How we make this list: we compare pricing pages, product documentation and public user reviews. Rankite is independent; if a vendor ever pays for a featured spot, that listing is clearly labeled Partner.
Key takeaways
- Most therapists do their client billing inside an EHR like SimplePractice or TherapyNotes, so the accounting tool handles the rest: expenses, taxes, and the profit picture.
- Wave, Zoho Books, and ZipBooks all offer genuinely free plans that cover invoicing and basic books for a solo practice.
- QuickBooks Online remains the safest pick if you work with an outside accountant, because nearly every US accountant already uses it.
- Solo practitioners who bill by the session should favor tools with strong invoicing and time tracking: FreshBooks, ZipBooks, and Wave stand out here.
Quick comparison
| Tool | Best for | Starting price | Free plan |
|---|
 QuickBooks Online | Practices working with an outside accountant | $38/mo (Simple Start) | Free trial |
 Xero | Clean, modern books without the Intuit ecosystem | $27/mo (Early) | Free trial (30 days) |
 Wave | Free double-entry accounting for solo practices | Free (Starter plan) | Yes |
 FreshBooks | Session billing and professional invoicing | $23/mo (Lite) | Free trial (30 days) |
 Zoho Books | Most features per dollar on paid plans | Free (free plan) | Yes |
 Sage | Established brand with simple cloud accounting | See website | No |
 Patriot Software | Simple accounting plus payroll in one place | $20/mo (Accounting Basic) | Free trial (30 days) |
 ZipBooks | Time tracking built into the books | Free (Starter plan) | Yes |
Is your product missing or out of date?
We review this list regularly. Vendors can request a listing, send updated pricing or ask about featured placement.
Accounting for a therapy practice
You became a therapist to help people, not to reconcile bank statements at midnight. But a private practice is a business, and the IRS does not grade on clinical skill. Session fees, rent, continuing education, supervision costs, and contractor payments all need tracking, and come tax time someone has to produce clean books. The right accounting software turns that chore into a fifteen-minute weekly habit. The wrong one adds a second unpaid job to your week. This list focuses on what actually matters for therapists: simple invoicing for session fees, expense tracking, tax-ready reports, and a price that makes sense for a solo or small group practice.
Starting price$38/mo (Simple Start)
Free planFree trial
QuickBooks Online is the default choice for a reason: your accountant already knows it. If you hire a CPA or bookkeeper, chances are they work in QuickBooks daily, which means clean handoffs, fewer questions, and lower billable hours at tax time. The Simple Start plan covers income and expense tracking, invoicing for session fees, and the standard profit-and-loss and balance-sheet reports a therapist needs.
The catch is price and complexity. At $38 per month for Simple Start, it costs more than most alternatives here, and the dashboard throws more features at you than a solo practice will ever use. If you run your own books and want simplicity, one of the free options below will feel lighter. If an accountant touches your books, QuickBooks pays for itself in saved professional fees.
What we like- Nearly every US accountant already uses it, so collaboration is easy
- Strong expense categorization and tax reports
- Large integration library
Watch out for- The most expensive starting price on this list
- The interface can feel busy for a simple solo practice
#2
Xero
Best for: Clean, modern books without the Intuit ecosystem
Visit xero.com
Starting price$27/mo (Early)
Free planFree trial (30 days)
Xero is the strongest QuickBooks alternative for a solo practice that wants clean books without the Intuit ecosystem. The interface is calmer and more modern, bank reconciliation is genuinely pleasant, and the Early plan at $27 per month undercuts QuickBooks Simple Start while covering invoicing, bill management, and real-time reports. For a therapist comfortable handling their own books, Xero is arguably the nicer daily experience.
The trade-off is ecosystem. Fewer US accountants live in Xero than in QuickBooks, so if you plan to hand everything to a CPA, confirm yours works with it first. Payroll runs through a partner integration rather than natively. Xero suits the therapist who wants to do their own bookkeeping with minimal fuss and likes software that stays out of the way.
What we like- Clean interface that non-accountants find easy
- Strong bank reconciliation and invoicing
- 30-day free trial to evaluate
Watch out for- Fewer US-based accountants specialize in it than in QuickBooks
- Payroll costs extra through a partner
Starting priceFree (Starter plan)
Free planYes
Wave is the rare genuinely free option that covers real double-entry accounting. The Starter plan costs nothing and includes unlimited invoices and estimates, income and expense tracking, and basic reports. For a solo therapist whose needs are session invoices, expense categories, and a clean profit-and-loss at tax time, the free tier is honestly enough.
Wave makes its money on the Pro plan at $19 per month, which adds automatic bank transaction imports, receipt capture, and late-payment reminders. If you enter transactions by hand without complaint, you may never pay a cent. The honest limitation is growth: practices with employees, contractors, or complex needs will eventually want payroll or deeper reporting, where paid tools pull ahead.
What we like- Real double-entry accounting at no cost on the Starter plan
- Unlimited invoices and estimates
- Simple enough for non-accountants
Watch out for- Automatic bank imports and receipt scanning require the $19/mo Pro plan
- No native payroll in some states
Starting price$23/mo (Lite)
Free planFree trial (30 days)
FreshBooks started life as invoicing software, and it still treats billing as the main event. For a therapist, that is exactly the right priority: professional session invoices, automatic reminders for unpaid balances, and a client portal where clients can view and pay. The Lite plan at $23 per month covers up to 5 billable clients, which fits a small caseload, and time tracking is included if you bill hourly.
Watch the client cap. Once you pass 5 active billable clients, you need Plus at $43 per month, and full double-entry accounting reports also start at Plus. A busy practice can outgrow Lite faster than expected. FreshBooks is the pick for therapists whose biggest pain is getting paid on time rather than categorizing expenses.
What we like- Excellent invoicing with late-payment reminders and client portals
- Time tracking built in
- 30-day free trial
Watch out for- The Lite plan caps billable clients at 5
- Double-entry reports start at the Plus tier
#5
Zoho Books
Best for: Most features per dollar on paid plans
Visit zoho.com
Starting priceFree (free plan)
Free planYes
Zoho Books gives you the most features per dollar once you outgrow the free tier. The free plan covers a solo practice's basics, and the Standard plan at $15 per month adds the automation, workflows, and deeper reporting that cost twice as much elsewhere. With 70-plus reports, recurring invoices, and solid expense management, it punches well above its price.
The downside is density. Zoho packs enormous functionality into every screen, and therapists who want the simplest possible tool may find it busy compared with Wave or ZipBooks. It also shines brightest alongside other Zoho apps. If you want maximum capability for minimum spend and do not mind a learning curve, Zoho Books is hard to beat.
What we like- Free plan plus very affordable paid tiers starting at $15/mo
- Strong automation and 70+ reports
- Good multi-currency support
Watch out for- The interface packs in a lot, which can overwhelm
- Best value shows when you commit to the Zoho ecosystem
#6
Sage
Best for: Established brand with simple cloud accounting
Visit sage.com
Starting priceSee website
Free planNo
Sage is the old guard of small-business accounting, and its cloud product is simpler than its reputation suggests. Sage Accounting covers invoicing, expense tracking, bank reconciliation, and cash-flow management in a clean online interface, with the backing of a vendor that has served small businesses for decades. For a therapist who values stability and a company that will still be around in ten years, that counts.
The friction is transparency. Sage does not publish US small-business pricing as plainly as its rivals, so you will need to talk to sales or start a trial to see numbers. The integration ecosystem is also smaller than QuickBooks or Xero. Sage fits the buyer who prefers an established name and straightforward books over the broadest app marketplace.
What we like- Long-established vendor with a reputation for reliability
- Straightforward cloud accounting for small businesses
- Good reporting
Watch out for- Pricing is not published upfront for the US small-business plans
- Smaller integration ecosystem than QuickBooks or Xero
Starting price$20/mo (Accounting Basic)
Free planFree trial (30 days)
Patriot keeps things deliberately simple: accounting plus payroll from one US-based company. Accounting Basic at $20 per month covers invoicing, expense tracking, and bank reconciliation, and every product comes with a 30-day free trial. If your practice grows to include W-2 employees or regular 1099 contractors, adding Patriot payroll under the same login is easier than stitching together separate vendors.
Patriot will not win on depth. The feature set is narrower than QuickBooks or Xero, and the interface prioritizes clarity over beauty. But the price is honest, support is US-based and free on every tier, and there are no long-term contracts. It suits the therapist who wants one vendor, one login, and books plus payroll without drama.
What we like- Accounting starts at $20/mo with a 30-day free trial
- US-based support included on all tiers
- Easy payroll add-on for practices with staff
Watch out for- Fewer advanced features and integrations than the big platforms
- Interface is functional rather than polished
Starting priceFree (Starter plan)
Free planYes
ZipBooks is the quiet pick for therapists who want time tracking built into their accounting. The free Starter plan includes unlimited invoices, basic reports, and one bank connection, and the Smarter plan at $15 per month adds time tracking, recurring invoices, and multiple bank accounts. Logging session hours and converting them to invoices in one click is exactly the workflow a fee-for-service practice needs.
The caveats are scale. ZipBooks is a smaller vendor, so support resources and third-party integrations are thinner than the giants offer, and the most insightful reports sit behind the $35-per-month Sophisticated tier. For a solo therapist who bills by the hour and wants the simplest path from timesheet to paid invoice, it deserves a look.
What we like- Free Starter plan with unlimited invoices
- Time tracking that flows straight into invoices
- Simple interface for non-accountants
Watch out for- Smaller company with a thinner support bench
- Advanced reporting requires the $35/mo Sophisticated plan
What to check before you buy
Where does client billing actually happen?
Most therapists bill clients and insurers through their EHR or practice management software, not their accounting tool. If that is you, prioritize expense tracking, tax reports, and bank reconciliation over fancy invoicing. If you bill sessions directly, flip that priority and favor FreshBooks, ZipBooks, or Wave.
How will you handle taxes?
Ask whether the tool produces the reports your tax preparer wants: profit and loss, balance sheet, and expense summaries by category. Also check 1099 support if you pay contractors or supervisors. Every tool here handles the basics, but confirming before tax season beats discovering a gap in April.
Who else touches your books?
If an accountant or bookkeeper is involved, ask what they use before you choose. A tool your CPA already knows will save you more in professional fees than any subscription difference. QuickBooks wins this test in the US almost by default.
Do you need payroll?
Solo therapists usually do not, but group practices with employees do. Patriot bundles it most simply, while QuickBooks, Xero, and Wave offer payroll as an add-on or integration. Price the whole stack, not just the accounting subscription.
Keep health information out of your books
Accounting software is not built for protected health information. Use client IDs or invoice numbers rather than names and diagnoses in your bookkeeping, and keep clinical records in your HIPAA-compliant EHR. This separation protects you and keeps your books clean.
Do you still need separate practice management software?
Yes, in almost every case. Accounting tools track the money; they do not schedule appointments, store clinical notes, or submit insurance claims. Your EHR or practice management platform remains the system of record for clients and claims, while the accounting software gives you the business-wide financial picture: total revenue, expenses, profit, and tax readiness. The two should connect through bank feeds or integrations, not duplicate each other. Buy accounting software to run the business side, and let your EHR run the clinical side.
How we chose
We started from the real workflow of a therapy practice: client billing usually lives in the EHR, so we weighted expense tracking, tax reporting, invoicing flexibility, and price for solo and small practices. We read each vendor's product and pricing pages directly: QuickBooks, Xero, Wave, FreshBooks, Zoho Books, Sage, Patriot, and ZipBooks. We checked public documentation for free and trial tiers, payroll options, and 1099 support. We weighed public reviews on G2, Capterra, and Reddit for recurring praise and complaints from service businesses and freelancers. Pricing figures appear only where the vendor publishes them; everything else is marked See website.
Frequently asked questions
Should I use accounting software or just my EHR's billing?
Use both for different jobs. Your EHR handles scheduling, clinical notes, and insurance claims. Accounting software tracks the full business: all income, all expenses, profit, and tax-ready reports. Relying on the EHR alone usually leaves expenses and tax prep as a year-end scramble.
What is the cheapest good option for a solo therapist?
Wave's Starter plan and ZipBooks' Starter plan are both free and cover invoicing plus basic books. Zoho Books also offers a free plan. Any of the three can carry a solo practice; pick based on which interface you find easiest.
Can accounting software handle insurance billing?
Not really. Insurance claim submission and ERA processing belong in your EHR or clearinghouse. What accounting software does well is record the resulting revenue, track outstanding balances in aggregate, and reconcile the deposits that land in your bank account.
How do I track 1099 contractors in these tools?
Most of these tools let you tag vendors as contractors and generate the expense records your tax preparer needs for 1099 filing. FreshBooks, QuickBooks, and Patriot all document contractor workflows; confirm the exact 1099 filing support on the vendor's site before January.
Is my client data safe in accounting software?
Accounting tools are not designed to store protected health information, so do not put it there. Use invoice numbers or client IDs instead of names where possible, and keep all clinical detail in your HIPAA-compliant EHR. Standard bookkeeping data like session fees and expenses is normal business financial data.
When should I hire a bookkeeper instead of doing it myself?
When the books consistently take more than a couple of hours a month, when you dread tax season, or when your practice adds employees. A bookkeeper using QuickBooks or Xero will cost more than software alone but usually pays for itself in caught deductions and saved time.
Sources we checked (8)
- https://quickbooks.intuit.com
- https://www.xero.com/us/
- https://www.waveapps.com
- https://www.freshbooks.com
- https://www.zoho.com/books/
- https://sage.com/
- https://patriotsoftware.com/
- https://zipbooks.com/
Is your product missing or out of date?
We review this list regularly. Vendors can request a listing, send updated pricing or ask about featured placement.
Shihab Mia · Founder, Rankite
Shihab has spent more than a decade helping SaaS and e-commerce brands grow through search. He writes Rankite's software buying guides from pricing pages, documentation and public user reviews. More about Shihab.