Bookkeeping for Psychologists and Psychiatrists
Bookkeeping led by Andrew Pizzello, CPA, for PhD, PsyD, and MD-led private practices. Testing batteries, neuropsych referrals, medication management, forensic and expert work, S-Corp planning, and HIPAA-aware workflows. From $199/mo.
Doctoral and Prescriber Practices Are Not Just Larger Therapy Practices
Psychologists and psychiatrists run economics that look fundamentally different from a master's-level therapy practice. Psychological testing reimburses on hour-based CPT codes (96130-96139) with documentation that takes longer than the testing itself. Psychiatry blends evaluation, medication management, and sometimes therapy, each with different time and reimbursement profiles. Forensic and expert-witness work flows on retainers and hourly billing entirely outside insurance.
Layer in supervision fees, hospital and consult contracts, neuropsych assessment batteries that span multiple sessions, and the increasingly common cash-pay concierge model, and the books most doctoral practices inherit from a generalist bookkeeper miss almost everything that matters for tax planning and partner comp.
We built our workflow around how doctoral and prescriber practices actually operate. Every psychology and psychiatry client gets revenue-stream segregation, supervision and consultation tracking, and HIPAA-aware financial workflows, in an engagement led by Andrew Pizzello, CPA.
Psychologists & Psychiatrists We Serve
PhD and PsyD private practices, on or off insurance panels.
Hour-based testing CPT billing, multi-session batteries, school and forensic referrals.
Medication management, evaluation, and hybrid therapy + meds practices.
Retainer-heavy work outside insurance, with travel and prep time tracked separately.
Multi-clinician shops with associate W-2s, 1099 contractors, and supervisor-supervisee setups.
Out-of-network and self-pay only. Cleaner revenue tracking, simpler reconciliation.
What We Handle That Generic Bookkeepers Miss
Testing CPT Billing Reconciliation
Psychological and neuropsych testing reimburses on time-based 96130-96139 codes. We track billed units against documented time, reconcile against payer EOBs, and surface the gap between testing time and write-up time so you can price honestly.
Multi-Session Battery Revenue Recognition
A neuropsych battery may span an intake, three testing sessions, and a feedback session over six weeks. We recognize revenue properly across the engagement instead of dumping it on the month the last code clears, so monthly P&Ls actually reflect the work.
Forensic and Expert Witness Retainers
Expert work is retainer-funded, and part of a retainer may have to go back if a case settles early. Prep, deposition, travel, and testimony each have different billing rates. We track time against every retainer so you do not accidentally spend client funds you have not earned.
Medication Management vs Therapy Revenue (Psychiatry)
Med management visits and therapy sessions reimburse very differently. Hybrid psychiatrists who do both should know which mix actually pays the bills. We separate the streams so you can schedule with eyes open.
Supervision Fees and Consultation Income
Doctoral clinicians often earn meaningful side income from supervising postdocs, group consultation, and teaching. We segregate this income for cleaner tax planning, especially around QBI optimization on non-clinical revenue.
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
Health and clinical work is SSTB so QBI phases out fast. The S-Corp self-employment tax savings still pencil out for most doctoral practices. We benchmark reasonable comp against BLS psychologist and psychiatrist wage data, with adjustments for forensic and consulting income.
Your Practice Software, Connected
TherapyNotes, SimplePractice, Tebra, AdvancedMD, Valant. We pull the financial data from your EMR into QuickBooks Online cleanly so your EMR is 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 PhD/PsyD/MD, clean books, monthly EOB recon
Testing batteries, supervision income, forensic retainers
Group practices, multi-revenue streams, live dashboard
Common Questions
How do you handle psychological testing revenue?
We track time-based testing CPT codes (96130-96139) against documented hours, reconcile against payer EOBs, and recognize revenue across the assessment battery rather than booking everything on the day the last code clears. This gives you accurate monthly P&Ls and clean tax planning.
Do you handle forensic and expert-witness work?
Yes. We track time against each retainer by activity (prep, deposition, testimony, travel) and keep a running schedule of unearned balances, so you know exactly what you owe back if a case settles early. Your monthly reports stay on the cash basis. How a retainer is taxed depends on your accounting method and the retainer's terms, which is a question for your tax preparer.
Do you offer a Business Associate Agreement?
Yes. Doctoral practices can request a BAA during onboarding. We never access PHI to do bookkeeping. Financial data is segregated from clinical records by design.
Should my doctoral practice elect S-Corp status?
Almost always once profit clears about $100,000 for a solo. Clinical work is SSTB so QBI phases out quickly, but self-employment tax savings on owner draws are significant. We benchmark reasonable comp against BLS doctoral-level wage data and adjust for non-clinical income streams.
I do supervision and group consultation. How do you track that?
We segregate supervision and consultation income from clinical revenue in your chart of accounts. This matters both for tax planning (some non-clinical income can avoid SSTB phaseout) and for understanding what is actually driving your practice economics.
Do you integrate with TherapyNotes, SimplePractice, or Valant?
Yes. We pull billing data from your EMR into QuickBooks Online so your financial picture matches what your clinicians are actually delivering. Your EMR stays the clinical system of record; QBO is the financial system of record.
What if I do both insurance and cash-pay psychiatry?
We separate them in the chart of accounts. Cash-pay psychiatry margins are dramatically different from insurance after write-offs. For hybrid prescribers, this is essential to making smart panel-participation decisions.
What does pricing look like for a solo psychologist or psychiatrist?
Most solo practices start at our $199/mo Starter tier. Practices with heavy testing batteries, forensic work, or multiple revenue streams 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 psychologists & psychiatrists 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 psychologists & psychiatrists). For legal questions, we coordinate with your attorney.
Guides from our blog for psychologists & psychiatrists
Bookkeeping for group therapy practices · Year-end bookkeeping for private practices · Psych testing revenue recognition · Supervisee billing and associate pay splits · W-2 vs 1099 clinicians: how each shows up in your books
Not a psychologist or psychiatrist?
We serve the full private practice ecosystem. Therapists & Counselors, Veterinarians, Optometrists & Ophthalmologists, Nurse Practitioners, Physical Therapists, Audiologists, Nutritionists & Dietitians, Acupuncturists, Speech-Language Pathologists, Dentists, Behavior Analysts (BCBAs), and more.
Books built for doctoral-level practices
Book a free 30-minute consult. Bring a recent month's deposits and a typical testing or evaluation engagement. We'll show you what's clean, what's noisy, and where revenue is hiding.
Book Your Free ConsultOr call us: 855.297.BOOK (2665)