What Does Med Spa Accounting Cost? Bookkeeping, Tax and Controller Fees

"What should I be paying for bookkeeping?" is the question we hear most from med spa owners, usually right after a surprise invoice or a year-end that did not reconcile. The number matters, but it is the wrong place to start. The fee follows the work, and the work in a med spa is set by things most pricing pages never mention: how many prepaid packages are outstanding, how many providers are on commission, whether there is an MSO, and what shape the books are in today.

This guide explains what drives the price, what a monthly engagement at our $1,500 starting point covers and what moves it up, how cleanup should be priced, what an in-house bookkeeper costs once you load the salary, and what you should refuse to pay for. The one price we quote is our own starting point; everything else is scope.

What drives the fee

AmSpa's 2024 industry report describes the average practice as a single location with about 8 employees, roughly 245 patient visits a month and about $1.4 million in annual revenue. At that scale the bookkeeping is not categorizing a bank feed. Seven factors set the price of doing it properly.

Locations and entities. Each legal entity is a separate set of books and a separate tax return, and more than one means intercompany balances to reconcile. Each location adds a POS, a merchant account and a bank account to tie out, plus a location-level P&L if you want to manage it.

Providers and how they are paid. Flat hourly wages need a payroll entry. Base plus commission on net service revenue, with a retail percentage on top, needs a month-end commission calculation that ties to the production report and an accrual that reverses when payroll runs.

Transaction volume and prepaid balances. Visits drive the volume of tickets, refunds, chargebacks and tips to reconcile. Packages, memberships and gift cards add a liability rollforward every month: opening balance, sales, redemptions, refunds, expirations, closing balance, reconciled to the POS.

Inventory. Injectables and retail on the balance sheet, a monthly count, and cost of goods sold from units dispensed. Without this, gross margin is noise.

States. Retail products are taxable nearly everywhere, and each state you are registered in is a return. Shipping skincare across state lines eventually creates economic nexus, which most states set at $100,000 of sales.

MSO and professional-entity structure. Two entities, a management fee under a written agreement, intercompany reconciliation, and two tax returns that have to agree with each other.

The condition of the books. If deferred revenue has never been recorded, inventory has never been counted and commissions were paid from a spreadsheet nobody kept, the first job is a rebuild, and that is priced on its own.

What a $1,500-a-month engagement includes, and what moves it up

Our med spa engagements start at $1,500 a month. That starting point fits a single-location, single-entity practice with one POS, one payroll provider, retail sales tax in one state, and books that are clean after onboarding. The monthly work is the close: posting the sales summary from the POS, reconciling bank and merchant accounts net of fees, the package and membership liability rollforward, the inventory and cost of goods sold entry, the commission accrual, the sales tax return, and a monthly package with a P&L by service line, a balance sheet and a KPI sheet. A CPA reviews the close before it reaches you.

The fee moves up with each driver above. A second location roughly doubles the reconciliation work even when it shares an entity. An MSO/PC structure adds a second set of books and the intercompany work. Multi-state retail adds returns. Adding the business return, owner tax planning and quarterly estimates to the monthly engagement is the most common step up, and usually the right one, because the person who recorded the deferred revenue and the inventory should be the person deciding how they are treated on the return. Controller-level reporting (budget versus actual, a 13-week cash forecast, location P&Ls, provider productivity) is a further tier.

We describe tiers by scope rather than publish a price list because two practices with the same revenue can be very different amounts of work: one has four locations and a membership program, the other has one location and no packages. The quote is written after a diagnostic, and it is flat.

Cleanup is a separate fixed project

If the books need rebuilding, do not let anyone fold that into the monthly fee. Cleanup for a med spa usually means reconstructing the package and gift card liability from POS history, counting inventory and backing into cost of goods sold, reclassifying commissions and payroll taxes, confirming whether retail sales tax was charged and filed, separating entities that ran through one bank account, and reconciling every month that was skipped. Our guide to catching up on months of bookkeeping covers the general process.

The right structure is a diagnostic first, a fixed quote for the cleanup, then the monthly engagement starting on clean books. Hourly cleanup rewards slow work; a fixed project puts the risk of a messy file where it belongs, on the accountant who scoped it.

In-house bookkeeper versus outsourced: the loaded cost

Owners often compare a monthly fee to a bookkeeper's salary and conclude the employee is cheaper. Load the salary first. The Bureau of Labor Statistics puts the median annual wage for bookkeeping, accounting and auditing clerks at $50,670 as of May 2025. The employer's share of Social Security and Medicare is 7.65% of wages, which on $50,670 is $3,876. Federal unemployment tax nets to 0.6% of the first $7,000 after the state credit, or $42. Florida reemployment tax for a new employer is 2.7% of the first $7,000, or $189. Benefits, paid time off, training and workspace vary widely; we assume 15% of salary, or $7,601, as a placeholder you should replace with your own numbers.

Two cautions. That median is a national figure for clerks across every industry; a bookkeeper who can run a deferred revenue rollforward and an inventory close for a two-entity practice is a more senior hire. And the employee does not replace a CPA: you still need someone to review the close, plan tax and sign the return. The outsourced comparison is a $1,500 monthly starting point, $18,000 a year, with CPA review built in, no vacation coverage to arrange and no turnover. In-house wins when there is enough daily work (payables, deposits and front-desk reconciliations across several locations) to fill a day, and even then most groups keep an outside CPA-led practice for the close and tax.

What you should not pay for

Hourly billing for routine monthly work, which makes the fee unpredictable and rewards inefficiency. Per-transaction pricing, which penalizes you for being busy and says nothing about whether the hard entries are being made. Markups on QuickBooks or payroll subscriptions; pay the vendor directly. A year-end "true-up" invoice for work that belonged in the monthly scope. Separate charges for answering a question; if you cannot ask whether to prepay a December injectables order, the engagement is not working. And cleanup buried inside the monthly fee, which means you cannot tell when it ends.

Questions to ask about any quote

What is the close date each month, and what do I receive? Is the package liability reconciled to my POS every month, and will I see the rollforward? Who counts inventory and who books it? How is the commission accrual calculated? Which tax returns are included, and are quarterly estimates and 1099s in scope? Which state sales tax returns are included? What happens to the fee when I add a provider, a location or a state? How is cleanup priced, and when does it end? Who does the work and who reviews it? What does it take to leave? Our guide on what a small business CPA costs covers the questions that apply to any business; our guide on choosing a med spa accountant covers the interview itself.

Where owners overpay and underpay

The expensive mistakes run both ways. Underpaying looks like a low monthly fee for a bookkeeper who books deposits as revenue, followed by a cleanup project, a sales tax assessment and a tax return built on the wrong numbers. Overpaying looks like hourly billing with no scope, a large retainer for "CFO services" at a practice that does not yet have a reliable monthly close, or an in-house bookkeeper's loaded salary for a single location that could be closed remotely in a fraction of the time. Get the close right first; add controller-level reporting when the numbers are trustworthy enough to steer by.

What med spa-focused firms publish (October 2026)

Most accounting firms that market to med spas do not publish prices. The ones that do give a useful range, as long as you read what each number buys. We checked the pricing pages of firms that advertise a med spa or aesthetics specialty on October 16, 2026; the figures below are their published starting points on that date and will change.

Two patterns are worth noticing. First, the low monthly figures are bookkeeping-only and are priced on volume, so a practice with 400 transactions a month, three providers on commission and a package liability to roll forward will not land at the starting number. Second, the firms that bundle tax, close and reporting under one fee cluster between roughly $1,000 and $2,000 a month for a single location, which is where our Core tier sits. Compare the deliverables, not the headline, and ask every bidder whether a deferred-revenue rollforward and an inventory reconciliation are in the monthly scope.

When to get help

If you cannot say what your package liability is today, whether retail sales tax is being charged, or what each provider costs as a percentage of the revenue she produces, your accounting is under-scoped regardless of what you pay. Balance Partners is a CPA-led accounting practice in Tampa working with med spas and aesthetics practices nationwide; our med spa accounting and tax services page describes the monthly engagement, and every engagement starts with a diagnostic, a written scope and a flat fee.

If you want a number for your own practice, request a 20-minute fit call. Bring last month's financials and your POS outstanding-balance report; we will tell you what the work is and quote it in writing. Our pricing page explains the starting point.

Jenny Gao, CPA, EA

Founder of Balance Partners. Florida-licensed CPA and IRS Enrolled Agent with more than a decade of accounting and tax experience. Jenny writes and reviews every guide on this site. About Jenny

This article is general educational information for U.S. business owners and is not accounting, tax, legal, payroll or financial advice for your situation. Rules change and vary by entity, state and facts. Balance Partners, LLC does not provide audit, review or other attest services. Last reviewed October 16, 2026.