Bookkeeping and accounting for therapists in 2026

This 2026 guide addresses bookkeeping and accounting for US therapists in private practice. The practice accounting hub compares the broad service categories; here the question is which published scope fits your therapy practice.

Choose your shortlist by ownership and scope

Bring the same facts to each conversation: number of owners, current tax classification, states involved, number of clinicians, existing software, condition of the records and the tasks you want outsourced. Do not select an entity type or an S-corp election from a service price table.

Therapy specialists: compare what their pages actually offer

For multiple-owner practices, the partnership scopes above are a reason to shortlist TL;DR or Aware, not a guarantee of eligibility, quality or savings. Request confirmation for your ownership structure and a complete first-year quote. (Sources: TL;DR: Accounting pricing, Aware CPA pricing)

Heard: a conditional option with explicit exclusions

For an eligible US therapy owner who wants one bookkeeping and tax-service package, Heard is worth comparing with the firms above; the choice depends on scope, billing commitment and the work left to you. Heard excludes non-health practices, practices outside the United States, practices with multiple owners, and practices taxed as C corporations. (Sources: Heard pricing, Heard how it works)

Heard Lite is shown for starting solo sole-proprietor practices at $129/month equivalent, billed $1,548 upfront for a year, with quarterly-tax services but no included annual filing. (Sources: Heard pricing, Heard terms)

For annual filing on Heard Lite, the page offers upgrading to Essential by December 31, paying a one-time $750 fee or filing outside Heard. (Sources: Heard pricing)

Heard Essential is shown for established solo sole-proprietor practices at $169/month equivalent, billed $2,028 upfront for a year, with quarterly and annual tax services. (Sources: Heard pricing, Heard terms)

Heard Premium is shown at $255/month equivalent, billed $3,060 upfront for a year, with quarterly and annual tax services and S-corp compliance; payroll costs extra. (Sources: Heard pricing, Heard terms)

On group practices, Heard describes Premium as "For S corps and group practices." Its FAQ states "Heard currently supports single-ownership group practices." Confirm eligibility directly with Heard for your particular practice before choosing the plan. (Sources: Heard pricing, Heard FAQ, Heard terms)

Heard lists its Gusto-powered payroll add-on at $39/month plus $6 per person, and catch-up bookkeeping at $99 for each month requiring catch-up work; third-party government and license filing fees are excluded. (Sources: Heard pricing)

Heard says annual-upfront subscribers commit to a full year with non-refundable subscription and one-time fees; its terms also describe automatic renewal and remaining payment obligations after early termination. (Sources: Heard pricing, Heard terms)

Heard also describes an annual plan paid monthly with a one-year commitment, so payment frequency should not be assumed to mean cancel-anytime service. (Sources: Heard pricing)

Heard pages disagree on monthly-payment pricing, savings percentages and payroll wording; obtain a written price and scope before signing, and do not treat the annual-upfront equivalents above as month-to-month prices. (Sources: Heard pricing, Heard FAQ)

Heard FAQ says Premium cannot be downgraded to Essential or Lite; include that restriction when comparing flexibility. (Sources: Heard FAQ)

For a multi-owner practice, use the partnership-service shortlist above. For a solo practice, compare the cost and scope of a combined package with a bookkeeper plus your own CPA. You do not need to change an arrangement that already covers the work you require.

DIY or a general bookkeeper can still fit

None of the three software pricing pages read mentions therapists. Their inclusion here is an editorial option for doing the work yourself, not a claim of a therapy-specific workflow or a verified connection to your EHR. (Sources: QuickBooks pricing, Xero pricing, FreshBooks pricing)

A local CPA or tax preparer is also a valid shortlist option, especially when you want a separately scoped year-end engagement. The pack does not establish a local-CPA price range or prove that general bookkeepers are cheaper than specialist firms. Ask each candidate for the same work before comparing totals.

First hire or group practice: check the payroll scope

Gusto lists Simple at $49/month plus $6 per person, Plus at $80 plus $12 per person, and Premium at $180 plus $22 per person. Paychex uses a pricing request; Rippling lists plans from $8 per employee per month plus a monthly base fee and quotes the total; ADP pricing was unread in the supplied pack. (Sources: Gusto pricing, Paychex payroll, Rippling pricing)

Kramer distinguishes payroll guidance from processing, while Gusto sells payroll plans. Ask who runs payroll and who advises on worker classification, compensation and filings; do not assume one engagement provides both. (Sources: Kramer CPA therapy services, Gusto pricing)

For three people on Gusto Simple, the observed list-price calculation is $49 + (3 x $6) = $67/month, before any separate services. This is an illustration, not a recommendation about your compensation or staffing. (Sources: Gusto pricing)

Questions that make quotes comparable

1. Do you serve my actual ownership structure and current tax classification?
2. Which individual, business and state returns are included, and what is separately priced?
3. Is monthly reconciliation performed by a person, software or both, and who reviews the result?
4. Does the service include cleanup, quarterly estimates, payroll processing or only guidance?
5. How will you use exports from my practice software, bank and payment processor, and what information do you require?
6. What is due upfront, what renews automatically, what is refundable and what happens if I leave?
7. Who owns the software account, and what records will I get when the engagement ends?

Common questions

Do I need a CPA if I buy accounting software?

Separate the software decision from the professional work you need. Ask what filings and advice your practice requires and whether you want those tasks handled in an engagement. The product price alone does not answer that question.

Can a group therapy practice use Heard?

Heard says "Heard currently supports single-ownership group practices." Confirm your eligibility with Heard; do not infer it from clinician count or the word "group" on a plan card. (Sources: Heard FAQ, Heard pricing, Heard terms)

Does a lower monthly number mean a cheaper engagement?

Compare twelve months of the same work, then add setup, cleanup, software, filing and payroll charges where applicable. Keep annual-upfront equivalents, starting prices and estimates distinct from fixed monthly quotes. Contract flexibility is also part of the choice.

Should I become an S corporation?

This guide does not recommend an S-corp election or estimate tax savings. Bring your income, ownership structure, current classification and full compliance costs to a qualified professional for a practice-specific assessment.

Choose the arrangement that covers your work

If you want to maintain the books, keep DIY and a separate professional engagement in view. If you want monthly work outsourced, compare the bookkeeper scopes. For multiple owners, start with firms that describe partnership services. For a solo practice, compare specialist packages on the same ownership, scope, total-cost and cancellation questions.

The facts here come from dated vendor pages. Service quality, therapy-software connections, tax savings and buyer behavior were not independently tested. No tax deductions, election thresholds, filing obligations or employment classifications are decided by this page.