Chances are you are MUCH better at the therapy side of your business than the business side of your therapy. But we all need to set and establish ethical fees and collection policies in order to thrive financially.

Today’s article answers six of your most frequently-asked questions about fees. While it was inspired by attorney Richard Leslie’s post in the November 2025 CPH Insurance Avoiding Liability Bulletin, I’ve added additional topics, and lots of my own thoughts, comments and resources.

• “How do I set my fee?” Generally, you should set a “full fee” – your normal, regular, maximum fee – for each service that you provide. You may want to take into account what other professionals in your area charge, or you may intentionally charge a bit less in order to attract clients. Another way to set fees is to figure how much income you want to bring in weekly after expenses, and divide it by how many clients you want to have weekly.

Leslie advises that you should consider how often you will increase fees,and whether you will increase fees only for new clients or for existing clients. I’d advise that you should also give ample notice of any increase, to allow clients time to budget for the change, or to get referrals if they cannot continue with you due to the increase.

• “Is it ethical to offer a sliding scale fee?” Some therapists mistakenly think that reducing (or “sliding”) their fees is unethical. However, you CAN offer sliding scale fees if you apply a clear, fair, and consistent policy for all clients.

In fact, the American Counseling Association (ACA) Code of Ethics states, “if a counselor’s usual fees create undue hardship for the client, the counselor may adjust fees, when legally permissible (see Code A.10.c). The National Association of Social Workers (NASW) code of ethics states, “when setting fees, social workers should ensure that the fees are fair, reasonable, and commensurate with the services performed. Consideration should be given to clients’ ability to pay” (NASW Code 1.13 a).

Legal experts I have consulted state that you may lower your fee simply based on a client’s stated inability to pay – there’s no requirement to ask for proof. In fact, one attorney advised against asking for documents like tax returns or income attestations, since such requests can invade privacy or prompt clients to misstate their income or even falsify documents.

If you bill insurance for a reduced-rate session, be sure you only bill the amount the client actually paid – not your standard full fee (or put your full fee but indicate the reduced fee discount).

While you can slide your fee down from your normal fee, Leslie also reminds clinicians to “make sure that you are not sliding your fee UP [i.e. higher than your normal rate] when you discover that there is insurance coverage.”

• “What about fees with clients seeking insurance reimbursement?” Network providers may collect no more than the “contracted rate” for the service, as is outlined in your plan’s fee schedule. You can’t charge the client the difference between your contracted rate with the health plan and your normal fee – collect only their copayment or coinsurance and any deductible. In general, you cannot slide or waive fees. During the deductible period, collect only your contracted rate from the client for each session – not your full fee.

If you are NOT a network provider, you are free to charge your full fee or to slide your fee. If the client has out-of-network benefits, you may give the client a superbill to seek reimbursement from the plan, but be sure you reflect the accurate amount the client paid, and be sure you collect that amount – you cannot generally waive any portion of a fee for which you have already billed insurance. If you offer clients a sliding scale fee, the superbill should reflect what they paid – not your regular fee, unless you also indicate the discount given (for more on this topic, see my webinar “What Out-Of-Network Therapists Should Know About Billing”).

• “What must I tell clients about my fees?” It is “best practice” (and may be legally and ethically required) to disclose all fees to clients before any service is performed. Leslie gives one example: “In California, one statute makes it unprofessional conduct if the practitioner fails to disclose, prior to the commencement of treatment, the fee to be charged for the professional services, or the basis upon which that fee will be computed.”
• “Can I charge for missed sessions, and if so, how much?” For self-pay clients, you can set any fee for missed sessions, as long as clients have been informed of your fee in advance. For insurance clients, most insurance plans and Employee Assistance Programs (EAPs) will not pay for missed sessions, though a few EAPs might. While it is true that some provider contracts and Employee Assistance Programs will NOT allow you to charge the client for a missed session, in my experience most plans allow this if the client has agreed in writing to this policy in advance.

There is ongoing debate online about whether therapists can bill insurance clients their full fee for a missed appointment, or if they are required to charge only the insurance contracted rate. Unfortunately, it isn’t always spelled out in our provider contracts. Some insurance industry leaders I’ve spoken with believe providers should stick to the contracted rate. Their view is that network agreements set the contracted session fee for their members, and thus therapists cannot charge clients more than what they would have received had the appointment taken place. However, many therapists argue that because a missed session isn’t covered by insurance, the contract terms should not apply. Check your contract. While I was practicing, I chose to charge the contracted rate for missed sessions. Other therapists I know charge a reduced flat fee (ex. $50) for missed sessions, feeling the client deserved a discount since they did not get the benefit of the sessions.

But here’s the catch: While most therapists have a policy stating they will charge for missed sessions, for a host of reasons, they often waive the fee, leading to thousands of dollars each year in lost income. I strongly recommend that this year, you vow to collect more often for missed sessions – read my article here about this whole topic.

• “Can I pay for referrals, or split fees?” According to Leslie, “it is typically unlawful for a health practitioner to pay for referrals or to give a portion of the fee to an unlicensed person who made the referral or to someone who is licensed but has performed no service other than making the referral. Laws in the various states may differ in fine nuance, but this general principle is well accepted.” Most major professional association ethics codes clearly mention these practices as unethical (see APA Ethics Codes 6.07, AAMFT 8.1, NASW 1.13c and 1.16c).

So what if your client is building up a big balance? Or refuses to pay? Or can’t pay? Can you refer the client to collections? Should you pursue them? Can you ethically end treatment? I’ll address all these questions in Part 2 of this article in my next newsletter. Subscribe here

Article Resources:

• November 2025 CPH Insurance Avoiding Liability Bulletin
• AAMFT Code of Ethics
• ACA Code of Ethics
• APA Code of Ethics
• NASW Code of Ethics