General Survey Findings
Respondent Profile:
Average Age: 42.9
Age Range: 24-81
Average No. of Years in Practice: 14.07
Male: 83%
Female: 17%
Solo Practitioner: 74%
Group Practitioner: 22%
Employed by DC: 4%
Have you ever wondered if your fees are similar to those being charged by the doctor down the street – or across the country? Perhaps even more importantly, is the amount you’re being reimbursed in line with what other doctors are bringing in?
In order to answer those questions, we conducted our Fourth 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, 403 readers sent back the surveys that we distributed in the May issue of Chiropractic Economics and via e-mail blast. We received input from doctors of chiropractic in all 50 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 reimbursements 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 our past Fees & Reimbursements Surveys. We also address the forms of payment and credit terms you offer.
Respondent Profile
Gender, Age, Years in Practice
A total of 403 readers responded to this year’s Fees & Reimbursements Survey. 83% of the respondents are male and 17% are female. That breakdown is the same as Chiropractic Economics’ 2000 Fees & Reimbursements survey. The age range is 24-81, compared to last year’s range of 19-96. The average age was 42.9, just a bit younger than last year’s of average of 43.8. The breakdown by age is: 12% 30 or younger; 25% aged 31-38; 23% 39-45; 29% 46-55; and 11% 56 and up. The average length of time respondents have been in practice is 14.07, similar to last year’s average of 14.65.
Location, Location, Location
States, Regions, Suburban vs. Urban
The survey responses came from DCs in all 50 states. Each major geographic region of the country is represented, broken down into the South, East, Midwest and West. The majority of the DCs practice in one state, but 37 have dual licensure, seven are licensed to practice in three states, and two are licensed in four states. Suburban practices are most common among this year’s respondents at 38.5%, followed by urban at 35.7%, and rural at 21.1%. No response was received from 4.7%. The breakdown last year was: suburban, 39.4%; urban, 34.7%; rural, 20.8%; and no response, 5.1%.
Principal Form of Practice
Group vs. Solo, Multi-Discipline
74% of the respondents are solo practitioners, 22% are in group practices, and 4% are associate doctors. Last year, 80% of the respondents were solo practitioners and 17% worked in group practices, while 3% were associate doctors. 26% 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, 23% said their practices offered multi-disciplines.
Of the respondents who work in these practices, the disciplines besides chiropractic include: MD/DO (16%), massage therapy (83%), rehabilitation/physical therapy (38%) and dietitian/nutritional counseling (22%). An additional 34% are in practices offering various services, such as acupuncture, Reiki, yoga, counseling, naturopathy, hypnotherapy, pilates, aesthetician services, and colonics. Last year, the break down of disciplines in addition to chiropractic included: MD/DO, 20%; massage therapy, 78%; rehabilitation, 41%; and dietitian/nutritional counseling, 38%.
Payment and Terms
Revenue Sources, Credit Cards, Payment Plans
Not surprisingly, the most common forms of payment accepted are cash, at 100%, and checks, 98%; followed by: 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%. Last year’s breakdown was: cash, 99%; checks, 96%; auto insurance, 90%; workers’ compensation and private insurance, both 85%; Medicare, 78%; major credit cards, 72%; managed care, 57%; Medicaid, 33%; and health-care credit cards, 16%.
80% of respondents accept credit cards, including: MasterCard and VISA, both 82%; Discover, 52%; American Express, 35%; and health-care credit cards, 12%. 2% accept other types of credit cards, and 17% don’t accept credit cards at all.
50% of respondents accept payment plans. 31% negotiate the terms on a per-case basis. The average terms offered are: 43% down with a 30-day billing cycle, with an average discount of 21% for cash. Last year, 53% reported that they offered standard payment plans, and 28% negotiated on a per-case basis. The average down-payment requested was 34.5%; the average billing cycle was 28 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 34-35. We have calculated the average fees, reimbursements, and percentages 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 for different CPT codes within Professional Care ranged from an average of $32.48 to $55.39. Last year’s range was $30.65 to $93.51, but this year we excluded the 99215 CPT code from the survey (Estab. Pat. w/Comp. Hist. & Exam w/High Complx. Trmt. Decis.), since word from coding consultants is that this code should be used rarely, if ever, by chiropractors. Actual payments for Professional Care procedures this year range from $27.55 to 46.08; last year, the range was from $26.94 to $75.60. The rate of reimbursement is 82.43% to 85%; last year, it was 80.85% to 87.9%.
For procedures under New Patient Exam CPT codes, the average fees range from $78.73 to $110.03. Last year, that range was $70.93 to $128.42, but this year we excluded CPT code 99205 from the survey (O.V. w/Comprehensive Hist. & Exam W/High Complx. Trmt. Decis.), for the same reasons mentioned above regarding 99215. Actual payments for new patient procedures range from $65.39 to $93.48. Last year, the range was $65.02 to $106.39. The percentage reimbursed was between 83% and 84.96%; last year, it was between 82.85% and 91.67%.
Average fees for Radiology CPT codes ranged last year from $52.29 to $150.71; last year, the range was a bit lower, at $49.12 to $150.14. Actual payments for Radiology procedures range from $45.24 to $125.43; last year’s range was $43.18 to $132.16. The percentage reimbursed was between 81.67% and 86.52%; last year, it was between 86.16% and 89.29%.
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 said they charge for the Established Patient CPT code 99213 was $54.21, the actual payment was $46.08, and the reimbursement rate was 85%. Last year, the average fee charged was $50.57, the actual payment was $44.09, and the reimbursement rate was 87.19%. In 1999, the fee was $51.94, the actual payment was $47.97, and the reimbursement rate was $92.35%.
The reimbursement rate for CPT code 99213 by region was: Southern Region, 84.66%; Eastern Region, 73.01%; Midwestern Region, 89.07%; and Western Region, 89.9%. Last year, the breakdown was: Southern Region, 91.73%; Eastern Region, 84.52%; Midwestern Region, 86.82%; and Western Region, 81.73%. In 1999, the breakdown was: Southern Region, 89.9%; Eastern Region, 80.92%; Midwestern Region, 90.39%; and Western Region, 93.74%.
The overall average fee that respondents charge for the New Patient Exam CPT code 99204 was $110.03, the actual payment was $93.48, and the reimbursement rate was $84.96%. Last year, the average fee charged was $99.39, the actual payment was $85.51, and the reimbursement rate was 86.03%. In 1999, the average fee charged was $102.39, the actual payment was $92.38, and the reimbursement rate was 90.22%.
The reimbursement rate for CPT code 99204 by region was: Southern Region, 82.56%; Eastern Region, 76.69%; Midwestern Region, 93.34%; and Western Region, 91.08%. Last year, the breakdown was: Southern Region, 88.26%; Eastern Region, 76.31%; Midwestern Region, 87.2%; and Western Region, 84.78%. In 1999, the breakdown was: Southern Region, 88.24%; Eastern Region, 86.60%; Midwestern Region, 83.86%; and Western Region, 83.45%.
Age Differences
For Established Patient code 99213, DCs 56 and up charged an average of $51.71 and received a reimbursement rate of 93.46% (last year, this group charged an average of $50.75 and received a reimbursement rate of 89.36%). DCs 39-55 charged an average of $54.50 and had a reimbursement rate of 85.71% (last year, they charged an average of $50.58 and had a reimbursement rate of 89.84%); DCs 38 and under charged $54.51, with a reimbursement rate of 82.19% (last year, the rate they charged was $50.53, with a reimbursement rate of 85.24%). In 1999, DCs 56 and up charged the least ($48.64) but received the highest reimbursement rate, at 97.09%. DCs 39-55 charged an average of $54.15 and had a reimbursement rate of 91.33%; DCs 38 and under charged $49.49, with a reimbursement rate of 92.16%.
For New Patient code 99204, DCs 56 and up charged an average of $102.67, with a reimbursement rate of 89.19% (last year, they charged $97.80, with a reimbursement rate of 86.36%). DCs 39-55 charged an average of $112.26, with a reimbursement of 79.16% (last year, they charged $100.96 and had a reimbursement rate of 86.75%); DCs 38 and under charged $108.85 and were reimbursed 86.32% (last year, they charged $98.65, with a reimbursement rate of 84.71%). In 1999, DCs 56 and up charged the most ($105.71) but received the lowest reimbursement rate, at 79.13%. DCs 39-55 charged an average of $103.53 and had a reimbursement rate of 91.30%; DCs 38 and under charged $100.56, with a reimbursement rate of 90.09%.
Gender Differences
For Established Patient code 99213, male doctors of chiropractic charged an average of $55.01 and had a reimbursement rate of 85.77% (last year, they charged $50.57 and received a reimbursement of 88.31%). Female DCs charged an average of $50.15 and were reimbursed at an average of 81.52%. In 1999, male and female doctors of chiropractic charged almost exactly the same fee — $51.94 for males, and $51.95 for females. However, female DCs received an average reimbursement rate of 88.79%, while male DCs were reimbursed at 93.05%.
For New Patient code 99204, male DCs charged an average of $111.57 and were reimbursed at 86.11% (last year, they charged $98.76 and were reimbursed at 87.49%). Female doctors charged an average of $103.00 for this code, and were reimbursed at 75.32% (last year, they charged $104 and were reimbursed at 77.88%). In 1999, female DCs charged an average of $96.06 and received a reimbursement rate of 91.38%. Male DCs charged an average of $103.66 and received a reimbursement rate of 89.78%.
Solo vs. Group Practices
Doctors of chiropractic in solo practice charge an average of $52.93 for Established Patient code 99213; these doctors received a reimbursement rate of 85.51% (last year, they charged an average of $49.11 and were reimbursed at 89.35%). Group practice doctors of chiropractic charged an average of $57.08, receiving a reimbursement of 85.21% (last year, they charged $57.13 and received a reimbursement rate of 80.57%). In 1999, doctors of chiropractic in solo practice charged an average of $52.31 for Established Patient code 99213; they received a reimbursement rate of 92.06%. Also in 1999, group practice doctors of chiropractic charged an average of $50.34 and received a reimbursement rate of 91.6%.
In this year’s survey, DCs in solo practice charged an average of $107.83 for New Patient code 99204 and received a reimbursement rate of 84.38% (last year, they charged $95.71 and received a reimbursement rate of 89.12%). Group practice DCs charged an average of $114.16 and had a reimbursement rate of 90.16% (last year, they charged $113.76 and had a reimbursement rate of 74.53%). In 1999, DCs in solo practice charged an average of $102.39 for New Patient code 99204, and they received a reimbursement rate of 89.81%. Also in 1999, group practice DCs charged an average of $104.84 and received a reimbursement rate of 89.93%.
Thank you to everyone who participated!
ABOUT THE SURVEY….
- 403 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 Tara Stultz, Editor-in-Chief, by fax: 440-234-2192 or e-mail: tarastultz@aol.com.
