Chiropractic Invoice Template: Superbills and Cash Pay Rates

Quick answer: A chiropractic invoice lists the clinic and patient details, a unique invoice number, each date of service, every procedure with its CPT code and units (such as 98941 for a three to four region adjustment), the fee, any discount, payments received and the balance due. For cash-pay patients, add ICD-10 diagnosis codes, NPI and tax ID so the same document works as a chiropractic superbill.

Chiropractic clinics bill in more ways than most healthcare practices: single cash visits, care plan packages, in-network insurance, Medicare with its own strict rules, and personal injury cases. A consistent chiropractic invoice template keeps all of them clear. You can create one with our US invoice generator and download a PDF for the patient in a few minutes.

This guide covers the fields a chiropractic invoice needs, the CPT codes you will use most, how Medicare treats chiropractic care in 2026, how to set and present cash pay rates and care plans, a worked example, and how a chiropractic superbill fits in. It is written for US practices; if you also run physical therapy services, see our sibling physical therapy invoice guide.

What a chiropractic invoice should include

Every chiropractic invoice should be readable by the patient and usable by an insurer. Include:

• Clinic details: clinic name, address, phone, email, logo, treating chiropractor, NPI and tax ID (EIN).
• Patient details: name, date of birth or account number, and the responsible party if different.
• Invoice number and date: sequential, such as CHIRO-2026-0731. Our invoice number generator can help you pick a format.
• Dates of service: one line per procedure per date, not a single lump sum for the month.
• CPT codes and units: with a plain description of each service.
• Diagnosis codes: ICD-10 codes when the invoice may be used for reimbursement.
• Fees, discounts and payments: fee per line, any package or prompt-pay discount, amounts paid and the balance.
• Terms: due date, accepted payment methods and your cancellation or missed appointment policy.

Chiropractic CPT codes on invoices

Chiropractic manipulative treatment (CMT) codes are based on how many spinal regions you treat, not how long the visit takes. Other services have their own codes. The table shows codes commonly seen on chiropractic invoices; always check the current CPT descriptors and each payer's policy.

CPT code	Service	Billing note
98940	CMT, spinal, one to two regions	Per visit, not timed
98941	CMT, spinal, three to four regions	Per visit, not timed
98942	CMT, spinal, five regions	Per visit, not timed
98943	CMT, extraspinal, one or more regions	Not covered by Medicare
99202 to 99205	New patient evaluation and management	Level depends on complexity or time
99212 to 99214	Established patient evaluation and management	Separate exam on the same day may need a modifier
97140	Manual therapy	Timed, 15-minute units
97110	Therapeutic exercise	Timed, 15-minute units

On the patient copy, add a plain description next to each code, such as "Spinal adjustment, 3 to 4 regions (98941)". The code helps the insurer; the description helps the patient.

Medicare rules for chiropractic billing in 2026

Medicare is the area where chiropractic invoices most often go wrong. According to the CMS billing and coding article for chiropractic services:

• Medicare covers only manual manipulation of the spine to correct a subluxation (98940, 98941 and 98942). Extraspinal manipulation (98943) is not covered.
• Active or corrective treatment must carry the AT modifier. Claims without it are treated as not medically necessary.
• Once the patient reaches maximum therapeutic benefit, ongoing maintenance care is not considered medically necessary.
• If you expect Medicare to deny a service as not medically necessary, the patient must sign an Advance Beneficiary Notice (ABN) before treatment and the claim carries the GA modifier.
• Other services ordered or performed by a chiropractor, including exams, X-rays, physiotherapy, traction, supplies and supplements, are excluded.

In practice this means Medicare patients often receive two kinds of bill: the patient share of covered manipulation after Medicare pays, and a direct invoice for excluded services or maintenance care they agreed in writing to pay for. Keep those clearly separated on your invoices so patients understand why some lines are not going to Medicare.

Chiropractic superbill for out-of-network patients

Many chiropractors run cash-based practices and give patients a superbill to claim out-of-network benefits. A chiropractic superbill adds the details an insurer needs: provider NPI and tax ID, the patient's date of birth, ICD-10 diagnosis codes, CPT codes with units, place of service, fees and the amount paid. Our full superbill template guide walks through every field and the reimbursement arithmetic, so we will not repeat it here.

The practical rule: a superbill is issued after payment, for the patient to file. Your invoice is the request for payment. Many clinics send an invoice, then send a superbill once it is paid, often monthly for patients on care plans. Our invoice vs receipt guide explains why the two documents are different.

Cash pay rates and care plan pricing

Cash pay chiropractic rates vary widely by city, clinic and what is included in a visit, so there is no single correct price. Rather than quote national averages, here are the pricing models clinics actually use and how each one looks on an invoice.

Model	How it works	Invoice line example
Per visit	One price per adjustment visit, with add-ons priced separately	Spinal adjustment, 3 to 4 regions (98941), 14 Oct
New patient package	Exam, any imaging and first adjustment at one price	New patient exam and first adjustment
Care plan	A set number of visits paid upfront or in instalments at a lower per-visit price	Care plan, 12 visits, instalment 2 of 3
Wellness membership	Monthly fee covering a fixed number of visits	Wellness membership, November, 2 visits

Set your cash rates by looking at what local clinics publish, the time each visit takes and your overhead. Be careful with discounts: offering lower prices to uninsured patients than you bill insurers, or routinely waiving copays, can create problems under payer contracts and anti-fraud rules. Keep one published fee schedule and document any discount, such as a prompt-pay or hardship discount, consistently. A healthcare compliance adviser can review your policy.

Some states regulate prepaid care plans, for example around refunds for unused visits. Put your refund policy in writing before the patient pays, and show the total plan price, payments to date and remaining balance on every instalment invoice. Our guide to showing a discount on an invoice covers the formatting.

Sample chiropractic invoice with real numbers

Here is a monthly invoice for a self-pay patient on a short treatment course. The fees are illustrative; use your own fee schedule.

Date	Code	Service	Qty	Rate	Amount
Oct 2, 9, 16, 23	98941	Spinal adjustment, 3 to 4 regions	4	$65.00	$260.00
Oct 2, 16	97140	Manual therapy, 15 min	2	$40.00	$80.00
Oct 9, 23	97110	Therapeutic exercise, 15 min	2	$35.00	$70.00
Subtotal					$410.00
Prompt-pay discount (10%)					-$41.00
Total					$369.00
Paid at first visit					$150.00
Balance due					$219.00

The check: $260 + $80 + $70 = $410. Ten percent of $410 is $41, so the total is $369. After the $150 already paid, $219 remains. Healthcare services are generally not subject to sales tax, so tax stays at zero. In our generator you would enter the three lines, apply a 10% discount and type 150 in the amount paid field; the balance due calculates itself. Once paid, issue a superbill with diagnosis codes for the patient to submit.

How to create a chiropractic invoice step by step

1. Open the free invoice generator and add your clinic name, logo, address, NPI and tax ID.
2. Enter the patient's name and account number, and the payer if it is a personal injury or third-party case.
3. Add a unique invoice number, invoice date and due date.
4. Add one line per service: date, CPT code, plain description, units and rate.
5. Apply any documented package or prompt-pay discount.
6. Leave tax at zero for treatment; add tax only if you sell taxable retail products and your state requires it.
7. Record deposits or payments in the amount paid field to show the true balance.
8. Add notes covering your cancellation policy and how to pay, then download the PDF.

The modern invoice template and emerald invoice template suit wellness-focused clinics, while the classic template works for a traditional medical look.

Special chiropractic billing situations

Most visits follow the simple pattern above, but a few situations cause most of the billing questions chiropractic offices receive. Handle each one with a written policy, a clear invoice line and the same treatment for every patient.

Missed appointments and care plan changes

Missed visits matter more in chiropractic than in many services because care plans depend on a steady schedule. Set a written policy before the first visit: how much notice the patient must give, whether a missed visit is charged or deducted from a package, and how many missed visits end a care plan discount. If you charge a fee, show it on the invoice as its own line, for example "Missed appointment, 18 Oct, per signed policy", so the patient can see exactly why it is there.

Medicare patients need extra care here. Check current CMS guidance before charging Medicare beneficiaries a missed appointment fee, and apply the same policy to every patient rather than only to Medicare patients. For patients who stop a prepaid care plan early, calculate the refund using the method in your written agreement, for example the visits used at the full per-visit rate subtracted from the amount paid, and show that arithmetic on a final statement.

Patients who move from active care to maintenance or wellness visits should also see the change on their invoices. Use a different line description, such as "Wellness adjustment", and remember that Medicare does not cover maintenance care, so an ABN signed in advance is needed if you expect Medicare to deny it.

Personal injury and third-party billing

Personal injury billing is where clear invoices matter most, because they may end up as evidence in a settlement. Auto accident and workplace injury cases often involve an insurer, attorney or employer paying instead of the patient. Bill the responsible party named in your agreement, include the claim or case number on every invoice, and keep the same line-by-line CPT detail. Lien cases can take months to settle, so track them separately in your accounts receivable aging report rather than letting them blur into ordinary overdue bills. State rules for these cases differ, so follow local guidance. When the case settles, issue a final statement showing every charge, every payment received and any reduction agreed with the attorney, so your records match the settlement figures.

HSA, FSA and payment terms

IRS Publication 502 lists fees paid to a chiropractor for medical care as medical expenses, so chiropractic visits are often reimbursable from an HSA or FSA. Patients need an itemized, paid receipt with the provider, date, service and amount. Put supplements, pillows or other retail items on separate lines, since they may not qualify.

Most clinics collect payment at the time of service, which keeps balances small and avoids chasing patients between visits. Card on file, with written consent, works well for care plans paid in instalments: charge on the agreed date and send the invoice as the record. For balances, net 15 or net 30 terms are common, and many keep a card on file for care plans. Our guide to invoice payment terms covers the wording, and the medical invoice template covers wider private practice billing. Dental colleagues can use our dental invoice template.

Common chiropractic invoice mistakes

• Lumping a month into one line: insurers and HSA administrators need each date of service and code.
• Billing 98943 to Medicare: extraspinal manipulation is not covered, so bill the patient directly with a signed notice where required.
• Missing the AT modifier: Medicare treats manipulation without it as not medically necessary.
• Two price lists: charging insured and uninsured patients different prices for the same service without a documented reason creates contract and compliance risk.
• Superbills without diagnosis codes: insurers send them back unprocessed.
• Undocumented care plan refunds: put the refund formula in writing before the patient pays.

This article is general information, not legal, tax or billing compliance advice. Confirm codes and payer rules with current CMS guidance and your payer contracts.

Create your chiropractic invoice

A clean chiropractic invoice lists every service by date with CPT codes and units, keeps Medicare-covered and excluded services apart, shows discounts and payments clearly, and gives cash-pay patients what they need for a chiropractic superbill. Build yours in the free invoice generator, download the PDF and keep a copy with each patient's financial record.