportation failures differently. CMS’s Medicaid Transportation Coverage Guide (SMD 23-006, September 28, 2023) starts from the patient’s side: “Beneficiaries may not receive necessary care when appointments are missed.” It bars states from denying rides because of a member’s no-shows or lateness, however often they happen, and bars states and providers from charging the member for them. On the other side, it gives states “ultimate oversight responsibility” to monitor complaints and make sure transportation is timely.

The guide calls a ride company that never arrives a “no-show provider.” It says states should be able to send a replacement on short notice and should tell members how to report a missed pickup and get another ride. No federal Medicaid money goes to a trip the provider never ran.

The ride company’s version of the same event is a missed trip: a pickup the provider failed to make. Brokers and health plans count those against the company. The clinic’s job is to make sure the miss lands in the right column.

Can the practice charge a missed-appointment fee

It depends on the payer, and the answer for most patients whose rides fail is no.

Medicare patients

CMS allows physicians and suppliers to charge Medicare patients for missed appointments under one condition, set out in the Medicare Claims Processing Manual, Chapter 1, section 30.3.13. The policy must apply equally to Medicare and non-Medicare patients, and the amount must be the same for both. CMS calls the fee a charge for “a missed business opportunity,” not a charge for a service, so it is never billed to Medicare and Medicare pays nothing toward it.

Two details trip practices up:

Exceptions must be even. Because the policy has to treat Medicare and non-Medicare patients alike, a practice that waives the fee when the ride never came should waive it for both groups, not only for patients with other coverage.
Hospital inpatients. A hospital outpatient department may charge outpatients a missed-appointment fee, but CMS says charging a hospital inpatient who misses an outpatient department appointment would violate 42 CFR 489.22.

Medicaid patients

Medicaid patients generally cannot be charged. North Carolina Medicaid’s guidance to providers puts it in one line: “Providers may NOT bill Medicaid beneficiaries for missed appointments.” The reason it gives, quoting CMS, is that a missed visit is not a separate service Medicaid pays for. It is one of the ordinary costs of running a practice. Texas Medicaid’s provider manual (October 2026) says the same, “in accordance with current federal policy,” and adds that only billings for services provided are considered for payment.

The federal payment-in-full rule leads to the same answer. Under 42 CFR 447.15, providers in the Medicaid program accept the state’s payment, plus any cost sharing the state plan requires, as payment in full. A missed visit produces no payment and leaves nothing to charge.

Ride companies face the same rule from their side. Our guide on billing Medicaid for no-shows covers why they cannot charge the rider either.

What to write in the chart

No federal rule prescribes the wording, but a clear note does three jobs: it keeps the patient off a no-show list, it supports a fee exception under a uniform policy, and it gives the patient or the clinic facts for a complaint. A useful entry records:

That the patient missed the visit because the scheduled ride did not arrive, or arrived too late to be seen.
Who reported it and when: the patient’s call, the caregiver’s, or the ride program’s.
The ride program and the trip or confirmation number, if the patient has it.
The scheduled pickup time and appointment time.
What happened next: rebooked date, ride rebooked, complaint reported.

Practices that record social needs on claims have a code for the underlying problem: ICD-10-CM Z59.82, transportation insecurity. Our guide to screening for transportation insecurity covers who may document it and what to do after a positive screen.

Rebook the visit and the ride together

A new appointment without a new ride often fails the same way. When the front desk rebooks, rebook the transportation in the same call or right after, and give the patient the new trip details.

Some Medicaid contracts put the duty to fix this on the health plan. Florida’s Medicaid health plan contract (update July 1, 2026) has a rule for members without a standing order. When one misses a visit because the transporter was late, never showed, or canceled, the plan must work expeditiously with the appointment provider and the member to reschedule the appointment for the nearest available time slot. SMD 23-006 also expects states to have processes for timeliness and for resolving unexpected interruptions in service.

When rebooking the ride, check three things:

Pickup time against appointment time. The pickup has to leave room for the drive and for check-in. Our guide to how long medical appointments take helps the return ride match the visit length.
The right vehicle. If the miss happened because the wrong vehicle came, correct the level of service on the new booking.
A contact the driver can reach. A caregiver’s number, or the facility’s, if the patient has no phone.

For a patient with repeat visits, ask the ride program for a standing order so each trip does not depend on a new call.

Report the missed pickup so it counts

A missed pickup that nobody reports does not exist in the ride program’s numbers. Reporting it is what holds the transportation company to its standards.

Contracts measure those standards through reports and complaints:

Florida. The standing-order rule (the contract’s examples are dialysis, cancer, and methadone treatments) is measured per occurrence “as determined from complaints received by the Agency.” The contract sets liquidated damages of $2,500 per occurrence when a plan fails to get a member to a pre-scheduled appointment on time and the member misses it, and $5,000 per occurrence for failing one or more of its transportation timeliness standards.
Virginia. MTM Health’s handbook for transportation providers in the state’s fee-for-service program sets standards of more than 95 percent on-time performance, vendor no-shows below 0.25 percent of assigned trips, and fewer than one substantiated complaint per 1,000 completed trips. Falling short can lead to an improvement plan, money penalties under the service agreement, or termination from MTM’s network.

For patients in a Medicaid health plan, federal grievance rules in 42 CFR 438.402 let the member file a grievance at any time, orally or in writing. Where state law allows, a provider may file one on the member’s behalf with the member’s written consent. Under 42 CFR 438.408, the state sets the resolution deadline, which may not exceed 90 calendar days from receipt.

A practical order for the front desk:

Call the broker or health plan’s ride line the same day and report the missed pickup, with the patient’s name, member ID, trip number, and scheduled times. If the visit can still happen, ask for a replacement ride.
Ask for a reference number and write it in the chart note.
Tell the patient how to file a grievance if they want to, or offer to file with their written consent if the state allows it.
If the misses repeat, escalate to the state Medicaid agency’s complaint line.

Our guide to filing a Medicaid transportation complaint walks through each door in more detail.

Dialysis and other visits where one miss changes care

For most visits, a missed ride means a delay. For some, it means harm.

Dialysis is the clearest case. The National Kidney Foundation lists what a skipped session sets up. The next treatment has to pull off more fluid, and patients may get cramps, headaches, nausea, or a drop in blood pressure. Potassium can climb high enough to cause heart rhythm problems, a heart attack, or death. Fluid can back up into the lungs, leaving the patient short of breath, and the patient may need emergency dialysis at a hospital.

Transportation is a measurable cause of those misses. A national cohort study published in 2025 in the Clinical Journal of the American Society of Nephrology followed 115,982 adults on in-center hemodialysis at one large dialysis organization from April 2022 through March 2023. Twenty-seven percent did not have private transportation. Patients using Medicaid transportation had a rate of missed treatments attributed to transportation 2.78 times that of patients with a private ride, after adjustment.

That is why Florida singles out standing orders for dialysis, cancer treatment, and methadone. For these patients:

Report every missed pickup, even when the clinic fits the patient in later the same day.
Ask the ride program to flag the standing order and the treatment schedule.
Keep the dialysis facility’s social worker in the loop. Medicare’s guide to dialysis coverage (November 2025) tells patients to talk to that social worker for help with non-ambulance transportation.

Our guide to getting transportation to dialysis covers the patient’s options, and the guide to opioid treatment program transportation covers daily methadone dosing.

When the clinic asks the ride company what happened

A clinic that calls about a missed pickup wants facts, not guesses. Ride companies on HealthRide keep signatures, GPS miles, on-time records, and recorded no-show wait times on every trip, so dispatch can say when the driver arrived and how long they waited, and the on-time report shows whether one miss is part of a pattern. See how reports work.

When a patient misses an appointment because the ride never came: fees, rebooking, and reporting