Chiropractic Billing Services: Compare Fees, Minimums, and Terms

A chiropractic billing service takes over your insurance claims, payment posting, denials, and follow-up. The published percentage fees below charge a share of collections, subject to any monthly minimum.

We checked six chiropractic billing services. Three publish a starting or standard percentage fee. Those rates run from about 6% to 7% of collections, with stated monthly minimums from $349 to $1,500. We did not find a public rate for the other three.

The rate is only half the price. The other half is what the rate is charged on.

Say your clinic collects $18,000 a month from insurers, $4,000 in copays, deductibles, and coinsurance, and $8,000 from cash and wellness plans. A 7% fee with a $1,500 minimum costs $1,500 a month if it only counts insurance payments. It costs $2,100 if it counts everything. That is $7,200 a year, decided by one line in the contract.

Want to keep the software you use now? Start with American Chiropractic Billing and Olympus. Both say they work inside your current system.

Compare the 6 companies

Run your numbers

Compare 6 chiropractic billing services

How we picked them. We selected chiropractic billing offerings with enough public information to compare. They are in A-to-Z order. This is not a ranking. CT RevAccel's current availability needs confirmation.

We read each company's own pages. We did not test their work. The company links on this page are direct source links. Payment does not determine the order or our editorial recommendations. How we make money.

"Not publicly stated" means we did not find it on the company pages linked below. Get it in writing before you sign.

ACOM Health

A chiropractic company that sells a billing service and its own practice software.

• Price: no public rate. Its page says "Pricing based on volume and payer mix." (Pricing)
• Scope: insurance billing. The same page says you keep managing patient payments.
• Software: its EHR is free with the billing service, or it will bill from the software you have. On its own, the software is listed from $329 a month.
• Company claim: ACOM says its clients receive insurance payments an average of 16 days from the date of service. (Billing service) That is ACOM's number. We have not independently verified the result.
• Ask: the rate, any minimum, the contract length, and what "manage patient payments" leaves on your desk.

Request an ACOM Health consult

American Chiropractic Billing

A chiropractic-focused biller that also serves multidisciplinary practices. The company says it has been at it since 2020.

• Price: 7% of net collections or $1,500 a month, whichever is more. (Pricing)
• What "net collections" means: money actually collected, not what you bill. Its pages do not say whether copays and cash your front desk takes count toward the 7%. Ask. (Cost guide)
• What the company says is included: coding, claim submission, denials, appeals, old unpaid claims, patient statements, and one named coordinator. Physical therapy, massage, acupuncture, and nurse practitioner visits are billed at the same rate. (Services)
• Pass-through costs: the company says hard costs, such as patient statements at about $0.50 each, are passed through at cost.
• Software: says it works inside any EHR (electronic health record) system. It names ChiroTouch, Jane, ChiroFusion, Genesis, and WebPT.
• Contract: month to month. No setup fee. No cancellation fee. Insurers and patients pay you directly.
• Pin this down: its service page lists benefit checks and prior authorizations under "Training." Ask whether its team does them or trains your staff to do them.

If your monthly fee base is less than about $21,400, you pay the $1,500 minimum, not 7%.

Contact American Chiropractic Billing

ChiroFusion Billing

A chiropractic-only billing team from the company behind ChiroFusion software.

• Price: rates "start from as low as 6% of the collected amount" and depend on your monthly collections. (Rates) A starting rate is not your rate. Get yours in writing.
• What the company says is included: charge entry, payment posting, and insurance follow-up. Its service list also names coding, denials, benefit checks, pre-authorizations, credentialing, personal injury, and workers' comp. Ask which of those are inside your rate. (Services)
• Software: unclear. One answer on its services page says the team works with most billing software. Another says the team uses ChiroFusion's own software for billing and collections. Ask which applies to you before you go further.
• Contract: a 3 to 6 month contract to start.
• Money: insurers pay you directly. ChiroFusion never holds your payments.

Request a ChiroFusion quote

ChiroTouch CT RevAccel

ChiroTouch announced CT RevAccel in March 2025 as a billing service for ChiroTouch Cloud customers.

• Availability: the launch notice said it was exclusive to ChiroTouch Cloud. The demo page still lists it in navigation, but its former product link now redirects to ChiroTouch's general software page. We could not confirm current availability or eligibility.
• Price: we found no RevAccel rate on the current pricing page.
• Announced scope: the launch notice described claims, denials, and follow-up, including personal injury and workers' comp. Confirm the current scope before requesting a quote.

If you use ChiroTouch Cloud, ask whether CT RevAccel is currently offered and whether your practice qualifies.

Book a ChiroTouch demo

Olympus Chiropractic Billing

A chiropractic billing company. It says it has served practices nationwide since 2012.

• Price: a percentage that changes with practice size. Quote only. (Prices)
• Cash payments: it says it does not charge on cash payments your office handles when Olympus is not involved. It will also work all your accounts or only some, and charge only for the ones it works.
• Contract: month to month. No setup fee. A 30-day free trial. Cancel without penalty.
• Extra costs: $4 for a benefits check that needs a phone call. $4 for a pre-authorization. Credentialing is $200 per provider, per insurer.
• Old unpaid claims: it will work claims up to one year old. Claims that were already denied may cost extra.
• Software: says it works in any EHR, practice management system, and clearinghouse, online or on your own server. (Services)
• Before you sign: Olympus says it will email a quote, references you can call, and a sample contract.
• Ask: the rate, any minimum, and how payments that arrive after the free trial are billed.

Request an Olympus quote

zHealth Managed Billing

zHealth is a chiropractic software company with a billing service on top.

• Price: Simple is 5.99% of collections with a $349 monthly minimum and email support only. High Touch is 6.99% with a $699 minimum and a weekly meeting with an account manager. (Pricing)
• When the minimum applies: when the monthly fee base is below about $5,826 on Simple or $10,000 on High Touch.
• Software plans are listed separately at $119 or $249 a month per provider, billed monthly with an annual commitment. The managed-billing terms include access to billing-service software components; ask which features your quote includes and whether a separate subscription costs extra.

zHealth links to managed billing terms last updated June 12, 2021 and general terms effective September 10, 2026. For the commercial terms discussed here, the order takes priority over conflicting product-specific and general terms. Ask for the current order and all incorporated policies. The posted managed-billing terms say:

• Coding is not included. You supply every code. zHealth cannot change a code unless you tell it to.
• Billing is exclusive for services after the start date in your order. During the order term, you cannot keep part of that billing and collection work in-house or with another biller.
• You must use zHealth's patient payment process. Card processing fees are separate.
• Confirm the term and exit cost in your order. The posted managed-billing terms give a six-month term and six-month renewals unless the agreement is month to month, with 30 days' notice before renewal. The newer general terms put the term in the order and also provide for automatic renewal. Early-exit charges depend on the applicable order and terms.
• Other service fees can apply on top of the minimum.
• Your money stays yours. Payments stay in your name, and zHealth does not endorse your checks.

See zHealth pricing

Which company to call first

This is our view, based only on what each company publishes.

Run your numbers

What will chiropractic billing cost your practice?

For a percentage quote with a monthly minimum, here is the math. Take the rate. Multiply it by the money it is charged on. Then check the minimum. You pay whichever is more. Last, add anything billed separately.

The step most people skip is the second one. A rate can be charged on three different piles of money:

The companies above do not all say which one they use. Olympus says it does not charge on cash your office handles when it is not involved. ACOM Health says you keep managing patient payments. American Chiropractic Billing and zHealth do not define the complete fee base on the pages checked. Get written confirmation of whether copays, deductibles, coinsurance, cash visits, wellness plans, products, and front-desk payments count.

A simple test: if your front desk took the payment and the billing company never touched it, ask why it is in the fee.

Use the worksheet below with your own month. It shows one quote three ways, or two quotes side by side.

One clinic, four published rates

This clinic collects $18,000 from insurers, $4,000 in copays, deductibles, and coinsurance, and $8,000 in cash and wellness plans. The table shows the monthly base billing fee under each company's published rate and minimum, or a lower bound where the rate is only a starting rate and the minimum is unknown.

The rates and minimums come from each company's page. The three columns are "what if" cases. They do not say what any company charges on. A lower fee does not mean the same work is included. These are base fees; they leave out separately charged work, pass-through costs, and any separate software subscription. ChiroFusion's actual rate and minimum need a quote.

When the minimum costs you more

A minimum is a floor. If the percentage comes out lower than the floor, you pay the floor.

Each crossover is the minimum divided by the rate, rounded to cents. Below it, the minimum controls the base fee.

Here is why that matters for a small clinic. If the fee applies only to $6,000 a month in insurance payments, a 7% fee with a $1,500 minimum costs $1,500. That is 25% of your insurance money, not 7%.

Two quotes, one month

These two quotes are made up to show the math. They are not offers from any company.

A clinic collects $40,000 in a month: $20,000 from insurers, $5,000 in copays, deductibles, and coinsurance, and $15,000 in cash.

The 6% quote costs $400 less each month than the 4% quote. Over 12 months it costs $4,500 less. The lower rate lost because it was charged on twice the money.

Get the questions to send

What will the billing company actually do?

"Full service" means different things at different companies. A good proposal names who does each job: the billing company, your staff, or both.

The company pages show why you have to ask:

• zHealth's terms say coding is not included. American Chiropractic Billing and ChiroFusion Billing both list coding as part of the service.
• Olympus charges $4 when a benefits check needs a phone call.
• American Chiropractic Billing lists benefit checks under "Training."

Watch for one phrase. "Eligibility included" is not much help if it means the company trains your front desk to do the checks.

Medicare rules a chiropractic biller has to get right

Documentation matters in Medicare billing. CMS's 2025 Medicare fee-for-service report estimates a 30.4% improper payment rate for chiropractic services. Insufficient documentation accounted for 89.5% of those improper payments. These are payment-error measures, not a practice's claim-denial rate. (CMS 2025 report)

So ask every company how it handles these four rules:

1. Original Medicare has a narrow chiropractic benefit. Part B covers manual manipulation of the spine to correct a subluxation. Medicare.gov describes this as abnormal spinal-joint movement while the joints remain in contact. Other services furnished or ordered by a chiropractor are outside that benefit. (Medicare.gov)
2. The notes must support the subluxation. It can be documented by X-ray or by exam. For an exam, CMS requires at least two P.A.R.T. criteria: pain or tenderness; asymmetry or misalignment; abnormal range of motion; or abnormalities in tissue tone, texture, or temperature. At least one must be asymmetry/misalignment or abnormal range of motion. (CMS documentation checklist)
3. Maintenance care is not covered under this benefit. When further clinical improvement cannot reasonably be expected and care becomes supportive rather than corrective, it is maintenance therapy. A chronic condition does not automatically make treatment maintenance. (Medicare Benefit Policy Manual, Chapter 15, sections 30.5 and 240.1.3)
4. Active treatment needs the AT modifier. A modifier adds detail to a billing code. CMS requires AT with 98940, 98941, or 98942 for active or corrective treatment of acute or chronic subluxation. Do not use it for maintenance care. AT alone does not establish medical necessity. (CMS documentation checklist)

Ask how the company handles the Advance Beneficiary Notice of Noncoverage, or ABN. For Original Medicare, a valid ABN given before care can transfer potential financial liability in specified situations, such as when a normally covered service is expected to be denied as not medically necessary. It does not automatically make every denied claim the patient's bill. Notices for services Medicare never covers are voluntary, and this ABN is not used for Medicare Advantage. Ask who prepares and explains it, obtains any required signature, and keeps it on file. (Current CMS form and instructions; CMS notice rules)

Then ask each company three direct questions:

• Do you read our notes before a Medicare claim goes out?
• Who decides when a visit is active treatment and when it is maintenance?
• Can you show us one deidentified sample claim for Original Medicare, one for our biggest insurance plan, and one for an injury case in our state?

American Chiropractic Billing says it checks the AT modifier, P.A.R.T. notes, and X-ray dates before a claim goes out. zHealth's terms say the codes are yours to supply. Those are two very different services.

This section is here to help you ask better questions. It is not coding or compliance advice for your claims. Check your Medicare contractor's applicable policy for Original Medicare claims and the plan's own requirements for Medicare Advantage and commercial coverage.

Software, reports, and your patient data

Software. "Works with your EHR" should mean it works with your version, with logins you approve, at a cost you know. Ask for a short screen share using a demo environment and sample data: enter a charge, show claim submission, post a payment, and work a denial in your software version. Ask about any export, double entry, extra login, or paid user seat.

Reports. Ask for a sample monthly report. It should show claims sent, claims still unpaid, denials by insurer, and how old your unpaid claims are. When a company quotes a percentage, ask what it measures. A claim marked "accepted" does not mean it has been paid.

Your money. American Chiropractic Billing, ChiroFusion Billing, and zHealth all say payments go straight to your accounts. Make sure your contract says the same.

Patient data. For a practice covered by HIPAA, an outside biller handling protected patient information is generally a business associate. Put the required written business associate agreement, or BAA, in place before sharing that information. (HHS, reviewed July 30, 2026) Ask for the BAA with the proposal. A signed BAA is a promise. It is not proof that the company's security works.

How to switch billers without losing unpaid claims

The risk in a switch is claims that nobody owns. Decide who works what before the first day.

1. Pull your starting numbers. Export your unpaid claims by age, plus rejected claims, open denials, and open appeals. Keep the files inside your own systems.
2. Split the backlog. Agree in writing which biller works which dates of service. Set one cutover date so two companies never send the same claim.
3. Price the old claims. A new quote may cover new visits only. Ask for a separate scope and rate for old unpaid claims.
4. Set up access and money. Sign the BAA. Give named logins, not shared ones. Confirm payments still land in your bank account.
5. Check the first cycle. Follow a few claims from sent to paid. Agree who you call when one stalls.
6. Close out the old biller. Settle final fees. Ask if they charge on payments that arrive after you leave. Get your exports and remove their access when their agreed follow-up work is complete.

What the companies say about timing: Olympus says setup takes two to five business days. American Chiropractic Billing says its coordinator runs the move and cleans up old unpaid claims. Those are company claims. Your timeline depends on your software, your payers, and how big the backlog is.

Send this quote request

Send the same request to two or three companies. Then compare the written answers side by side.

Use totals only. Do not attach patient records, claims, or passwords.

Subject: Chiropractic billing proposal: scope, software, and fees

Hello,

We are comparing billing services for a chiropractic practice in [state] with [number] providers. Our practice software is [system and version]. We [need to keep it / are open to changing it].

For the same recent month, we collected about:
- Insurance payments: $[amount]
- Copays, deductibles, and coinsurance collected at our front desk: $[amount]
- Cash visits, wellness-plan payments, and product sales with no insurance claim: $[amount]

Our main payers and services are [short list]. We also need [personal injury, workers' comp, or other provider types, if any]. We are looking for [ongoing billing / help with old unpaid claims / both].

Please send a written proposal that answers these:

1. What is your rate, and exactly which payments is it charged on? Insurance payments only, or also the copays, deductibles, coinsurance, cash visits, wellness-plan payments, and product sales our front desk collects?
2. Is there a monthly minimum or a setup fee? Please show a sample invoice using the amounts above.
3. What else do you charge for? Statements, benefit checks, prior authorizations, credentialing, software, clearinghouse.
4. Can we keep our current software? If we must use yours, what does it cost, and how do we get our data back if we leave?
5. Who chooses the codes and modifiers? Do you review our notes, or bill what we send?
6. Who does each of these: benefit checks, authorizations, claim submission, payment posting, denials and appeals, patient statements?
7. How do you handle Original Medicare patients, including active treatment versus maintenance care, the AT modifier, and ABN notices? How do you check the separate coverage, authorization, and notice rules for Medicare Advantage plans?
8. Will you work our unpaid claims from before the start date? Which dates, and at what rate?
9. What is the contract length, the notice to cancel, and any early termination fee? Do you charge on money that arrives after we leave?
10. Do payments go straight to our bank account? Do we keep full access to our reports? Will you sign a business associate agreement (BAA)?

Please also send a sample contract and a sample monthly report. We would like a written answer first and can set up a call after that.

Thank you,
[Name and practice]

You choose who gets it. We do not send this request or your details to anyone.

Got quotes back? Put them in the worksheet.

Compare my quotes

Questions people ask before they choose

Is a billing service cheaper than keeping a biller on staff?

It depends on what your biller costs you. Add up wages, payroll taxes, benefits, billing software, and clearinghouse fees for one month. Compare that with the monthly cost from the worksheet, plus the staff time and software costs you would still have after outsourcing. Count each cost once.

Do not count on a jump in collections to close the gap. ChiroFusion advertises increases of up to 17% in net collections. That is a company claim, not a forecast for your practice.

You also give something up. An in-office biller can explain a bill to a patient face to face.

Is a billing service worth it for a mostly cash practice?

It may not be. If you send few insurance claims, a monthly minimum can eat most of what the service collects. Look at Olympus, which says it skips cash your office handles when it is not involved and will bill only the accounts you hand over. Or keep billing with your own staff and better software. Our homepage covers what to check when you keep billing in-house.

If you see Medicare patients, being mostly cash-pay does not remove the applicable Medicare billing obligations. CMS says chiropractors cannot opt out of Medicare to use private contracts. Check the requirements with your Medicare contractor before changing how you bill those patients. (CMS checklist)

Can I hire help only for old unpaid claims?

Yes, but ask for it as its own project. List the dates of service, how old the claims are, and what has been tried. Ask for the rate and which claims they will not take. Olympus says it works claims up to one year old. No company can promise that every old claim gets paid.

Do I need a local billing company?

Not necessarily. American Chiropractic Billing and Olympus both say they serve practices nationwide. What matters is whether the company knows your state's injury and workers' comp rules, your insurers, and your software, and can handle your work remotely.

Can a general medical billing company do it for less?

Maybe. Some general billers advertise lower rates. BilNow's chiropractic page says 2.7% of collections in its text and 3.0% in the banner at the top, with no setup fee. We did not find a minimum on that page.

A lower rate only helps if the work is the same. Send a general biller the same quote request, and ask how many chiropractic offices it bills for.

I am a patient with a chiropractic bill. Who do I call?

This page is for practices that are hiring a billing company. For a bill you received, call the billing office on your statement first, then your health plan. For Medicare questions, see Medicare's chiropractic coverage page.

How we checked

We checked the company pricing, service, and terms sources linked here on October 6, 2026. Every price and contract term above is what the company says about itself. We did not test any service, call any company, or measure results.

Where a detail is not established in the pages checked, we say so and do not guess. The Medicare and HIPAA facts come from CMS, Medicare.gov, and HHS pages linked next to each one. The worksheet only does arithmetic on the numbers you enter.

Prices change. If one here is out of date, tell us and we will check it. Read more about how we compare billing companies.

Your next step

Still choosing? Go back to the table and pick two or three companies that fit your software and your size.

Have a short list? Copy the quote request and send it today.

Compare the 6 companies

View the quote request

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