Two new patients walk into the same practice on the same Monday. Both found it through the same Google ad, both clicks cost about the same, and both get adjusted by the same doctor.
One pays cash. The other is on Medicare. Over the next few months they could be worth very different amounts to the practice, and the ad account has no idea which is which.
That's the budget problem this chapter solves. Before you decide how much a click is worth, you need to know what a new patient is worth, and for a chiropractor that answer depends on who pays.
A Chiropractic Click Is Worth What the Patient Behind It Pays Over Months
Every Google Ads budget rests on a short chain of numbers:
- What a click costs.
- How many clicks become a lead: a call, a form or a booking (Chapter 1 counts these).
- What each lead costs: the click cost divided by the share of clicks that become leads.
- How many leads become a kept first visit. This is the practice's number, and the front desk controls a lot of it.
- What each new patient costs: the lead cost divided by that share.
- What a new patient is worth: everything they pay over the visits that follow.
The first five numbers come from the ad account and your tracking. The sixth comes from your own books, and it's the one most practices skip. Without it, nobody can say whether a $70 new patient is a bargain or a loss.
For a chiropractor, number six isn't one figure. It's one per payer.
Medicare Covers the Adjustment and Nothing Else a Chiropractor Does on the First Visit
Medicare is the easiest payer to price, because Medicare publishes its rates and its rules are strict.
Under Medicare Part B, a chiropractor can bill for one thing: manual manipulation of the spine to correct a subluxation. That's three procedure codes, priced by how many spinal regions are treated. Medicare's 2026 national allowed amounts for an office setting are:
- 98940 (one or two regions): $26.72
- 98941 (three or four regions): $38.41
- 98942 (five regions): $49.77
Your local amounts will be a little higher or lower. Medicare pays 80% of the allowed amount, and the patient owes the other 20% after meeting the Part B deductible, so the practice collects the full amount from two places.
Everything else a chiropractor does on a first visit is outside that coverage when the chiropractor performs it: the exam, X-rays, other therapies, and adjustments of joints other than the spine. Medicare also pays only for active, corrective care. Once a patient's care becomes maintenance, Medicare denies it, and a practice that expects a denial has to give the patient an Advance Beneficiary Notice before treating if it wants to bill the patient instead. Chiropractors also can't opt out of Medicare.
How many visits does a Medicare patient bring? The best published figure we found comes from a study of Medicare claims that reported an average of 10.8 chiropractic services per patient in a year. That data is from 2008, so treat it as a rough marker, not a current average. At the 98941 rate, 10.8 visits is about $415 a year. Your own Medicare patients' records will give you a better number in an afternoon.
Cash, Insurance, Medicare and Auto Injury Patients Each Need Their Own Budget Math
The National Board of Chiropractic Examiners surveyed chiropractors in 2025 about who pays. Practices could choose more than one answer, and the shares reported were: cash 41% of patients, private health insurance 37%, personal injury 9% and Medicare 9%. Your practice's mix could look nothing like that, which is exactly why the math has to be done per payer.
Cash patients. Cash practices publish their prices, so the visit value is easy to see. One national chain lists a $29 new patient special and a $55 single visit. One practice in our example market, Baltimore, charges $175 for the first visit and $75 for each follow-up. A 2024 survey by the trade magazine Chiropractic Economics put the average US fee at $80 (168 respondents in all, about half outside the US). What's missing is how many visits a cash patient makes. Only your schedule knows that.
Private insurance. There's no national rate to look up. What an insurer pays depends on the plan and your contract with it. Pull a few months of explanation-of-benefits statements for new patients and you'll have your real per-visit number, plus the copays patients cover. Check two things while you're in there: how much of the allowed amount lands on the patient through deductibles, and whether the plan limits chiropractic visits in a year, which caps what one insured patient can be worth. Patients notice both. In the 183 low-star chiropractic reviews we read, 27 were about insurance, including quotes that turned out wrong and coverage that ran out. Build both into your per-payer value.
Auto injury. Car accident patients are often paid for by auto coverage, and the rules change at the state line. Some states use no-fault coverage, where the patient's own auto policy pays first. Florida's personal injury protection, for example, pays only for care that starts within 14 days of the crash and caps non-emergency care at $2,500. Other states set different deadlines and limits. Chapter 14 covers auto-injury patients in full.
Cost per Patient Starts With the Click and Finishes at the Front Desk
Now the cost side of the chain.
The click. Around Baltimore, our example market, Keyword Planner puts the typical top-of-page bid range for "chiropractor near me" at $2.59 to $20.00. That's a record of what advertisers have bid, not a quote for your clicks, and your actual cost depends on your ads and pages (Chapter 4). Neither of the two big benchmark reports we checked, from LocaliQ and WordStream, has a chiropractic category. The closest is LocaliQ, an ad-platform company, whose healthcare benchmarks (US campaigns from October 2024 to September 2025) give physical therapy a median cost per click of $4.95 and a median cost per lead of $32.79. Treat it as a neighbor's number, not yours.
The lead. Once Chapter 1's calls, forms and bookings are counting, a few weeks of spend will show you a real cost per lead for your own practice. Use that instead of any benchmark.
The kept first visit. Here's where the front desk earns its keep. In our example market, five of the twelve practices we studied take new patients through a request form and a callback. A request answered in ten minutes is a different lead from one answered the next afternoon, and no bid change in Google Ads will fix the second one. The share of leads that become kept first visits is the number your front desk owns. Track it monthly.
A One-Page Worksheet Sets the Most You Can Pay for Each Kind of New Patient
Put the chain together, run it backward from value, and you get the most you can afford at each step. Here's a worked example. Every input below is a placeholder to show the arithmetic, not a benchmark; swap in your own.
A cash patient. Say your records show a cash patient pays $175 for the first visit and $75 for each follow-up, and makes eight visits in all. That patient is worth $700. If you're willing to spend 20% of that to win them, the most you can pay for a new cash patient is $140.
A Medicare patient. At the $415 marker from earlier, the same 20% gives you $83.
Working back to the click. If half your leads become kept first visits, a $140 patient means you can pay up to $70 per lead. If one click in ten becomes a lead, that's a $7 ceiling per click. The Medicare patient, at $83, works back to about $4 a click.
Two lessons come out of that worksheet. First, a practice that sees mostly cash patients can afford clicks that a mostly Medicare practice can't, even for the same search. Second, the front-desk share matters as much as the click price: lift kept first visits from half to two-thirds and every ceiling above rises with it.
Do this once a quarter with your real numbers. The ceilings become the starting bids in Chapter 7.
Referrals Make a Happy Chiropractic Patient Worth More Than Their Own Visits
The worksheet counts only what each patient pays. Good patients bring more than that.
In the 1,266 Google reviews we read across Baltimore-area practices, 19 say a friend or family member sent them, and six more credit a doctor, physical therapist or trainer. One reviewer wrote: "I was referred to the Baltimore Sports Clinic by a friend." Only four of those reviews say the patient found the practice through Google or by reading reviews. Patients you win through ads can become the source of patients you don't pay for.
That's hard to put a number on, so leave it out of the worksheet and treat it as margin. But it's one more reason to judge new patients by what happens after the first visit, not just by the visit itself. If you'd like a second set of eyes on your numbers, our Google Ads agency team builds these worksheets with practices all the time.
Next: Google Charges Less When the Sciatica Ad Lands on the Sciatica Page
With a ceiling on what each patient is worth, the next job is paying less to reach them. Chapter 4 explains how Google ranks ads, and why a chiropractic ad that sends sciatica searches to a sciatica page tends to cost less than one that sends everyone home. For the first two steps, see Chapter 1 on tracking and Chapter 2 on which searches to buy first. The full list is on the Google Ads for Chiropractors guide home.
