Medical & Dental Credit-Card Surcharge: State-by-State Compliance Checklist (2026)
A per-state landing checklist for medical and dental practices: whether you can surcharge, the 52-jurisdiction matrix, and the go-live steps that fit insurance billing and patient care.
Last verified: 2026-09 · Educational reference, not legal advice
No federal statute singles out medical or dental practices for surcharging. The same network baseline applies everywhere surcharging is allowed: cap at the lower of 3% (Visa) / 4% (Mastercard) or your actual cost, give 30 days’ notice, exclude debit, disclose, post signage, and print a separate receipt line.
What is different for practices
Two practical wrinkles: (1) payer and processor agreements sometimes restrict surcharging on patient card payments, especially insurance copays; and (2) cash-discount programs are widely used for elective and cosmetic care because they avoid the contested-state risk and read as a patient courtesy rather than a fee. Confirm your merchant agreement before enabling a surcharge.
| State | Status | Surcharge? | Cash discount? | State cap | Key rule |
|---|---|---|---|---|---|
| Alabama (AL) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Alaska (AK) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Arizona (AZ) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Arkansas (AR) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| California (CA) | Contested | No | Yes | — | Statute bans surcharging; legal status contested — cash discount recommended |
| Colorado (CO) | Restricted | Yes | Yes | 2% | State cap 2% (lower than Visa 3%) |
| Connecticut (CT) | Banned | No | Yes | — | Surcharging prohibited by state law |
| Delaware (DE) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| District of Columbia (DC) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Florida (FL) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Georgia (GA) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Hawaii (HI) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Idaho (ID) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Illinois (IL) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Indiana (IN) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Iowa (IA) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Kansas (KS) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Kentucky (KY) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Louisiana (LA) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Maine (ME) | Contested | No | Yes | — | Statute bans surcharging; legal status contested — cash discount recommended |
| Maryland (MD) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Massachusetts (MA) | Banned | No | Yes | — | Surcharging prohibited by state law |
| Michigan (MI) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Minnesota (MN) | Restricted | Yes | Yes | Actual cost | Cap = your actual processing cost |
| Mississippi (MS) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Missouri (MO) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Montana (MT) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Nebraska (NE) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Nevada (NV) | Restricted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| New Hampshire (NH) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| New Jersey (NJ) | Restricted | Yes | Yes | Actual cost | Cap = your actual processing cost |
| New Mexico (NM) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| New York (NY) | Restricted | No | Yes | — | No line-item surcharge; cash-discount model required |
| North Carolina (NC) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| North Dakota (ND) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Ohio (OH) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Oklahoma (OK) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Oregon (OR) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Pennsylvania (PA) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Rhode Island (RI) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| South Carolina (SC) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| South Dakota (SD) | Restricted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Tennessee (TN) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Texas (TX) | Contested | No | Yes | — | Statute bans surcharging; legal status contested — cash discount recommended |
| Utah (UT) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Vermont (VT) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Virginia (VA) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Washington (WA) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| West Virginia (WV) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Wisconsin (WI) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Wyoming (WY) | Permitted | Yes | Yes | 3% | Visa 3% / Mastercard 4% (3% effective if you accept both); lower of cap or actual cost |
| Puerto Rico (PR) | Banned | No | Yes | — | Surcharging prohibited by state law |
Your practice go-live checklist
- Confirm your state status in the matrix above (banned in CT, MA, PR; contested in CA, TX, ME; restricted in a few states).
- Verify your merchant-processor and any payer/network contracts — some prohibit surcharging insurance-copay card payments.
- If surcharging, submit the ~30-day notice to your acquirer and exclude debit cards at the terminal.
- If unsure or in a contested/banned state, run a cash-discount (dual-price) program instead — legal in all 50 states + DC + PR.
- Post both prices (or the surcharge disclosure) at check-in and at the payment desk; print the fee as its own receipt line.
- Train front-desk staff on the disclosure script and the debit-card exemption before going live.
Some merchant-processor agreements and payer/network contracts restrict surcharging on patient card payments. Verify your contract before enabling a surcharge on copays or balanced bills.
Estimate your cash-discount savings instead.Open the Cash Discount Calculator →
Related guides
Frequently asked questions
Where the state allows surcharging, yes — under the standard network rules. But verify your merchant agreement and any payer contract, since some restrict surcharging on insurance-related card payments.
Often yes. A cash-discount (dual-price) program is legal in every state and reads as a patient courtesy, avoiding the contested-state risk that surrounds surcharging in CA, TX, and ME.
No federal statute changes the card-network surcharge baseline for medical practices. The only added step is checking your payer/processor contract, which may independently restrict fees on patient card payments.
Educational content, not legal advice. Cashbizly is an independent educational resource. Nothing here is personalized legal advice and it does not replace a licensed attorney or your state’s Attorney General.
Our state-by-state status reflects the consensus of published 2025–2026 compliance guides (card-network rules, LawPay, Stax, NCSL) as of the “last verified” date on each page. Surcharge law changes frequently and is actively litigated — always confirm current figures with your state Attorney General or a professional. Read our full disclaimer.