Credit Card Surcharging for Dental Practices: What Is Allowed?

I run Summit Payments (getsummit.co). Our site, pricing, and support are built for dental practices. Office managers ask our team about surcharging all the time, usually right after they open a processing statement and see the monthly total. This post covers the card brand rules in plain language and how our team sets the program up in your payment gateway.

A surcharge is a fee added to a transaction when a patient pays with a credit card. It offsets part of what your practice pays to accept that card. Example: If a patient owes $400 for a crown copay and pays with a credit card, a 3% surcharge adds $12, and the receipt shows the $400 charge and the $12 surcharge on separate lines.

Patients who pay with debit, cash, or check pay no surcharge.

A dual pricing program, where the practice shows a cash price and a card price, is a different approach with different rules. This post covers surcharging. For the broader question of passing card costs to patients, see how to pass credit card fees to patients.

In most of the country, yes. Surcharging on credit cards is allowed by the card brands, and many states permit it. Some states restrict or ban it, and the rules can change, so our team checks your state before setting anything up. You can start with our state surcharge rules lookup.

You also have to follow the card brand rules below, or you risk fines and problems with your merchant account. Our surcharging compliance hub covers them in more depth.

Visa and Mastercard set the rules that apply everywhere surcharging is allowed. The main ones:

• Register before you start. Your practice registers its surcharge program with the card brands and your acquirer before the first surcharged transaction.
• Respect the cap. Visa limits the surcharge to the lower of your merchant discount rate (MDR) and 3%. The MDR is what your practice pays to accept the card.
• Post notice at the point of entry. Patients need to know before they reach checkout. That usually means a sign at the front door and a notice on your website or online payment page.
• Post notice at the point of sale. A sign at the front desk, next to the terminal.
• Show it on the receipt. The surcharge appears as its own line item, separate from the treatment charge.
• Credit cards only. More on that next.

No. Never surcharge a debit card. This rule has no exceptions.

That covers:

• PIN debit cards
• Signature debit cards, sometimes called check cards, even when the patient chooses "credit" at the terminal
• Prepaid cards that are treated as debit

This matters for dental offices because many HSA and FSA cards are debit or prepaid cards, so they can't be surcharged. A patient paying with one of those cards should not see a surcharge.

You cannot tell a debit card from a credit card by looking at the logo. Our team configures your payment gateway so the surcharge applies to credit cards only, which keeps your front desk from having to make that call at checkout.

Colorado's surcharge law is C.R.S. 5-2-212, as amended by SB21-091. You can read the bill at https://leg.colorado.gov/bill_files/52458/download.

Colorado practices can add a credit card surcharge of up to 3% under the merchant discount rate option in C.R.S. 5-2-212(1)(c)(II). That option limits the surcharge to your merchant discount rate (MDR), which is what your practice pays to process the card. Visa also limits the surcharge to the lower of your MDR and 3%, so if your MDR is below 3%, your MDR is the limit. Summit Payments follows this option when our team sets up your payment gateway.

The card brand rules above (credit only, registration, notice, receipt line) apply in Colorado too. More detail is on our Colorado surcharging page.

This post is general information, not legal advice. If your practice has specific legal questions, talk with your attorney.

Patients who ask about the surcharge usually ask one question: "Can I avoid this?" The honest answer is yes. They can pay with debit, cash, or check and pay no surcharge.

What helps:

• Signs that are easy to read, at the door and at the front desk, so the surcharge is not a surprise at checkout.
• A short script for the front desk. Something like: "We add 3% when you pay with a credit card, to cover the processing cost. There's no fee for debit, cash, or check."
• A line in your financial policy and on treatment plan estimates, so patients see it before the appointment.
• The same answer from everyone. The front desk, the treatment coordinator, and the billing team should all give the same explanation.

Our team gives every practice the signage and a front desk script as part of setup.

Here is how Summit Payments sets up a surcharge program in a dental practice's payment gateway:

1. Send a recent processing statement. Our team looks at what you pay today and your effective rate. (See the savings analysis.)
2. Check your state. Our team checks your state's rules. If your state restricts or bans surcharging, we tell you and talk through other options, such as a dual pricing program. (See the state surcharge rules lookup and surcharging compliance hub.)
3. Register your program. Our team registers your program with the card brands and your acquirer.
4. Configure your payment gateway. Your payment gateway applies the surcharge to credit cards only and shows it as a separate line on the receipt.
5. Provide signage. Our team provides the signage for your front door, front desk, and website.
6. Train your front desk. Our team trains your front desk on how to answer patient questions.
7. Go live. You go live, and our team checks the first transactions with you.