How much do mental health billing services cost? (2026)

What mental health billing companies charge in 2026

The seven mental health billing companies below publish their prices on their own websites. Four charge a percentage and three a flat monthly fee, and Psyquel also prices per claim when you use its EHR. We read each company's pricing, FAQ or home page on November 2, 2026. Companies that quote only on request aren't in this table. Psychiatric Billing Associates, for example, charges a percentage of total collected revenue and quotes it for each practice.

Why the fee basis matters as much as the rate

The same percentage can produce different bills, because each company applies it to a different number. TheraThink charges on the allowed amount, which its FAQ defines as the insurance payment plus the client's share. Sawgrass charges on total monthly collections, MedStates on collected reimbursements, and Psychiatric Billing Associates on total collected revenue. The difference shows up when part of a session goes unpaid. Take an example session with a $150 allowed amount. The client owes a $50 deductible and never pays it, so the practice collects $100 from the insurer. At 7% of the allowed amount, the fee is $150 × 7% = $10.50. At 7% of what was collected, the fee is $100 × 7% = $7.00. The basis adds $3.50 to one session. Across 100 sessions like it, that's $350. The example is an illustration and doesn't come from any company's invoice.

Each basis has a reason behind it. TheraThink's FAQ says it charges on the allowed amount because it files claims for both the practice and the client, whoever pays. A fee on collections ties the company's income to money that reaches your account. In the example, the basis moves the fee by $3.50, while a full percentage point on the same $150 moves it by $1.50.

The extras that change what you pay

The percentage or flat fee is only part of the bill. These are the extras listed on the same seven pages, plus the ones to ask about before you sign.

• Setup and onboarding fees. Sawgrass's onboarding fee starts at $99 and varies by provider type and credentialing needs. TheraThink, SimpleBilling and The Bowerbirds say they charge no setup fee.
• Per-provider monthly fees. TheraThink adds $35 a month for each tax ID and rendering NPI combination in months when claims are submitted. It drops that fee when it would be less than 5% of your total invoice.
• Credentialing. TheraThink prices credentialing per application, and its pages list three sets of prices, from $120 to $160 per commercial application and $260 to $270 for Medicare or Medicaid. It was also advertising free credentialing as a limited-time promotion when we checked. A new clinician joining several insurers needs an application for each one.
• Minimums. Sawgrass says minimum requirements apply, without listing them. Cascade charges nurse practitioners (ARNPs) 7% with a $500 minimum. Ask what you'd pay in a slow month. Psyquel's billing-only plan has no minimum monthly fee.
• Old unpaid claims. Ask whether claims that were already unpaid when you sign are included, at what rate, and how far back the company will go.
• Statements and reminders. TheraThink lists patient statements as included, and The Bowerbirds includes them in its flat fee. Ask every company whether postage and reminder calls cost extra.
• Clearinghouse and software. TheraThink's $35 monthly fee is its clearinghouse's claims processing fee. Ask every company who pays for the clearinghouse and the billing software.
• Contract terms. TheraThink is month to month, The Bowerbirds says no contracts, cancel anytime, and Psyquel lists no contracts. Ask every company for its notice period in writing.

What an in-house or part-time biller costs

An employed biller costs a wage plus benefits, and the Bureau of Labor Statistics (BLS) publishes both. BLS doesn't track medical billers as a separate occupation. The closest one, billing and posting clerks, had a national median wage of $23.32 an hour in May 2025, or $48,500 a year. BLS counts medical coders under a different occupation, medical records specialists, with a May 2025 median of $24.59 an hour. Benefits come on top of the wage. In June 2026, wages and salaries were 70.0% of private employers' compensation costs, and benefits were the other 30.0%. As an illustration, a full-time biller at the $48,500 median, with benefits in that proportion, would cost about $69,300 a year ($48,500 ÷ 0.70). A part-time biller at 20 hours a week and the median wage earns about $24,250 a year before benefits. Wages in your area may differ from the national median.

Here's how that compares with a percentage fee for a practice that collects $500,000 a year. The collections figure is assumed for the example and isn't a benchmark.

Hire a biller or use a billing company?

Hire a biller when you have steady claim volume, clean intake data, someone to supervise the biller and a plan for cover. Outsource to a billing company when you'd rather pay a percentage or flat fee than manage a person, and your front desk already collects accurate insurance details. The biggest differences are who manages the work, whose insurance contracts the claims use, and what HIPAA paperwork you need.

A freelance biller who works outside your direct control is a business associate under HIPAA, so you need a written agreement before they see client records.

What platforms like Alma charge

Alma charges members a membership fee, listed at $95 a month on an annual plan ($1,140 a year), and says income from cash-pay clients stays with the clinician. It credentials members under Alma's tax ID, even those already credentialed with the same payers, so compare what Alma pays per session after its fee with what your own contracts pay after a billing company's fee. Our guide to Headway, Alma and independence covers both platforms and what changes if you leave.

The jobs next to billing

A biller works from the session record forward, and many claim problems start earlier, at the first call and the intake form. Whichever option you choose, decide who owns these jobs too:

• Eligibility at intake. Someone checks coverage, the deductible and in-network status before the first session.
• Registration data. The client's name, date of birth, member ID and subscriber details have to match the insurer's records.
• Clinician notes. The note has to support the code billed, for example 90837 versus 90834. The clinician decides the code and writes the note.
• Client balances. Copays, deductibles, statements, payment plans, and the call when a client questions a bill.
• Payroll by session. If clinicians are paid per session, someone matches the sessions in the EHR to each payroll run.

How the workload grows with practice size

A therapy practice's billing work grows in step with its clinicians, and so does the cost of a week with nobody filing claims. Take an illustration that assumes 20 insurance sessions per clinician per week, one claim per session and 52 weeks spread over 12 months. A 3-clinician practice then sends about 260 claims a month, an 8-clinician practice about 690 and a 15-clinician practice about 1,300. If we also assume 1 in 10 claims needs follow-up, that's about 26, 69 and 130 follow-ups a month. With 2 new clients per clinician per month, eligibility checks run to 6, 16 and 30. A week with no biller leaves 60, 160 or 300 claims unfiled. None of these figures is market data. Each one follows from the assumptions, so swap in your own caseload to see your numbers.

If you hire a biller

These six steps make the hire safer and keep the practice from depending on one person's memory.

1. Write down the job

   List every step you're handing over, such as charge entry, claim submission, payment posting, denials, appeals, client statements and eligibility checks. Name what stays with you.

2. Ask about mental health billing

   Ask which of your payers they've billed, how they bill 90837 versus 90834, supervised clinicians and telehealth claims, and how they track filing deadlines.

3. Test with real work

   Give them three sample denials or remittances with every client detail removed. Ask what they'd do next and why.

4. Set up access properly

   Give them their own login, never yours. HIPAA's Security Rule requires a unique user ID for each person. Grant only the access the job needs.

5. Sign the right paperwork

   An employee is part of your workforce under HIPAA. A freelancer or company outside your direct control is a business associate, so sign a business associate agreement before they see any client record.

6. Plan for cover and exit

   Keep payer portals and the clearinghouse account in the practice's name. Write down the procedures. Read the aging report yourself every month so a gap shows up early.

Questions to ask before you sign

Put these money questions to every billing company you're considering, and ask for the answers in writing. For questions about the work itself, see how to judge a billing company.

• Does your percentage apply to the allowed amount, to collections or to my full fee?
• What counts as collected? Do copays, deductibles and late payments on old claims count?
• Is there a monthly minimum, and what do I pay in a slow month?
• What does credentialing cost per application, and who tracks each application's status?
• Will you work claims that were already unpaid before we start, and at what rate?
• How much notice do I give to leave, and who finishes the open claims and hands back the data?

Where Cortexa fits

Cortexa publishes this guide. Its Full Service Partner membership puts billing with intake, credentialing and payroll under one team, and its price is in the options table above. See how our billing service works and what it costs.

If you have a biller you trust, keep them. If your front desk and intake run well and you only want claims worked, a billing company from the price table at the top of this guide may be the simpler choice.