As a chiropractor, you may be dedicated to helping your patients, but you also need consistent revenue to keep your practice going. Reimbursement rates for chiropractic care can be low, and the average chiropractor surveyed reported receiving just 57% for services billed to insurance in 2024.¹

Low reimbursement rates and insurance coverage gaps might be challenging, but you can take steps to provide patients with the care they want and need while still building a healthy practice. Tactics such as implementing bundled payments, improving documentation accuracy and offering chiropractic financing may help you build a sustainable chiropractic practice while improving patient affordability and care continuity. 

Chiropractic Reimbursement Insurance Gaps

Chiropractors traditionally earn lower reimbursement rates than other healthcare providers. For example, a 2024 survey found that chiropractors reported an average reimbursement rate of $51 for new patient evaluation and management, compared with $72 for physicians providing the same service. For a more complex visit requiring medical decision-making, chiropractors’ average reimbursement was $81, compared with $167 for physicians.¹

Not only are reimbursement rates low, but insurance coverage for chiropractic procedures is often limited. For example, many individual and small group plans under the Affordable Care Act only cover chiropractic services if the state’s benchmark plan or mandates include them. Even then, coverage is often capped at a fixed number of visits per year. Coverage typically requires medical necessity and stops once a maximum visit limit is reached, while chiropractic treatment for general wellness or maintenance is generally not covered at all.²

Some patients may pay out of pocket when they visit a chiropractor. In 2023, 38% of surveyed chiropractors received up to 25% of their revenue in cash, and about 8% received all their practice income in cash.³

Impact of Low Reimbursement Rates and Insurance Gaps

When patients pay out of their own pocket, care can become unaffordable, or they may choose to delay or forgo treatment when other household expenses take priority. As a result, patients may be less likely to adhere to recommended treatment plans.

From a practice perspective, accepting cash payments can also increase administrative demands on your staff. To better understand this dynamic, consider tracking the amounts your patients pay out of pocket and analyzing whether increased out-of-pocket expenses translate to decreased continuity of care. Research shows that greater cost-sharing among patients can lead to lower adherence to treatment and worse care continuity.⁴

Strategies to Combat Reimbursement Challenges

If your chiropractic practice is facing reimbursement challenges and gaps in patient insurance coverage, consider some of the following strategies.

Value-based care and bundled payment programs

The Centers for Medicare and Medicaid Services offers financial incentives for healthcare providers that cooperate with value-based care, which emphasizes efficiency and prevention over volume of visits. Chiropractors can join government-led frameworks such as Advanced Alternative Payment Models and the Merit-Based Incentive Payment System, which offer financial incentives for providing value-based care and bundled payment programs, and can improve the predictability of reimbursements.⁵

Accurate chiropractic billing documentation

Comprehensive and accurate documentation is essential for accurate chiropractic billing and reimbursement.⁶ While billing requirements and codes can be complex, staying informed about documentation standards can help reduce claim denials and improve reimbursement rates. Taking time to maintain precise records can help support smoother billing processes and better financial outcomes for your practice.

Payer contract reviews

If you have contracts with insurance companies, it’s a good idea to regularly review and renegotiate those contracts. Rather than maintaining the same contracts year after year, you may be able to secure better reimbursement rates and fewer visit restrictions by building relationships with the payers and revisiting the agreements regularly. 

Chiropractic patient financing options

For patients who pay out of pocket for their chiropractic care, consider offering patient financing options. Chiropractic patient financing may help patients manage their costs over time, which may result in better adherence for patients and improved cash flow and streamlined billing for your practice.  

With simple financing options, you can help engage your chiropractic patients and build long-term relationships with them, while helping support revenue. For example, when a patient uses the CareCredit credit card to pay their bill at your office, you’ll receive payment within two business days.*

Overcoming Chiropractic Reimbursement and Insurance Challenges 

Insurance gaps and reimbursement challenges may be common trials for chiropractors, but there are steps you can take to try to improve the situation. Whether you choose to participate in value-based care, focus on accurate documentation, review payer contracts, offer chiropractic patient financing options or a combination of these strategies, you may be able to drive increased revenue and higher reimbursement rates.

Frequently Asked Questions

Still have questions about chiropractic reimbursement? Here are answers to some common questions.

Why are chiropractic health reimbursement rates lower than other specialties?

Lower reimbursement rates for chiropractic services are often driven by insurer policies that closely scrutinize or deny chiropractic evaluation and management (E/M) services billed on the same day, often classifying them as manipulation rather than separate, billable care. Insurance companies often require documentation that the E/M work is separate and distinct from the primary service, and might force appeals when claims are denied. This can limit a chiropractor’s ability to bill and be paid for higher‑level E/M work compared with MDs, whose complex visits are more routinely accepted.​⁷

How can providers help patients manage out-of-pocket expenses?

Chiropractors can help patients manage out-of-pocket expenses by offering chiropractic financing options. That might include in-house payment plans, which require providers to handle administrative work and delay the receipt of full payment.

Another option is to provide patient financing through a third-party provider, such as the CareCredit credit card. Qualifying patients can use the card to finance packages, bundled services and treatments that will be received within 90 days in a single transaction.*

What financing options exist for chiropractic care?

The two main options for financing chiropractic care are in-house payment plans provided and administered by a chiropractic practice and third-party financing programs.

Offer Flexible Financing at Your Practice

If you are looking for a way to connect your patients or clients with flexible financing that empowers them to pay for the care they want and need, consider offering the CareCredit credit card as a financing solution. CareCredit allows cardholders to pay for out-of-pocket health and wellness expenses over time while helping enhance the payments process for your practice or business.

When you accept CareCredit, patients or clients can see if they prequalify with no impact to their credit score, and those who apply, if approved, can take advantage of special financing on qualifying purchases.* Additionally, you will be paid directly within two business days.

Learn more about the CareCredit credit card as a financing solution or start the provider enrollment process by filling out this form.

Author Bio

Nancy Mann Jackson is a journalist and content writer who writes regularly about finance and healthcare. Her work has been published by AARP, CNBC, Entrepreneur and Fortune. 

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