Home → Blog

Billing

Billing software for psychologists: superbills, sliding scale and what it costs per month

Superbills, psychotherapy codes, sliding scale, no-show policy and Good Faith Estimates, plus the real monthly bill at one, three and six clinicians.

October 28, 2026 · 13 min read

There are two completely different products sold as psychology billing software, and buying the wrong one costs you either money or months. The first files claims: it holds payer contracts, checks eligibility, sends an 837P through a clearinghouse and works a denial queue. The second takes the money from the client and hands them a superbill they file themselves. If you are out of network, you need the second one, and it should cost between $49 and $130 a month for a solo clinician.

Here are the list prices, read on each vendor's own pricing page on October 28, 2026. For one clinician with an AI note drafter turned on: TherapyNotes Solo $69 plus $40 for TherapyFuel is $109; SimplePractice Starter $49 plus $35 for Note Taker is $84; our Essential plan at $49 plus $20 for the scribe is $69. At three clinicians the same stack is $299 on TherapyNotes, $352 on SimplePractice Plus and $179 on our Clinic plan. Full table, including six clinicians, further down.

Billing insurance and issuing superbills are not the same job

A claims practice needs software that knows about payers. Contracted rates per CPT code per plan, eligibility checks before the session, electronic claim submission, electronic remittance, a worklist for the claims that come back wrong, and secondary billing. That machinery is most of what you pay for in a practice management system, and it is why the serious claims products cost what they cost.

A cash-pay practice needs almost none of it. What it needs is this sequence, every session, with no gaps:

1. The session happens and gets documented.
2. The client pays, at the time of service, by card on file or at the desk.
3. The receipt, the invoice and the superbill all agree with each other on the amount actually paid.
4. The superbill carries the code, the diagnosis, the NPI, the EIN and the place of service, so it survives contact with a claims examiner.

Step 3 sounds trivial and is where most practices leak. If a client on a sliding scale pays $110 against a $185 standard fee and the superbill shows $185, you have handed an insurer a contradiction. If a client bought a block of eight sessions at $1,200 and the superbill shows the walk-in rate, same problem. The document has to come out of the payment record, not out of your fee schedule.

We are the second kind of software, and we say so on the page for psychologists in private practice. There is no clearinghouse here, no eligibility verification, no denial management, and we are not going to add them. If in-network billing is your revenue engine, buy TherapyNotes or SimplePractice and pay what claims software costs. That is a real recommendation, not a disclaimer.

The codes, and who enters them

CPT is copyrighted by the American Medical Association, whose licensing FAQ states that "Any entity using CPT content anywhere worldwide must have a license authorizing the use of CPT code set from the AMA or an authorized distributor" (ama-assn.org). Which is why we do not ship a searchable CPT database and why no honest vendor in this price bracket does either. You enter the codes you bill, once, saved against each service, and they come out on every superbill after that.

The set a psychologist uses is small. San Francisco's published behavioral health code sheet gives the billable time ranges most clinicians argue about (sf.gov):

Code	Description on the published sheet	Billable range for one unit
90791	Psychiatric Diagnostic Evaluation, 60 Min	31 to 67 minutes
90832	Psychotherapy, 30 Min with patient	16 to 37 minutes
90834	Psychotherapy, 45 Min with patient	38 to 52 minutes
90837	Psychotherapy, 60 Min with patient	53 to 67 minutes
90847	Family psychotherapy, with patient present	26 to 57 minutes
90853	Group psychotherapy	23 to 57 minutes
90785	Interactive complexity, add-on	No assigned time

Two notes that save arguments. 90846 is family or couples therapy without the patient present, and 90847 is with the patient present, which is the distinction examiners check. 90785 is an add-on for interactive complexity and never stands alone; neither do 90833, 90836 and 90838, the psychotherapy add-ons that attach to an evaluation and management code and therefore belong to prescribers, not to psychologists.

The practical trap is the 90834 and 90837 boundary. A 48-minute session coded 90837 is an error an insurer can find, and a clinician who writes 90837 by habit for every session is building a pattern. Set the code on the service, let the duration on the appointment match it, and stop deciding it from memory at 7pm.

Sliding scale, properly

A sliding scale is not a discount you remember. It is a rate attached to a client, applied automatically, visible on the invoice and reflected on the superbill. Three things have to be true for it to work without creating compliance problems.

The reduced fee is the fee for that client. Not a courtesy write-off against a higher charge. The amount you charged and the amount you collected should be the same number for that client, documented the same way every time.

The criteria are written down. A one-page policy with the income bands, the documentation you ask for and the review interval. Arbitrary discounting is where practices get into trouble, especially if any part of the practice ever touches a federal program.

The superbill shows what was paid. $110, not $185. Our superbill generator pulls the amount from the payment record for exactly this reason.

Here is what a sliding scale does to a caseload, with my own arithmetic on a 25-session week:

Band	Sessions per week	Fee	Weekly	Annual at 46 weeks
Full fee	16	$185	$2,960	$136,160
Reduced	6	$130	$780	$35,880
Lowest	3	$90	$270	$12,420
Total	25	blended $160	$4,010	$184,460

The blended rate, not the headline rate, is the number to run your practice on. A practice that advertises $185 and blends to $160 has given away $28,750 a year, which may be exactly what you intended. What you cannot do is not know.

Collect at the time of service, or earlier

A weekly therapy client at $150 is worth roughly $7,800 a year. Accounts receivable in a cash practice is almost entirely self-inflicted, and it comes from one decision: billing after the session instead of charging at it.

Three options, in order of how well they work:

1. Card on file, charged when the session is marked complete. Highest collection rate, lowest front desk time. Authorize at intake with the fee and cancellation policy in the same document.
2. Prepayment at online booking. Good for new clients and for anyone who has already no-showed once. A deposit or the full fee holds the slot.
3. Payment link after the session. Works, but it is a chase. Use it as the fallback, not the default.

Our payment handling at the desk, online and by link does all three, and the invoice, the receipt and the superbill come off the same record so they cannot disagree.

[CAPTURA: la ficha de un paciente con tarifa sliding scale propia y el saldo de un bono de sesiones]

No-shows and the cancellation policy that actually holds

Mental health has the structural no-show problem: a recurring weekly slot, an ambivalent client, and a condition whose symptoms include not wanting to leave the house. Studies put the average no-show rate around 5% to 7% when reminders go out and 15% to 20% without them, and the cost of a lost slot in the $150 to $250 range.

Run the numbers on a 25-session week at $160 blended. At a 6% no-show rate you lose 1.5 sessions a week, about $11,000 a year. At 18% you lose 4.5 sessions a week, about $33,000. The difference is reminders and a policy you enforce, and both are cheaper than a single lost month.

What a policy needs to survive a complaint:

• A fee stated in dollars and a notice window stated in hours, signed at intake, not verbally agreed.
• Automatic reminders at a sensible interval with one-tap confirm or cancel, so nobody can say they were not told.
• Documented TCPA consent for text messages, collected in the same intake form. Penalties are commonly cited in the $500 to $1,500 per message range, which makes a checkbox the cheapest insurance in the practice.
• The same rule for everyone, with clinical exceptions you write down when you make them.

One caution specific to this field. A hard late-cancellation fee applied to a client in crisis is a clinical decision as much as a business one, and it belongs in your notes when you waive it. If you want the longer version of the reminder math, we covered it in the write-up on cutting no-shows.

The Good Faith Estimate almost nobody issues

This is the compliance gap in cash-pay mental health, and it is federal. Under the No Surprises Act, a self-pay patient is owed a written Good Faith Estimate of expected charges before the service. Critically, a client who has insurance but chooses not to have a claim submitted counts as self-pay for this purpose, which describes most of an out-of-network caseload.

CMS's model estimate spells out the consequence of getting it wrong: a patient whose bill is "$400 or more for any provider or facility" above the estimate may dispute it, must begin the process "within 120 calendar days (about 4 months) of the date on the original bill," and pays a $25 fee to use it (cms.gov). The model form's fields are the same data as a superbill: patient name and date of birth, diagnosis and diagnosis codes, service or procedure codes, quantity, expected cost per line, a total, and each provider's name, NPI and Taxpayer Identification Number.

The part that trips clinicians up is the diagnosis code on a first appointment. CMS guidance resolves it: "A provider or facility is required to provide a diagnosis code only where one is required for the calculation of the GFE," and providers are not required to include one when no diagnosis has been determined, such as an initial screening visit (cms.gov). So an intake estimate can list 90791 and your fee with no diagnosis code and still be compliant.

For ongoing therapy the practical form is an estimate of a course of care: 90837 weekly for 12 weeks at your fee, with a line saying the frequency may change clinically. Write it once as a template, merge the client's data, deliver it through the portal and keep the signed copy. It is the same information you already hold.

What it costs per month, at 1, 3 and 6 clinicians

List prices, read on each vendor's public pricing page on October 28, 2026, with an AI note drafter included because almost everyone turns it on. Verify them yourself before you buy; SimplePractice was running a 50% discount on the first three months, and promotions move.

Clinicians	TherapyNotes	SimplePractice	DrinCloud
1, no AI	Solo $69	Starter $49	Essential $49
1, with AI	$109 ($69 + $40)	$84 ($49 + $35)	$69 ($49 + $20)
3, with AI	$299 ($79 + $50 x 2 + $40 x 3)	$352 ($99 + $74 x 2 + $35 x 3)	$179 ($119 + $20 x 3)
6, with AI	$569 ($79 + $50 x 5 + $40 x 6)	$679 by list math, but 6+ is a custom quote	$407 ($287 + $20 x 6)

Read the fine print in that table, because the fine print is the point.

TherapyNotes charges $69 for Solo and $79 for the first clinician on Group, plus $50 per additional clinician, with TherapyFuel at $40 per clinician. SimplePractice's Starter plan at $49 does not support additional clinicians at all, so a group practice starts at Plus $99 plus $74 per added practitioner, and its own pricing page says groups of six or more get custom pricing, so treat the $679 as arithmetic rather than a quote. DrinCloud's prices are $49 Essential for one professional, $107 Solo, $119 Clinic for one to three users, $287 Medical Center for four to thirty, all billed annually, with month to month at $59, $128, $143 and $344, and the AI scribe at $20 per clinician. The full breakdown is on our pricing page.

Two honest caveats on our own column. Essential at $49 covers charting, superbills and payments, but the client portal and unlimited video are $10 a month each on that plan, so a solo teletherapy practice is realistically $69 before AI or $107 on the Solo plan where both are included. And there is no free trial: signup is paid, online, about three minutes, and the smallest commitment is one month. Some people will hate that. It is the trade for not having a sales team.

Processing fees are the cost everyone forgets. Jane lists 2.85% plus $0.25 online, SimplePractice lists 3.15% plus $0.30. On $20,000 a month of card volume that spread is roughly $60 a month, which is more than the software for a solo clinician.

Telehealth, licensure and the thing software cannot fix

Video sessions are table stakes now and nobody should be paying per minute for them. Our unlimited video visits are included from the Solo plan up, launched from the appointment, with no separate login.

What software cannot solve is licensure. Treating a client who is physically in another state is governed by that state's board and, for psychologists, usually by PSYPACT participation. The platform will connect the call regardless, which is exactly the problem. Decide the question before the appointment exists, and record the client's location at the start of each session, because place of service 10 on the superbill means the patient was at home and that has to be true.

Frequently asked questions

Can psychology billing software submit claims to insurance for me?

Some can, ours cannot. TherapyNotes and SimplePractice both include claim submission and are the right purchase if you are in network. Our software produces superbills with your NPI, EIN, the CPT and ICD-10 codes you enter and the amount the client actually paid, and the client files the claim. There is no clearinghouse, no eligibility check and no denial queue here.

What is the cheapest billing software for a solo psychologist?

On list prices read on October 28, 2026, the cheapest serious options for a solo clinician were SimplePractice Starter at $49 a month and our Essential plan at $49 a month billed annually, with TherapyNotes Solo at $69. Add an AI note drafter and the order changes: $69 for us, $84 for SimplePractice, $109 for TherapyNotes. Card processing is on top in every case.

Does a sliding scale cause problems with insurance or compliance?

Not if you run it as a published policy with written criteria rather than ad hoc discounts, and if the amount you charge equals the amount you collect for that client. The risk comes from charging one number and collecting another, because the superbill then contradicts your fee schedule. Keep the policy on one page and review it annually.

Do I have to give clients a Good Faith Estimate if they have insurance?

Yes, if they are not having a claim submitted to that insurance. Under the No Surprises Act an insured person who chooses to self-pay is treated as a self-pay individual for this purpose, which covers most out-of-network therapy clients. CMS's model form shows what it has to contain, and the dispute threshold is a bill $400 or more above the estimate within 120 calendar days (cms.gov).

How do I charge for a no-show without arguing about it?

Put the fee in dollars and the notice window in hours in a document the client signs at intake, send automatic reminders with one-tap confirm, keep the texting consent on file, and apply the rule the same way to everyone. Then charge the card on file rather than invoicing after the fact, which is where collection rates collapse.

Is there a free trial of your software?

No. Signup is paid, takes about three minutes online, and the smallest commitment is one month with no setup fee and no contract. We do not run guided sales demos either. You can request access to a demo environment, and data import from Excel or XML is free and run by you, as is full CSV export if you leave. If you want the cost comparison in more detail, read what an EHR really costs a small practice and the superbill guide for therapy practices.

We build practice management software for clinics the patient pays directly, with superbills, sliding scale and unlimited telehealth, from $49 a month. We file no insurance claims, on purpose. See how it works for a psychology practice.

← All articles