Getting paid · California
What a session is worth, and who actually pays it.
53 guides on the money side of the caseload: what insurance really reimburses per code, what the platforms keep, how long a panel takes to open, and the paperwork a private-pay client is owed.
See what a session actually pays →Three decisions sit under everything here. What to charge. Whether to take insurance at all, and if so whether to hold the contracts yourself or let a network hold them for you. And what paperwork you owe the clients who pay you directly, which in California is most of them.
What this section can settle: the arithmetic, and the difference between a published rate and a rumor. Medicare pays a California LMFT 75% of the physician fee schedule, which is $134.47 for a 60-minute session in Los Angeles, and every commercial rate in the state is quoted against that number. What it cannot settle is your own contracted rate, because those are confidential — and no network publishes a California per-session figure, whatever their marketing implies. Where a number is unknowable, these pages say so rather than guessing.
39 pages, in 8 sections: Model the whole practice · Start with the insurance decision · What the work is worth · Getting on a panel, or not · The paperwork · Business structure and California tax · Retirement, deductions and estimated payments · Modeling the payer mix. Every figure below is computed or cited, and links to the page that carries it.
Key insights
$1.24 a session
All four routes priced at three caseloads, with the crossover
What you should know about this figure
This figure comes from Headway, Alma, Grow — or my own contracts?, on the 2026 Medicare and Medi-Cal fee schedules and the platforms' own published terms. Your own number will differ — the page shows the working and, where there is a calculator, runs it on your figures.
$41,234 a year
Medicare and Medi-Cal computed, and the truth about commercial rates
What you should know about this figure
This figure comes from What does insurance actually pay per session?, on the 2026 Medicare and Medi-Cal fee schedules and the platforms' own published terms. Your own number will differ — the page shows the working and, where there is a calculator, runs it on your figures.
$106–132 insurance against $180–350 Bay Area private pay
Panel rates and private-pay ranges by region, and what moves yours
What you should know about this figure
This figure comes from What should I be charging?, on the 2026 Medicare and Medi-Cal fee schedules and the platforms' own published terms. Your own number will differ — the page shows the working and, where there is a calculator, runs it on your figures.
Insurance & pay tools
Model the whole practice
Start with the insurance decision
What the work is worth
Getting on a panel, or not
The paperwork
Business structure and California tax
Retirement, deductions and estimated payments
Modeling the payer mix
The other four areas
How therapists get paid, in four answers
The short version of the guides below. Reviewed 10 October 2026.
How do therapists get paid?
Four ways, and most California practices mix them. A client pays your fee directly (self-pay); an insurer pays a contracted rate after you submit a claim; a network such as Headway, Alma or Grow Therapy bills the insurer for you; or an employer pays a salary or an hourly wage. What to charge · Headway vs Alma vs Grow Therapy · A W-2 job against private practice
How much does insurance pay a therapist per session?
Medicare and Medi-Cal publish their rates to the cent. Commercial payers and the networks do not publish theirs at all, so the only other numbers are the contracts therapists are offered and what they report being paid. Every published rate, by code · Check an offer you have been sent
How do Headway, Alma and Grow Therapy pay therapists?
Headway and Grow Therapy sit between you and the insurer, pay you a rate per session, and keep a share of the reimbursement that neither publishes. Alma charges a published membership and takes no percentage of a session. Which costs less depends on how many sessions a week you hold. The three priced side by side
Can a private-pay client get reimbursed by their insurance?
Often, through out-of-network benefits. You give the client a superbill, an itemized receipt formatted so they can send it to their own insurer, and the insurer reimburses the client, not you. Make a superbill · Estimate what the client gets back
Insurance pays $106 to $132 a session where Bay Area private pay runs $180 to $350. That gap decides everything else.
Nine guides on what each code actually reimburses, what the platforms keep, how long a panel takes to open, and the paperwork a private-pay client is owed.
