October 2002

EXCLUSIVE REPORT:
Fifth ANNUAL Chiropractic Economics’
Fees & Reimbursements Survey Results
By Tara Stultz

About the Survey
• 412 readers responded to the survey.

• The survey results reflect averages, regardless of the number of responses received to each question. In a few cases, a low response rate may have affected the statistical outcome.

• The results of this survey are for informational purposes only, and are not to be construed as a recommendation - implied or otherwise - on how you should set your fees.

If you have any thoughts about fees and reimbursements and how the trends are affecting the chiropractic profession, please send your letter to the editor to Linda Segal, Editor-in-Chief, or e-mail: lsegall@chiroeco.com

How closely have you looked at your fees and reimbursements lately? What are you charging for various CPT® codes, and even more importantly, are you getting paid what you should? Is the amount you’re being reimbursed in line with the reimbursement rates of other doctors in your region - and across the country? In order to answer those questions, we conducted our Fifth Annual Fees & Reimbursements Survey, a comprehensive survey of the chiropractic profession that will give you a benchmark to compare your fees and reimbursements with those of your colleagues.

We appreciate the support of our loyal readership for taking the time to share this important information. In all, 412 readers sent back the surveys that we distributed exclusively through an e-mail blast and online survey. This is the first year the survey was completed exclusively online. We received input from doctors of chiropractic in 48 states. The respondents represent a wide variety of DCs, with demographic representation by region, age, years in practice, gender, and type of practice.

We have broken down by code the average fees charged, the amount received, and the reimbursement rate for a variety of common procedures. We have focused on a variety of CPT codes, under the categories of Professional Care, New Patient Exams, Radiology, and Procedures and Modalities. The fees and reimbursement averages are reported on a national level, and are also broken down by practice type, gender, age, and region of the country. Where appropriate, we have compared this year’s statistics to those from last year’s Fees & Reimbursements Survey. We also address the forms of payment and credit terms you offer.

Respondent Profile
Gender, Age, Years in Practice
A total of 412 readers responded to this year’s Fees & Reimbursements Survey. 86% of the respondents are male and 14% are female. That breakdown is similar to the Chiropractic Economics’ 2001 Fees & Reimbursements survey, at 83% male and 17% female. The age range is 24-85, compared to last year’s range of 24-81. The average age was 43.9, as compared to last year’s of average of 42.9. The breakdown by age is: 9% 30 or younger; 24% aged 31-38; 20% 39-45; 34% 46-55; and 13% 56 and up. The average length of time respondents have been in practice is 14.25, similar to last year’s average of 14.65.

Location, Location, Location
States, Regions, Suburban vs. Urban
The survey responses came from DCs in 48 states. Each major geographic region of the country is represented, broken down into the South, East, Midwest and West. 45.4% have licensure in one state, 35.2% have dual licensure, 13.7% have licensure in three states, and 5.6% hold a license in four states. Suburban practices are most common among this year’s respondents at 45%, followed by urban at 34%, and rural at 18%. No response was received from 3%. The breakdown last year was: suburban, 38.5%, followed by urban at 35.7%, and rural at 21.1%. No response was received from 4.7%. Principal Form of Practice

Group vs. Solo, Multi-Discipline
79% of the respondents are solo practitioners, 19% are in group practices, and 2% are associate doctors. Last year, 74% of the respondents were solo practitioners, 22% were in group practices, and 4% were associate doctors. 36% report that they work in a practice offering multi-disciplines (with “multi-discipline” defined as practices that do not include an MD/DO on staff, as well as those that do). Last year, 26% said their practices offered multi-disciplines. Of the respondents who work in these practices, the disciplines besides chiropractic include: MD/DO (19%), massage therapy (83%), rehabilitation/physical therapy (18%) and dietitian/nutritional counseling (13%). An additional 19% are in practices offering various services, such as acupuncture, Reiki, yoga, counseling, naturopathy, hypnotherapy, and more. Last year, the break down of disciplines in addition to chiropractic included: MD/DO, 16%; massage therapy, 83%; rehabilitation, 38%; and dietitian/nutritional counseling, 22%.

Payment and Terms
Revenue Sources, Credit Cards, Payment Plans
Not surprisingly, the most common forms of payment accepted are cash, at 96%, and checks, 93%; followed by: auto insurance, 85%; private insurance, 83%; workers’ compensation, 82%; major credit cards, 77%; Medicare, 74%; managed care, 50%; Medicaid, 23%; and health-care credit cards, 9%. Last year’s breakdown was: cash, 100%; checks, 98%; auto insurance, 94%; workers’ compensation, 90%; private insurance, 88%; Medicare, 82%; major credit cards, 80%; managed care, 60%; Medicaid, 28%; and health-care credit cards, 12%.

84% of respondents accept credit cards, including: VISA, 77%; MasterCard, 76%; Discover, 50%; American Express, 37%; and health-care credit cards, 4%. 3% accept other types of credit cards, and 16% don’t accept credit cards at all. Last year, 80% of respondents accepted credit cards, including: MasterCard and VISA, both 82%; Discover, 52%; American Express, 35%; and health-care credit cards, 12%. 2% accepted other types of credit cards, and 20% didn’t accept credit cards at all.

52% of respondents accept payment plans. 38% negotiate the terms on a per-case basis. The average terms offered are: 38% down with a 31-day billing cycle, with an average discount of 19% for cash. Last year, 50% reported that they offered standard payment plans, and 31% negotiated on a per-case basis. The average down-payment requested was 43%; the average billing cycle was 30 days, and the average discount for cash was 18.5%.

Office Visit Fees
What You Charge, What You Get Paid
Doctors of chiropractic reported fees and reimbursements in the areas of Professional Care, New Patient Exams, Radiology, and Procedures and Modalities, as illustrated on the charts on pages 56-57. We have calculated the average fees, reimbursements, and percentage reimbursed. The averages are reported on a national level (overall response), as well as by region in the South, East, Midwest and West.

The average fees charged nationwide for different CPT codes within Professional Care ranged from an average of $35.28 to $59.02. Last year’s range was $32.48 to $55.39. Actual payments for Professional Care procedures this year range from $30.96 to $48.96; last year, the range was from $27.55 to $46.08. The rate of reimbursement range is 78.6% to 87.75%; last year, it was 82.43% to 85%.

For procedures under New Patient Exam CPT codes, the average fees range from $84.18 to $109.23. Last year, that range was $78.73 to $110.03. Actual payments for new patient procedures range from $71.66 to $95.94. Last year, the range was $65.39 to $93.48. The percentage reimbursed was between 85.12% and 87.84%; last year, it was between 83% and 84.96%.

Average fees for Radiology CPT codes ranged last year from $54.69 to $147.34; last year, the range was $52.29 to $150.71. Actual payments for Radiology procedures range from $43.62 to $121.27; last year’s range was $45.24 to $125.43. The percentage reimbursed was between 76.8% and 82.31%; last year, it was between 81.67% and 86.52%.

The following information examines some of the differences between the fees charged and the payment received for the CPT codes 99213 (established patient) and 99204 (new patient).

Fees Around the Country
The overall average fee that respondents across the country said they charge for the Established Patient CPT code 99213 was $59.02, the actual payment was $48.96, and the reimbursement rate was 82.95%. Last year, the average fee was $54.21, the actual payment was $46.08, and the reimbursement rate was 85%.

The reimbursement rate for CPT code 99213 by region was: Southern Region, 82.02%; Eastern Region, 81.11%; Midwestern Region, 81.93%; and Western Region, 77.95%. Last year, the breakdown was: Southern Region, 84.66%; Eastern Region, 73.01%; Midwestern Region, 89.07%; and Western Region, 89.9%.

The overall average fee that respondents charge for the New Patient Exam CPT code 99204 was $109.23, the actual payment was $95.94, and the reimbursement rate was $87.84%. Last year, the average fee charged was $110.03, the actual payment was $93.48, and the reimbursement rate was $84.96%.

The reimbursement rate for CPT code 99204 by region was: Southern Region, 80.96%; Eastern Region, 83.48%; Midwestern Region, 81.66%; and Western Region, 81.64%. Last year, the breakdown was: Southern Region, 82.56%; Eastern Region, 76.69%; Midwestern Region, 93.34%; and Western Region, 91.08%.

Age Differences
For Established Patient code 99213, DCs 56 and up charged an average of $58.56 and received a reimbursement rate of 84.16% (last year, this group charged an average of $51.71 and received a reimbursement rate of 93.46%). DCs 39-55 charged an average of $56.48 and had a reimbursement rate of 80.35% (last year, they charged an average of $54.50 and had a reimbursement rate of 85.71%); DCs 38 and under charged $54.51, with a reimbursement rate of 82.19% (last year, the rate they charged was $54.51, with a reimbursement rate of 82.19%).

For New Patient code 99204, DCs 56 and up charged an average of $110.20, with a reimbursement rate of 92.03% (last year, they charged $102.67, with a reimbursement rate of 89.19%). DCs 39-55 charged an average of $105.73, with a reimbursement of 79.57% (last year, they charged $112.26, with a reimbursement of 79.16%); DCs 38 and under charged $105.57 and were reimbursed 80.94% (last year, they charged $108.85 and were reimbursed 86.32%).

Gender Differences
For Established Patient code 99213, male doctors of chiropractic charged an average of $59.06 and had a reimbursement rate of 83.01% (last year, they charged $55.01 and had a reimbursement rate of 85.77%). Female DCs charged an average of $59.09 and were reimbursed at an average of 83.03% (last year, they charged $50.15 and were reimbursed at an average of 81.52%).

For New Patient code 99204, male DCs charged an average of $109.31 and were reimbursed at 88.02% (last year, they charged $111.57 and were reimbursed at 86.11%). Female doctors charged an average of $110.38 for this code, and were reimbursed at 89.63% (last year, they charged $103.00 for this code, and were reimbursed at 75.32%).

Solo vs. Group Practices
Doctors of chiropractic in solo practice charge an average of $58.58 for Established Patient code 99213; these doctors received a reimbursement rate of 82.9% (last year, they charged an average of $52.93 and were reimbursed at 85.51%). Group practice doctors of chiropractic charged an average of $59.88, receiving a reimbursement of 82.23% (last year, they charged charged an average of $57.08, receiving a reimbursement of 85.21%).

In this year’s survey, DCs in solo practice charged an average of $108.40 for New Patient code 99204 and received a reimbursement rate of 88.75% (last year, they charged $107.83 and received a reimbursement rate of 84.38%). Group practice DCs charged an average of $106.83 and had a reimbursement rate of 89.81% (last year, they charged $114.16 and had a reimbursement rate of 90.16%).

Thank you to everyone who participated!