Private Practice Break-Even Calculator for Therapists

To find how many visits your practice needs to break even, divide your monthly fixed costs by what each completed visit leaves after its own costs: the amount you actually collect per visit minus the per-visit expenses. That gives completed visits per month. Divide by your working weeks to get a weekly number, then scale it up for cancellations to see how many visits you have to schedule.

The calculator below does that for two scenarios side by side, starting as "Insurance" and "Cash pay" with illustrative example values. Replace them with your own numbers. It shows break-even visits per week and per month, your monthly surplus or shortfall at your current schedule, the payment per visit you'd need, and an owner-pay target kept separate from operating break-even. Nothing you enter leaves the page.

The break-even formula in plain words

Three numbers drive the answer:

1. Fixed costs per month. What you pay whether you see one patient or a hundred: rent, staff salaries, EHR and scheduling software, liability insurance, a billing service on a flat fee, loan payments.
2. Cost per completed visit. What each visit adds: supplies, linens, a billing service's percentage, card processing, per-visit platform fees. Leave out anything already in fixed costs so it isn't counted twice.
3. Collected per completed visit. The average money that actually arrives for a visit, after payer adjustments, denials, write-offs and patient balances you never collect.

Collected minus cost per visit is each visit's contribution. Fixed costs divided by contribution is the number of completed visits a month that covers everything. Working weeks turn that into a weekly target, and your cancellation rate turns completed visits into scheduled ones.

A worked example

These numbers are illustrative, chosen to be easy to follow, not typical or recommended values. A solo therapy practice with:

1. Contribution per visit: $90 − $10 = $80.
2. Break-even completed visits per month: $12,000 ÷ $80 = 150.
3. Per working week: 150 × 12 ÷ 48 = 37.5, so 38 completed visits.
4. Scheduled, with 10% cancelling: 37.5 ÷ 0.9 = 41.7, so 42 scheduled visits a week. That fits in 45 slots.
5. At the full schedule: 45 × 0.9 × 48 ÷ 12 = 162 completed visits a month, $14,580 collected, and a surplus of 162 × $80 − $12,000 = $960 a month.
6. Payment needed per visit at that schedule: $10 + $12,000 ÷ 162 = about $84.

Now add an illustrative owner-pay target of $8,000 a month. The target becomes $20,000 ÷ $80 = 250 completed visits a month, or 63 a week and 70 scheduled. That's more than the 45 slots available, so at these assumptions the practice covers its costs but not that owner pay. The fix is a higher collected amount (about $133 a visit at 162 visits), more capacity, lower costs, or a smaller target. The calculator flags any target that exceeds your weekly slots.

Collected revenue isn't billed charges or the fee schedule amount

The input that most often makes a break-even estimate wrong is payment per visit. Three different numbers get confused:

A Medicare reference amount can help you sanity-check an insurance assumption, but it isn't expected collections: a visit is several codes with reductions, patients owe coinsurance you may not collect, and commercial plans pay their own contracted rates. To see Medicare reference amounts by code, use the physical therapy fee schedule, behavioral health fee schedule or primary care fee schedule; to compare a contract with Medicare, use the contract check. For PT visits, the therapy MPPR calculator shows how much a multi-unit visit is reduced. The best source for the collected number is your own deposits divided by completed visits over several months.

What counts as a fixed cost and what counts per visit

Sort each expense by one question: does it change when you see one more patient?

• Fixed: rent and utilities, salaried or hourly staff on a set schedule, software subscriptions, professional liability insurance, licensing and continuing education, marketing retainers, equipment leases and loan payments.
• Per visit: clinical supplies, a percentage-based billing service, card processing fees, per-session telehealth or scheduling fees, contractor clinicians paid per visit.
• Owner pay: keep it out of fixed costs and enter it as the owner-pay target, so you can see operating break-even and the target separately.

Insurance usually adds costs a cash practice doesn't have, such as a billing service, eligibility checks and more front-desk time. Put those in the insurance scenario only, so the comparison is fair.

Cancellations and no-shows

The calculator assumes a cancelled slot isn't refilled and earns nothing. That's why it reports both completed and scheduled visits: with a 10% cancellation rate you schedule about 11% more visits than you need to complete, and at 20% you schedule 25% more. If you charge a late-cancellation fee you actually collect, you can lower the rate you enter; don't assume fees you rarely collect.

Cash pay vs insurance: comparing your own scenarios

The two scenarios are only labels. They don't contain market rates, and the right numbers for your area and specialty are yours to enter. A useful comparison changes everything that really differs: collected per visit, per-visit costs, fixed costs (billing staff, software) and how many slots you expect to fill. A cash practice often needs fewer visits per week to break even but may fill fewer slots; an insurance practice may fill more slots at a lower collected amount. Put both in and read the break-even visits and monthly surplus side by side.

Use the sensitivity grid before you decide

Under the scenarios, the grid shows the monthly surplus or shortfall as payment per visit and weekly slots each move 10% and 20% up or down. Read it for robustness: if a 10% drop in collections or a quieter month turns the surplus negative, your plan has little margin. Switch the grid between scenarios to see which one holds up better. Copy the results or print them to share with a partner or accountant.

This is a planning calculation, not accounting, tax or payroll advice. It doesn't model taxes, retirement contributions, benefits, debt principal schedules or seasonality; talk to an accountant for those.

Need a sheet built around your codes and contracts?

The weakest input in most break-even plans is the payment per visit. If you want the codes you bill priced at your locality with your payers' rates beside Medicare's, you can request a custom fee sheet. Tell us your codes, location and the dates you need; we confirm the details and prepare it. It's a reference schedule, not a forecast of collections, and it's handled as a request, not an upload or an automated contract analysis.

FAQ

How many clients do I need to break even in private practice?

Divide your monthly fixed costs by what each session collects minus its per-session costs. With illustrative fixed costs of $12,000 and $80 left from each session, that's 150 completed sessions a month, about 38 a week over 48 working weeks, before cancellations. Your own numbers will differ; enter them in the calculator.

What is the typical caseload for a private practice therapist?

It varies too much by profession, payer mix and session length to give one number. Work backward instead: the calculator shows the weekly caseload your costs and owner-pay target require, and whether it fits the slots you can offer.

How do you calculate break-even for a medical practice?

Use the same formula: fixed monthly costs ÷ (collected revenue per visit − variable cost per visit) = visits per month. Use collected revenue, not charges, and add a separate target for owner pay.

Is cash pay or insurance better for a private practice?

It depends on what you collect, what each model costs to run and how many slots each fills. Enter both as scenarios with your own assumptions and compare the break-even visits, monthly surplus and the sensitivity grid. The calculator doesn't supply market rates.

Should owner salary be included in break-even?

Show it separately. Operating break-even with no owner pay tells you when the practice stops losing money; the owner-pay target tells you what it takes to pay you. The calculator keeps both, before personal tax.

Related: physical therapy fee schedule, behavioral health fee schedule, contract check, and 8-minute rule calculator.