INDUSTRY · THERAPY PRACTICES
Bookkeeping for therapists
in private practice, solo or group.
Bookkeeping for therapists records insurance payments and self-pay sessions separately, grosses card payments up before processor fees, books late-cancellation fees as revenue, pays contract clinicians their agreed share of what they collect, and keeps owner pay out of expenses. ZeraBooks bookkeeping services do this for counseling practices from $150 a month, without clinical notes.
Free call · from $150 a month (USD) · no session notes or diagnoses needed
WHAT MAKES PRACTICE BOOKS DIFFERENT
Why is bookkeeping for a therapy practice different?
A therapy practice sells hours, and most of the bookkeeping is working out who paid for each one and who gets a share of it.
Two kinds of payer
Insurance EFTs arrive in batches covering many sessions, often weeks later. Self-pay clients pay by card at the session. Keep them in separate revenue accounts so you can see how much of the practice depends on each panel.
Superbills are not your receivable
Out-of-network clients pay you in full and send a superbill to their insurer. Any reimbursement goes to the client, so nothing extra is owed to the practice.
Clinicians on a split
Group practices often pay contract clinicians a percentage of what they collect. The split is calculated on collections, not on sessions booked, so the books need collections by clinician.
No-shows and late cancels
A late-cancellation fee charged to a card is revenue. It is usually small, but it belongs in its own line if you want to know what your policy actually brings in.
Small recurring costs add up
Practice management and telehealth software, liability insurance, license renewals, continuing education and clinical supervision. Each is minor; together they are the practice’s overhead.
Tell us about your books. We’ll scope the work and quote it before anything starts.
CHART OF ACCOUNTS
What chart of accounts does a therapy practice need?
Enough to answer how the practice is paid and what it costs to run. A solo practice can skip the clinician lines.
| Account | Type | What goes in it |
|---|---|---|
| Insurance revenue | Income | EFT payments from insurance payers |
| Self-pay revenue | Income | Card, cash and HSA card payments from clients |
| Cancellation fees | Income | Late-cancellation and no-show fees |
| Contract clinician payments | Cost of services | Each clinician’s share of their collections |
| Clinical supervision | Expense | Supervision paid for associate clinicians |
| Practice software | Expense | Practice management, telehealth, scheduling |
| Licensing and continuing education | Expense | License renewals, CE courses, memberships |
| Professional liability insurance | Expense | Malpractice and general liability |
WORKED EXAMPLE
What does a group therapy practice’s month look like in the books?
Harborlight Counseling is a fictional practice: the owner and two contract clinicians paid 60% of what they collect. Here is October 2026, cash basis.
| Line | Amount | Account |
|---|---|---|
| Insurance EFTs, 4 payers | 9,860.00 | Insurance revenue |
| Self-pay card payments, incl. $300 of late cancels | 6,240.00 | Self-pay and cancellation fees |
| Card processor fees | (180.96) | Merchant fees |
| Contract clinicians: 60% of $7,400 they collected | (4,440.00) | Contract clinician payments |
| Practice management and telehealth software | (149.00) | Practice software |
| Office rent | (1,600.00) | Rent |
| Liability insurance | (62.00) | Professional liability insurance |
| Continuing education course | (295.00) | Licensing and continuing education |
| October profit before owner pay | 9,373.04 |
Revenue is $16,100 and expenses are $6,726.96. The clinicians’ $4,440 is worked out from their collections that month, which is why the books need payments by clinician, not just a total. What the owner takes home comes out of the $9,373.04 as a draw or salary, depending on how the practice is set up.
WITH ZERABOOKS
How does ZeraBooks keep a therapy practice’s books?
Our team keeps the books on our own AI-native ledger. You upload financial documents and see the result in a read-only login.
- 1
A free call
Solo or group, which panels you are on, how clinicians are paid and how you pay yourself. The price is agreed on the call.
- 2
Upload each month
Bank and card statements, the payments report from your practice software and any clinician split report. Session notes, diagnoses and client records are never needed.
- 3
Revenue by payer and clinician
Insurance and self-pay kept apart, card deposits grossed up, clinician payments booked against their collections.
- 4
A month you can trust
Every account tied to its statement to the cent, then a P&L that shows what each payer brings in.
MORE INDUSTRIES
Books for other kinds of business
- Church accounting softwareFunds, restricted gifts and several bank accounts in a general ledger.
- Bookkeeping for nonprofitsRestricted grants, functional expenses and a worked month.
- Bookkeeping for restaurantsPrime cost, tips and sales tax, with a worked month P&L.
- Bookkeeping for law firmsTrust accounts, three-way reconciliation and a worked month.
- Bookkeeping for property managementTrust accounts, deposits and a 12-unit worked month.
- Bookkeeping for contractorsRetainage, over and under billing, and subs.
How much does bookkeeping cost for a therapist?
ZeraBooks starts from $150 a month in U.S. dollars, with the exact price agreed after a free call. A solo practice with one account usually sits at the low end; group practices with clinician splits cost more.
Do you need access to client records?
No. The books are kept from bank and card statements and payment totals. No session notes, diagnoses or treatment details are needed, and ZeraBooks does no insurance billing or claims.
Should a solo therapist keep books in a spreadsheet?
It works while the practice is small and you reconcile to the bank every month. Once you add a second payer panel or a clinician, it gets hard to keep straight; that is usually the point to hand it over or use ZeraBooks AI bookkeeping yourself.
Are contract clinicians employees or contractors?
It depends on how the work is actually arranged, and your accountant should decide it. The books follow the answer: contractors are paid as contract clinician payments, employees through payroll.
Is this the same as bookkeeping for physical therapy?
No. Physical therapy, chiropractic and dental clinics run more like medical clinics, with equipment loans and staff payroll; see bookkeeping for medical practices. Practices that are a few months behind can start with catch-up bookkeeping.
WE DO YOUR BOOKS
Keep your hours for clients.
We’ll keep the books.
Insurance, self-pay and clinician splits, booked and proven every month from $150 (USD). Book the free call. Not sure what to expect from a bookkeeper? Read how much a bookkeeper costs.
Last updated November 4, 2026 · Written by Damin Mutti, founder of ZeraBooks