Practice business tool
Sliding scale fee calculator for therapists
Set a fair, consistent sliding scale anchored to the official federal poverty guidelines. Enter your full fee and floor, plus the client's household size and income, to get a suggested fee and a tier table you can reuse. Everything stays in your browser.
Why anchor a sliding scale to the poverty level
The hardest part of a sliding scale is making it fair and explainable. If fees feel arbitrary, clients sense it and the policy creates resentment instead of access. Anchoring to the federal poverty guidelines — the same income standard used for Medicaid and ACA subsidies — ties each fee to an objective measure of need: the client's household income as a percentage of the poverty line for their household size. That makes your scale consistent across clients and easy to defend if anyone asks how you set it.
How to set yours up
- 1. Set your full fee. Your standard rate, which most clients pay.
- 2. Set your floor. The lowest fee you can sustain without resentment. A sliding scale you cannot afford does not last.
- 3. Choose where the full fee applies. Commonly around 300–400% of the poverty level. Above that, clients pay your full rate; at or below 100%, they pay your floor; in between, the fee scales smoothly.
- 4. Apply it consistently. Write the policy down and use the same scale for everyone.
Where this fits for a private-pay practice
A sliding scale lets an out-of-network or private-pay practice serve lower-income clients without taking insurance. Pair it with the Good Faith Estimate generator (required for self-pay clients) and the revenue leak calculator, and see how a private-pay EHR keeps fees, invoicing, and documentation in one place.
Frequently Asked Questions
How do therapists calculate a sliding scale fee? +
Most sliding scales set a full fee and a floor (the lowest fee you can sustain), then place a client between them based on financial need. Anchoring "need" to the federal poverty level — the client’s household income as a percentage of the official poverty guideline for their household size — makes the scale consistent and easy to explain. This tool does exactly that, using the 2026 HHS guidelines.
Is a sliding scale required? +
No. A sliding scale is a private policy you choose to make therapy accessible to lower-income clients. It is not legally required. The key is to define it clearly and apply it consistently to everyone, so it is fair and defensible.
What is the federal poverty level and why use it? +
The federal poverty guidelines are published every year by the U.S. Department of Health and Human Services and are used to determine eligibility for Medicaid, ACA subsidies, and many assistance programs. For 2026, 100% of the poverty level is $15,960 for a household of one, rising with household size. Using it as the anchor means your sliding scale is tied to a recognized, objective income standard rather than a guess.
How many income tiers should I have? +
Many practices use three to five tiers between their floor and full fee. This calculator produces a smooth scale and a tier table you can adapt. Decide where the full fee kicks in (commonly around 300–400% of the poverty level) and reserve your lowest fees for the greatest need.
Should I verify a client’s income? +
Practices vary. Some take the client at their word; others ask for proof such as a recent pay stub or tax return, especially for the lowest tiers. Whatever you choose, write it into your policy and apply it the same way for everyone.
Does this store my clients’ information? +
No. The calculator runs entirely in your browser. Nothing you enter — your fees or a client’s income and household size — is sent to or stored by CoralEHR.
Keep going
Run a private-pay practice without the spreadsheet
CoralEHR keeps your fees, sliding scale, invoicing, and notes in one chart — so accessible pricing is a setting, not a manual workaround.
See CoralEHR for private pay