What should the D9987 chart note include?
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Cancelled appointment. Appointment Details: Scheduled date: Scheduled date Scheduled time: Scheduled time Scheduled procedure: Scheduled procedure Appointment duration: Appointment duration Cancellation Information: Cancellation date/time: Cancellation date/time Notice given: Notice given Cancellation method: Cancellation method Reason for Cancellation: Reason provided: Reason provided Follow-Up Actions: Rescheduled during call: Rescheduled during call Patient to call back to reschedule. Recall letter/message sent. Added to short-call list. Notes: Notes Rescheduled Appointment (if applicable): New date: New date New time: New time
What documentation is required for D9987?
A defensible D9987 chart entry serves two audiences: (1) a future provider in your own practice who needs to understand the patient's reliability pattern, and (2) a payer, attorney, or board reviewer evaluating whether a late-cancel fee was charged appropriately. Required elements:
- Original appointment details — scheduled date and time, scheduled procedure(s), expected appointment duration (e.g., "90 min RCT #30"). The duration matters: a 15-minute hygiene check is not the same financial loss as a 3-hour sedation case, and most fee policies scale with chair-time blocked.
- Cancellation timestamp — exact date and time the cancellation was received. This is the single most important field: it determines whether the cancellation was inside or outside the practice's notice window.
- Notice given — the calculated interval between cancellation and appointment (e.g., "12 hours notice," "same-day cancel — 2 hours before appointment"). Stating the math explicitly removes ambiguity.
- Cancellation method — phone call, text/SMS, voicemail, email, online portal, in-person at the door. Note who took the call (front-desk staff initials) for phone/in-person cancels.
- Reason given by the patient — quote it when possible ("woke up sick," "child has fever," "transportation fell through," "forgot," "no reason given"). This often determines whether the fee will be waived as a courtesy.
- Reference to the practice's cancellation policy — note that the patient was advised of the practice's policy at the time of scheduling (or at a prior visit), and confirm the policy applies to this cancellation. Many practices keep a signed financial-and-cancellation policy on file; reference it in the note ("late-cancel fee policy on file, signed [date]").
- Fee assessed (or waived) and rationale — state whether a late-cancel fee was charged, the dollar amount, and any clinical or compassionate reason for waiving it (first offense, documented illness, established hardship, weather emergency, practice-side scheduling change). The fee is patient self-pay only — never billed to insurance.
- Follow-up actions — rescheduled at the time of the call, asked patient to call back, recall message sent, added to short-call/cancellation list, flagged for pre-pay or shortened scheduling on next booking, or (for repeat offenders) flagged for dismissal warning.
- Rescheduled appointment — new date/time/procedure if booked during the cancellation call, or a clear statement that the patient declined to reschedule.
- Staff member documenting — front-desk initials and provider awareness if the cancellation affects clinical follow-up (e.g., open RCT, healing extraction site, post-surgical check).
Per 's adjunctive-services guidance, the chart entry should be brief but specific: the goal is a contemporaneous record that an auditor or attorney can reconcile against the appointment book, the cancellation log, and the practice's posted policy. Avoid editorializing ("patient is irresponsible," "always cancels"); stick to facts and timestamps. Patterns of cancellation are documented by a series of factual entries, not by a single judgmental one.
Why does D9987 get denied?
D9987 is rarely "denied" in the traditional clinical sense because it is rarely submitted to insurance. The relevant adverse outcomes are complaints, chargebacks, contract violations, and disputed balances. Common pitfalls:
- PPO contract violation — the practice charged a late-cancel fee to a contracted patient whose PPO agreement prohibits it. Most common with Delta Dental, MetLife PPO, and several BCBS networks. Result: refund demand, possible network termination, claw-back of paid claims.
- Medicaid program violation — fee charged to a Medicaid or Medicaid MCO patient. Many state Medicaid programs treat this as a program-integrity violation; can trigger a referral to the state OIG.
- No written cancellation policy on file — fee charged but the patient never signed (or was never given) a policy disclosing the fee at scheduling. Almost always reversed on dispute.
- Inconsistent application of the fee — practice charges some patients but waives others without documented rationale. Patients who learn of the inconsistency frequently win disputes; auditors flag it as discriminatory.
- Submitted to insurance accidentally — front-desk staff submits D9987 on a claim form. The carrier denies it as non-covered; some PPO contracts treat the attempt to bill as a contract violation regardless of the outcome.
- Charged in lieu of a clinical code — D9987 used to bill for chair-time on a partially-completed visit. Not its purpose; this is a coding error.
- Patient-of-record dispute — fee charged to a patient who claims they cancelled within the notice window. Without a contemporaneous timestamped chart entry showing the exact cancellation time and method, the practice usually loses the dispute.
- Repeated small fees on a vulnerable patient — boards and AGs increasingly view aggressive late-cancel fees on Medicaid, low-income, or elderly patients as predatory; can trigger complaints even when technically permissible.
- State-board complaints — patient files with the dental board claiming the fee was excessive, undisclosed, or coercive (e.g., "won't see me again until I pay $250 for a missed cleaning"). The practice's defense is the signed policy and the chart documentation.
- Missing front-desk initials / unsigned chart entry — auditors flag administrative chart entries with no author. Especially important for D9987 because the entire record may later be the only evidence of when and how the cancellation occurred.
The single best protection: a signed financial-and-cancellation policy on file, a contemporaneous timestamped chart entry, and a uniform practice-wide fee schedule applied to self-pay patients only.
What do practices ask about D9987?
What's the difference between D9986 and D9987?+
D9986 is a missed appointment (no-show) — the patient did not appear and did not call. D9987 is a late cancellation — the patient did call (or text, or use the portal), but the notice was inside the practice's published cancellation window. Both are non-covered, chart-administrative codes used to anchor a self-pay fee on patients whose plan/contract permits it. Functionally similar; documentation requirements differ slightly (D9986 should record outreach attempts; D9987 should record the cancellation timestamp, method, and reason).
Can D9987 be billed to insurance?+
No. D9987 is universally non-covered by commercial carriers, Medicare Advantage dental plans, and Medicaid programs. It should not be submitted on a claim form. Submitting it can also trigger PPO contract issues — several PPO agreements treat the attempt to bill a non-billable administrative code as a contract violation. The fee, if charged, is patient self-pay only.
Can a PPO patient be charged a late-cancellation fee?+
It depends on the specific PPO contract. Most participating-provider agreements (Delta Dental, MetLife PPO, Cigna, Aetna, several BCBS networks) include language restricting or prohibiting fees charged to contracted patients in connection with covered services — including no-show and late-cancel fees. Read the specific provider agreement before assessing the fee. Charging a contracted patient in violation of the agreement is a recurring cause of network termination and refund demands. Out-of-network and self-pay patients are governed by the practice's own written policy.
Can a Medicaid patient be charged a D9987 fee?+
Usually no. Many state Medicaid programs and Medicaid MCOs (DentaQuest, Envolve, MCNA, Liberty Dental) explicitly prohibit charging Medicaid beneficiaries no-show or late-cancellation fees, and some treat the practice as having committed a program-integrity violation if it does. Texas, California, and New York Medicaid all prohibit such charges in most circumstances. When in doubt, do not assess the fee on a Medicaid patient.
What does a defensible late-cancel policy look like?+
Three pieces. (1) A written policy that defines the notice window (commonly 24 or 48 hours), the fee amount or tiered fee schedule (often scaled by appointment length), and the circumstances under which the fee is waived. (2) Patient acknowledgment of the policy at scheduling, ideally with a signature in the financial policy. (3) Uniform application across all self-pay patients — no selective enforcement. Add a contemporaneous timestamped chart entry per occurrence, and the policy is defensible against patient disputes and most regulatory complaints.
Is there a 'reasonable' amount for a D9987 fee?+
There's no CDT-prescribed amount, but typical practice ranges are $25–$75 for short hygiene visits and $100–$250 for long restorative, surgical, or sedation cases. The fee should bear a reasonable relationship to the lost chair time and the practice's overhead — boards and AGs occasionally flag fees that look punitive (e.g., a $500 fee on a $90 hygiene appointment). Some states cap administrative fees by statute; check state law before setting the schedule.
Should the same chart-note structure be used for both D9986 and D9987?+
The structure is similar but the content differs. D9986 entries emphasize the time the patient was expected, the time the slot was released, and the outreach attempts made (call, voicemail, text). D9987 entries emphasize the cancellation timestamp, the method (phone/text/portal/in-person), the calculated notice given, and the patient's stated reason. Both should reference the practice's policy and document the fee (charged or waived) with a brief rationale.