Bookkeeping and Accounting for Physical Therapists
Bookkeeping and accounting for solo and group physical therapy practices, led by Andrew Pizzello, CPA. Insurance, cash-pay, and Medicare tracking, productivity-based comp, equipment depreciation, S-Corp planning, and HIPAA-aware workflows. From $199/mo.
PT Practices Live in Three Reimbursement Worlds at Once
A modern PT practice usually mixes commercial insurance, Medicare Part B, and cash-pay wellness or sports performance work. Each pays differently, writes off differently, and ages on AR differently. Generic bookkeepers see the deposits and book them as one revenue stream, which makes it impossible to know which stream is actually profitable.
Add productivity-based associate comp, package pricing for cash-pay programs, and the new wave of PT-led performance gyms with hybrid revenue, and the books most PTs inherit from a generalist bookkeeper are simply wrong. The numbers might tie. They are still telling you the wrong story about your practice.
We built our workflow around how PT practices actually bill, collect, and pay clinicians. Every PT client gets revenue-stream segregation, productivity-tracking infrastructure, and HIPAA-aware financial workflows, in an engagement led by Andrew Pizzello, CPA.
Physical Therapists We Serve
One-clinician outpatient practices, cash-pay, insurance, or hybrid.
Associate PTs and PTAs, productivity comp, and partner draws done cleanly.
Out-of-network mobility, sports, or pelvic-floor practices on session or package pricing.
Multi-payer EOB reconciliation, write-off tracking, and Medicare cap monitoring.
Multi-state telehealth, with revenue tracked by patient state.
Pelvic floor, vestibular, sports, hand therapy, and pediatric private practices.
What We Handle That Generic Bookkeepers Miss
Cash-Pay vs Insurance Mix Tracking
PT margins are completely different on a $200 cash session and a $98 insurance reimbursement after write-offs. We separate the streams in your chart of accounts so you can price, schedule, and hire with honest data.
Package and Membership Plans, Tracked Until Delivered
Prepaid session packages and monthly memberships are money collected for visits you still owe. Your monthly reports stay on the cash basis, and we keep a running schedule of unused visits, so you always know what you owe in visits or refunds.
EOB Reconciliation and Medicare Cap Tracking
Insurance pays a fraction of what you bill, and Medicare's therapy threshold complicates revenue recognition. We reconcile EOBs against deposits, track contractual adjustments separately, and surface AR aging by payer.
Productivity-Based Associate Comp
Many group practices pay associates on visits, units, or collected revenue. We model the comp formula in your books so payroll math is auditable, partner draws are clean, and the question of which clinician is profitable has a real answer.
Equipment Depreciation
Treatment tables, ultrasound and TENS units, BFR cuffs, force plates, AlterG treadmills. We track depreciation properly, and PizzelloCPA, PLLC, our affiliated CPA firm, handles the Section 179 vs bonus depreciation choice, or we coordinate with your own CPA.
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
PT services are SSTB so the QBI deduction phases out quickly. The S-Corp self-employment tax savings still pencil out for most clinicians once net profit clears overhead. We benchmark reasonable comp against BLS PT wage data, not guesswork.
Your Practice Software, Connected
WebPT, Heno, Prompt, Practice Pro, Raintree, Therabill. We pull the financial data from your EMR into QuickBooks Online cleanly so your EMR stays the system of record for clinical, and QBO is the system of record for finance.
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 PT, clean books, cash-pay/insurance split
Multi-payer EOB recon, prepaid package tracking
Group practices, productivity comp, live dashboard
Common Questions
How do you handle prepaid PT package and membership plans?
We keep a running schedule of each patient's unused visits, updated as visits are redeemed, and your monthly reports stay on the cash basis, so you always know what you still owe. The schedule does not change your taxes: on the cash method most practices use, a package payment is income in the year you receive it (IRS Publication 538). An accrual-method practice may be able to defer part of it to the next tax year, but no further.
Do you separate cash-pay from insurance revenue?
Always. Cash-pay margins look almost nothing like insurance margins after contractual write-offs. For hybrid practices, splitting the streams is essential to making smart pricing and hiring decisions.
Do you offer a Business Associate Agreement?
Yes. PT clients can request a BAA during onboarding. We never need access to PHI to do bookkeeping. Financial data is segregated from clinical records by design.
Should my PT practice elect S-Corp status?
Often, once profit clears about $80,000 for a solo. PT services are SSTB so QBI phases out quickly, but self-employment tax savings on owner draws still pencil out. We benchmark reasonable comp against BLS PT wage data during onboarding.
How do you track productivity-based associate comp?
We model your comp formula (visits, units, or collections) in the chart of accounts and reconcile actual payroll against earned comp every month. If associates are 1099, we also flag classification risk on long-running full-time relationships.
Do you integrate with WebPT, Heno, or Prompt?
Yes. We pull billing data from your EMR into QuickBooks Online so your financial picture matches what your clinicians are actually delivering. No double-entry, no month-end scramble.
I run a hybrid PT and performance gym. How do you handle that?
We split the revenue streams and the cost centers in your chart of accounts so the clinical practice and the gym each have honest margins. Hybrid models are common now, and lumping them together hides which side is funding the other.
What does pricing look like for a solo PT?
Most solo practices start at our $199/mo Starter tier. Practices with heavy insurance billing or productivity-based associate comp 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 physical therapists 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 physical therapists). For legal questions, we coordinate with your attorney.
Guides from our blog for physical therapists
Year-end bookkeeping for private practices · Cash-pay vs insurance economics for PTs
Not a physical therapist?
We serve the full private practice ecosystem. Therapists & Counselors, Veterinarians, Optometrists & Ophthalmologists, Nurse Practitioners, Psychologists & Psychiatrists, Audiologists, Nutritionists & Dietitians, Acupuncturists, Speech-Language Pathologists, Dentists, Behavior Analysts (BCBAs), and more.
Books built for how PT practices actually bill
Book a free 30-minute consult. Bring a recent month's deposits and a typical insurance EOB. We'll show you which revenue stream is actually paying the bills.
Book Your Free ConsultOr call us: 855.297.BOOK (2665)