Title 42 — The Public Health and WelfareRelease 119-73

§300gg–136 Provision of information upon request and for scheduled appointments

Title 42 › Chapter CHAPTER 6A— - PUBLIC HEALTH SERVICE › Subchapter SUBCHAPTER XXV— - REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE › Part Part E— - Health Care Provider Requirements › § 300gg–136

Last updated Apr 6, 2026|Official source

Summary

Starting January 1, 2022, every health care provider and facility must act quickly when someone schedules a service. If the appointment is made at least 3 business days before the service, the provider must, within 1 business day after scheduling, ask whether the person has a group health plan, individual or group insurance from a health insurer, or a Federal health care program. If the appointment is made at least 10 business days ahead (or the person asks), the provider has up to 3 business days to ask. The provider must also give a clear, good‑faith estimate of expected charges and the expected billing and diagnostic codes for the scheduled service and any related services (including ones another provider or facility may give). If the person is enrolled in a plan and wants the claim submitted, the estimate goes to that plan or issuer. If the person is not enrolled and not in a Federal program, the estimate goes to the person.

Full Legal Text

Title 42, §300gg–136

The Public Health and Welfare — Source: USLM XML via OLRC

Each health care provider and health care facility shall, beginning January 1, 2022, in the case of an individual who schedules an item or service to be furnished to such individual by such provider or facility at least 3 business days before the date such item or service is to be so furnished, not later than 1 business day after the date of such scheduling (or, in the case of such an item or service scheduled at least 10 business days before the date such item or service is to be so furnished (or if requested by the individual), not later than 3 business days after the date of such scheduling or such request)—

(1)inquire if such individual is enrolled in a group health plan, group or individual health insurance coverage offered by a health insurance issuer, or a Federal health care program (and if is so enrolled in such plan or coverage, seeking to have a claim for such item or service submitted to such plan or coverage); and

(2)provide a notification (in clear and understandable language) of the good faith estimate of the expected charges for furnishing such item or service (including any item or service that is reasonably expected to be provided in conjunction with such scheduled item or service and such an item or service reasonably expected to be so provided by another health care provider or health care facility), with the expected billing and diagnostic codes for any such item or service, to—

(A)in the case the individual is enrolled in such a plan or such coverage (and is seeking to have a claim for such item or service submitted to such plan or coverage), such plan or issuer of such coverage; and

(B)in the case the individual is not described in subparagraph (A) and not enrolled in a Federal health care program, the individual.

Reference

Citations & Metadata

Citation

42 U.S.C. § 300gg–136

Title 42 — The Public Health and Welfare

Last Updated

Apr 6, 2026

Release point: 119-73