Medical practices & clinics
Books and taxes for pain management clinics.
Injection procedures billed apart from office visits, in-house urine drug testing, and a fluoroscopy unit that cost as much as a small building. Gus sorts all of it, an accountant checks every transaction, and you get one number a month.
- From $197 a month
- An accountant on every transaction
- Cancel whenever
October came in at $40,600. Injection procedure volume ran heavy, so I kept that revenue apart from office visit deposits to show you where the month actually came from.
- Availity batch deposit, proceduresInterventional procedure reimbursements
- Availity batch deposit, visitsOffice visit reimbursements
- Urine drug testing reimbursementsIn-house testing revenue
- Fluoroscopy unit leaseInterventional equipment
- Clinical staff payrollClinical wages
Why your books are different
A pain management clinic's books go wrong across office visits, procedures, and testing.
A single patient can generate an office visit fee, a separate procedure fee for an injection, and an in-house drug testing fee, each paid on its own schedule. A generalist blends all three, and you lose sight of which part of the practice actually drives the month.
-
1
Procedure and office visit revenue get blended
An epidural injection or a nerve block reimburses very differently than a standard office visit, and if both land in one generic visit category, you cannot tell whether procedure volume or visit volume is actually carrying the practice.
What we doKeeps interventional procedure reimbursements apart from office visit reimbursements, so each revenue source shows its true weight. -
2
In-house drug testing revenue needs its own line
Urine drug testing billed alongside a visit is a distinct revenue stream with its own reimbursement pattern and its own cost for cups and reagents, and payers scrutinize testing billing closely, which makes clean separation from other revenue especially important.
What we doKeeps in-house testing revenue and its supply cost in their own lines, so the pattern is visible and easy to hand to the accountant if a payer ever asks questions. -
3
Interventional equipment reads as a supply run
A fluoroscopy unit or a radiofrequency ablation generator can cost as much as a full year of rent. Filed as supplies, it wrecks the month it was bought and hides what it's worth over years.
What we doFlags a big equipment purchase the day it lands, logs it as equipment, and lets the accountant decide how it gets written off. -
4
Controlled substance handling costs blend into general supplies
Secure storage, tracking systems, and DEA registration fees tied to prescribing controlled substances are real, recurring costs that have no equivalent in most other medical practices.
What we doKeeps controlled substance handling and compliance-related costs in their own line, so they're visible instead of disappearing into general office expenses.
Your categories
The categories Gus keeps for a pain management clinic.
Set up once for how visits, procedures, and testing all get paid. You never pick a category. He does, and an accountant checks it.
Money in
- Office visit reimbursementsDeposits from payers for standard evaluation and management visits.
- Interventional procedure reimbursementsInjections, nerve blocks, and ablation procedures, kept apart from visits.
- In-house testing revenueUrine drug testing billed alongside patient visits.
- Cash-pay procedure feesAny procedures paid directly where insurance does not apply.
Money out
- Interventional equipmentFluoroscopy units and ablation generators, logged so they get written off right.
- Drug testing suppliesCups, reagents, and lab send-out fees for urine drug testing.
- Controlled substance handlingSecure storage, tracking systems, and DEA registration costs.
- Clinical wagesNurses and clinical staff, kept apart from provider compensation.
- Malpractice insuranceAnnual or quarterly premiums, often higher given procedure volume.
- Rent and utilitiesProcedure rooms and imaging space.
- Practice management softwareScheduling, charting, and billing tools.
What we watch for you
- Procedure versus visit mix
How much revenue comes from procedures versus standard office visits.
- Testing revenue and cost
What in-house drug testing brings in against its supply cost, kept visible for its own review.
- Equipment cost trend
What interventional equipment leases or purchases are costing month to month.
- The set-aside
What you will owe, tracked every month, so April is a number you already knew.
Ask Gus
Things pain management clinic owners ask Gus.
Text him like you would text anybody. He answers in plain English, and when a question is above his pay grade, an accountant looks and gets back to you.
I keep interventional procedure reimbursements apart from office visit reimbursements, so you can see the real split directly instead of guessing from the total.
I keep that revenue and its supply cost in their own lines so the pattern is clear. If a payer ever raises questions about testing billing, that's above my pay grade, and the accountant or your billing service should look at it directly.
Usually it can. I logged it as equipment, not supplies, and flagged it so the accountant makes the call with your whole year in view.
The tax side
The tax side of a pain management clinic.
Most of what matters here is separating procedure, visit, and testing revenue, and knowing where the pass-through deduction starts to phase out.
What your return has to get right
Your accountant signs it, so it gets done right the first time.
- The pass-through deduction phases outA pain management clinic can lose part or all of the 20 percent pass-through deduction once taxable income passes $201,750 single or $403,500 joint, since medical practices are a specified service trade.
- Interventional equipment purchasesFluoroscopy units and ablation generators can usually be written off the year you buy them, with 100 percent bonus depreciation available for property acquired after January 19, 2025.
- Drug testing supplies and lab feesTesting cups, reagents, and lab send-out fees are generally deductible as ordinary business expenses in the year they are used.
- Contract or covering physiciansA physician covering your clinic occasionally who bills you directly is often a contractor and gets a 1099-NEC if you pay them $2,000 or more in 2026, due January 31.
Deductions pain management clinics miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Drug testing cups and reagents
- Interventional equipment maintenance
- Controlled substance storage systems
- DEA registration fees
- Malpractice premiums
- CME courses and travel
- Board certification renewal
- Practice management software
- Scrubs and clinical apparel
- Biohazard disposal
General information about 2026 federal rules, not advice for your business. Your accountant looks at your actual numbers before anything gets filed.
All year, not just April
A pain management clinic year, kept every month.
Procedures, visits, and testing each move on their own rhythm. Your taxes come on a fixed schedule. Your team keeps you ahead of both. Every month in between, your bookkeeper closes the books and speaks up the moment something looks off.
- January
Plan the year
Last year's return gets started, and you get a monthly set-aside so April is already handled, even with procedure and testing revenue moving separately.
- April
Filed. Done.
Your return is filed and signed. No surprise bill, because the set-aside has been running since January.
- July
Halfway check
Where you stand, what you will owe, and whether procedure volume or testing revenue changed the number.
- October
Before year end
Gus looks at equipment worth buying and anything worth doing before December, while procedure scheduling often stays steady through winter.
What you get
What you pay depends on what your business needs, and it does not move after that, busy season or slow. No hourly bills, no surprise invoices, no setup fee.
Book a call- Monthly bookkeeping
Every transaction sorted into categories set up for pain management clinics. You never categorize a thing.
- An accountant checks every transaction
Real review, every month, before your books close. Not a spot check.
- Your business tax return, filed
Prepared, reviewed, and signed by that same accountant every year.
- The monthly number
What you made, what you spent, what to set aside for taxes.
- Your own bookkeeper
A real person assigned to your business, in the app whenever you need them. No hold music.
- On your books all year
Every month, not just in April. Your team speaks up whenever something is worth your attention.
- Cancel any time
No contract. No cancellation call. Your books are yours.
Straight answers
Questions pain management clinic owners ask first.
Do you bill insurance for procedures or handle prior authorizations?
No. Gus does not handle insurance billing, medical coding, prior authorizations, or claims of any kind. Your practice management software or billing service still does that. Gus works from what actually lands in your bank account.
Our drug testing revenue gets a lot of scrutiny from payers. Does Gus handle any of that?
No, Gus does not review testing billing patterns for compliance. He keeps testing revenue and its cost in their own line so the numbers are clean and ready if your accountant or billing service needs to look closer.
How do you separate procedure revenue from regular office visits?
By the deposit itself. Interventional procedure reimbursements and office visit reimbursements are kept in separate lines from the start, so you can see the real split.
Does Gus track our DEA registration or controlled substance compliance?
No, that's outside what Gus does. He tracks the cost of registration and secure storage as a business expense, but compliance itself is handled by you and your own systems.
We bought a new fluoroscopy unit. How does that affect our taxes?
It can usually be written off the year you buy it, and Gus flags the purchase and logs it as equipment so the accountant can make that call with your whole year in view.
Is a real accountant checking my books?
Yes. You get your own bookkeeper, Gus does the first pass on every transaction, and an accountant checks every one before your month closes. That same accountant prepares, signs, and files your business return. Goatkeeper is not a CPA firm, and we never pretend a person looked when they did not.
What does it cost, and can I cancel?
It starts at $197 a month, depending on what your business needs. No setup fee, no hourly bills, no contract. Cancel any time from the app, and your books go with you.
More in medical practices & clinics
We keep books for the business next door too.
- Compounding pharmacies
- Durable medical equipment (DME) suppliers
- Elective 3D/4D ultrasound studios
- Independent pharmacies
- Medical billing companies
- Mobile nursing & concierge nurse services
- Mobile phlebotomy services
- Mobile x-ray & ultrasound services
- Occupational health & DOT physical clinics
- Orthotics & prosthetics providers
- Sleep clinics
- Wound care clinics
- Allergy clinics
- Audiology & hearing aid centers
- Concierge medicine practices
- Direct primary care (DPC) practices
- Independent eyewear boutiques
- Naturopathic doctors
- Occupational therapy practices
- Pediatric therapy clinics
- Podiatrists
- Speech therapy practices
- Sports medicine clinics
- Tattoo removal clinics
- Fertility clinics
- Functional medicine practices
- Independent urgent care clinics
- Optometrists
- Private practice physical therapy
- Regenerative medicine clinics
What makes a bookkeeper worth paying for Every business we keep books for
Book a call
Pick a time. That's the whole signup.
Fifteen minutes with a real person on our team. They look at where your books are, tell you straight what it takes to get caught up, and get you set up on the spot if it fits.
- $197 a month to start
- An accountant on every transaction
- Cancel whenever