Download Free Chiropractor Invoice Templates

Download a template, then edit in PDF, Word, Excel, Google Docs or Google Sheets. Print or email when ready.

Sheets, Excel, Word and Doc Templates Coming November 21, 2025.

Custom Chiropractor Invoice Template

Best for:

Logo, plan and claim fields.

Editable Chiropractor Invoice Template

Best for:

Edit codes, therapies, discounts.

Printable Chiropractor Invoice Template

Best for:

Copay, insurance, signatures, dates.

Free Chiropractor Invoice Template

Best for:

Adjustments, modalities, CPT, units, notes.

How to Invoice as a Chiropractor

Keep it simple, patient-friendly, and compliant so you get paid without back-and-forth.

Free Online Invoice Generator

☝️ No sign-in. Save as PDF.

In 5 Steps:

Confirm what was done today and whether it’s patient-pay or insurance-assisted.
Create an itemized invoice by visit, adding brief descriptions alongside treatment codes.
If a care plan or product deposit was taken, record it and apply the deposit to today’s charges.
Add required identifiers and any supporting notes, then double-check dates and totals.
Send the invoice with a clear due date, payment options, and an automatic reminder.

Free Online Invoice Generator

☝️ No sign-in. Save as PDF.

What to Include in a Chiropractor Invoice

These are the must-have fields for clear, professional, and compliant invoices.

Invoice number and issue date
Practice legal name, address, phone, and email
Provider name, credentials, license #, and NPI
Patient full name and date of birth
Date(s) of service
Itemized treatment with brief description and CPT code
Diagnosis description with ICD-10 code(s)
Units or visit count and rates
Insurance details if applicable (payer name, member ID, claim #)
Totals and terms: payments received/deposit applied, tax on supplies if any, balance due, payment terms (check local rules)

Billing Scenarios for Chiropractors

How to label charges so every invoice makes sense the moment your clients see it.

New patient exam; Initial adjustment

First visit with assessment and treatment

This separates evaluation from treatment so the first-visit total makes sense.

Follow-up adjustment; Therapeutic exercise

Standard follow-up with added rehab

This shows a base visit plus an add-on so changes from visit to visit are obvious.

Care plan visit; Deposit applied

Prepaid care plan visit using deposit credit

This makes it clear today’s fee is reduced by prior payment.

X-ray imaging; Radiology read

In-house X-ray before treatment

Split totals into insurance pending and patient responsibility, and note when you’ll update the balance. Keep a running previous balance so nothing is hidden.

Custom orthotics; Casting/scan fee

Custom orthotics ordered after evaluation

This distinguishes a product from the service so warranties and taxes are clear.

After-hours visit; Priority booking fee

This flags premium timing so the higher rate isn’t a surprise.

Free Online Invoice

No sign-in. Save as PDF.

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Common services and patient fees for chiropractors

Itemize adjustments, exams, therapy sessions, supplies, and copays with professional invoice line items.

Charge or Service

Unit

Taxable

When to use

How to show it

New Patient Exam & History

Time

First visit or intake

Time × hourly rate; document findings, medical necessity, and plan before treatment begins.

Spinal Adjustment

Item

Routine spine manipulation

Qty × unit rate; list regions treated and response in your notes.

Extremity Adjustment

Item

Shoulder, wrist, hip, or ankle

Qty × unit rate; specify joint adjusted and patient tolerance.

Therapeutic Exercise, 15 min

Time

Active rehab session

Time × hourly rate; record goals, reps, and progression for each unit.

Manual Therapy, Soft Tissue

Time

Reduce muscle tension/pain

Time × hourly rate; note targeted tissues and outcome measures.

Electrical Stimulation Therapy

Time

Nerve pain or spasm relief

Time × hourly rate; track pad placement, settings, and patient response.

Traction/Decompression Therapy

Time

Disc or facet unloading

Time × hourly rate; capture protocol, hold times, and safety checks.

X-Ray Imaging (per view)

Item

Diagnostic views in clinic

Qty × unit rate; record body region, number of views, and interpretation.

Custom Orthotic Inserts

Item

Taxable

Patient needs arch support

Cost × (1 + markup%); include size, fit notes, and manufacturer.

After-Hours Visit Surcharge

Item

Visit outside normal hours

Qty × unit rate; use when treatment occurs beyond posted hours.

Save and reuse your chiropractic services and fees

Create a free account and save adjustment rates, exam fees, and therapy prices once, so nothing gets retyped.

Create a Free Account

☝️ Risk-free 30-day trial. No card.

Common Chiropractor Invoicing Mistakes

Busy days make details easy to miss. Use these quick fixes to keep invoices clean and avoid payment delays or disputes.

Mistake

How to fix it

Leaving off your license # or NPI leads to claim rejections and stalled payments.

Include provider identifiers in the header every time and keep them current. Save them in your template so they auto-fill.

Using codes only with no plain-English descriptions confuses patients and slows payment.

Pair each code with a short, readable service name. Write it like you’d explain it chairside.

Add the service date on every line. If a package spans dates, list each visit separately.

Split totals into insurance pending and patient responsibility, and note when you’ll update the balance. Keep a running previous balance so nothing is hidden.

Skipping a required prior authorization or referral number causes outright nonpayment.

Capture the number before treatment when needed and reference it on the invoice. If rules vary, check local rules.

No written cancellation or no-show terms on the invoice invites disputes.

State the policy and fee clearly in the footer and point to full terms. Apply it consistently after the effective date.

Chiropractors Invoice FAQs

Get paid fast on adjustments, exams, X-rays, modalities, and DME with the Chiropractors Invoice Template, markup, codes, terms, and add-ons explained with clear answers.

How do I bill an initial exam versus a routine adjustment?

List the evaluation code and the manipulation separately. Example: “CPT 99203 New Patient Exam: $120” and “CPT 98941 Spinal Manipulation 3–4 regions: $55.”

How should time-of-service discounts and insurance write-offs appear?

Show the full fee, the discount, then the net. Example: “98940: $50; Time-of-Service Discount: −$10; Patient Pays: $40.” For write-offs, add “Insurance Contract Adjustment: −$12.”

Can I sell care plans, like a 12-visit bundle, and track remaining visits?

Yes. Add a prepayment line, then deduct visits each appointment. Example: “12-Visit Wellness Plan: Prepaid $480; Visit 3 of 12: $0 (Plan Balance: $360).” Rules vary—check local rules.

How do I charge for X-rays, re-exams, and a report of findings?

Itemize each service on the same day or as separate dates of service. Example: “72040 Cervical X-ray: $75; 99212 Re-Exam: $60; Report of Findings: $25.”

What’s the right way to bill Medicare, including ABNs and non-covered services?

Note covered vs non-covered and attach an ABN when required. Example: “98940: $30 (Medicare Allowed); 97140 Manual Therapy: $0 (Non-covered, ABN on file); Patient Responsibility: $25.” Rules vary—check local rules.

How do I handle auto accident or workers’ comp cases and liens?

Bill the carrier, list the claim number, adjuster, and lien language. Example: “Claim: WC-12345; 98941: $55; 97035 Ultrasound: $20; Balance Pending Lien Settlement.”

How do I itemize DME like braces or cervical pillows with tax?

Use a separate product line with quantity, SKU, and sales tax if applicable. Example: “Cervical Pillow SKU CP-02: Qty 1: $45; Sales Tax: $3.83.”

What goes on a superbill for out-of-network patients?

Include patient info, your NPI, diagnosis codes, CPT codes, units, and paid amount. Example: “Dx: M54.2; 98941 x1: $55; 97110 x2: $60; Patient Paid: $115.” A DC or chiropractic physician should sign.