Medical practices & clinics
Books and taxes for pediatric therapy clinics.
OT, PT, and speech sessions under one roof, week-long intensives paid up front, diagnostic evaluations, and waitlist deposits. 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
June came in at $21,800. Three summer intensive weeks paid up front, so I kept that revenue tagged separately from regular weekly sessions.
- Summer intensive depositsIntensive program fees
- Availity batch depositInsurance visit reimbursements
- Diagnostic evaluation, Marsh familyEvaluation fees
- Sensory gym equipment leaseTreatment equipment
- Clinical staff payrollClinical wages
Why your books are different
A pediatric therapy clinic's books go wrong across three or four disciplines at once.
You have OTs, PTs, and speech therapists in the same building, sometimes treating the same child in the same hour, plus intensives and evaluations that do not run on a weekly rhythm. A generalist averages all of it, and you lose sight of which service is actually worth expanding.
-
1
A week-long intensive lands as one lump payment
A family paying $3,200 up front for a week-long summer intensive hands you a big deposit before the week of sessions has even happened, which can make one week look outstanding and the surrounding weeks look thin by comparison.
What we doKeeps intensive program revenue in its own line, tagged to the week it covers, so it doesn't distort how regular weekly sessions are actually doing. -
2
Co-treat sessions double the staff cost without doubling the revenue
When an OT and a speech therapist see the same child together in one session, you often bill it once, but you are paying two clinicians for that hour.
What we doFlags co-treat sessions so the staffing cost against a single session fee is visible, instead of hiding inside average labor cost. -
3
Diagnostic evaluations skew the weekly average
A comprehensive sensory or developmental evaluation is often priced far higher than a regular session and paid cash up front, which can make a light session week look strong for the wrong reason.
What we doKeeps evaluation fees in their own line, apart from regular session revenue, so the two don't get confused for each other. -
4
Waitlist deposits get spent before they're earned
A nonrefundable deposit to hold a spot on a waitlist gets collected months before the family ever starts services, and if it is booked as regular income the month it's paid, it inflates that month for work not yet done.
What we doKeeps waitlist deposits separate until the family starts services, so income shows up when the work actually happens.
Your categories
The categories Gus keeps for a pediatric therapy clinic.
Set up once for how families and payers pay across every discipline. You never pick a category. He does, and an accountant checks it.
Money in
- Insurance visit reimbursementsDeposits from payers across OT, PT, and speech sessions.
- Cash-pay sessionsFamilies paying directly for services insurance does not cover.
- Intensive program feesWeek-long intensive blocks, paid up front and tagged to the week they cover.
- Evaluation feesComprehensive diagnostic and developmental evaluations, billed apart from regular sessions.
- Waitlist depositsNonrefundable deposits to hold a spot, tracked separately until services start.
Money out
- Clinical wages by disciplineOTs, PTs, and speech therapists, kept visible against each discipline's revenue.
- Treatment equipmentSensory gym equipment and discipline-specific tools, logged so they get written off right.
- Rent and utilitiesA larger multi-room facility built to host several disciplines at once.
- Malpractice insuranceCoverage across every licensed clinician on staff.
- Intensive program staffing and suppliesExtra hours and materials specific to running week-long intensives.
- Continuing educationDiscipline-specific certifications across OT, PT, and speech staff.
- Practice management softwareScheduling, documentation, and billing across multiple disciplines.
What we watch for you
- Discipline revenue mix
How much each discipline brings in against its own staffing cost, tracked separately by service line.
- Intensive program margin
What a week-long intensive brings in against the extra staffing it takes to run.
- Waitlist deposit balance
How much deposit money is still tied to families who have not started services yet.
- The set-aside
What you will owe, tracked every month, so April is a number you already knew.
Ask Gus
Things pediatric therapy 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 intensive revenue tagged to the week it covers, so it shows up as a strong intensive week, not a strong regular week that never happened.
I flag those sessions so you can see two clinicians' time against one session fee, which is worth knowing before scheduling more of them.
I keep them separate until the family actually starts services, so it doesn't look like income for work that hasn't happened yet. The accountant confirms exactly how that's reported.
The tax side
The tax side of a pediatric therapy clinic.
Most of what matters here is timing intensive and deposit revenue correctly, 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 pediatric therapy 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.
- Treatment equipment purchasesSensory gym equipment and discipline-specific tools can usually be written off the year you buy them, with 100 percent bonus depreciation available for property acquired after January 19, 2025.
- Deposits and prepaid intensivesA nonrefundable deposit or an intensive paid weeks in advance is generally income when received, but keeping it clearly labeled helps the accountant match it to the right period on the return.
- Contract clinicians across disciplinesA clinician who covers occasional shifts, sets their own terms, and 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 pediatric therapy clinics miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Sensory gym equipment
- Intensive program supplies
- Malpractice premiums across disciplines
- Continuing education and certifications
- Practice management software
- Diagnostic evaluation materials
- License renewal fees
- Scrubs and clinical apparel
- Waiting room and family space furnishings
- Referral and outreach marketing
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 pediatric therapy clinic year, kept every month.
Summer intensives, school-year sessions, and evaluations each run on their own rhythm. Your taxes run on a fixed one. 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, any contract clinician's 1099 is ready, and you get a monthly set-aside so April is already handled.
- 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 how the summer intensive season changed the number.
- October
Before year end
Gus looks at equipment worth buying and anything worth doing before December, as the school-year schedule settles in.
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 pediatric therapy 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 pediatric therapy clinic owners ask first.
Do you bill insurance across our different disciplines?
No. Gus does not handle insurance billing, medical coding, 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.
How do you handle revenue from our week-long summer intensives?
Gus keeps intensive program revenue in its own line, tagged to the week it covers, so it doesn't distort how regular weekly sessions are actually doing.
We co-treat some children with two clinicians in one session. Does that change the books?
It doesn't change how the session is billed, but Gus flags those sessions so you can see two clinicians' time against one fee, which matters for scheduling.
Do diagnostic evaluations need their own category?
Yes, and Gus already keeps them apart from regular session revenue, since one high-priced evaluation can make a light week look stronger than it is.
What happens to a waitlist deposit if a family never starts services?
Gus keeps deposit money tracked separately from earned revenue. What happens if a family doesn't follow through is a policy question for you and your accountant, not something Gus decides.
Our books mix three disciplines and it feels tangled. Can it be untangled?
Yes. Send the bank statements you have. Gus sorts income and cost by discipline, the accountant checks it, and most owners see it clearly within a week.
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
- Podiatrists
- Speech therapy practices
- Sports medicine clinics
- Tattoo removal clinics
- Fertility clinics
- Functional medicine practices
- Independent urgent care clinics
- Optometrists
- Pain management clinics
- 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