There’s no single best EHR for therapists. The real answer splits on one question: how much of your money comes from insurance. If you bill payers heavily, TherapyNotes usually wins on billing and certification. If you’re mostly private pay, SimplePractice usually wins on workflow and its mobile app. This compares the field on the things that decide it (price, billing, the documentation load) and then draws the line we’re honest about: we make a scribe, not an EHR, and we’ll tell you where that fits.
Key takeaways
- The choice is mostly a billing decision: insurance-heavy leans TherapyNotes, private-pay leans SimplePractice.
- Solo plans run roughly $49 to $99 a month, but the realistic all-in lands near $100 to $180 once telehealth, e-prescribing, and AI notes stack on.
- SimplePractice is not ONC-certified; TherapyNotes is. That matters for interoperability incentive programs.
- An EHR stores your note; a scribe writes the first draft. Many practices run both, and that’s a feature, not a failure.
SimplePractice Starter (omits insurance billing and telehealth)
TherapyNotes solo, per published 2026 comparisons
Typical AI note-taker add-on across the two EHRs
How should a therapist actually choose an EHR?
Start with your payer mix, not the feature list. A practice where 70 percent of revenue runs through insurance has very different needs than a private-pay practice that never touches a claim.
For the insurance-heavy practice, billing accuracy and certification carry the decision. TherapyNotes is built around structured clinical documentation and claims, and it holds ONC certification, which puts it on the federal Certified Health IT Product List. SimplePractice is not on that list, which the EHR Source review notes “disqualifies practices from Promoting Interoperability incentive payments” and means the platform “has not been independently validated against federal interoperability and security standards.” If those incentive programs or that validation matter to you, that’s a real differentiator, not marketing.
For the private-pay practice, the daily experience matters more than claims plumbing. SimplePractice has one of the strongest mobile apps in behavioral-health software, with scheduling, notes, telehealth, messaging, and billing on iOS and Android. If you run your practice from your phone between sessions, that’s worth real money.
What do the leading therapist EHRs actually cost?
Here’s the honest table. All figures pulled from each vendor’s pricing page or published 2026 comparisons in June 2026; rates change, so confirm before you commit.
| Product | Solo monthly | Insurance billing in base | ONC certified | AI note add-on |
|---|---|---|---|---|
| SimplePractice | $49 Starter · ~$69 Essential · $99 Plus | Not in Starter | No | Note Taker ~$35/clinician |
| TherapyNotes | ~$59 solo (per 2026 comparisons) | Yes | Yes | AI documentation ~$40/clinician |
SimplePractice’s $49 Starter is the lowest headline number, but it leaves out insurance billing and the telehealth most solo therapists need, so your real entry tier is Essential or Plus. SimplePractice also sells e-prescribing as a $49-a-month add-on with an $89 one-time setup fee, per its own pricing page. TherapyNotes folds more of the clinical and billing core into its base plan, which is why a like-for-like comparison usually narrows the headline gap.
- Insurance-heavy practice leans TherapyNotes (billing, ONC)50%
- Private-pay practice leans SimplePractice (app, workflow)50%
What about the documentation burden itself?
This is the part the EHR comparison usually skips, and it’s the part that eats your evenings. The EHR is where the note lives. It is not, by itself, what writes the note. DAP notes, BIRP notes, treatment plans, progress notes: that’s still you, typing, often after the last client leaves.
Both leading EHRs now sell an AI note-taker as an add-on, roughly $35 to $40 a clinician, because they know the documentation load is the real pain. That’s a reasonable path if you want one vendor and one bill. The other path is a standalone scribe that drafts the note and works alongside whichever EHR you keep, so you’re not locked into one vendor’s note quality. Neither path is wrong; they’re different trades. One bill versus the better draft.
Where does an AI scribe fit, and what won’t we claim?
Right at that documentation layer, and we’ll be precise about the boundary. AI Medical Scribe by Patient Square is one module inside Practice Copilot: it listens during the visit and hands back a structured SOAP note, ICD-10 suggestions, and a prescription draft, ready to review and sign about two minutes after the visit. For a therapist that means a drafted DAP or BIRP note waiting two minutes after the session, not a blank template at 9pm.
Here’s the line. If you already run SimplePractice or TherapyNotes, we don’t replace it. The scribe drafts the note; you keep your existing chart, scheduling, and billing. We don’t push notes into your EHR or claim integration with one; every note exports as PDF, HL7, or FHIR, so you move it where it needs to go. Audio is processed in memory and discarded once the note drafts, so there’s no recording archive; the notes belong to your practice to export or delete anytime. We don’t quote an accuracy percentage, because no honest vendor can. What we do is write the first draft well enough that the note stops outlasting the session.
So the real stack for many therapists is an EHR for the system of record plus a scribe for the documentation, and you pick each on its own merits. If you want to see how that split plays out in your day, the AI scribe for therapists page walks the DAP and BIRP workflow, and the therapy notes templates guide covers when to stop templating and start drafting. Or book a short demo and bring your current EHR; the question is never which tool replaces it, but which one finally writes the note. See the pricing page for the flat number, no sales call.