Practice accounting in 2026: DIY, bookkeeper or specialty CPA?

Practice accounting in 2026 starts with a scope decision. This guide compares DIY software, a bookkeeper, a specialty CPA and therapist-specific firms for US independent practices.

Start with the job you want to hand off

A bookkeeper and a CPA can be part of the same arrangement. Specify the tasks rather than assuming a company name or a job title includes everything. Ask who handles the monthly close, who answers questions, who signs off on filings and what remains your responsibility.

DIY: compare list price with the work you will do

These are software prices, not quotes for a professional engagement. Compare who performs the work, the plan limits and the cost after the promotional period. A spreadsheet plus a separately scoped year-end CPA engagement is another option; this guide has no sourced local-CPA price range. (Sources: QuickBooks pricing, Xero pricing, FreshBooks pricing)

Bookkeepers: low starting prices can describe different services

If you want a named person reviewing your books, request that explicitly. Pilot describes Essentials as AI-led and places a US-based bookkeeper in Core, so its $99 price should not be treated as the cost of the Core service. (Sources: Pilot pricing)

Pilot lists single-member LLC tax services from $1,000 per year and partnership or S-corp tax services from $2,000 per year, purchased with Pilot Bookkeeping. (Sources: Pilot pricing)

Specialty CPAs: compare the engagement, not a generic price range

For entity-specific filings, multiple owners or questions outside routine bookkeeping, shortlist firms that expressly describe those engagements. That is a fit recommendation based on published service scopes, not a claim that every CPA provides the same services. (Sources: TL;DR: Accounting pricing, Kramer CPA therapy services, Aware CPA pricing)

Aware CPA lists bookkeeping from an initial $350/month base estimate, individual returns typically from $1,000 and partnership returns typically from $2,000; final quotes depend on review and complexity. (Sources: Aware CPA pricing)

Use the Healthcare CPA & Tax Advisory directory to build a local shortlist, then request a written scope. Ask about healthcare experience, your states, ownership structure, software access, handoff dates and fees for work outside the engagement. No local-CPA market average is established by the supplied reads.

Therapist-specific firms: an ownership filter comes first

Therapy owners can compare TL;DR: Accounting, Kramer CPA, Aware CPA and The Private Practice CPA by their stated scope. TL;DR lists LLC accounting from $199/month, S-corp accounting from $349/month and custom pricing for partnerships and C corporations. (Sources: TL;DR: Accounting pricing, Kramer CPA therapy services, Aware CPA pricing, Private Practice CPA pricing)

For an eligible US therapy owner who wants a combined bookkeeping and tax service, Heard is one candidate: its annual-upfront plan cards show Lite at $1,548/year, Essential at $2,028/year and Premium at $3,060/year. 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 has no included annual tax filing; its pricing page offers an upgrade to Essential, a one-time $750 filing fee or filing outside Heard. (Sources: Heard pricing)

For group practices, Heard says "Heard currently supports single-ownership group practices." Confirm eligibility with Heard for your actual ownership structure before relying on that scope. (Sources: Heard FAQ, Heard pricing, Heard terms)

Continue to the therapist bookkeeping and accounting guide for a fuller ownership, plan and contract comparison. Specialist branding alone does not settle which engagement fits.

Payroll is a separate scope and cost check

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 requests pricing; Rippling says plans start at $8 per employee per month plus a monthly base fee, with a custom quote for the total. (Sources: Gusto pricing, Paychex payroll, Rippling pricing)

Heard lists its Gusto-powered payroll add-on at $39/month plus $6 per person on its pricing page; treat it as an add-on, not an included Premium benefit. (Sources: Heard pricing)

Do not substitute a standalone payroll price for an accounting engagement, or assume that adding payroll includes advice on employee classification. Ask the provider to name both the processing tasks and the advisory work in writing. ADP pricing was unread in the supplied pack, so no ADP number is offered.

Compare the first-year commitment

Request a total that separates the recurring service, software, onboarding, catch-up work, filing, payroll and third-party fees. Multiply monthly charges only after checking whether the offer is billed monthly or requires an annual contract. The total should also name excluded work and the person responsible for it.

Heard annual-upfront subscribers commit to a full year and its fees are non-refundable; the pricing-page catch-up fee is $99 for each month requiring catch-up work, and third-party government and license filing fees are excluded. (Sources: Heard pricing, Heard terms)

For example, Bookkeeper360 monthly bookkeeping at its $400 starting rate for twelve months, plus $1,000 starting catch-up cleanup, totals $5,800 before any separately scoped work. This is arithmetic using two starting prices, not a vendor quote or a market average. (Sources: Bookkeeper360 pricing)

Questions to take to your shortlist

1. Which owner and entity structures do you serve, and which do you exclude?
2. Which monthly tasks and returns are included, and which cost extra?
3. Who reviews the books and answers questions, and what response times are in the engagement?
4. What will you need from my practice software, banks and payment processors, and what access will I retain?
5. What is the full first-year commitment, including setup, cleanup, add-ons and cancellation terms?
6. What records will I receive if I switch providers, and who completes the final handoff?

How to make the choice

Keep DIY on the shortlist if you want to own the recurring work. Compare bookkeeping services if you want that work handed off. Seek a scoped CPA engagement for filings and ownership-specific advice. For a therapy practice, compare specialist firms through the same scope and cost questions; a specialist should earn its place by fit.

The supplied evidence consists of dated public pricing and service reads. No service-quality test, tax-savings study or original buyer research was performed. This guide gives a purchasing framework; it does not determine your tax status, deductions or filing obligations. Have a qualified professional assess those questions for your practice.