Background/objectives: The increasing cost of healthcare is a major issue for US policymakers and patients and their families. To date, little research has focused on physician-patient communication about healthcare costs. This systematic review identifies themes present in that literature and synthesizes findings. Methods: PubMed, CINAHL, PsycINFO, and Communication and Mass Media Complete were searched to identify articles regarding physician-patient communication about healthcare costs. The search yielded 24 articles based on inclusion criteria. Results: Empirical findings showed that most physicians and patients were open to discussion about costs; however, few actual conversations were reported across research studies. Most of the research on physician-patient communication about healthcare costs explored issues of nonadherence and identified relevant communication barriers. Research on physician-patient communication about healthcare costs currently lacks evidence-based strategies for increasing and improving these discussions. Conclusions: Physicians and patients judge communication about healthcare costs to be important and to have the potential to influence health and financial outcomes; however, discussions between physicians and patients on the topic are rare.