Therapist Estimate Template
A therapist estimate forecasts the price before work starts: 7 lines for a first month of weekly individual therapy for a self-pay client, starting with an intake assessment and including one joint session with a partner, totalling $1,035.00, with services the largest share (93%). It states its assumptions and stays valid for 30 days. Edit the lines and download the PDF.
Pre-filled for a therapist: a first month of weekly individual therapy for a self-pay client, starting with an intake assessment and including one joint session with a partner. Example prices: replace them with your own.
From
Granite Private Therapy
781 Market Street
Salem, MA 01970
billing@example.com
(512) 555-0181
Estimate
Prepared for
Dana Whitfield
14 Elm Street
Springfield, IL 62704
client@example.com
| Description | Qty | Rate | Amount |
|---|---|---|---|
| Intake assessment (CPT 90791)Initial diagnostic evaluation, 60 min | 1 session | $200.00 | $200.00 |
| Individual psychotherapy, 45 min (CPT 90834) | 3 session | $150.00 | $450.00 |
| Joint session with partner present (CPT 90847)50 min | 1 session | $170.00 | $170.00 |
| Late cancellation, under 24 hours' notice | 1 each | $75.00 | $75.00 |
| Between-session phone consultationBilled after the first 10 minutes | 2 15 min | $40.00 | $80.00 |
| Treatment summary letter to client's physician | 1 each | $60.00 | $60.00 |
| Superbill for out-of-network claim | 1 each | $0.00 | $0.00 |
- Subtotal
- $1,035.00
- Estimate total
- $1,035.00
Notes
For self-pay clients a therapist's estimate is usually the Good Faith Estimate: the expected number of sessions, the code and fee for each, and the period it covers.
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Therapist estimate at a glance
| Scope estimated | A first month of weekly individual therapy for a self-pay client, starting with an intake assessment and including one joint session with a partner |
|---|---|
| Estimate total | $1,035.00 before tax |
| Valid for | 30 days from the estimate date |
| Services (5 lines) | $960.00, 93% |
| Fees (2 lines) | $75.00, 7% |
| Priced in | session |
Estimate breakdown for a first month of weekly individual therapy for a self-pay client, starting with an intake assessment and including one joint session with a partner
| Item | Type | Est. quantity | Est. amount |
|---|---|---|---|
| Intake assessment (CPT 90791) | Services | 1 session | $200.00 |
| Individual psychotherapy, 45 min (CPT 90834) | Services | 3 session | $450.00 |
| Joint session with partner present (CPT 90847) | Services | 1 session | $170.00 |
| Late cancellation, under 24 hours' notice | Fees | 1 each | $75.00 |
| Between-session phone consultation | Services | 2 15 min | $80.00 |
| Treatment summary letter to client's physician | Services | 1 each | $60.00 |
| Superbill for out-of-network claim | Fees | 1 each | $0.00 |
| Estimated total | $1,035.00 |
What to write on a therapist estimate
For self-pay clients a therapist's estimate is usually the Good Faith Estimate: the expected number of sessions, the code and fee for each, and the period it covers.
This estimate has no material lines: 0% of it is labour, so the hours are the number to explain.
Charges a set fee per clinical session of a fixed length, often 45 to 53 minutes, collected per session or monthly, with a sliding scale offered to some clients.
Assumptions behind each line
Write these next to the 7 lines so the customer sees what the $1,035.00 depends on.
- Intake assessment (CPT 90791): 1 session, $200.00.
- Individual psychotherapy, 45 min (CPT 90834): 3 session, $450.00.
- Joint session with partner present (CPT 90847): 1 session, $170.00.
- Late cancellation, under 24 hours' notice: a flat $75.00.
- Between-session phone consultation: 2 15 min, $80.00.
- Treatment summary letter to client's physician: 1 each, $60.00.
- Superbill for out-of-network claim: a flat $0.00.
Changes, overruns and change orders
If the customer adds work, put it on a signed change order first. Pricing the extra in session keeps it comparable with the $1,035.00 you estimated.
Tips from psychotherapy billing
- When clients seek out-of-network reimbursement, turn the invoice into a superbill: each date of service, the CPT code and session minutes, the ICD-10 diagnosis code, your NPI and license number, and the practice tax ID.
- Choose the psychotherapy code by actual face-to-face minutes (90832 for about 30, 90834 for about 45, 90837 for 53 or more) and print the minutes next to it, because insurers compare the code with documented time.
- US clients who are uninsured or paying out of pocket are entitled to a Good Faith Estimate of expected charges under the No Surprises Act, so keep the fees on your invoices consistent with the estimate given at intake.
- Keep therapy invoices sparse: a date, a service code and a fee are enough, and nothing about session content belongs on a bill that a partner or employer might open.
Turning the therapist estimate into an invoice
-
Get it approved
Ask Dana Whitfield to sign or reply in writing to estimate EST-7578.
-
Record the changes
Update quantities to what was actually used across the 7 lines.
-
Switch the document type
Change Estimate to Invoice in the tool; the lines and parties stay.
-
Deduct what was paid
Enter any deposit as amount paid so the balance due is correct.
Frequently asked questions
How do I write a therapist estimate?
Describe the job (A first month of weekly individual therapy for a self-pay client, starting with an intake assessment and including one joint session with a partner), list each line with an estimated quantity and rate, total it ($1,035.00 in the sample), state how long it is valid and what it assumes, then send it as a PDF for approval.
Is a therapist estimate binding?
An estimate is a forecast, not a fixed price, so the final invoice can differ when the work or materials change. Rules vary by country and state; to stay safe, get written approval before billing noticeably more than the $1,035.00 you estimated.
How long should a therapist estimate be valid?
Thirty days is common and is what this template uses. With little material cost, a longer validity is usually safe.