When it comes to making money, there are two things that matter most: what you charge, and what you get paid. With that in mind, Chiropractic Economics’ Third Annual Fees & Reimbursements Survey takes a look at both of those areas. This comprehensive survey of the chiropractic profession will give you a benchmark to compare your fees and reimbursements to those of your colleagues.
ABOUT THE SURVEY….
- 611 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; fax: 440-234-2192; e-mail: tarastultz@aol.com
Thanks go out to our loyal readership for taking the time to share this important information. In all, 611 readers sent back the surveys that we distributed in May — nearly twice the response rate we generated last year. We received input from doctors of chiropractic in 45 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 past Fees & Reimbursements Surveys. We also address the forms of payment and terms you offer and your acceptance of credit cards and health-care cards.
Respondent Profile
Gender, Age, Years in Practice
Eighty-three percent of the respondents are male and 17% are female. That breakdown is the same as Chiropractic Economics’ 1999 Fees & Reimbursements survey. The age range is 19-96, broader than last year’s range of 23-77. The average age was 43.81, compared to last year’s average of 42.9. The breakdown by age is: 16% under 30; 20% aged 31-38; 25% 39-45; 23% 46-55; and 16% 56 and up. The average length of time respondents have been in practice is 14.65, similar to last year’s average of 14.42 years.
Location, Location, Location
States, Regions, Suburban vs. Urban
The survey responses came from DCs in 45 of the country’s 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 20 have dual licensure, and one is licensed to practice in three states. Suburban practices are most common among this year’s respondents at 39.4%, followed by urban at 34.7%, rural at 20.8%. No response was received from 5.1%. The breakdown last year was: suburban, 40.3%; urban, 35.6%; rural, 21.3%; and no response, 2.8%.
Principle Form of Practice
Group vs. Solo, Multi-Discipline
Eighty percent of the respondents are solo practitioners, 17% are in group practices, and 3% are associate doctors. Last year, 82% of the respondents were solo practitioners and 18% worked in group practices. Twenty-three percent report that they work in a practice offering multi-disciplines, while last year, 30% did. Of the respondents who work in these practices, the disciplines besides chiropractic include: MD/DO (20%), massage therapy (78%), rehabilitation (41%) and dietitian/nutritional counseling (38%). An additional 28% work in practices offering various services, such as acupuncture, allergy treatment, psychology, Reiki, yoga, counseling and naturopathy. Last year, the break down of disciplines in addition to chiropractic included: MD/DO, 5%; massage therapy, 27%; rehabilitation, 11%; and dietitian/nutritional counseling, 10%.
Payment and Terms
Revenue Sources, Credit Cards, Payment Plans
Not surprisingly, the most common forms of payment accepted are cash, at 99%, and checks, 96%; followed by: auto insurance, 90%; workers’ compensation, 85%; private insurance, 85%; Medicare, 78%; major credit cards, 72%; managed care, 57%; Medicaid, 33%; and health-care credit cards, 16%. Last year’s breakdown was: cash and checks, 98%; workers’ compensation and private insurance, both 90%; Medicare, 81%; major credit cards, 77%; managed care, 61%; Medicaid, 32%; and health-care credit cards, 15%.
Seventy-two percent of respondents accept credit cards, including: MasterCard, 75%; VISA, 74%; Discover, 47%; American Express, 28%; and the Care Credit health card, 4%.
Fifty-three percent of respondents accept payment plans. Twenty-eight percent negotiate the terms on a per-case basis. The average terms offered are: 34.5% down with a 28-day billing cycle, with an average discount of 18.5% for cash. Last year, 64% reported that they offered standard payment plans, and 42% negotiated on a per-case basis. The average down-payment requested was 34%; the average billing cycle was 32 days, and the average discount for cash was 30%.
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 30-31. 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.
Compared to last year, the average fees charged for different CPT codes within Professional Care remained fairly stable, but reimbursement rates appear to be declining. This year’s fees range from an average of $30.65 to $93.51, and last year’s fees were in the $30.30 to $95.40 range. Actual payments for Professional Care procedures this year range from $26.94 to $75.60; last year, the range was from $27.59 to $83.73. The rate of reimbursement is 80.85% to 87.9%; last year, it was higher, at 84.44% to 92.35%. In our first-ever Fees & Reimbursements Survey in 1998, the range was even higher, at 92.03% to 99.05%.
For procedures under New Patient Exam CPT codes, the average fees range from $70.93 to $128.42. Last year, that range was $71.50 to $134.58. Actual payments for new patient procedures range from $65.02 to $106.39. Last year, the range was $65.46 to $123.30. The percentage reimbursed was between 82.85% and 91.67%; last year, it was between 88.34% and 91.56%; and in 1998, it was 91.06% to 94.52%.
Average fees for Radiology CPT codes ranged last year from $49.12 to $150.14; last year, the range was similar, at $51.33 to $148.98. Actual payments for Radiology procedures range from $43.18 to $132.16; last year’s range was $45.93 to $128.44. The percentage reimbursed was between 86.16% and 89.29%; last year, it was between 86.21% and 89.72%; in 1998, it was 84.26% to 91.84%.
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 $50.57, the actual payment was $44.09, and the reimbursement rate was 87.19%. Last year, the average fee charged was $51.94, the actual payment was $47.97, and the reimbursement rate was 92.35%. In 1998, the fee was $48.27, the actual payment was $44.06, and the reimbursement rate was $91.28%.
The reimbursement rate for CPT code 99213 by region was: Southern Region, 91.73%; Eastern Region, 84.52%; Midwestern Region, 86.82%; and Western Region, 81.73%. Last year, the breakdown was: Southern Region, 89.90%; 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 $99.39, the actual payment was $85.51, and the reimbursement rate was 86.03%. Last year, the average fee charged was $102.39, the actual payment was $92.38, and the reimbursement rate was 90.22%. In 1998, the average fee charged was $92.22, the actual payment was $85.46, and the reimbursement rate was $92.68.
The reimbursement rate for CPT code 99204 by region was: Southern Region, 88.26%; Eastern Region, 76.31%; Midwestern Region, 87.2%; and Western Region, 84.78%. Last year, 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 $50.75 and received a reimbursement rate of 89.36%. DCs 39-55 charged an average of $50.58 and had a reimbursement rate of 89.84%; DCs 38 and under charged $50.53, with a reimbursement rate of 85.24%. Last year, 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 $97.80, with a reimbursement rate of 86.36%. DCs 39-55 charged an average of $100.96 and had a reimbursement rate of 86.75%; DCs 38 and under charged $98.65, with a reimbursement rate of 84.71%. Last year, 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 charge an average of $50.57 and receive a reimbursement of 88.31%. Female DCs charge an average of $49.48 and are reimbursed at an average of 85.51%. Last year, 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 actual payment of $46.14 for a reimbursement rate of 88.79%, while male DCs receive an average actual payment of $48.33, for a reimbursement rate of 93.05%.
For New Patient code 99204, female doctors of chiropractic charge more than their male counterparts ($104 vs. $98.76), but female doctors get reimbursed at an average of 77.88%, while males are at the 87.49% mark. Last year, female DCs charged an average of $96.06 and received an actual payment of $87.78, for a reimbursement rate of 91.38%. Male DCs charged an average of $103.66 and received an actual payment of $93.07, for a reimbursement rate of 89.78%.
Solo vs. Group Practices
Doctors of chiropractic in solo practice charge an average of $49.11 for Established Patient code 99213; these doctors received an actual payment of $43.88, for a reimbursement rate of 89.35%. Group practice doctors of chiropractic charge an average of $57.13 and received an actual payment of $46.03, for a reimbursement rate of 80.57%. Last year, doctors of chiropractic in solo practice charged an average of $52.31 for Established Patient code 99213; these doctors received an actual payment of $48.15, for a reimbursement rate of 92.06%. Also last year, group practice doctors of chiropractic charged an average of $50.34 and received an actual payment of $46.11, for a reimbursement rate of 91.60%.
In this year’s survey, DCs in solo practice charged an average of $95.71 for New Patient code 99204, and they received an actual payment of $85.30, for a reimbursement rate of 89.12%. Group practice DCs charged an average of $113.76 and received an actual payment of $84.79, for a reimbursement rate of 74.53%. Last year, DCs in solo practice charged an average of $102.39 for New Patient code 99204, and they received an actual payment of $91.96, for a reimbursement rate of 89.81%. Also last year, group practice DCs charged an average of $104.84 and receive an actual payment of $94.29, for a reimbursement rate of 89.93%.
Thank you to everyone who participated!
