Good Faith Estimate generator
Every element 45 CFR 149.610 requires, in a template you can reuse — the itemized list, the provider identifiers, the four notices and the deadlines. Free, and it never asks for a patient name, because that part belongs in your own system.
Itemized list — one row per expected item or service
Your template
GOOD FAITH ESTIMATE OF EXPECTED CHARGES
Issued under the No Surprises Act, 45 CFR 149.610
Date issued: September 12, 2026
PATIENT
Name: [Patient name]
Date of birth: [Date of birth]
PROVIDER OR FACILITY
Name: [Practice or facility name]
National Provider Identifier (NPI): [NPI]
Tax Identification Number (TIN): [TIN]
Location where services will be provided: [Address]
PRIMARY ITEM OR SERVICE
[Describe the primary item or service in clear and understandable language]
ITEMIZED LIST OF EXPECTED ITEMS AND SERVICES
Grouped under: [Practice or facility name]
Service code Diagnosis code Qty Description Expected charge
----------------------------------------------------------------------------------------------
[code] [dx] 1 [description] [charge]
----------------------------------------------------------------------------------------------
Total expected charges: [total]
ITEMS OR SERVICES EXPECTED TO REQUIRE SEPARATE SCHEDULING
[List any items or services that are anticipated to require separate scheduling, or state "None anticipated"]
REQUIRED NOTICES
• There may be additional items or services that are recommended as part of the
course of care that are not reflected in this good faith estimate. These would
need to be scheduled separately, and an estimate for them can be requested.
• The actual items, services or charges may differ from this good faith estimate.
• You have the right to initiate the patient-provider dispute resolution process if
the actual billed charges are substantially in excess of the expected charges in
this good faith estimate. Starting that process will not affect the quality of
health care services you receive.
• This good faith estimate is not a contract. It does not require you to obtain the
items or services from any of the providers or facilities identified in it.
• For questions or more information about your right to a good faith estimate, or
to dispute a bill, visit www.cms.gov/nosurprises.
Questions about this estimate: [Practice telephone] · [Practice email]When it has to be issued
- Scheduled at least three business days ahead — the estimate is due within one business day of scheduling.
- Scheduled at least ten business days ahead — due within three business days of scheduling.
- Requested by an uninsured or self-pay individual — due within three business days of the request.
45 CFR 149.610(b)(1)(vi). The section itself. Read 12 September 2026.
What the regulation requires on it
The elements above are quoted from 149.610(c)(1): patient name and date of birth; a description of the primary item or service in clear and understandable language; an itemized list grouped by provider or facility; applicable diagnosis codes, expected service codes and expected charges; the name, NPI and TIN of each provider; a list of items expected to require separate scheduling; and the four notices reproduced in the template. The published list we read has a gap in its numbering between (vi) and (viii), so read the section itself before relying on this for compliance — we would rather say that than fill the gap with something plausible.
This is a drafting aid, not legal advice, and it does not cover the convening-provider rules that apply when several providers are involved in one episode of care.
Why this is the compliance obligation practices quietly fail
The Good Faith Estimate reaches every health care setting, including the solo practice with one administrator, and it is triggered by something as ordinary as scheduling an uninsured patient. There is no software that does it by default, no payer chasing it, and no remittance that shows it was missed. So it gets done from a half-remembered template, missing two of the required notices, and nobody finds out until somebody disputes a bill.
The fix is boring and complete: a template that carries every element the section lists, reused. That is all this page is.
Questions
Who has to give a Good Faith Estimate?
Providers and facilities must give one to individuals who are uninsured or who are insured but not using their insurance for the item or service — the self-pay case. It applies to all health care settings, including solo and small practices, and the obligation is triggered by scheduling or by a request.
How quickly does a Good Faith Estimate have to be provided?
Under 45 CFR 149.610(b)(1)(vi): within one business day of scheduling where the service is scheduled at least three business days ahead; within three business days of scheduling where it is scheduled at least ten business days ahead; and within three business days of a request from an uninsured or self-pay individual.
What has to be on a Good Faith Estimate?
Patient name and date of birth; a description of the primary item or service in clear and understandable language; an itemized list grouped by each provider or facility; applicable diagnosis codes, expected service codes and expected charges; the name, NPI and TIN of each provider; a list of items expected to require separate scheduling; and notices covering additional items, that actual charges may differ, the right to patient-provider dispute resolution, and that the estimate is not a contract.
Why does this tool not ask for the patient’s name?
Because the name and date of birth are patient information and this site does not accept any on any page. The template leaves both as marked placeholders for you to complete in your own system. A practice issues hundreds of these — what is actually missing is a correct template, not the ability to type a name.
Is this legal advice?
No. It is a drafting aid built from the text of the regulation, with the citation on the page. It does not cover the convening-provider rules that apply when several providers are involved in one episode of care, and the published list we read has a gap in its numbering which the page points out rather than filling in. Read the section.
The estimate is the easy half
What follows it is eligibility checked before the visit, the self-pay balance collected at the desk rather than chased for ninety days, and the claim that does go out coded to match what the estimate said. That is a seat's work, at $1,700 a month, full time, on your hours.
Nothing you typed into the tool above is attached to this. This form sends the three fields in it and which page it came from — that is all it can send. Or write to ops@softhomeglobal.com and skip the form entirely. What happens to it.
Next step
Twenty minutes is enough to tell whether this fits
If it does not, I will say so. There is no sequence and nobody chases you.
Or write to ops@softhomeglobal.com