One clinician and one week of hours: what each payer pays for an hour, and the few habits that keep a solo practice whole.
A practice starts with the state license, malpractice insurance, a practice-management system with a secure way to see clients by video, and contracts with the payers you will take. Credentialing with an insurer can take months, so start it before the first client. The first clients come from colleagues, physicians, directories and the panels themselves.
The week fills from referrals and panels. The habits that count now: a written cancellation policy every client signs, insurance checked before the first session, notes finished the same day, and a calendar that keeps room for testing, supervision and your own time off.
Once the week is full, more hours aren't how the practice grows; what each hour pays is. That means raising your self-pay fee, renegotiating or closing low-paying panels to new clients, and adding work your training covers, such as psychological testing. The number to watch is what a session pays, payer by payer.
Past one person's week the choices are a group practice with associates, supervision and consultation, workshops and teaching, or a narrower niche at a higher fee. Each changes the job: a group practice makes you an employer and a supervisor, with payroll, liability and other clinicians' notes to answer for.
| Revenue stream | Pays | Scales |
|---|---|---|
| Individual psychotherapy Most of the practice, billed by time: 90837 for 53 minutes or more, 90834 for 38 to 52. The same hour pays very different amounts depending on who pays for it. | By the session, at each payer's rate | Your hours |
| Intake evaluations 90791, the first session. A practice that keeps clients a long time does fewer of them; short-term work does more. | Once per client, at a higher rate | Follows new clients |
| Couples and family sessions Billed under their own code (90847 with the client present). Check each plan's rules for them before the first session. | By the session | Your hours |
| Psychological testing Assessments for ADHD, learning, memory and diagnosis: hours of testing, scoring and a written report, often self-pay. It's the work that sets a psychologist apart from other therapists. | By the evaluation | Good, in blocks |
| Self-pay and out-of-network No contract sets the rate, and clients can claim out-of-network benefits with the statement you give them. Every uninsured or self-pay client is owed a good-faith estimate before care. | Your full fee | Depends on demand |
| EAP referrals Employee assistance programs pay a set fee for a handful of sessions. They bring new clients; they don't fill a week. | A flat fee for a few sessions | A door in, not a business |
| Supervision, consultation and teaching Supervising early-career clinicians, consulting to schools and employers, workshops. Time away from the client week that still pays. | By the hour or the event | Good later |
Psychology is licensed by each state, and a video session follows the client: someone sitting in another state needs you licensed there, or authorized under PSYPACT in a member state (Alaska passed its law to join in June 2026). Under HIPAA, psychotherapy notes need the client's written authorization for almost any disclosure. The No Surprises Act requires a good-faith estimate for uninsured and self-pay clients. Each payer contract sets your rates, whether you may charge clients for missed sessions, and the notice needed to leave the panel or close it to new clients; whatever you decide, keep current clients' care uninterrupted. This is general information, not legal, tax or clinical advice.
Run this against real numbers → The same handbook inside the tool, on a worked example you can swap for your own spreadsheet. Free, no account.Figures are sourced from published industry research (IBISWorld, trade associations and regulator data) and are stated with their year. They describe typical conditions, not your situation. This is general information for business owners, not financial, tax, or legal advice.