Sliding Fee Schedule for Therapists: An Example to Copy

Search for "sliding fee schedule" and most of what you find is community health centers explaining their discount programs to patients. This guide is for the other side of the desk: a therapist in solo private practice who wants a sliding scale that is fair to clients and still keeps the practice open. You'll get two example schedules you can copy (income bands, or a few set fees the client chooses), the arithmetic for how many reduced-fee places you can afford, a client agreement, the legal checks (Good Faith Estimates, insurance contracts, Medicare and Medicaid), what the ACA, APA and NASW codes say, and words for the money conversation.

Every session fee in this article is invented for the examples, and so is the practice they belong to. Use your own numbers. The income limits are real: they come from the 2026 HHS poverty guidelines, cited below.

What a sliding fee schedule is, and why yours isn't a health center's

A sliding fee schedule is a short written document with two parts: the fees you charge at different levels of ability to pay, and the rules for who pays which fee. Most pages that rank for the term belong to community health centers because federally funded health centers are required to have one.

Their rules are worth knowing, because they are a tested model. HRSA's Health Center Program says a health center "must operate in a manner such that no patient shall be denied service due to an individual's inability to pay." Its discount schedule must give a full discount at or below 100% of the federal poverty guidelines (a small nominal charge is allowed), partial discounts between 101% and 200% in at least three steps, and no discount above 200%. The policy must be adopted by the health center's board, applied the same way to every patient, and evaluated at least every three years (HRSA Health Center Program Compliance Manual, chapter 9).

Those rules come with HRSA's funding, so they don't bind a private practice. As a solo therapist you decide whether to offer a sliding scale at all, what the fees are, who qualifies and how many places you keep. What does limit you:

Each one has its own section below. From the health center model, borrow three ideas: base eligibility on household income and household size, write the policy down, and review it on a schedule.

Start with two numbers: your full fee and your floor

Your full fee is what most of your self-pay clients pay. A sliding scale slides down from it, so set it first, from what licensed therapists with your training charge locally and what your practice has to earn. The worksheet in our guide to becoming a private practice therapist walks through that.

Your floor is the lowest fee you'll accept for a session. Check it two ways:

Your tiers sit between those two numbers.

Two ways to set the tiers

Income bands tied to household size

The client tells you their household income and how many people it supports, and the band they fall in sets the fee. To make household size count, define each band as a multiple of the HHS poverty guideline, the way health centers do. For 2026 the guideline for the 48 contiguous states and Washington, DC is $15,960 for one person, plus $5,680 for each additional person; Alaska and Hawaii have higher figures (HHS ASPE, 2026 poverty guidelines). HHS publishes new figures early each year, so update your schedule when it does.

A few set fees the client chooses

You publish two to four fees with a plain description of who each one is for, and the client picks. No income figures change hands.

Other ways to lower the cost

A scale isn't the only tool. The same APA Monitor piece collects several from practicing psychologists: sessions every other week instead of weekly, shorter sessions, a payment plan, group sessions, or a referral to a community clinic or university training clinic when you can't go low enough. Whatever you offer has to be clinically sound for that client. A less frequent schedule is a fair answer to a money problem only if it's also a reasonable treatment plan.

Which structure fits your practice

Sliding fee schedule example: two versions to copy

Both versions use the same invented practice: a solo therapist whose full fee is $150 for a 50-minute session. Replace the fees with your own full fee, floor and tiers.

Example 1: a therapy sliding scale by household income

This one doubles as a sliding scale fee chart by household size. The income limits are the 2026 HHS poverty guidelines for the 48 contiguous states and DC, multiplied by 2, 3 and 4.

Example 2: three fees the client chooses

How many reduced-fee places can you afford?

The cap keeps a sliding scale sustainable. Work it out from money, not from a percentage you read somewhere. Here is the invented practice from Example 1:

What the numbers show:

Put it in writing: your policy and the client's agreement

The schedule above is also your policy: it says who qualifies, how the tier is set, how many places you keep and when fees are reviewed. Date each version and keep the old ones, so you can show which rule applied when.

Each client on the scale also signs a short agreement. Keep it with their intake paperwork, and mention the sliding scale in your informed consent. The informed consent template has a fees section with a line for it.

What to keep in each client's record

The legal checks before you offer it

This section covers federal rules and common contract terms. Your state may add its own, so read it with your contracts in front of you, and ask a health care attorney about anything that doesn't fit your situation.

Good Faith Estimates for self-pay clients

Under the No Surprises Act rules, a self-pay client is someone with no coverage for the service, or someone with private coverage who chooses not to have a claim submitted (45 CFR 149.610). Nearly every sliding scale client is in that group. What the rule asks of you:

The estimate also lists the client's name and date of birth, the service, applicable diagnosis codes and expected service codes, your NPI and Tax ID, where the service takes place, and several required disclaimers; the full list is in section 149.610(c). CMS's provider requirements page has training slides on the estimate and the dispute process.

In-network clients: read your insurance contracts

If you're in network with a plan, your contract sets what you collect for a covered session: the plan's payment plus the member's copay, coinsurance or deductible. Private payer contracts generally require you to collect that cost share, and failing to collect it without the payer's express agreement would violate the contract's terms (Holland & Hart, "Waiving Copays and Deductibles"). In 2009, APA's legal staff said most insurers don't allow waived copays or deductibles, and suggested asking the insurer to waive them for specific clients (APA Monitor).

In practice:

Clients with Medicare or Medicaid

Federal programs have their own rules, and CMS notes that the No Surprises Act requirements don't apply to people with Medicare or Medicaid coverage, which have other protections (CMS, provider requirements and resources). Since January 1, 2024, marriage and family therapists and mental health counselors can bill Medicare, so this now reaches more therapists than it used to (CMS, Marriage and Family Therapists and Mental Health Counselors).

The HHS Office of Inspector General's guidance is direct. Where Medicare and Medicaid require patients to pay copays, you are generally required to collect them; routinely waiving them could implicate the Anti-Kickback Statute; and you may not advertise that you'll forgive them. You may waive a copay after an individual determination that the patient can't afford it, or after reasonable collection efforts fail. OIG adds that discounted services for uninsured people are legal (OIG, Fraud and Abuse Laws). The statute's exception says the same: the waiver isn't advertised, isn't routine, and follows a good-faith finding of financial need or failed collection efforts (42 U.S.C. 1320a-7a(i)(6)(A)). OIG's older fraud alert lists warning signs that are relevant to a sliding scale: advertisements promising "discounts" to Medicare beneficiaries, and routine use of hardship forms with no real look at the patient's finances (OIG Special Fraud Alerts, reprinted December 1994).

For your schedule, that means: don't present your sliding scale as a discount for Medicare or Medicaid clients, and don't use it to waive their cost share. Before you see a client with either program for a private fee, check that program's rules for your license and enrollment status.

Your state and your board

Some states have their own laws against routinely waiving copays or deductibles, including for private insurance (Holland & Hart gives Idaho as an example). Your licensing board may also have rules on fees and on how you advertise them. Check both before you publish your scale.

What the ACA, APA and NASW codes say about fees and pro bono work

None of the three codes requires a sliding scale. All three ask you to weigh a client's ability to pay, to be clear about fees early, and to keep fee practices within the law.

Pro bono work doesn't have to happen in your own caseload. A no-fee place counts, and so do talks, consultation to a community group, or volunteer hours at a clinic.

How to talk about your sliding scale

Money conversations go better when they follow a script you've used before. Raise them early, at the start of a session rather than the last five minutes, and leave room for whatever the client feels about it.

On your website

Put your full fee where clients can see it, and a short line about the scale beside it. Our therapist website examples show where fees usually go.

In the first call

"Before we book, can I ask how you're planning to pay for sessions? ... I keep a few places at reduced fees for people paying themselves. The fee depends on household income and how many people it supports. I can send you the schedule and a one-page form, and I'll send a Good Faith Estimate once we've set your fee."

Asking about income

"I ask everyone the same two questions, so there's nothing personal in it: roughly how much does your household earn in a year before tax, and how many people does that income support? A rough figure is fine."

When someone needs less than your floor

"My lowest fee is $70, and I can't go below that right now. I don't want cost to keep you from getting help, so here are two places that see people for less: [community clinic] and [university training clinic]. I can also add you to my waitlist for a reduced place."

At the yearly review

"It's been a year since we set your fee, so it's time for our review. Has anything changed with your income or your household? If your tier changes, the new fee starts in 30 days, and I'll send you a new Good Faith Estimate."

When a client's situation improves

"Congratulations on the new job. Under my sliding scale policy, that moves you to the $120 fee. I'd like it to start a month from now, on [date]. How does that sit with you?"

If your reduced places are time-limited

Some therapists offer a reduced place for a set period, such as 6 or 12 months, so more clients can use it. If you do, say so in the policy and in the first call, and plan the step back up with the client well before it happens.

Common sliding scale mistakes

How this works in TranqBay

TranqBay lets you set your own fees on your booking page.

practice.tranqbay.health shows a booking page from the client's side, with each service and its fee, if you want to see how your fees would look to someone booking before you decide how to word your scale.

Frequently asked questions about sliding fee schedules

Before you offer your sliding scale

Run through this list once, then put the review dates in your calendar.

When your schedule is ready, practice.tranqbay.health lets you look at a practice website template and the booking page your clients would use, where your fees appear. If you're deciding whether to join, this page explains how joining TranqBay works.

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