Title 42, The Public Health and WelfareRelease 119-102

§300gg–136 Provision of Information Upon Request and for Scheduled Appointments

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

Last updated Aug 21, 2026|Official source

Summary

Starting January 1, 2022, if a person books a medical item or service at least 3 business days before it will happen, the health care provider or facility must act quickly. If the booking is at least 3 business days before the service, the provider must, within 1 business day of scheduling, ask whether the person has group health insurance, individual coverage, or is in a Federal health care program. If the booking is at least 10 business days ahead, or if the person asks for an estimate, the provider has up to 3 business days after the booking or request to do this. The provider must also give a clear estimate of the expected charges, including any related items or services that might be done by other providers, and include the likely billing and diagnosis codes. If the person has a group or individual plan and wants the provider to bill that plan, the estimate must be sent to the plan or its issuer. If the person does not have such a plan and is not enrolled in a Federal health care program, the estimate must be sent 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

Aug 21, 2026

Release point: 119-102