MunichDental Academy

Missed appointment cost calculator for dental practices

Work out how much revenue your practice loses through no-shows and late cancellations, per week, month and year. Below, a summary of what German law and the courts say about charging a missed appointment fee (Ausfallhonorar), each point with its source.

Last reviewed: 28 October 2026 · Charging a missed appointment fee in Germany: the legal position

Your missed appointments

No-shows and appointments cancelled at too short notice, as an average.

Average, e.g. from your practice software

Read as: 0 % · Share of the lost time you fill with other patients. Empty = 0 %.

Your revenue

Your own figure, e.g. fee revenue ÷ treatment hours. Work it out with the hourly rate calculator

Excluding holidays, public holidays and training

Optional: effect of a measure

For example appointment reminders. Enter your own assumption; the calculator does not suggest a value.

Empty = €0

Result

Enter missed appointments per week, the appointment length, the revenue per hour and the working weeks.

Enter missed appointments per week, the appointment length, the revenue per hour and the working weeks.

A calculation aid and overview, not legal or tax advice. The calculator uses only the figures you enter. The calculation runs in your browser. Your figures are neither sent to our server nor stored.

What the calculator works out

The calculator multiplies the appointments missed each week by their average length and subtracts the share of that time you manage to fill with other patients at short notice. The remaining minutes are valued at your revenue per treatment hour. The result is the revenue your practice loses per week, per month (average over the year) and per year.

For the revenue per hour, use your own figure, for example fee revenue divided by treatment hours from your accounts. If you have used our hourly rate calculator, its result can be carried over: the link there opens this page with the value filled in. Euro results are rounded half up to the cent; minutes are exact, so you can recompute every line.

Revenue is not profit: the calculator does not deduct materials or lab costs that a missed appointment saves. If you charge a missed appointment fee, the law requires you to set off such savings and what you earn elsewhere in the freed time (see below).

Optional: the effect of a measure

If you plan a measure such as reminders, enter by how many per cent you expect it to reduce missed appointments and what it costs per year. The calculator then shows the avoidable loss and the result after the cost. We do not suggest a percentage: we found no official or peer-reviewed source for dental practices in Germany that states one. Measure your own rate before and after.

The formulas

Treatment time lost per week
= missed appointments per week × average appointment length in minutes
Of which not refilled
= lost time × (100 % − share you manage to refill at short notice)
Revenue lost per week
= minutes not refilled × revenue per hour ÷ 60
Revenue lost per year
= minutes not refilled per week × working weeks × revenue per hour ÷ 60
Per month
= revenue lost per year ÷ 12
Avoidable loss (optional)
= revenue lost per year × your assumed reduction in missed appointments in %
After the cost of the measure (optional)
= avoidable loss − annual cost of the measure

Charging a missed appointment fee in Germany: the legal position

This section sets out what German law and published court decisions say, each point with its sources. It is not legal advice. Before you introduce an agreement or charge a missed appointment fee, ask your dental chamber, your KZV or a lawyer specialising in medical law.

The basis: section 615 of the German Civil Code (BGB)

If the patient is in default of acceptance, the practice may claim the agreed fee under section 615 sentence 1 BGB without having to provide the treatment later. In 2022 the Federal Court of Justice (BGH) held that section 615 BGB applies to treatment contracts via section 630b BGB (judgment of 12 May 2022, III ZR 78/21).

Sources: Section 615 BGB; Section 630b BGB; Federal Court of Justice (BGH), 12 May 2022, III ZR 78/21; Dental Chamber Westfalen-Lippe, fact sheet on missed appointment fees (2015); KZV Berlin (dental association), missed appointment fees

The BGH case did not concern a dental practice but an occupational therapy practice with a flat fee of 25 euros per missed appointment, and the claim failed: under the coronavirus regulation in force on that day the practice could not lawfully have treated the children. If the practice itself cannot perform, the patient is not in default (section 297 BGB).

Sources: Section 297 BGB; Federal Court of Justice (BGH), 12 May 2022, III ZR 78/21; IWW, on BGH III ZR 78/21 (2022)

Under section 615 sentence 2 BGB the practice must set off what it saves because the treatment did not take place and what it earns, or wilfully fails to earn, by using the time otherwise.

Sources: Section 615 BGB; Local Court Bielefeld, 10 February 2017, 411 C 3/17; Dental Chamber Westfalen-Lippe, fact sheet on missed appointment fees (2015); zm (BZÄK/KZBV journal), on Local Court Bielefeld (2018)

Appointment-only practice: the slot must be exclusive

Without a further offer by the practice, the patient is only in default if the appointment counts as a time fixed by the calendar (section 296 BGB). According to the BGH this depends on the individual case; a schematic approach is ruled out. What matters are the interests of both sides, how the practice organises its appointments and whether the patient could recognise this.

Sources: Section 296 BGB; Federal Court of Justice (BGH), 12 May 2022, III ZR 78/21; Local Court Bielefeld, 10 February 2017, 411 C 3/17; KZV Berlin (dental association), missed appointment fees; Dental Chamber Westfalen-Lippe, fact sheet on missed appointment fees (2015); zm (BZÄK/KZBV journal), “Was tun bei No Shows?” (2023)

In the BGH case the practice gave exclusive appointments rather than booking several patients into one slot, and the signed notice of the 24-hour cancellation period and the fee made clear that the time was reserved for this patient only. The Local Court Bielefeld (10 February 2017, 411 C 3/17) also relied on the exclusive booking of a pure appointment-only practice.

Sources: Section 296 BGB; Federal Court of Justice (BGH), 12 May 2022, III ZR 78/21; Local Court Bielefeld, 10 February 2017, 411 C 3/17; Dental Chamber Westfalen-Lippe, fact sheet on missed appointment fees (2015); North Rhine Medical Association, Rheinisches Ärzteblatt 2/2026; KZV Berlin (dental association), missed appointment fees; zm (BZÄK/KZBV journal), “Was tun bei No Shows?” (2023)

Where patients are seen in order of arrival despite having an appointment, or slots are double-booked, these standards speak against a claim.

Sources: Section 296 BGB; Federal Court of Justice (BGH), 12 May 2022, III ZR 78/21; Local Court Bielefeld, 10 February 2017, 411 C 3/17; KZV Berlin (dental association), missed appointment fees; Dental Chamber Westfalen-Lippe, fact sheet on missed appointment fees (2015); zm (BZÄK/KZBV journal), “Was tun bei No Shows?” (2023)

Cancelling an appointment is not terminating the contract

Patients may terminate the treatment contract at any time (section 627 BGB); after that, default of acceptance can no longer occur. A patient who only cancels one appointment and wants to continue treatment has not terminated the contract, according to the BGH.

Sources: Section 627 BGB; Federal Court of Justice (BGH), 12 May 2022, III ZR 78/21; zm (BZÄK/KZBV journal), “Was tun bei No Shows?” (2023)

Patients with statutory health insurance (GKV)

The patient owes the missed appointment fee personally, even with statutory insurance. The health insurer pays only for treatment that actually took place; waiting in vain for a booked patient is not an insured service. It therefore cannot be billed to the insurer.

Sources: Federal Court of Justice (BGH), 12 May 2022, III ZR 78/21; North Rhine Medical Association, Rheinisches Ärzteblatt 2/2026; zm (BZÄK/KZBV journal), “Was tun bei No Shows?” (2023); Dental Chamber Westfalen-Lippe, fact sheet on missed appointment fees (2015); zm (BZÄK/KZBV journal), “Termin abgesagt. Und jetzt?” (2016)

Older decisions sometimes took a different view: according to the Dental Chamber Westfalen-Lippe, the Local Court Tettnang (1999) held section 615 BGB inapplicable to statutory patients. The BGH settled the question in 2022.

Sources: Federal Court of Justice (BGH), 12 May 2022, III ZR 78/21; Dental Chamber Westfalen-Lippe, fact sheet on missed appointment fees (2015)

The alternative: damages, which must be proven

Some courts examine a claim for damages instead, because a late cancellation breaches an ancillary duty (section 280 BGB). The practice must then show concretely that, had the patient cancelled in time, it would have treated another patient it otherwise lost (section 252 BGB). An oral and maxillofacial surgeon failed on this point before the Higher Regional Court Stuttgart (17 April 2007, 1 U 154/06), although the patient had cancelled only four hours in advance.

Sources: Section 280 BGB; Section 252 BGB; Higher Regional Court Stuttgart, 17 April 2007, 1 U 154/06 (full text at ra-kotz.de); KZV Berlin (dental association), missed appointment fees; North Rhine Medical Association, Rheinisches Ärzteblatt 2/2026

Courts decide differently

What an agreement should contain

How high may the fee be?

The law sets no fixed limit, and the courts take different approaches. Under section 615 BGB it is the agreed fee minus what the practice saves or earns elsewhere; a flat fee worded as damages must not exceed the damage normally to be expected. The loss is best supported by a traceable calculation of your practice hour; in the Bielefeld case the court based its award on the figure stated by the practice, because the patient said nothing against it.

Sources: Section 615 BGB; Section 309 no. 5 BGB; Higher Regional Court Stuttgart, 17 April 2007, 1 U 154/06 (full text at ra-kotz.de); Local Court Bielefeld, 10 February 2017, 411 C 3/17; North Rhine Medical Association, Rheinisches Ärzteblatt 2/2026; Dental Chamber Westfalen-Lippe, fact sheet on missed appointment fees (2015); zm (BZÄK/KZBV journal), on Local Court Bielefeld (2018)

Preventing missed appointments

Reminders
A reminder by text message, email or phone a day or two before the appointment, with an easy way to cancel. Check with your data protection officer which consent you need for reminders. Whether and how much reminders reduce your missed appointments shows in your own figures; enter your assumption in the calculator above.
Confirm the appointment in writing
A written booking confirmation that states the cancellation period and that the time is reserved for the patient. It is also the basis for a missed appointment agreement (see above).
Make early cancellation easy
A slot cancelled in good time can be given to someone else. A waiting list of patients who can come at short notice helps you refill it. Online booking with a cancellation link works around the clock.
Long appointments
For long or prepared appointments, such as surgery, a second confirmation a few days in advance gives you time to reschedule.
Be reachable by phone
A patient who wants to cancel by phone and gets no answer may cancel too late or not at all; one who wants to book may call another practice. Options are fixed phone hours with enough staff, a call-back service, online booking or an AI phone assistant. Such assistants, for example Milo, which Dr. Jan Hajtó uses in his practice, answer calls and book appointments. (dialmilo.com)

Frequently asked questions

May a dentist in Germany charge a missed appointment fee?

Possibly. The basis is section 615 BGB; in 2022 the Federal Court of Justice confirmed that it applies to treatment contracts. Above all, the appointment must have been reserved exclusively for the patient, and the patient must have been able to recognise this. Courts decide individual cases differently; a clear written agreement made in advance helps. This is not legal advice.

Can I bill the fee for a statutory patient to the health insurer?

No. According to the Federal Court of Justice, waiting in vain for a booked statutory patient is not covered by statutory health insurance. The patient owes the fee personally.

How much notice should patients give when cancelling?

24 hours is the most common period in agreements and court decisions; some courts have accepted 48 hours.

Does the calculator show revenue or profit?

Revenue. It does not deduct costs saved by the missed appointment. If you charge a fee, the law requires you to set off such savings and earnings from other patients in the freed time.

How much do reminders reduce missed appointments?

We do not give a figure: we found no official or peer-reviewed source for dental practices in Germany that states one. Enter your own assumption, or measure your rate before and after introducing reminders.

Are my figures stored?

No. The calculation runs in your browser; nothing is sent to our server or saved. A value carried over from the hourly rate calculator travels in the part of the link after “#”, which browsers do not send to the server.

Sources

All sources checked on 28 October 2026. Every statement above rests on the text of the law or of a judgment and on at least one further source.

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Cost per treatment hour and minimum fee revenue per hour and minute from your own figures, also per treatment room.

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21 recurring deadlines of a dental practice in Germany (radiation protection, medical devices, occupational safety, fire safety) with legal basis, next due date and calendar file.

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Last reviewed: 28 October 2026 · A calculation aid and overview, not legal or tax advice. The calculator uses only the figures you enter. · Publisher: Munich Dental Academy