Chiropractor Invoice Template — Adjustments, Superbill
Per-visit adjustments, treatment plan packages, insurance-claim-ready superbills, sliding scale. The template includes the diagnostic and procedure code fields insurance reimbursement needs.
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The line items a chiropractic invoice needs
●Initial exam / consultation. Often longer/separate billing code.
●Adjustment (per visit). Spinal manipulation; CPT code on superbill.
●Therapeutic modalities (e-stim, ultrasound, traction). Each is its own CPT code.
●X-rays / imaging. If on-site.
●Treatment plan package (e.g., 12 visits). Pre-paid; one invoice on purchase.
●Wellness / maintenance care. Self-pay, often outside insurance.
How chiropractors usually bill
Most clinics handle insurance billing internally; superbills issued for out-of-network reimbursement.
Self-pay packages: one invoice on purchase.
Always include CPT code, ICD-10 code, your NPI/license number — insurance reimbursement requires all three.
Tax notes
Chiropractic services are typically exempt from sales tax in most US jurisdictions as healthcare. UK chiropractic by registered chiropractors is exempt from VAT. Wellness/maintenance care without diagnosis may be treated as wellness (taxable in some places) rather than healthcare.
Frequently asked questions
What does an insurance superbill need?
Your name and NPI, license number. Patient name, DOB. Date of service, CPT code(s), ICD-10 diagnosis code(s), fee paid. Insurance won't reimburse without all of these.
How do I invoice a treatment plan?
One invoice on plan purchase ('12-visit treatment plan — $X'). Track visits in your EMR/booking system, not on the invoice. The plan invoice is the financial record.
Should I bill maintenance / wellness visits differently?
Yes — wellness/maintenance care is typically self-pay (insurance doesn't cover). Use a different fee schedule from acute care, and label clearly so the patient knows it's not insurance-billable.
How do I bill insurance directly?
Most chiros use practice management software (Chiro Touch, Genesis) to file CMS-1500 forms with insurance. The patient invoice may show $0 (insurance billed) with a co-pay/deductible separately.
What a chiropractic invoice looks like
Realistic, copy-and-paste-ready line items chiropractors typically use. Fee schedules vary by region and by carrier contract, so read these as a guide rather than set rates.
●98941 — Chiropractic manipulative treatment (3-4 spinal regions) ($75 standard rate, in-network adjusted): $52.50
●97140 — Manual therapy (15 min, soft tissue) ($60): $45
●97014 — Electric stimulation (15 min) ($35): $25
●99203 — Initial examination + history (new-patient eval, 45 min) ($175): $135
●X-ray series — 3-view cervical (interpretation included) ($120, pass-through to imaging facility): $120
●Therapy package — 6-visit care plan (paid upfront, 10% discount) (per visit $65 × 6): $390
●Assignment of Benefits — claim filed with carrier per AOB (included): no charge
Notes: Services billed using CPT codes per AMA standards. Initial evaluation and care plan presented in writing. In-network adjusted rates per Aetna fee schedule (see contract); out-of-network full rate. Personal-injury (auto, work-comp) cases require AOB and lien on settlement. NPI __ and state DC licence # __. Card, HSA/FSA, and assignment-of-benefits to carrier accepted.
How chiropractic billing gets paid
Chiropractic income splits across three lanes: cash-pay wellness adjustments, insurance-billed treatment (in-network and out-of-network), and personal-injury (PI) or workers'-comp casework. Cash-pay adjustments pay same-day at the desk. In-network claims pay Net 30-60 from the carrier at the contracted fee schedule (often 40-70% of your standard rate). Out-of-network claims pay through the patient (AOB) or through the patient submitting superbills.
PI and workers'-comp are the slow-pay lanes but at higher rates: the chiropractor takes a lien on the eventual settlement, treating the patient over months and getting paid 6-18 months later when the case settles. PI volume can be a high-margin practice line if you have referral relationships with PI attorneys, but the cash-flow burden is real. Most successful chiropractic practices run 60-70% insurance + 20-30% cash-pay + 10-20% PI/work-comp, with the mix optimised for cash flow.
Five invoicing mistakes that slow chiropractic payments
●Not getting AOB (Assignment of Benefits) signed at intake. Without AOB, you bill the patient and the patient submits to insurance. With AOB, you bill insurance directly and patient pays the balance. AOB makes the cash-flow predictable. Standard intake form; should be signed before the first adjustment.
●Forgetting to bill the examination separately on new patients. The CMT (98940-98943 codes) is the adjustment; the new-patient eval is 99203-99205 (new patient E&M). Bill both on the first visit. Bundling them into 'first visit fee' costs you 30-50% of the legitimate billing on every new patient.
●Skipping the care plan document. A written care plan ('6 visits over 4 weeks, then re-evaluation') is what justifies the multi-visit relationship. Without it, every visit is a one-off and patients drop after 2-3 visits. State the plan in writing; bill the package or have patients commit visit-by-visit.
●Not setting up an in-network credentialing strategy. Carrier credentialing takes 60-120 days. Decide which networks you want (typically 2-4 of: Aetna, BCBS, UnitedHealthcare, Cigna, Medicare). The carriers you don't credential with become cash-pay or out-of-network referrals.
●Letting PI cases run without status updates to the attorney. PI attorneys settle cases when treatment notes and records are complete. Quarterly status update letters to the referring attorney keep your case on the active-settlement list. Without updates, your invoice sits as 'pending records' for months longer than necessary.
US tax notes for chiropractors
Chiropractic services are non-taxable in nearly every state (licensed healthcare service). The main exceptions are Hawaii's GET, New Mexico's GRT, and Washington's B&O. Retail sales (supplements, orthotics, supports) are taxable as tangible property in every state — track resale items separately from service income.
Federal: Most chiropractors run their own practice (sole-prop, LLC, or S-corp). DC deductibles often missed: state DC licence and continuing-ed (typically 12-24 hours every 1-2 years), specialty certifications (CCSP for sports chiro, CCEP for ergonomics — significant cost), table and equipment depreciation (chiropractic tables, decompression units, electrical-stim units — Section 179 capital expenses), liability insurance, association dues (ACA, ICA), credentialing fees per carrier, software (EHR like ChiroTouch, Genesis Chiropractic Software), and the under-claimed line — patient-education materials and home-care recommendation tools (anatomy models, pillows, posture aids that you stock at cost for retail resale).
Not tax advice — confirm specifics with your CPA or state department of revenue.
Other questions chiropractors ask
How do I bill personal-injury (PI) cases?
Get AOB and a lien letter at intake. Treat through the active recovery phase per the attorney's case timeline. Send monthly status updates to the attorney. When the case settles, the attorney pays from the settlement proceeds at the agreed schedule (often the full billed rate or a negotiated reduction). PI cases are high-margin but slow-cash; balance the practice mix accordingly.
Should I sell supplements and retail products?
Some practices do; many ethical boards encourage caution. The state Board guidance varies; some chiropractors run a separate retail entity to avoid practice-conflict concerns. If you do sell retail (orthotics, supplements, support pillows), keep clear ethical disclosure ('practitioner financial interest in products') and don't conditionally bundle retail with treatment recommendations.
How do I handle a Medicare patient who needs maintenance care?
Medicare covers active care (acute injury, documented condition improvement) but not maintenance/wellness care. Have the patient sign an ABN (Advance Beneficiary Notice) before maintenance visits, then bill them directly. Medicare may audit; the ABN is your documentation that the patient was informed and accepted financial responsibility.
Can I bill for X-rays I refer to an imaging facility?
If you refer to an outside imaging facility, the facility bills the patient/insurance for the imaging and you bill only for the interpretation/professional component (with modifier 26 if applicable). Don't double-bill; coordinate with the imaging facility on which entity bills which component.
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