A fractional CFO for a small physical therapy practice typically costs $1,500 to $6,000 a month, and the spread is scope, not haggling room. Around $1,500–$3,000 buys oversight: someone reviews the reports you already have. $3,000–$6,000 buys an active CFO who builds forecasts and works your payer mix. Multi-location groups pay $6,000 and up. Hourly help runs about $175–$400; one-off projects $3,000–$20,000. This guide covers what each tier includes, who sells it, and the question to ask before buying any tier: what numbers will the CFO be working from?
The market at a glance
| Tier | Typical monthly fee | Who it fits | What you get |
|---|---|---|---|
| Oversight-only | $1,500–$3,000 | Solo to about 3 clinicians | Monthly review of existing reports, KPI check-in, budget vs. actual |
| Active CFO | $3,000–$6,000 | Growing clinic, roughly 4–10 clinicians | Forecasting, cash planning, payer-mix and rate analysis, growth modeling |
| Multi-location | $6,000+ | Multi-location groups | Consolidated reporting, per-location performance, expansion planning |
Outside the retainer model: hourly advisory at $175–$400, defined projects at $3,000–$20,000, and a few firms priced at 0.5–2% of revenue — convert that to a monthly dollar figure before comparing.
What drives the price
Three things move a quote inside those bands. Scope — oversight (reading your reports) versus active work (building forecasts, negotiating-ready payer analysis, cash planning). Size — clinician count and locations, because more providers and payers mean more moving parts. Engagement model — retainer, hourly, project, or percent-of-revenue.
There's a fourth driver no price sheet shows: the state of the data underneath. More on that below, because it decides whether any tier is worth its fee.
Who sells it
The therapy niche has real specialists. Therapy CFO focuses on therapy practices specifically. ProfitUp Advisory publishes fractional-CFO scope pages for physical therapy clinics. K38 Consulting serves healthcare businesses more broadly. Generalist fractional-CFO firms and marketplaces sit around them, usually at the hourly or project end. Descriptions here come from each firm's own public positioning; the ranges above are market-wide, not any one firm's price sheet.
At the low end, some PT-specific providers advertise entry retainers around $1,500 a month for one- and two-location practices. That's a real offer — just read the scope line. At that price the engagement is oversight: a monthly look at your existing numbers, not the building of new ones.
The question under every tier: what numbers is the CFO standing on?
A fractional CFO works from your reports — practice-management data, books, payroll. Every tier on the table assumes those inputs are right. In physical therapy, that assumption does real work: your EMR says what you earned, payer remittances say what was paid, and your bank statement says what arrived — and at most practices, matching the three is nobody's job. We mapped who covers what in PT practice finance in the companion guide.
That's not a knock on the CFO. It's a sequencing fact. When a CFO scope sheet lists "revenue cycle analysis," it usually means reading the reports your billing system produces — not verifying that posted payments reached the bank. If your books are already tight — deposits tied to visits, reconciliation running — the oversight tier is a fair buy and the cheapest way to get a finance brain in the room.
If they're not, a forecast built on unverified numbers inherits every gap in them, at any price. Fix the data first, then buy strategy on top of it. We compared the two layers directly in fractional CFO vs. embedded financial operations.
Where RealizedAI fits
RealizedAI prices in the active-CFO band — from $4,000 a month, flat — with one structural difference: the engagement starts by building the verified-data layer the rest of this market assumes you already have. We tie your EMR, remittance, and bank data together first (three-way payment reconciliation), then run the CFO-layer reporting on verified numbers: cash-flow reporting, payer-mix analysis, expense tracking, monthly close support.
For a multi-location Florida PT practice, that process took payment-dollar verification from roughly 80% to 98% and has documented $39K+ per year in recurring costs cut. The write-up is on our case studies page.
Engagements start with a fixed-price $5,000 Discovery Sprint, then from $4,000 a month — never a percentage of collections. PHI is handled under a HIPAA business associate agreement. And the honest boundary: if you already trust your numbers and want a board-meeting CFO, the specialist firms above are the right list. If your deposits don't match what your EMR says you earned, the CFO layer isn't the first purchase. Full pricing is published here.
How to budget it
The full finance stack for a small practice typically runs: bookkeeper $300–$1,000 a month, CPA $2,000–$6,000 a year, fractional CFO on top per the table. A common rule of thumb puts a standing CFO retainer worth it above roughly $1–2 million in annual revenue — around four or more clinicians. Below that, an hourly or project engagement covers a specific decision (a second location, a big hire, a payer-contract question) without the monthly commitment.
How to choose
- You trust your numbers and need strategy → an oversight or active-tier CFO from the specialist firms.
- One specific decision to make → a project engagement, $3,000–$20,000, or hourly advisory.
- Deposits don't match what the EMR says you earned → reconciliation first, then the CFO layer on top. Start with who covers what in PT practice finance.
- Multiple locations, consolidation pain → the multi-location tier — and ask how per-location numbers get verified, not just reported.
Frequently Asked Questions
How much does a fractional CFO cost for a small physical therapy practice?
Typically $1,500–$6,000 a month (August 2026): roughly $1,500–$3,000 for oversight-only, $3,000–$6,000 for active CFO work at a growing clinic, $6,000+ for multi-location groups. Hourly advisory runs about $175–$400.
What does an oversight-only engagement include at $1,500–$3,000 a month?
A monthly review of the reports your systems already produce — KPIs, budget vs. actual, a standing call. It does not include building the underlying data or verifying that posted payments reached your bank account.
When is a fractional CFO worth it for a PT practice?
The common threshold is roughly $1–2 million in annual revenue or four-plus clinicians. Below that, hourly or project engagements cover specific decisions without a retainer.
What should be in place before hiring a fractional CFO?
Numbers you trust: bank-reconciled books, and payments traceable from EMR through remittance to deposit. A CFO's forecasts are built on those inputs — verified data first makes every tier of CFO help worth more.