Operational costs are rising for behavioral health practices. From payroll to liability insurance to office space, margins are tightening. In this context, even small expenses—like credit card processing fees—deserve a closer look. While these fees may seem minor per transaction, over time, they can chip away at a behavioral health practice’s bottom line.

Practices face a decision: absorb the fees or pass them on to patients.

What Are Healthcare Payment Processing Fees?

Credit card processing fees typically range from 1.5% to 3.5% of the transaction amount, plus a flat fee per transaction (usually around 25 to 30 cents). These rates are set by card networks such as Visa, Mastercard, and Amex, and by the payment processors that handle the transaction. Online transactions or card-on-file payments may carry higher fees than swiped payments.

Many practices have EHR platforms that directly integrate healthcare payment processing. For practices that want to offer their patients the convenience of online bill pay or autopay, these fees are a virtually unavoidable part of providing modern payment options.

Why Some Practices Choose Passing Credit Card Fees to Patients

With costs rising across the board, for many practices, the decision to implement a pass-through fee is about sustainability. Practices want to avoid frequent rate increases while keeping services accessible.

A pass-through fee—often called a convenience fee or a surcharge—is one way to offset growing expenses. Some practices add a flat percentage (such as 2.5%) to card transactions. While this practice is increasingly common in healthcare and other service settings, it is regulated differently in each state.

As of 2025, states including Massachusetts, Connecticut, and Maine prohibit or heavily restrict credit card surcharges. In states that do allow them, laws typically require:

• Disclosure before payment (e.g., signage, intake forms, billing policies).
• Fee amounts that don’t exceed the actual processing cost (often capped at 3%–4%).
• Line-item visibility on receipts or invoices.

The Patient Perspective

Behavioral healthcare often comes with a high out-of-pocket cost. Between insurance deductibles, co-insurance, and limited coverage for mental health services, many patients are already stretched financially. Even modest fees may be perceived as nickel-and-diming—especially if they’re not disclosed clearly or explained with care.

Trust and transparency are key. The right tone and communication approach can help patients understand the reasoning behind a change. Offering alternatives—such as ACH transfers, checks, or FSA/HSA cards—also gives patients some control over how they manage payments.

ACH (Automated Clearing House) transfers are generally more secure and less costly to process than credit card payments. They are direct transfers from a patient’s bank account to a practice—similar in function to services such as Zelle or Venmo but designed for business use. These secure transfers can be handled through an EHR’s integrated payment tools.

Legal and Compliance Considerations

Before passing credit card fees along to patients, it’s essential for a practice to ensure it is compliant with both state laws and industry standards:

• Surcharge regulations: Laws vary by state. Some ban them entirely; others allow them with strict requirements.
• Disclosure requirements: In states that allow surcharges, practices must disclose them clearly before payment is collected.
• Fee limitations: Practices cannot charge more than the actual cost of processing the transaction.
• PCI compliance: Payment Card Industry (PCI) standards apply to any organization that processes, stores, or transmits cardholder data—even when using integrated payment tools. Valant’s payment integrations support PCI compliance, but each practice is ultimately responsible for ensuring that all of their systems and processes meet required standards.

Failure to meet these standards could result in fines, refund demands, or reputational harm. To verify what’s permitted in your state, check the consumer protection or business section of your state attorney general’s website. Most states publish guidance there about surcharge regulations and disclosure requirements.

Communicating with Patients About Fees

For any behavioral health billing practice, proactive communication with patients matters. When it comes to passing fees along to patients, best communications practices include:

• Outlining the fee in intake forms, billing policies, and online payment screens.
• Using neutral, clear language, such as: “To offset rising administrative costs, card payments will now include a 2.9% processing fee. No fee applies to payments made by ACH , check, or HSA/FSA card.”
• Offering alternative payment options wherever possible.
• Giving patients advance notice before implementing any new fees.

Alternatives to Passing Credit Card Fees to Patients

A credit card surcharge isn’t the only option. Many practices choose instead to:

• Increase session rates slightly: A flat fee increase may be better received by patients than a line-item surcharge.
• Promote ACH payments: These are generally more secure and less costly than credit cards. Valant Behavioral Health EHR supports integrated ACH alongside credit card processing, making it easy to offer patients this alternative payment option.
• Negotiate with payment processors: Larger practices may be able to secure lower rates based on volume.
• Absorb fees into overhead: Some practices treat card processing as a cost of doing business, building it into their financial planning.

What Practices Can Consider

There’s no one-size-fits-all answer. Each practice should approach the decision by weighing their financial realities and patient needs. Start by asking:

• What percentage of patients pay by credit card?
• Will a fee affect collection rate or patient satisfaction?
• Does the practice’s EHR support multiple payment options?
• Do patients have access to alternative methods such as ACH or FSA/HSA cards?

Ultimately, the goal is balancing a positive patient experience with managing costs.
And while healthcare payment processing fees may not be the biggest line item in a practice’s budget, they can be substantial enough to require consideration.

Whether a practice chooses to absorb the cost or implement a surcharge, it’s important to communicate any policy changes clearly. The best solution is one that supports practice sustainability while preserving patient trust.