Free Chiropractor Invoice Template Invoice Template
A free, professional chiropractor invoice template for chiropractic clinics and DCs who bill patients or insurers for adjustments, exams, and therapies. Download it as Word, Excel, PDF, Google Docs, or Google Sheets and itemize the exam, spinal adjustment, therapies, and modalities on a superbill-style statement. Add your NPI, CPT codes, and patient details so claims and self-pay receipts are clean and complete.
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| Description | Qty | Unit price | Amount |
|---|---|---|---|
| New patient exam and consultation (99203) | 1 | $150.00 | $150.00 |
| Chiropractic manipulation — spinal, 1-2 regions (98940) | 1 | $65.00 | $65.00 |
| Therapeutic exercise (97110) | 1 | $45.00 | $45.00 |
| Electrical muscle stimulation (97014) | 1 | $35.00 | $35.00 |
| X-ray, spine (72100) | 1 | $85.00 | $85.00 |
| Subtotal | $380.00 | ||
| Sales tax (8%) | $30.40 | ||
| Total | $410.40 | ||
Example figures — every field is editable in the download.
Who uses this template
- ✓Chiropractic clinics
- ✓Doctors of Chiropractic (DCs)
- ✓Sports and wellness chiropractors
- ✓Multi-provider integrated practices
- ✓Cash-based / self-pay chiropractic offices
What to include
- ✓Patient name and date of service
- ✓Provider name, NPI, and clinic info
- ✓CPT/procedure codes for each service
- ✓ICD-10 diagnosis code(s)
- ✓Charge per service and units
- ✓Insurance/copay applied vs patient balance
- ✓Payment terms and superbill note for reimbursement
Available in 5 formats
Word (.docx)
Fully editable in Microsoft Word, Google Docs, Apple Pages and LibreOffice — best for quick text edits.
Excel (.xlsx)
Line totals, subtotal and tax calculate automatically — best if you want the math done for you.
A clean, print-ready, fixed layout — best for emailing a finished invoice to a client.
Google Docs / Sheets
Open in your browser, then File → Make a copy to edit and share with your team.
Invoicing tips for chiropractor invoice template
- ✓ Use a superbill format with CPT and ICD-10 codes so patients can self-submit to insurance for reimbursement
- ✓ List each service (exam, adjustment, modality) on its own line with its code and units, as payers expect
- ✓ Include your NPI and tax ID, which insurers require to process or reimburse a claim
- ✓ Show copay or insurance amounts separately from the patient's out-of-pocket balance
- ✓ For cash-based plans, offer a prepaid visit package as a discounted line and note the per-visit savings
Chiropractor Invoice Template invoice FAQ
Is chiropractic care subject to sales tax?
No. Chiropractic and other healthcare services are not subject to sales tax in the US. You bill for services and procedures by their codes, not taxable goods, though retail items like supports may be taxed.
What is a superbill and why does it matter?
A superbill is an itemized receipt with CPT procedure codes, ICD-10 diagnosis codes, your NPI, and charges. Patients in cash or out-of-network practices submit it to their insurer for reimbursement, so including the codes is essential.
Should I list insurance and patient balances separately?
Yes. Show the total charge, any insurance payment or copay applied, and the remaining patient responsibility on separate lines so the patient understands exactly what they owe out of pocket.
Do I need CPT and ICD-10 codes on a self-pay invoice?
If the patient may seek any reimbursement, yes. Even cash patients often submit to HSA/FSA accounts or out-of-network benefits, all of which require the procedure and diagnosis codes and your NPI.
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