Bookkeeping for BCBAs and ABA Therapy Practices
Bookkeeping led by Andrew Pizzello, CPA, for solo and group BCBA practices. Insurance and Medicaid waiver billing, RBT supervision and comp, parent training, in-home and clinic and telehealth mix, revenue tracked by client state, and S-Corp payroll. From $199/mo.
ABA Practices Have Billing Patterns Almost No Generic Bookkeeper Has Ever Seen
ABA therapy is one of the fastest-growing private-practice categories in the country, and its billing pattern is genuinely complex. Insurance pays under a specific set of CPT codes (97151 to 97158) with state-specific Medicaid waiver overlays, parent-training time billed separately from direct-treatment time, and Registered Behavior Technician supervision time billed under specific ratios. The mix of in-home, clinic-based, and telehealth delivery creates additional documentation requirements and state-tax considerations.
Most generic bookkeepers have never seen any of this. They book deposits as revenue, lump RBT comp into general payroll, and have no visibility into per-client or per-service-line profitability. The result is books that pass an audit but cannot answer the operational questions a growing ABA practice owner asks every week.
We built our workflow around how ABA practices actually operate. Every BCBA client gets service-line revenue tracking (assessment, direct treatment, supervision, parent training), RBT supervision-hour modeling, revenue tracked by client state, payer-by-payer EOB reconciliation, and HIPAA-aware financial workflows, in an engagement led by Andrew Pizzello, CPA.
Behavior Analysts (BCBAs) We Serve
Single-BCBA practices delivering assessment and treatment, often blending insurance and cash-pay families.
Multi-BCBA shops with associate analysts, RBTs, and BCaBA supervision structures.
Practices delivering across settings with the documentation and travel-time tracking that involves.
Multi-state telepractice with state Medicaid waiver and licensure considerations tracked.
Early-intervention, school-consultation, feeding therapy, and specialty BCBA practices.
Out-of-network practices delivering assessment, parent coaching, and consultation outside insurance.
What We Handle That Generic Bookkeepers Miss
Service-Line Revenue Tracking
Assessment (97151/97152), direct treatment (97153/97154), supervision (97155), and parent training (97156/97158) get tracked separately so the practice can see what each service line contributes to the bottom line.
RBT Supervision-Hour Modeling
BCBAs supervise RBTs at specific ratios, and the supervision time is itself billable. We model the supervision-hour math in the chart of accounts so the comp and revenue picture for each BCBA-RBT pairing is auditable.
Insurance and Medicaid Waiver Reconciliation
Commercial insurance and state Medicaid waivers each have their own EOB and adjustment patterns. We reconcile them separately by payer and surface AR aging so problem payers become visible early.
Multi-State Telehealth, Tracked by State
Telehealth-heavy ABA practices often deliver across state lines. We record revenue by client state so it can be reported when it is asked for; whether that creates a filing obligation is a question for your tax preparer, which for our clients is PizzelloCPA, PLLC under a separate engagement.
In-Home Travel Time and Mileage
In-home practices generate real travel time and mileage that are sometimes billable, sometimes reimbursable, and sometimes neither. We track them per service-delivery setting so the cost is visible and the IRS-required mileage logs are clean.
1099 vs W-2 for RBTs and BCaBAs
Long-running, full-time-equivalent RBTs almost always fail the IRS independent contractor test. We help document the working relationship and flag classification risk before it becomes a state labor letter.
HIPAA-Aware Workflows, BAA Available
We never need PHI to do bookkeeping. Financial data is separated from clinical by design, and we sign Business Associate Agreements on request.
S-Corp Election and Reasonable Comp
BCBA services are SSTB so QBI phases out fast. The S-Corp self-employment tax savings still pencil out once profit clears overhead. We benchmark reasonable comp against BLS and BACB compensation survey data with adjustments for the practice owner mix of clinical, supervisory, and administrative work.
Packages Starting at $199/mo
Every package includes a dedicated bookkeeper, monthly reports, and tax-ready books. Surge adds a licensed CPA's review of every deliverable (PizzelloCPA, PLLC).
Solo BCBA, clean books, service-line revenue tracking
RBT supervision modeling, multi-payer recon, multi-state
Group practices, mixed delivery models, live dashboard
Common Questions
How do you handle the 97151-97158 CPT code family?
Each code maps to its own service-line revenue account so assessment, direct treatment, supervision, and parent-training revenue are visible separately. This matters both for operational reporting and for the comp math when you have multiple BCBAs on the team.
How do you handle Medicaid waiver billing?
State Medicaid waiver programs each have their own billing rules and adjustment patterns. We reconcile them as their own payer category and surface AR aging by waiver so practices serving multiple states or counties can see what each program is actually paying.
How do you treat RBT comp and supervision?
We model the supervision-hour math in your chart of accounts. Each BCBA-RBT pairing has its own implicit revenue and comp picture, and we surface the per-pairing margin so hiring and supervision-load decisions are made on real data.
Do you offer a Business Associate Agreement?
Yes. ABA clients can request a BAA during onboarding. We never need PHI to do bookkeeping. Financial data is segregated from clinical records by design.
I deliver in multiple states via telehealth. Is that a tax problem?
It can be. Whether delivering services in another state creates a filing obligation depends on the states involved and is a question for your tax preparer; for our clients that is PizzelloCPA, PLLC under a separate engagement. Our part is making sure revenue can be reported by client state when it is asked for.
Should my BCBA practice elect S-Corp status?
Often, once profit clears about $80,000 for a solo BCBA in private practice. ABA is SSTB so QBI phases out quickly, but self-employment tax savings on owner draws still make sense. We run the analysis during onboarding.
Do you integrate with CentralReach, Rethink Behavioral Health, or Sandata?
Yes. We pull billing data from your ABA practice software into QuickBooks Online so your clinical system stays the system of record for treatment, and QBO is the system of record for finance.
What does pricing look like for a solo BCBA?
Most solo practices start at our $199/mo Starter tier. Group practices, multi-state telepractice, or those running mixed in-home/clinic delivery usually land in Grow ($349/mo) or Surge (custom). Every engagement is led by Andrew Pizzello, CPA, and Surge adds a licensed CPA's review of every deliverable.
Cited authorities and resources
We benchmark our work against primary sources, not opinion. Some of the references we coordinate with for behavior analysts (bcbas) engagements:
- • BLS Occupational Employment & Wage Statistics for reasonable-compensation benchmarks.
- • IRS Form 2553 for S-Corp election timing and eligibility.
- • IRS Section 199A (QBI) guidance for the SSTB phaseout that applies to most private practices.
- • IRS Publication 946 for depreciation, Section 179, and bonus depreciation choices on practice equipment.
- • HHS HIPAA for Professionals for the workflow expectations on practices that touch PHI.
S-Corp planning, reasonable-comp analysis, and tax strategy are performed by our affiliated CPA firm, PizzelloCPA, PLLC, under a separate engagement (see PizzelloCPA’s tax services for behavior analysts (bcbas)). For legal questions, we coordinate with your attorney.
Guides from our blog for behavior analysts (bcbas)
Year-end bookkeeping for private practices · W-2 vs 1099 clinicians: how each shows up in your books · RBT supervision cost modeling
Not in ABA?
We serve the full private practice ecosystem. Therapists & Counselors, Veterinarians, Optometrists & Ophthalmologists, Nurse Practitioners, Physical Therapists, Psychologists & Psychiatrists, Audiologists, Nutritionists & Dietitians, Acupuncturists, Speech-Language Pathologists, Dentists, and more.
Books built for ABA therapy practices
Book a free 30-minute consult. Bring a recent month's deposits and a representative supervision-hour breakdown. We'll show you what service-line tracking would look like on your numbers.
Book Your Free ConsultOr call us: 855.297.BOOK (2665)