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

Where Cortexa fits

Cortexa is an operations team for independent therapy practices that runs the front desk, intake, billing, credentialing and payroll as one team. Billing runs about 3% of what you collect, and the front desk, intake and billing together about 6%. There's no long-term contract, and there's a 30-day money-back guarantee.

With Cortexa running billing, collections went from 82% to 97% of billed revenue. On $120,000 billed a month, 15 points is $18,000, three times a 6% fee on $100,000 collected. See whether it pays for itself with your numbers.

What mental health billing companies charge in 2026

The seven mental health billing companies below publish how they charge on their own websites. Six publish a rate, and four charge a percentage. We read each company's pricing, FAQ or home page on September 30, 2026. Companies that quote only on request aren't in this table.

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 monthly income. 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. Psychiatric Billing Associates charges a $300 initial registration fee. 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's pricing page lists $120 per commercial insurance application and $260 for Medicare or Medicaid. Psychiatric Billing Associates charges extra for credentialing help. 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.
• 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 postage. Psychiatric Billing Associates charges extra for postage, envelopes and patient reminder calls. TheraThink lists patient statements as included.
• Clearinghouse and software. Psychiatric Billing Associates says its fee covers clearinghouse fees and software upgrades. Ask every company who pays for these.
• Contract terms. TheraThink is month to month. Psychiatric Billing Associates asks for 30 days' notice to end service. The Bowerbirds says no contracts, cancel anytime. MedStates says no long-term contracts.

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.

What platforms like Alma charge

A platform such as Alma is priced differently from a billing company. It charges members a membership fee, and Alma says the income from cash-pay clients stays with the clinician.

The bigger difference is whose contracts the claims go under. Alma credentials members under Alma's tax ID, and its support center says past credentialing with the same payers doesn't shorten that process. Claims go through the Alma portal. So compare what the platform pays you 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 how both platforms work and what changes if you leave.

Questions to ask before you sign

Put these questions to every billing company you're considering, and ask for the answers in writing.

• 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?
• Who does the work? Is there a named person, and who covers when they're out?
• Will you sign a business associate agreement? If your practice is covered by HIPAA, the rules require a written one before a billing company handles your clients' health information.
• What reports will I get, how often, and can I check a claim's status myself?
• How much notice do I give to leave, and who finishes the open claims and hands back the data?

When Cortexa fits and when a billing company is simpler

We agree the exact scope and rate before you start, and you can start with only the work you need most.

On billing, we file claims after sessions, follow up on pending and denied claims and pursue appeals where appropriate. We also file out-of-network claims on the client's behalf, with no add-on fee. Credentialing is passed through at our actual documented cost, and your contracts stay in your practice's name. It's a billing team that follows every claim until it's paid, and you can check the status of any claim on your dashboard, any time. See how our billing service works.

If your front desk and intake already run well and you only want claims worked, a billing company from the table above may be the simpler choice.