How Much Does a Fractional CFO Cost? (And When It Pays Off for a Healthcare Agency)

Christian Soriaga, CPAOct 15, 202611 min read

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Quick answer: A fractional CFO costs whatever the scope costs. The price is set by how much work you need each month, not by a standard rate, and no government source publishes one. At Soriaga & Associates, our fractional CFO service is a monthly retainer, quoted in writing on a free call. This article explains the pricing models, what moves the price, and how it compares with a full-time hire.

BLS reports a median annual wage of $166,570 for financial managers (May 2025). With the average employer benefit load, we estimate one full-time hire costs about $237,979 a year, before recruiting (BLS Occupational Outlook Handbook; BLS Employer Costs for Employee Compensation, June 2026).

If you are searching for "fractional CFO cost," you probably want a number. We understand that. We also will not hand you a made-up range. Plenty of websites quote "typical" monthly fees, but none we found cite a neutral, published source, and we could not find one either. What we can do is show you the pieces that drive the fee, the one comparison that has government data behind it (a full-time hire), and a labeled example of when the spend can pay off for a home health, hospice or home care agency.

Key takeaways

No neutral source publishes fractional CFO rates. Be skeptical of any "average" without a primary source. Ask for a written scope and fee instead.
Three pricing models exist: a monthly retainer, hourly billing and a project fee. Ongoing oversight usually fits a retainer.
Scope drives price. Transaction volume, number of entities, Medicare cost reports and how often you want forecasts are the big levers.
Our Medicare cost reports are a flat $1,599.99 for low or full utilization and $500 for no utilization. The fractional CFO retainer is quoted on a free call.
A full-time financial manager is expensive. BLS puts the median wage at $166,570 (May 2025). Our illustrative loaded cost is about $237,979 a year.
Employer payroll tax alone is 7.65% of wages for Social Security and Medicare (IRS Publication 15, 2026).
A fractional CFO pays off when the decisions it improves are worth more than the fee. Our example below uses a hypothetical agency and is not a promise of results.

Want a written quote instead of a guess? Tell us your entities, monthly transaction volume and when your cost report is due. Book a free 20-minute call and we will quote the scope in writing.

Fractional CFO cost: the three pricing models

Fractional CFOs generally bill one of three ways. The model matters as much as the number, because it decides who carries the risk of scope creep.

Model	How it works	Best for	Watch for
Monthly retainer	Fixed monthly fee for a defined scope and cadence	Ongoing oversight, monthly reporting, forecasting	Scope should be written down, including what is not included
Hourly	You pay for time used	A single question, a short review, a second opinion	Costs rise fast when a problem is larger than expected
Project or flat fee	One price for one deliverable	A cost report, a budget model, a cleanup	The deliverable should be defined before you sign

What we charge, and what we do not publish

We keep this simple. These are the prices on our website:

Medicare cost report (home health or hospice): $1,599.99 flat for low or full utilization.
Medicare cost report, no utilization: $500 flat.
Fractional CFO service: a monthly retainer, quoted in writing on your free 20-minute call.

We do not publish a fractional CFO price list, because the right scope for a single-location agency with one set of books is not the right scope for three entities with payroll in several states. The call is free, and you get the quote in writing before you commit. You can see every published fee on our pricing page.

What drives the price of a fractional CFO

If two quotes for "a fractional CFO" differ by a lot, the scope almost always differs too. These are the factors that matter most.

Scope: oversight only, or the whole finance function

Our fractional CFO services include four pieces: monthly CPA oversight of your books, annual business tax preparation, Medicare cost reporting, and a monthly financial analysis that shows where money goes and which services are most profitable. A quote that includes all four is not comparable with one that only includes a monthly call.

Transaction volume and bookkeeping quality

A CFO who reviews clean books spends less time than one who has to fix them. If a bookkeeper already closes your books each month, a CPA can review and oversee. If the books are behind, expect cleanup work first, which is usually a project fee rather than part of the retainer.

Number of entities

Each entity adds books, a tax return and intercompany questions. A home health agency, a separate management company and a real estate holding company are three sets of numbers, not one.

Medicare cost reports

Home health agencies file Form CMS-1728-20 and hospices file CMS-1984-14. Cost reports are due on or before the last day of the fifth month after the period closes (42 CFR 413.24(f)(2)(i)). If the period ends on a day other than the last day of a month, the report is due 150 days after the last day of the period. We prepare cost reports ourselves, so for our fractional CFO clients the report is part of the service rather than a separate vendor bill.

Forecasting cadence

A quarterly forecast takes less time than a rolling 13-week cash forecast updated every month. The more often you want the model rebuilt, the more the work costs. Ask what the forecast will contain and how often it will be updated.

Not sure which of these applies to you? Most agencies have one or two that matter. Book a free 20-minute call and we will tell you which ones will move your quote.

The comparison with real data: a full-time financial manager

Most fractional CFO articles skip this comparison or fill it with unsourced numbers. We can do it with government data.

The U.S. Bureau of Labor Statistics reports that the median annual wage for financial managers was $166,570 in May 2025. BLS describes the typical path as a bachelor's degree plus five years or more of experience in a related business or financial occupation. That is a broad occupation, and a CFO of a larger organization may earn more, so treat it as a reference point, not a quote for any one person.

Wages are only part of the cost. Two public sources help here:

Employer payroll tax: the employer pays 6.2% Social Security tax and 1.45% Medicare tax on wages, 7.65% in total (IRS Publication 15, 2026). The 2026 Social Security wage base is $184,500, so a $166,570 wage is fully subject to both.
Benefits and other compensation: in June 2026, BLS reported that private industry employers paid $46.89 per hour worked in total compensation, of which $32.82 was wages and salaries and $14.07 was benefits (30.0% of total compensation). Legally required benefits were $3.40 an hour, or 7.2% of total compensation (BLS Employer Costs for Employee Compensation, June 2026).

Illustrative, not a published figure

Here is the arithmetic using those public numbers. This is Illustrative, not a published figure. It applies an average for all private-industry workers to a financial manager wage. Your actual benefit costs, bonus and recruiting costs will differ.

Line	Amount	How we got it
Median financial manager wage	$166,570	BLS OOH, May 2025
Employer Social Security (6.2%)	$10,327	$166,570 x 6.2%
Employer Medicare (1.45%)	$2,415	$166,570 x 1.45%
Employer payroll tax subtotal	$12,743	7.65% of wages
Wage plus payroll tax only	$179,313	Lower bound
Wage grossed up by the BLS ratio	about $237,979	$166,570 x ($46.89 / $32.82)
Monthly equivalent of the last line	about $19,832	$237,979 / 12

The ratio in the last two rows is BLS total compensation per hour divided by wages per hour for all private industry. It captures benefits such as paid leave, insurance and retirement along with payroll tax. It does not include recruiting or the cost of a vacancy.

So a full-time hire at the median wage costs somewhere between about $179,000 (wages and payroll tax only) and about $238,000 a year (average benefit load), before recruiting. That is roughly $15,000 to $19,800 a month. A fractional engagement only has to cost less than that to be cheaper, and for many small and mid-size agencies it will, because you are not paying for hours you do not need. The question for most owners is not "is it cheaper" but "is the scope right for my size."

When a fractional CFO pays off for a healthcare agency

A fractional CFO should change a decision, a cash position or a risk. These are the places we look first for home health, hospice and home care agencies.

1. A cost report that ties to the ledger

Medicare cost reports are filed on a deadline set by regulation (42 CFR 413.24). A CPA who closes the books monthly and also files the report keeps the two lined up, so the report is built from numbers you already reviewed instead of a scramble at year end.

2. Margin by service line

CMS has paid home health in 30-day periods since January 1, 2020 under PDGM (CMS, CY 2026 Home Health PPS final rule fact sheet). Because payment is per 30-day period, a monthly look at which services make money is more useful than an annual one. For the cash side, see our guide to PDGM 30-day periods and home health cash flow.

3. The hospice aggregate cap

If you run a hospice, the aggregate cap limits total Medicare payments, and CMS finalized a cap amount of $36,174.75 for FY 2027 (CMS FY 2027 hospice final rule fact sheet). Knowing your position before the year closes matters. Our flat cost report fee covers preparing and filing the report; cap review is separate, so raise it when you scope the work. Our explainer on the hospice aggregate cap shows how it works.

4. Cash forecasting and decisions

Hiring a clinician, opening a branch and buying software are all cash decisions. A forecast that updates monthly lets you answer "can we afford this" with numbers.

Illustrative payoff example

This is Illustrative, not a published figure. The assumptions are ours and hypothetical. They are not a client result and not a promise.

Hypothetical agency with $3,000,000 in annual revenue.
Monthly analysis finds a service line or cost problem worth 1 percentage point of margin.
1% of $3,000,000 is $30,000 a year.

In this example, a fractional CFO engagement breaks even if its annual cost is below $30,000, or $2,500 a month, and the 1-point gain actually happens and lasts. If the gain were 2 points ($60,000), the break-even rises to $5,000 a month. The point is the method: take your revenue, estimate a realistic margin gain, and compare it to the quote. If the numbers do not clear, do not buy.

How to evaluate a fractional CFO quote

Ask for these items in writing before you sign:

Scope: what is included each month and what is extra.
Cadence: when books close, when reports arrive, how often you meet.
Forecasting: what the model contains and how often it is updated.
Tax and cost reports: whether preparation and filing are included or billed separately.
Who does the work: the CPA, or staff under review.
Term and exit: minimum commitment and how to stop.
Healthcare experience: whether the firm has filed cost reports for agencies like yours.

If a quote cannot answer these, it is not ready to compare. Our free 20-minute call ends with a written scope you can compare.

When a fractional CFO may not be the right fit

Not every business needs one.

If you only need bookkeeping, start with bookkeeping and add oversight later.
If you need a one-time cost report, a flat-fee report may be all you need.
If your finance needs outgrow part-time help, a full-time controller or CFO may be justified. The BLS-based cost above is the figure to compare.

Ready to see what a quote looks like for your agency? Bring your last cost report and a recent profit and loss statement. Book a free 20-minute call and you will leave with a clear next step, whether or not you hire us. Our fractional CFO services page lists what the service includes.

Frequently asked questions

How much does a fractional CFO cost per month?

It depends on scope, and no government source publishes a market rate, so we will not quote a range. Fees are set by what you need: monthly oversight, transaction volume, entities, cost reports and how often you want forecasts. At Soriaga & Associates, our fractional CFO service is a monthly retainer quoted in writing on a free 20-minute call.

Is a fractional CFO cheaper than a full-time CFO?

Usually, because you pay for the scope you need instead of a full salary and benefits. BLS reports a median of $166,570 a year for financial managers (May 2025), and BLS compensation data imply benefits add roughly 43% on top of wages for the average private employer. Your own fractional quote is the number to compare against.

Should I pay hourly or a monthly retainer?

Hourly works for a one-time question. A monthly retainer fits ongoing oversight, because the cost is predictable and the work happens on a schedule. Project fees fit a defined deliverable such as a cost report, which we price at a flat $1,599.99 for low or full utilization and $500 for no utilization.

When does a fractional CFO pay for itself?

When the decisions it improves are worth more than the fee. Typical places are a better margin per service line, a cost report that ties to your ledger and cleaner cash forecasting. We show an illustrative example in this article; your own numbers will differ.

Does a fractional CFO file my Medicare cost report?

At our firm, yes. The fractional CFO service includes Medicare cost report preparation and filing, plus audit assistance for IDOA audits. Cost reports are due on or before the last day of the fifth month after your fiscal year ends (42 CFR 413.24).

Sources

Last updated: October 2026.

This article is general information, not legal or tax advice.

Soriaga & Associates, LLC is a CPA firm founded in 1985 in Lisle, Illinois, serving home health, hospice, home care, wound care and dental providers nationwide. (630) 491-1268.