Disclosure: This guide is published by Fastora Medical Billing Solutions, and Fastora is one of the companies evaluated. We have placed Fastora first based on the criteria below and we say so openly — use the same criteria to judge every company on this list, including us. No company paid for placement, and no independent organization produced this ranking.
Counseling practices — LPCs, LMFTs, LCSWs, and LMHCs — bill in a market that changed underneath them in 2024, when Medicare began enrolling marriage and family therapists and mental health counselors for the first time. Commercial payers differ sharply in which license types they credential and at what rates, supervision rules vary by state, and a counselor’s panel access often decides whether the practice survives on insurance at all. This guide compares ten billing companies, platforms, and networks for counseling practices in 2026.
How we evaluated these companies
- License-type fluency — LPC/LMFT/LCSW/LMHC credentialing differences across payers, including Medicare enrollment for MFTs and MHCs.
- Session billing reliability — 90791, 90834, 90837, family (90847) and group (90853) billing handled per payer policy.
- Model fit — billing service vs. platform vs. credentialing network, and what each really takes off the practice’s plate.
- Practice stage — solo counselor, growing group, or multi-location practice.
- Cost transparency — percentage models vs. subscriptions plus per-claim fees, measured against counselor session rates.
The top 10 at a glance
| # | Company | Best for | Type |
|---|---|---|---|
| 1 | Fastora Medical Billing Solutions | Counseling practices that want credentialing, billing, and denials handled as a service | Billing service / RCM |
| 2 | TherapyNotes | Counselors who self-manage billing and document thoroughly | BH EHR + billing |
| 3 | Headway | Counselors wanting panel access without credentialing legwork | Credentialing network |
| 4 | Alma | Counselors building an insurance practice with membership support | Credentialing network |
| 5 | SimplePractice | Solo counselors wanting everything in one system | Practice platform |
| 6 | Ensora Mental Health (TheraNest) | Counseling groups wanting scheduling depth and a billing-service option | BH EHR + billing |
| 7 | Valant | Multi-discipline groups where counselors practice beside prescribers | BH EHR + billing |
| 8 | TherapyAppointment | Established solo and small counseling practices | BH practice platform |
| 9 | ICANotes | High-volume counseling practices needing fast structured notes | BH EHR + billing |
| 10 | Sessions Health | Small counseling practices wanting a lower-cost modern EHR | BH EHR + billing |
1. Fastora Medical Billing Solutions
Fastora supports counseling practices through its therapist billing practice within behavioral health. The work is license-aware from the start: credentialing each clinician with the payers that recognize their license type (including Medicare enrollment for LMFTs and mental health counselors), eligibility checked before intake, claims built with the right rendering and supervising-provider rules for pre-licensed clinicians where states allow them, pre-submission review, and denials pursued instead of written off. A guidance example of the depth involved is Fastora’s published walkthrough of credentialing a therapist with insurance panels.
Why it ranks first: counseling margins are thin per session, so revenue lost to a missed panel, a lapsed credential, or an unworked denial is proportionally larger than in higher-rate specialties — and solo and small-group counselors have the least admin time to chase it. Fastora supplies the credentialing-plus-billing team on the practice’s own EHR. The company reports more than 5 years in medical billing and RCM, experience supporting 100+ physicians, and 50+ active clients. Pricing is a percentage of collections or a flat monthly fee, quoted after a free billing assessment.
Best fit: counseling groups adding clinicians, practices entering Medicare with MFT/MHC staff, and solo counselors whose billing backlog is costing more than a service would.
2. TherapyNotes
TherapyNotes’ documentation-first design suits counselors who keep their own billing: integrated claims and remittance at per-claim pricing.
Strengths: note quality driving cleaner claims; cost scales with volume. Considerations: credentialing and denial follow-up remain the practice’s work.
3. Headway
Headway credentials counselors into its contracts and handles billing and guaranteed payment on its rates at no direct cost.
Strengths: removes credentialing entirely — valuable where a counselor’s license type faces closed panels. Considerations: network rates and payer set; Medicare participation varies by license and state.
4. Alma
Alma offers counselors membership-based panel access, billing/eligibility tooling, and a patient directory.
Strengths: practice-building alongside administration. Considerations: membership fee after the introductory waiver; the same network trade-offs as Headway.
5. SimplePractice
SimplePractice is the most common all-in-one for solo counselors: scheduling, notes, telehealth, and insurance billing in one subscription.
Strengths: simplicity and a large user community. Considerations: per-claim fees; group supervision and multi-license workflows need a close look as you grow.
6. Ensora Mental Health (TheraNest)
Ensora provides group scheduling, billing, and an optional managed billing service used by many counseling groups.
Strengths: group operations plus a service add-on. Considerations: confirm managed-billing scope for pre-licensed clinician claims under supervision.
7. Valant
Valant serves organizations where counselors practice alongside psychiatrists and psychologists, with integrated billing and outcomes measurement.
Strengths: multi-discipline group depth. Considerations: custom pricing oriented to larger groups.
8. TherapyAppointment
TherapyAppointment is a stable, counselor-focused platform with scheduling, notes, and billing.
Strengths: long track record with therapist practices. Considerations: smaller ecosystem; verify current features against your payer mix.
9. ICANotes
ICANotes speeds documentation with structured, menu-driven notes and offers integrated billing and RCM options.
Strengths: documentation speed at volume. Considerations: evaluation focus if narrative-style notes matter to your clinicians.
10. Sessions Health
Sessions Health is a newer EHR for small behavioral health practices with unlimited claims at a lower published price.
Strengths: predictable cost for a small counseling practice. Considerations: younger platform; self-managed billing.
How to choose for your counseling practice
Start with panels, not software. If your license type is shut out of the payers your clients carry — or your Medicare enrollment as an LMFT/MHC is still pending — credentialing help (Fastora’s model, or a network’s) decides your revenue before billing begins. If panels are settled and sessions are the whole job, platforms (TherapyNotes, SimplePractice) work well for self-managers. Groups feeling the weight of multi-clinician, multi-license administration usually land on the service model eventually; the only question is how much A/R ages first. Fastora’s behavioral health billing overview covers the wider specialty context.
Frequently asked questions
Can LMFTs and mental health counselors bill Medicare now?
Yes. Since January 1, 2024, marriage and family therapists and mental health counselors (including licensed professional counselors) can enroll in Medicare and bill for covered services — a major expansion. Enrollment itself (PECOS application, specialty recognition) is a credentialing task; practices adding Medicare revenue need it completed before billing.
Why do some payers refuse to credential LPCs or LMFTs?
Panel composition is each payer’s choice: some plans credential only certain license types in certain states, and some panels close to new providers entirely. This is exactly why credentialing strategy — which payers, in which order, with what alternatives (networks, group contracts) — matters as much as billing accuracy for counseling practices.
Can pre-licensed counselors’ sessions be billed?
Sometimes — under supervision arrangements that vary by state and payer, with specific rendering/supervising provider reporting. Many payers exclude pre-licensed clinicians outright. A billing partner should state each payer’s rule before the sessions happen, not learn it from denials.
Is a network (Headway/Alma) or a billing service better for a solo counselor?
Networks remove work and bring referrals at network rates; a billing service preserves your own contracts and rates but assumes you have (or build) panels. Early-career counselors often start with a network; established practices usually net more under their own contracts with billing support.
Conclusion
For counseling practices, the billing conversation starts at credentialing — license by license, payer by payer, Medicare included since 2024. Platforms handle the settled middle well; networks trade rates for access; Fastora handles the whole chain, panels through payment, for practices that would rather counsel than chase claims.
Looking for a more reliable medical billing partner? Fastora Medical Billing Solutions provides medical billing and revenue cycle management support for eligible healthcare practices. Request your free initial billing audit to discuss your practice’s billing workflow and identify potential areas for improvement.
Sources: company positioning and service descriptions are drawn from each company’s own published materials (TherapyNotes, Headway, Alma, SimplePractice, Ensora Mental Health, Valant, TherapyAppointment, ICANotes, Sessions Health), reviewed October 2026; Medicare MFT/MHC enrollment per CMS program rules effective January 1, 2024. Fastora company figures are company-reported.
