Is pay per lead legal for lawyers?

Under the ABA model rule, yes, if the lead seller does not recommend the lawyer and the fee is not a share of legal fees. New York’s ethics committee accepted a per-lead fee because it stays the same whether or not the person hires the lawyer; Florida treats lead sellers as qualifying providers with conditions.

Can a dentist pay a marketing company per new patient?

In Colorado the dental practice act allows per-patient pay to an independent marketing agent. In Texas the fee must be set in advance and not based on the volume of patient referrals. The ADA code treats a share of patient fees as fee splitting.

Can a medical practice or med spa pay per booked appointment?

California says internet booking is not a referral when the service does not recommend a provider; Texas and Florida criminalize paying for securing patients. Where Medicare or Medicaid may pay for the care, the federal Anti-Kickback Statute also applies.

Can a real estate agent pay for leads?

Paying for marketing aimed at a wide audience is a service; paying a fee per referral of settlement business on a federally related mortgage is what RESPA bars, and Texas limits commissions to license holders.

Why do agencies charge a percentage of ad spend?

It is simple to bill and grows with the account. No rule read for this page targets it, but it rises with your budget rather than your results, so ask for spend billed at cost.

How marketing agencies charge practices: what the rules allow

By Erik Jia, founder of Oak Reel · Updated November 4, 2026

Agencies charge practices in six ways: a fixed monthly fee, a percentage of ad spend, per lead, per booked consultation, per new client, or a share of revenue. A fixed fee set in advance fits every professional rule read for this page. A share of fees is barred for lawyers and dentists, and pay per client is barred or restricted in most professions, so the pricing model is a compliance question before it is a price question.

Disclosure: Oak Reel charges a fixed $2,500 a month, so it has an interest in the first row looking good. Every cell cites the rule behind it; check them. To judge the work before any fee, see free sample ads for your practice.

Agency pricing models by profession

“Allowed” means generally allowed under the rules quoted below; “Depends on state” means no rule read settles it. Read on November 4, 2026; your own bar, board or counsel decides.

Pricing model	Law firms	Medical and med spas	Dentists	Chiropractors	Therapists	Real estate agents
Fixed monthly feeSet in advance, the same whatever the results	AllowedA reasonable cost of advertising (ABA 7.2(b)(1); Texas 7.03(e)(1))	AllowedFits the federal safe harbor if written, a year or longer and at fair market value (42 CFR 1001.952(d))	AllowedTexas 108.58(c) describes exactly this; the ADA targets fee shares	AllowedTexas excludes advertising in public media from soliciting (Penal Code 38.01(11))	AllowedThe ACA code addresses referral pay, not advertising	AllowedMarketing aimed at a wide audience is a paid service (CFPB RESPA FAQ)
Percentage of ad spendThe fee is a share of what goes to Meta or Google	AllowedAn advertising cost, if reasonable (ABA 7.2(b)(1)); no rule read targets it	Depends on stateNot tied to patients, but no rule read addresses it	Depends on stateNo rule read addresses it	Depends on stateNo rule read addresses it	Depends on stateNo rule read addresses it	AllowedPayment for services actually performed (12 U.S.C. 2607(c)(2))
Pay per leadA set price per inquiry, whether or not the person becomes a client	RestrictedOnly if the seller does not recommend you (ABA 7.2 comment [5]; NYSBA 1131); Florida adds conditions (4-7.22)	RestrictedCalifornia allows it without endorsement (650(h)); Florida 817.505 has no advertising exception	Depends on stateTexas bars fees based on the volume of patient referrals (108.58(c)); whether a lead is one is unsettled	Depends on stateTexas 102.001 and California 650(h) point different ways	Depends on stateTexas 102.001 and California 650(h) point different ways	RestrictedLawful as marketing; barred when it pays for referrals of settlement business (12 U.S.C. 2607(a))
Pay per booked consultationA price for each appointment the agency books	Depends on stateThe per-lead conditions apply at least (ABA 7.2 comment [5])	RestrictedCalifornia names appointment booking as no referral without endorsement (650(h)); Texas and Florida stricter	Depends on stateAllowed in Colorado (12-220-201(1)(v)(I)); restricted in Texas (108.58(c))	Depends on stateNo chiropractic rule read	Depends on stateNo therapy rule read	Depends on stateNo rule read addresses it
Pay per new client or caseA fee for each signed case, new patient or closing	BarredPay for recommending a lawyer (ABA 7.2(b)); barratry in Texas when it pays for solicitation (Penal Code 38.12)	BarredTexas 102.001, Florida 817.505, California 650(a); federal kickback law for federally paid care	Depends on stateAllowed in Colorado; barred in Texas (108.58(c))	BarredIn Texas (102.001; Penal Code 38.12) and California (650(a)); elsewhere depends on state	RestrictedACA A.10.b bars pay for client referrals; Texas 102.001 and California 650(a)	BarredAs a referral fee on a federally related mortgage (12 U.S.C. 2607(a)); Texas limits commissions to license holders
Revenue shareA percentage of the practice’s fees, collections or commissions	BarredSharing legal fees with a nonlawyer (ABA 5.4(a)), in most states	BarredIn New York (6530(19)) and Florida (817.505); California only if it matches the work’s value (650(b))	BarredFee splitting under the ADA code (4.E.1); state law varies	Depends on stateCalifornia only if it matches the work’s value (650(b))	RestrictedBarred under the ACA code when tied to referrals (A.10.b)	BarredIn Texas, for broker work by an unlicensed company (1101.651(a))

What agency pricing guides leave out

Oak Reel read 22 rules in 21 official texts for this page. The agency pricing guides that ranked on November 4, 2026 give price ranges and call a model good or bad for the client; none says which models a profession’s rules forbid. Three findings stand out.

Pay per lead is not one thing. For lawyers it turns on whether the seller recommends you; New York’s committee accepted a lead fee because it does not change when the person hires the lawyer.
Dentistry has no national answer. Colorado’s dental act allows per-patient pay to a marketing agent; Texas’s dental rule bars fees based on the volume of patient referrals.
For practices with Medicare or Medicaid patients, the federal safe harbor for agency pay expects a written agreement of at least a year with pay set in advance. A month-to-month fee, Oak Reel’s included, sits outside that harbor; outside is not illegal, it just lacks the harbor’s protection.

Ten questions to ask any agency before signing

1
How is the fee worked out, and does any part of it move with leads, patients, cases, closings or revenue?
The fee basis is what the rules above judge; a share of fees is barred for lawyers and dentists.
2
If you charge per lead or per booking, does your page or caller recommend us, screen the person’s problem or choose who gets them?
A lead fee is allowed for lawyers, and in California for health practices, only when the seller does not recommend.
3
Can we see the pages and scripts our leads come from?
A lawyer answers for what a lead seller tells people, and it may not suggest it is neutral or unpaid (ABA 7.2, comment [5]).
4
Whose name is on the ad account, the Page and the pixel, and do we keep them if we leave?
An account in the agency’s name holds your ad history and audiences.
5
Who owns the footage and the finished ads when the contract ends?
The ads show your own professional; without a written grant you may not be able to reuse them.
6
Is ad spend billed at cost, separately from your fee, with no markup?
A markup hidden in “media” is a fee nobody agreed to.
7
How long is the term, and what notice ends it?
Long terms lock you in. Practices with federally paid patients should know the safe harbor for agency pay expects a written term of a year or more.
8
Who approves each ad before it runs, and who files it where filing is required?
The professional answers for the ad; Texas, for one, requires lawyers to file ads with the State Bar.
9
What client data will you see or store, and will you sign a business associate agreement?
Health practices need one from any vendor that handles patient information.
10
Do you also market our direct competitors here, or run a directory or referral site?
A referral site that recommends providers is the arrangement most of these rules target.

The rules behind the table, quoted

Grouped by profession. Each card links the official text and the day it was read. Some come from a reputable copy of the official text, which the source line says.

Law firms

ABA model rule
A lawyer may not pay anyone for recommending the lawyer, but may pay the reasonable cost of advertising. A fixed fee for making and running ads is that cost.
“pay the reasonable costs of advertisements or communications permitted by this Rule”
ABA Model Rule 7.2(b)(1), read 2026-11-04
ABA model rule
Paying per lead is allowed under the model rule only if the seller does not recommend the lawyer, and the payment must also respect the fee-sharing rule (5.4).
“A lawyer may pay others for generating client leads, such as Internet-based client leads, as long as the lead generator does not recommend the lawyer”
ABA Model Rule 7.2, Comment [5], read 2026-11-04
ABA model rule
A marketer paid a percentage of the firm’s fees or a cut of each settlement is sharing legal fees; none of the rule’s exceptions covers a marketing company. Some states have changed their version of this rule.
“A lawyer or law firm shall not share legal fees with a nonlawyer”
ABA Model Rule 5.4(a), read 2026-11-04
New York (state bar ethics opinion)
New York’s state bar ethics committee accepted a per-lead fee because it stays the same whether or not the person hires the lawyer. A fee per retained client fails that test. Opinions advise; they do not bind.
“the fee does not vary depending on whether the lead results in retention of the lawyer”
NYSBA Committee on Professional Ethics, Opinion 1131 (2017), ¶2, read 2026-11-04
Texas
Texas bars paying a nonlawyer for soliciting or referring clients (7.03(e)), but allows reasonable fees for advertising. Paying someone to solicit employment is also the crime of barratry (Penal Code 38.12(a)(4)).
“This Rule does not prohibit a lawyer from paying reasonable fees for advertising and public relations services”
Texas Disciplinary Rules of Professional Conduct 7.03(e)(1), read 2026-11-04
Florida
In Florida a company paid for leads is a “qualifying provider”. A lawyer may use one only if, among other conditions, it takes no fee that is a division or sharing of fees (4-7.22(d)(2)).
“providing tips or leads for prospective clients to lawyers or law firms”
Rules Regulating The Florida Bar 4-7.22(b)(4), read 2026-11-04

Medical practices and med spas

Federal
Paying anything to induce referrals of patients whose care Medicare, Medicaid or another federal program may pay for is a federal felony. Fees that rise with patients delivered are where the question starts.
“offers or pays any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind to any person to induce such person”
Anti-Kickback Statute, 42 U.S.C. 1320a-7b(b)(2), read 2026-11-04
Federal (OIG advisory opinion)
The HHS Inspector General has said a marketer paid a percentage of a practice’s revenue may be receiving prohibited pay. An advisory opinion binds only the party that asked.
“Percentage compensation arrangements for marketing services may implicate the anti-kickback statute.”
HHS OIG Advisory Opinion 98-4 (1998), read 2026-11-04
Texas
Texas makes paying for securing patients a crime for every state health licensee, whoever pays for the care. Advertising itself is not barred unless false or misleading (102.004), and federal safe harbors carry over (102.003).
“any remuneration in cash or in kind or any benefit or commission to or from another for securing or soliciting a patient or patronage”
Texas Occupations Code 102.001(a) (Patient Solicitation Act), read 2026-11-04
Florida
Florida’s Patient Brokering Act covers every payer, not only Medicare, and has no general exception for advertising. A per-patient or split-fee deal with a marketer is the shape it targets.
“or engage in any split-fee arrangement, in any form whatsoever, to induce the referral of a patient or patronage to or from a health care provider”
Florida Statutes 817.505(1)(a), read 2026-11-04
California
California bars paying for referrals (650(a)), but internet advertising and appointment booking are not referrals if the service does not recommend or endorse a specific provider.
“shall not constitute a referral of a patient if the internet-based service provider does not recommend or endorse a specific licensee to a prospective patient”
California Business and Professions Code 650(h), read 2026-11-04
California
California allows percentage pricing for services other than referral, but only when the amount matches the value of the work. A violation of section 650 is a crime.
“based on a percentage of gross revenue or similar type of contractual arrangement shall not be unlawful if the consideration is commensurate with the value of the services furnished”
California Business and Professions Code 650(b), read 2026-11-04
New York
For New York physicians, letting a marketer share in fees is professional misconduct, and so is paying a third party for referring a patient (6530(18)).
“Permitting any person to share in the fees for professional services, other than: a partner, employee, associate in a professional firm or corporation”
New York Education Law 6530(19), read 2026-11-04

Dentists

ADA code
The ADA treats paying a marketer a share of patient fees as fee splitting, coupon deals included. It warns that state law may add more.
“sharing a specified portion of the professional fees collected from prospective or actual patients with the vendor providing the advertising or marketing services is engaged in fee splitting”
ADA Principles of Ethics and Code of Professional Conduct, Advisory Opinion 4.E.1, read 2026-11-04
Texas
Texas dentists may pay for advertising and marketing if the fee is set in advance, at fair market value and not based on patient referrals. A fee that rises with each patient fails the last test.
“provided the remuneration is set in advance, is consistent with the fair market value of the services, and is not based on the volume or value of any patient referrals”
22 Texas Administrative Code 108.58(c) (mirror: Cornell LII), read 2026-11-04
Colorado
Colorado is the exception: its dental practice act lets a dentist pay an independent marketing agent per patient. Federal kickback law still applies to federally paid care.
“including compensation that is based on the results or performance of the services on a per-patient basis”
Colorado Revised Statutes 12-220-201(1)(v)(I) (mirror: colorado.public.law), read 2026-11-04

Chiropractors and therapists

Texas
Texas barratry law names chiropractors and every health licensee, so paying someone to solicit patients for them is a crime. Its definition of soliciting excludes advertising through public media (38.01(11)).
““Professional” means an attorney, chiropractor, physician, surgeon, private investigator, or any other person licensed, certified, or registered by a state agency that regulates a health care profession.”
Texas Penal Code 38.01(12), applied by 38.12(a)(4), read 2026-11-04
ACA code
Counselors bound by the ACA code may not split fees or pay or take commissions for client referrals. A fee per client or a share of session fees to a marketer is the risky shape; plain advertising is not addressed.
“Counselors do not participate in fee splitting, nor do they give or receive commissions, rebates, or any other form of remuneration when referring clients for professional services.”
ACA Code of Ethics (2014), A.10.b, read 2026-11-04

Real estate agents

Federal
RESPA bars paying or taking a fee for referring settlement business on a federally related mortgage loan, and Regulation X counts an agent’s services as settlement services (12 CFR 1024.2). A referral fee per closing is the risky shape.
“No person shall give and no person shall accept any fee, kickback, or thing of value pursuant to any agreement or understanding, oral or otherwise”
RESPA Section 8(a), 12 U.S.C. 2607(a), read 2026-11-04
Federal (CFPB guidance)
The CFPB separates marketing from referrals: ads aimed at a wide audience are a paid service, while payments based on the number of referrals are not.
“a marketing service is not directed to a person; rather, it is generally targeted at a wide audience.”
CFPB RESPA FAQs, Section 8: Marketing Services Agreements, read 2026-11-04
Texas
In Texas only license holders may be paid a commission for broker work, so an unlicensed marketing company cannot take a share of commissions for it. A fee for advertising is a separate question.
“A licensed broker may not pay a commission to or otherwise compensate a person directly or indirectly for performing an act of a broker unless the person is”
Texas Occupations Code 1101.651(a), read 2026-11-04

What every agency contract should say

Federal
For practices with federally paid patients, the safe harbor for agency pay needs a signed written agreement of at least one year and pay set in advance at fair market value, not based on referrals. A fixed monthly fee fits; per patient and percentage do not.
“is not determined in a manner that takes into account the volume or value of any referrals or business otherwise generated between the parties”
42 CFR 1001.952(d)(1)(iv), read 2026-11-04

How Oak Reel charges

One fixed fee, $2,500 a month, the same for every practice, set before any ad runs and never tied to leads, consultations, cases or revenue. The practice pays Meta directly from its own ad account, with no markup, and can stop month to month. The details are on the pricing page, and the free sample ads show the work before anything is paid.

Questions about agency fees

Is pay per lead legal for lawyers?: Under the ABA model rule, yes, if the lead seller does not recommend the lawyer and the fee is not a share of legal fees. New York’s ethics committee accepted a per-lead fee because it stays the same whether or not the person hires the lawyer; Florida treats lead sellers as qualifying providers with conditions.
Can a dentist pay a marketing company per new patient?: In Colorado the dental practice act allows per-patient pay to an independent marketing agent. In Texas the fee must be set in advance and not based on the volume of patient referrals. The ADA code treats a share of patient fees as fee splitting.
Can a medical practice or med spa pay per booked appointment?: California says internet booking is not a referral when the service does not recommend a provider; Texas and Florida criminalize paying for securing patients. Where Medicare or Medicaid may pay for the care, the federal Anti-Kickback Statute also applies.
Can a real estate agent pay for leads?: Paying for marketing aimed at a wide audience is a service; paying a fee per referral of settlement business on a federally related mortgage is what RESPA bars, and Texas limits commissions to license holders.
Why do agencies charge a percentage of ad spend?: It is simple to bill and grows with the account. No rule read for this page targets it, but it rises with your budget rather than your results, so ask for spend billed at cost.