What Can a Private Practice Counselor Really Earn per Year?

I came across the following article written by the owner of Thriveworks.  I found it to be insightful, and EXTREMELY optimistic.  I appreciate the optimism and I do believe it is possible to make over $100,000 per year, but as a private practioner myself, here is my perspective on the article...

Let's start with number of sessions per year.  Scheduling 35 clients per week is very doable once you have built up a practice, BUT it is not likely you will actually see 35 clients.  With insurance clients, you will have to require the client to make the full payment if they miss because insurance companies typically do not cover no-shows.  

Next, $80 per session would be a wonderful average, but very unlikely (at least in Texas).  I have a very close friend that runs a highly successful practice and below is what he wrote me about current insurance reimbursements:

Insurances pay based on an “allowable amount”. That allowable amount depends on:
· Type of insurance and plan (for example BCBS may have several different plans that reimburse different amounts for the same services)
· CPT code (the service being performed….ie initial eval, family, individual, etc.)
· Location (geographic location influences the reimbursement rate) the exact same plan, patient, and clinician pays differently in Austin as opposed to smaller markets
· Licensure – LPCs, LMFTs, LCSW, Psychologist all get paid differently
· The contracted amount (if the clinician is contracted individually they may have some leeway to negotiate their contracted reimbursement rate)

The amount can vary greatly across so many factors it is impossible to keep an accurate list….. also they are ever changing!

If you are looking for approximate numbers they are:
An initial evaluation (CPT code 90791) $65 to $100
A 55 min. ind. session (CPT code 90837) $55 to $85

A couple things stand out to me after reading this:

  1. It is complicated!  Trying to figure it out on your own and do your own billing could take up a lot of time and energy.
  2. It's always changing.  What you are paid today could change tomorrow.  Sadly, counseling is the one area of medical billing that has even reduced it's reimbursement rates over the past five years.

Regarding expenses, there are also some areas that I believe are very optimistic on Thrivework's article.  For example, I have never found an office space for $500 per month that would offer that atmosphere that brings high paying clients.  You could probably get a cheap office space for that price, but don't expect to get a lot of private paying clients to walk in the door and pay you $100 per hour if your office is not top notch.  Overall, it's very expensive to run a business.  I would recommend writing a pro forma, listing all business expenses you may incur over a year.  Be realistic and specific.  Try to think of all the different costs you will expect to pay.

What can a private practice counselor really earn in a year?  There is no easy answer.  There are too many variables to give a specific answer.  After talking to many therapists, the general yearly salary seems to range between $50K to $75K, depending on time and effort.

Again, I do believe it's possible to create a profitable practice.  If you are willing to put in the work to market your business, develop a niche market for private pay clients, and keep your expenses low; you can do it.  If you are currently operating a private practice earning over $100K, let me hear from you.  I think other counselors would truly appreciate an opportunity to learn more about how you are growing your practice.