# How do you estimate the cost of appointment no-shows?

Canonical: https://prospyrmed.com/resources/practice-answers/no-show-cost-model
Sources reviewed: 2026-09-19 · Prepared by Prospyr

Define the appointment cohort, calculate missed slots and subtract slots backfilled. Multiply remaining unfilled slots by net service revenue for scheduled value, or by revenue minus avoidable service cost for contribution at risk. Neither estimate is automatically lost profit or recoverable revenue.

## Define the denominator

No-show rate is no-shows divided by scheduled appointments in a consistent cohort. Define cancellations, reschedules and multi-service appointments before comparing periods. Do not mix blocked calendar time with patient appointments.

Source: [Prospyr no-show cost model](https://prospyrmed.com/blog/post/no-show-rates-impact-revenue) — First-party illustrative contribution model; not an outcome benchmark, causal estimate or accounting advice.

## Distinguish contribution from revenue

Subtract only service costs genuinely avoided when an appointment does not happen. Fixed overhead, retained deposits, subsequent visits and intervention costs need separate treatment. A scenario is not evidence of the effect of a new reminder.

Source: [Prospyr no-show cost model](https://prospyrmed.com/blog/post/no-show-rates-impact-revenue) — First-party illustrative contribution model; not an outcome benchmark, causal estimate or accounting advice.

## Practical checklist

1. Choose one period and consistent appointment statuses.
2. Record scheduled appointments and the no-show rate.
3. Estimate backfilled slots without double counting.
4. Separate net service revenue from avoidable costs.
5. Review comparable attendance cohorts and accounting assumptions.

## Worked example

With 200 appointments, a 10% no-show rate and 25% backfill, 15 slots remain unfilled. At $150 net revenue and $35 avoidable cost per service, scheduled value is $2,250 and contribution at risk is $1,725 before fixed costs. All inputs are illustrative.

## Mistakes to avoid

- Calling all scheduled value lost profit.
- Subtracting fixed salaries as if they were avoided.
- Claiming a reminder caused improvement without a suitable comparison.

## Related questions

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- [How do you reconcile inventory in a med spa?](https://prospyrmed.com/resources/practice-answers/inventory-reconciliation)

Prepared by Prospyr from the cited primary sources. These are educational workflow resources, not individualized clinical, coding, legal or tax advice. No clinician, certified-coder or attorney review is claimed. Confirm current code instructions, payer terms and applicable law for the actual service and date. CPT is a registered trademark of the American Medical Association; this is not a substitute for a licensed current code set.