Reimbursement equity is not a hope, it is a goal within reach, powered by transparency, collaboration and a renewed commitment to data-driven advocacy.
Reimbursement equity is not a hope, it is a goal within reach, powered by transparency, collaboration and a renewed commitment to data-driven advocacy.Let’s he honest. Chiropractic reimbursement has always been a challenge. And while 2025 has brought some stability in fee structures, that doesn’t mean things are fair. We’re still facing significant disparities, especially when compared to our colleagues in other provider categories. The good news? We now have the data and tools to take action.
Stable fees, unstable reality
According to the 28th Annual Fees and Reimbursements Survey from Chiropractic Economics, average chiropractic fees rose slightly in 2024 from $67 to $76. But at the same time, the average reimbursement rate fell from 63% to 57%. Group practices are faring a bit better than solo providers (59% vs. 55%), but even that doesn’t paint a full picture. In some regions, such as the Midwest, reimbursement rates are at 70%. In the West? It’s down to 45%.
These numbers tell a bigger story. One of long-standing undervaluation of our services by payers. It’s not just about balance sheets. It’s about recognition, access and sustainability.1
A game changer: Transparency in coverage
That’s where the National Fee Schedule Equity Project comes in. Through Chiropractic Future’s Reimbursement Workgroup, we are exploring using data from federal Transparency in Coverage (TiC) requirements to expose discrepancies in how DCs are paid compared to other providers billing the same CPT codes.
With access to this data, we will be able to:
- Compare chiropractic vs. medical reimbursement rates at scale
- Identify regional and payer-specific trends
- Push for rate floor legislation and network adequacy reforms
- Back up our advocacy efforts with real, undeniable evidence
This is the first time we’ve been able to access this level of transparency, and it will be a big deal.2
The reimbursement dashboard: Real-time advocacy in action
In 2022, we launched the Reimbursement Dashboard. This tool provides state association leaders with real-time insights into submitted claims. It red flags changes in policy, rising denials and reimbursement dips, allowing states to act quickly. The dashboard benchmarks both state and national data, allowing executive directors to:
- Monitor local trends
- Compare results to those of other states
- Share operational metrics with providers to help improve cash flow
We even hosted a nationwide training webinar to help leaders understand how to use the dashboard to support smarter, more strategic advocacy. And we’re not stopping there. Our focus on data literacy and proactive response continues to grow.3
Same codes, unequal Reimbursement pay
We already know this, but now we have the proof. DCs and MDs billing the same codes, such as CPT 99203, are seeing drastically different payments:
CPT code | DCs | MDs |
99202 | $51 | $72 |
99203 | $68 | $112 |
99204 | $81 | $167 |
These aren’t just numbers. They represent lost revenue and lost opportunities to deliver conservative, effective care to more patients.
Chiropractic is cost-effective and we have the research
A 2023 systematic review found patients who started their care with a DC:
- Had fewer opioid prescriptions
- Avoided more surgeries
- Received fewer diagnostic imaging procedures
- Incurred lower total episode costs
With spine-related pain costing the US more than $134 billion annually, it’s time we fully recognize the value of starting care with a DC. Not just for better outcomes, but for a more cost-efficient system.4
What’s next? A data-driven path forward
Our goal isn’t just better pay. It’s parity. And it aligns perfectly with national priorities: reducing opioid use, cutting unnecessary imaging and lowering healthcare costs.
With new data from the American Medical Association’s Physician Practice Information Survey (which finally includes DCs), we have an opportunity to reshape how chiropractic costs are factored into future Medicare rates. This has been long overdue since the last update in 2006.
Final thoughts
The bottom line? We’re no longer guessing. We’re showing up with data, with strategy and with purpose. Chiropractic Future’s efforts, like the National Fee Schedule Equity Project, the Reimbursement Dashboard Project and Data Aggregation System for Health (DASH), are critical in making the invisible visible: turning anecdotal frustration into statistical truth. And that truth has the power to drive legislation, improve insurer negotiations and ultimately support a more sustainable future for chiropractic care.
Ray Foxwarth, DC, FICC, is the visionary behind ChiroHealthUSA, serving as its esteemed founder and CEO. With more than 39 years of dedicated service in chiropractic care, Foxworth has navigated the complexities of billing, coding, documentation and compliance firsthand. His rich experience includes roles as the former staff DC at the GV Sonny Montgomery VA Medical Center and past chairman of the Chiropractic Summit and Mississippi Department of Health. He is an at-large board member of the Chiropractic Future Strategic Plan and holds an executive board position with the Foundation for Chiropractic Progress. For more information, visit chirohealthusa.com. Learn more about Chiropractic Future and their data-driven advocacy projects at chiropracticfuture.org.
References
- Hall GN, Payne AM. Equilibrium achieved. What’s next? Results of the 28th annual Fees and Reimbursements Survey. Chiropractic Economics. 2024;70(15):16-33. https://www.chiroeco.com/equilibrium-achieved-whats-next-results-of-the-28th-annual-fees-and-reimbursements-survey-2024/ . Accessed July 24, 2025.
- Chiropractic Future Strategic Plan. June 2025. Reimbursement Workgroup Brief. https://chiropracticfuture.org/about-us/workgroups/reimbursement/ . Accessed July 24, 2025.
- Chiropractic Future Strategic Plan. 2024. Reimbursement Dashboard. https://chiropracticfuture.org/current-projects/reimbursement-dashboard/. Accessed July 24, 2025.
- Farabaugh R, et al. Cost of chiropractic versus medical management of adults with spine-related musculoskeletal pain: A systematic review. Chiropr Man Therap. 2024;32:8. https://pmc.ncbi.nlm.nih.gov/articles/PMC10918856/ . Accessed July 24, 2025.
