Genetic Counseling Break-Even: About $79K Monthly Revenue

Fixed costs $16.5K Monthly base cost

Contribution margin 86% After variable lines

Break-even revenue $19.3K Monthly target revenue

Break-even timing Month 1 Launch month

Break-even calculator

Use this to test how monthly revenue, variable expenses, and fixed costs shape break-even for a genetic counseling practice.

Lean Base Full

Monthly revenue Revenue is the top line that funds fixed costs. $ Low revenue High revenue Variable expenses These rise with each counseling session and case handled. $ Low costs High costs

Money available to cover fixed costs $152,000 $178,000 revenue - $26,000 variable expenses

Margin ratio

85%

Covers fixed costs

Yes

Fixed monthly costs These are the monthly overhead costs break-even must cover. $ Low overhead High overhead

Break-even chart Revenue Total costs

Which genetic counseling expenses are fixed, variable, semi-variable, or semi-fixed at break-even?

Cost classification

Break-even is reliable only when stable overhead, session-linked fees, and staffing steps are modeled separately. For this practice, the big risk is hiding labor ramps inside a simple fixed-cost number.

Expense	Cost	Break-Even Treatment	Common Mistake
Lead Genetic Counselor payroll	Fixed	Include $140,000 annually, or about $11,667 monthly, as baseline clinical leadership overhead.	Spreading this salary across sessions and understating the monthly hurdle.
Office Rent (Virtual/Admin)	Fixed	Include $1,500 monthly from Month 1 through Month 60.	Removing admin space because visits happen online.
Base Software Subscriptions	Fixed	Include $800 monthly as stable platform overhead before per-user charges.	Treating all software as usage-based and missing the base bill.
Telehealth Platform Per Session Fee	Variable	Apply 3.0% of revenue in the first year, falling to 2.2% by the fifth year.	Modeling it as a flat monthly subscription instead of a session-linked fee.
Digital Marketing Spend	Variable	Apply 8.0% of revenue in the first year, declining to 6.0% by the fifth year.	Leaving no-shows out of revenue planning while still spending to acquire them.
EHR/CRM Per User License	Semi-variable	Model separately from base software; it runs 2.0% of revenue in the first year and falls to 1.2% by the fifth year.	Treating every software line as fixed and missing user-linked growth.
Billing Specialist payroll	Semi-fixed	Add in staffing steps: 0.5 FTE in the first year, rising to 2.0 FTE by the fifth year at $55,000 per FTE annually.	Ignoring billing labor until collections slow or denials rise.
Genetic Counselor payroll	Semi-fixed	Scale counselor capacity in steps from 6.0 FTEs in the first year to 23.0 FTEs by the fifth year at $90,000 per FTE annually.	Assuming each added session has no staffing impact.

How does break-even change across lean, base, and full genetic counseling setups?

Scenario table

Break-even improves as referral depth and counselor capacity scale up. The lean case works, but the base and full cases create a wider cushion because fixed staffing is spread over more revenue.

Planning assumptions only. Actual break-even will move with referral flow, payer mix, and counselor capacity.

Scenario	Monthly Revenue	Variable Costs	Fixed Costs	CM Ratio	Operating Profit	Break-Even Signal
Lean genetic counseling setup	$14,823	$2,145	$5,626	85.5%	$7,052	Break-even is about $79k a year, so this case has the thinnest cushion.
Base genetic counseling plan	$42,450	$5,349	$11,910	87.4%	$25,191	Break-even is about $164k a year, so scale helps but staffing still matters.
Full genetic counseling scale	$86,707	$9,191	$18,525	89.4%	$58,990	Break-even is about $249k a year, so volume and referral density have to stay high.

What can push a genetic counseling practice below break-even?

Stress test

You’re fine in the base plan, with about $98,875 of monthly cushion above the $79,000 break-even line. The risk is a referral slowdown, weaker reimbursement, or higher staff and software costs shrinking that cushion fast.

Stress Case	Changed Assumption	Break-Even Revenue	Revenue Gap	Risk Signal
Current plan	No change.	$79,000	$98,875 cushion	Healthy base case, but referrals still drive the cushion.
Revenue shortfall	Collected revenue falls 20% as OB/GYN, fertility, oncology, or pediatric referrals slow.	$79,000	$63,300 cushion	A referral miss trims the buffer fast.
Fixed-cost pressure	Monthly fixed costs rise 10% from rent, billing coverage, or software.	$86,900	$90,975 cushion	Overhead creep lifts the floor even if volume holds.
Margin pressure	Variable load rises 2 points from billing friction, no-shows, or higher platform fees.	$80,893	$96,982 cushion	Lower reimbursement or leakage reduces room above break-even.
Combined pressure	Collected revenue falls 55% while fixed costs rise 10% and variable load rises 2 points.	$88,983	$8,939 gap	This is the fail state; collected revenue slips below break-even.

What should a genetic counseling founder verify before hiring beyond core staff and signing space?

Founder checklist

Don’t hire beyond the core team or sign a larger lease until referral flow, payer credentialing, and telehealth workflows can support the Year 1 load. The model needs $894K cash in Month 1 and $54K in launch setup items, so early spend only works if booked sessions are real.

1Demand proof493/mo

Verify referral sources and marketing channels can support 493 Year 1 sessions a month before you hire past core staff, because empty counselor time burns cash fast.

2CredentialingClaims ready

Confirm payer credentialing can finish before you count on insurance collections, because slow reimbursement turns good demand into bad cash flow.

3Margin check85.5% CM

Check that each consult keeps about 85.5% after telehealth, software, marketing, and professional development costs, because that margin has to fund payroll and overhead.

4Staffing load$67.5K/mo

Keep staffing tied to booked sessions, since the Year 1 salary plan and base overhead run about $67.5K a month before variable spend.

5Launch setup$54K

Hold the office lease light until telehealth and admin workflows are stable, and keep launch setup near the listed $54,000 so cash is not trapped before the schedule fills.

6Cash cushion$894K

Protect the $894,000 minimum cash need in Month 1, and confirm malpractice and business insurance before the first client visit so one claim does not erase early margin.