While private practice therapists continue to face significant reimbursement challenges from payers, as a whole, providers have increased their income over the last year.

That’s according to Heard’s 2025 Financial State of Private Practice Report, which found that therapists earn significantly less from each session from insurance companies than from private pay.

“Consistent with last year’s survey, insurance companies continue to under-reimburse therapists,” according to the report. “While the average private pay rate for individual therapy for all license types was $159, the average reimbursement rate from insurance was 36% less at $111.”

Reimbursement rates varied by payer and state. Therapists reported Aetna had the highest average reimbursement rate and Cigna had the lowest of all large providers. Geographical location also played a role in reimbursement, California had the highest reimbursement rate of any state.

Therapist income 

The report highlighted some positive trends when it comes to provider salary. While 67% of therapists said they did not increase their fees in 2024, more than a third of providers reported increasing profits.

As a whole, therapists are making more in 2024 than in 2023 from their practice. In fact, 31% of therapists said they made $100,000 or more last year. That’s up from just 14% in 2023.

There are also fewer therapists making under $25,000 from their practice. In 2023, 29% said they were making less than $25,000, compared to 20% in 2024.

Nearly 40% of therapists report earning an income from non-therapy sources. Consulting, supervision and teaching were therapists’ most popular alternative income sources.

Just over half of survey respondents said their therapy practice was a full-time position–and 68% said they see fewer than 20 clients per week.

Despite the strides therapists have made in income, the vast majority of providers are concerned about the future.

“85% of respondents said they were concerned with the financial impact the new Trump administration could have on their practices, with 40% feeling “very concerned,”” authors of the report said. “Large, unpredictable cuts to federal funding in early 2025–including cuts to health care spending–may be fueling these fears.”