China’s sewage treatment standards have been gradually improving, yet there is a widening gap between sewage treatment fees and actual costs. This discrepancy, where the fees for sewage treatment are lower than the actual operational expenses, poses a significant bottleneck to the sustainable development of China’s sewage treatment industry. As a core aspect of environmental economic policies, sewage treatment fees are pivotal in regulating water pollution emissions and addressing water resource shortages. Currently, there are major issues with sewage treatment fees, including an incomplete pricing system, insufficient fees, unclear fee distribution, and a heavy reliance on local finances. These problems impede systematic planning, diminish management efficiency, and hinder the sustainable development of the sewage treatment industry. Thus, future research efforts should prioritize the establishment of a pricing mechanism that comprehensively covers the full cost of sewage treatment. This article presents a concise summary and review of the current situation, types of fee collection, cost accounting methodologies, challenges, and proposed countermeasures for sewage treatment fees, and could serve as a relevant reference for future research on sewage treatment fees. By comprehensively addressing these issues, the sewage treatment industry would progress towards healthier and more sustainable development, ultimately achieving the goal of green growth.